bluuebunny/crossref_metadata_2025 huggingface dataset:
In Vitro Evaluation of Lateral Femur Condyle Free Chondral Fragment Swelling after Soaking in Normal Saline
Authors: Montgomery Carver , Scalisi Wayne , Robinson James , Sherman William , Solitro Giovanni F. , Massey Patrick
Published: October 2023

Objective

After traumatic knee injuries, chondral fragments can avulse off bone with the progeny fragment becoming a loose body. The loose fragment may be larger than expected when trying to surgically repair the fragment back to its original site. The purpose of this study was to determine whether a loose chondral fragment from the lateral femur condyle would increase in size and weight after soaking in normal saline (NS) for 14 days.

Design

Twelve 6-mm OAT (osteoarticular transfer) plugs were harvested from 6 cadaver knees on the lateral femoral condyle to simulate a chondral fragment. The chondral fragments were then placed inside an airtight specimen container with NS (0.9% sodium chloride) and were measured over 14 days.

Results

After 14 days, the chondral fragments showed no increase in diameter as they measured an average of 5.567 ± 0.448 mm on Day 1 and 5.702 ± 0.253 mm on Day 14 ( P = 0.183). The chondral fragments showed an increase in mass from an average of 0.058 ± 0.012 g on Day 1 to 0.073 ± 0.012 g on Day 14 ( P < 0.001) and an increase in thickness from an average of 2.038 ± 0.346 mm on Day 1 to 2.229 ± 0.297 mm on Day 14 ( P = 0.033).

Conclusions

Chondral fragments in NS increase in mass and thickness over time, but do not change in diameter. When surgeons are evaluating loose chondral fragments for fixation, they should consider that these fragments may appear thicker than the recipient location.
Implanted intrathecal drug delivery systems may be associated with improved survival in patients with cancer
Authors: Mitchell Alison , Somerville Lesley , Williams Nicola , McGhie Jonathan , McConnachie Alex , McGinn Gordon , Lee Jiyoung
Published: October 2023

Background

Intrathecal Drug Delivery Systems (IDDS) are underused in the management of cancer-related pain despite evidence of both efficacy and survival benefit. There is currently limited evidence to indicate which patients might benefit most from IDDS.

Aim

The aim of the study was to describe the baseline characteristics and survival outcomes of patients who accepted IDDS, patients who declined IDDS and patients who wished to go ahead with IDDS but whose condition deteriorated before they could do so.

Design/participants

The survival data for 75 consecutive patients who had been offered intrathecal drug delivery were examined as part of a retrospective cohort study. Survival data was compared between three groups: those who accepted intrathecal drug delivery and went on to receive it ( n = 41), those who accepted it but whose condition deteriorated before it commenced ( n = 17) and those who declined this treatment modality ( n = 17).

Results

Patients who received IDDS survived significantly longer after assessment compared to those who declined IDDS (hazard ratio (HR) for the IDDS group relative to the declined group 0.29 (95% CI 0.16 to 0.53), and 0.23 (95% CI 0.12 to 0.44) after adjustment for gender and baseline functional status. In patients who accepted IDDS but who were unable to commence treatment, survival after assessment was not significantly different from those who declined the IDDS (HR for the deteriorated group relative to the declined group 1.28 (95% CI 0.65 to 2.53), and 0.80 (95% CI 0.65 to 2.53) after adjustment for gender and baseline functional status).

Conclusion

In this retrospective analysis, an improvement in survival may be associated with patients who accept ongoing pain management with an implanted intrathecal drug delivery system compared to those patients who either declined intrathecal drug delivery or deteriorated before it could be commenced.
Nurses’ roles, views and knowledge regarding vaccines and vaccination: A pan-European survey
Authors: de Graaf Ysanne , Oomen Ber , Castro-Sanchéz Enrique , Geelhoed Jeannette , Maria Vrijhoef Hubertus Johannes
Published: October 2023

Introduction

Nurses play a crucial part in responding to pandemics. Not only are they often in direct contact with patients but nurses also can inform and educate the general public regarding vaccination. Mapping nurses’ preferences and knowledge on the value of vaccination can contribute to shaping policy, generate support for policy measures and help address vaccination hesitancy.

Methods

The present exploratory study was based on an electronic survey distributed amongst nurses working in Europe. Analysis included descriptive statistics to summarize knowledge levels, attitudes and demographics and tests for associations.

Results

Of 103 respondents, most assessed their knowledge about vaccines, the immune system and pathogens on a medium level. Most respondents agreed that the best policy is to leave influenza vaccination voluntary for healthcare workers and vulnerable groups, but to make COVID-19 vaccination mandatory. Country of employment of respondents was associated with their preferred policy of influenza- and COVID-19 vaccination. Most needed by nurses in the current study to increase their involvement in vaccination programs were improved perceptions amongst patients and society at large. To perform better in responding to future pandemics, the most needed type of institutional support was continuous free nursing education.

Discussion

This study emphasizes a need for more nurse-generated data regarding the value of vaccination. Complexity of vaccine-related decision-making was highlighted by findings that opinions of nurses on (vaccination-) policy differ between influenza- and COVID vaccines and appear to be influenced by the policy environment in their country of employment.
The association between internet use and depression among older adults in China: The mediating role of social networks
Authors: Wang Chenyang , Zhu Yuqi , Ma Jin , Chu Jianxun
Published: October 2023

Objective

In the aging world, the depression of older adults has aroused great concern. It brings detrimental side effects to old adults and the sustainability of society. The information and communication technologies have reshaped how people live among which the Internet has gained much popularity in the senior community. This study aims to explore the association between Internet use and depression in older adults.

Methods

This study applied a representative national dataset (China Longitudinal Aging Social Survey, CLASS 2018) to examine by conducting regression analysis. Inspired by the social capital theory, we further examined the mediating role of general social networks (as a general concept) and specific networks (family and friend networks) in reducing depression. All calculations and analyses were conducted by STATA.

Results

(a) Internet use significantly reduces depressive symptoms among Chinese older adults; (b) internet use enhances social network support for Chinese older adults; and (c) social networks in general and family networks and friend networks in specific all play a mediating role between internet use and depression symptoms.

Conclusion

This work proved that internet use could reduce depression levels in older adults in China, and social networks, including family networks and friend networks, have a mediation role in the relationship between internet use and depression in older adults in China. Combined with the Chinese social context, we explained that the existence of an empty-nest elderly community in Chinese society and the emphasis on kinship in Chinese tradition may be the reasons. Based on the main findings, tailor-made suggestions for addressing depression issues among older adults were discussed.
Lifestyle Factors Associated With Erosive Esophagitis in Japanese Individuals With and Without Obesity Undergoing Health Checkups
Authors: Shiota Seiji , Shibata Aika , Horinouchi Noboru , Yamamoto Kyoko , Miyazaki Eishi
Published: October 2023

Background:

Several lifestyle factors have been reported to be associated with erosive esophagitis (EE). Many studies examined the associated factors for EE independent of obesity. However, lifestyle factors associated with EE might differ depending on sex or the presence of obesity. This study thus aimed to investigate the lifestyle risk factors for EE stratified by obesity and sex.

Methods:

A cross-sectional survey was conducted among Japanese people who underwent an annual health checkup at the Oita Health Checkup Center between 2019 and 2021. Multivariate analysis was performed to determine the factors associated with EE in participants stratified by sex and the presence of obesity.

Results:

EE was diagnosed in 676 of 5240 participants (12.9%) who were analyzed, and occurred most often in males (601 cases). The percentage of obesity based on body mass index was significantly higher among EE than non-EE participants (50.3% and 26.5%, P < .001). In obese males, eating just before bedtime (OR = 1.34, 95% CI 1.01-1.78) and hiatal hernia (OR = 3.42, 95% CI 2.57-4.54) were significantly associated with EE in multivariate analysis. In non-obese males, current smoking (OR = 1.48, 95% CI 1.07-2.04), alcohol consumption of 40 to 60 g/day (OR = 1.60, 95% CI 1.11-2.30), and hiatal hernia (OR = 3.63, 95% CI 2.79-4.73) were significantly associated with EE.

Conclusions:

We found that factors associated with EE were different between obese and non-obese males. In obese males, avoiding going to bed within 2 h after dinner might contribute to preventing the occurrence of EE. In non-obese males, prevention of obesity, quitting smoking, and avoiding heavy alcohol consumption might be important for preventing the development of EE.
The Effect of Innovation Strategies on the Business Performance of Global Semiconductor Firms
Authors: Hsieh Jin-Chi
Published: October 2023

Innovation strategies form the bedrock of sustainable business development in semiconductor firms. Using dynamic network data envelopment analysis (DN-DEA), the performance of the main global semiconductor firms during 2015 to 2019 was evaluated and the effects of intangible assets within their innovation strategies were explored. Operating efficiency (OPE) was found to be greater than R&D efficiency (RDE), and the average overall efficiency of Asian firms was found to be higher than that of American & European (AMEU) firms. A low intangible asset efficiency (ISE) indicates greater operating risks (2017 showed the highest value and 2015 the lowest). Establishing four regions, Region A showed innovation ability, but lacked business performance. Region B showed lack of both progress and operating performance. Region C showed good innovation ability and good operating performance. Region D showed innovation ability, but lack of progress. Thus, innovation achievements and intangible assets are key indicators of global semiconductor companies’ business sustainability.
Internal Auditing in the Arab World: A Systematic Literature Review and Directions for Future Research
Authors: Hazaea Saddam A. , Al-Matari Ebrahim Mohammed , Khatib Saleh F. A. , Albitar Khaldoon , Zhu Jinyu
Published: October 2023

This study provides a systematic review of the literature on internal auditing (IA) research in 17 Arab countries. It focuses on four key aspects, namely the quality and effectiveness of IA, the objectivity and independence of IA, the consequences of IA, and the challenges facing IA in Arab countries in order to provide insights and avenues for future research in this field. Ninety-one (91) articles collected from the Scopus database between 1996 and April 2022 were analyzed in this study. The results show that there has been an increase in the number of studies that discussed IA, especially in the last 6 years. Most of these studies have focused on the quality of IA and its functions. It also shows that Jordan and the Kingdom of Saudi Arabia dominate the literature published so far in terms of the number of studies. Also, most of the studies were based on agency and institutional theory evaluating the various aspect of IA. This study highlights the lack of in-depth qualitative research that allows researchers to challenge the theories developed in the auditing field, add nuances to the existing theoretical framework, and unpack new theoretical directions. Furthermore, the results also show that the IA literature did not contribute significantly to the knowledge of internal audit functions (IAFs) as specified by the Institute of Internal Auditors (IIA). This study contributes to the body of knowledge by determining future research directions and surveys by interested researchers and regulators, including IIA.
Determinants of Quality of Life in Family Caregivers of Patients With Leukemia: A Cross-Sectional Study
Authors: Al Ali Nahla M. , Eid Amjad , Aljada Nabela
Published: October 2023

This study aimed to determine the quality of life of family caregivers of patients with leukemia and the factors contributing to it. The RAND 36-Item was used to collect data from 152 caregivers. The mean scores of six dimensions of Quality of life (QoL) were low, indicating a limited health state. Caregivers’ educational level, age, number of admissions, time since diagnosis, relationship with the patient, and family income significantly predicted the caregivers’ QOL. This study confirms the need for ongoing interventions to improve caregivers’ quality of life. Particular attention should be paid to older caregivers, who have low education, are from a low socioeconomic background, and care for the patients for a long time. Oncology nurses must ensure that family caregivers receive the appropriate support and resources to care for their patients at home and to assess the areas of need to achieve a better quality of life for patients and their caregivers.
Collaborative Action Research with Diverse Stakeholders: Building the Disability Champions Mentoring Network
Authors: Ellis-Robinson Tammy , Slusarz Elizabeth , Haji-Georgi Maria , Slichko Julienne , Mohammed Audrey , Terry Kayla , Hazell Ketrina
Published: October 2023

Historically based systemic oppressions have exacerbated disparities in post-school outcomes among youth with disabilities transitioning to adulthood. Using a community action research (CAR) approach, the Disability Champions Mentoring Network was founded in the United States by a community of diverse stakeholders to address inequities in transition outcomes. Centering transition as a cultural practice, the project connected theoretical frameworks to develop a supportive community through interagency collaboration and mentorship. We conducted a self-examination using deductive category application and an open coding process to identify major themes in the project development process. The themes identified by collaborators include self-determination/mentorship; authentic interagency collaborative processes; identification of needs, barriers, and resources; and promotion of public awareness. Project achievements and barriers recognized by the community network are discussed in the context of the CAR model. Implications for policy, programming, and research are considered.
Description of the Simple Ankle Value: A Simplified Patient-Reported Outcome Measure for the Assessment of Ankle and Hindfoot Function
Authors: Barnavon Thomas , Hardy Alexandre , Duguay Tristan , Bouche Pierre-Alban , Lopes Ronny
Published: October 2023

Background:

The Simple Ankle Value (SAV) is a patient-reported outcome measure (PROM) in which patients grade their ankle function as a percentage of that of their contralateral uninjured ankle.

Purpose/Hypothesis:

The primary aims of this study were to validate the SAV and evaluate its correlation with other PROMs. It was hypothesized that the SAV would be seen as a valid score that provides results comparable with those of the Foot and Ankle Ability Measure (FAAM) and the European Foot & Ankle Society (EFAS) score.

Study Design:

Cohort study (Diagnosis); Level of evidence, 2.

Methods:

Patients seen for an ankle or hindfoot tissue were divided into those treated operatively and nonoperatively. A control group of patients treated for issues outside of the foot and ankle was also created. All patients completed the SAV followed by the FAAM and the EFAS scores. Patients treated operatively completed the questionnaires before surgery and 3 months after surgery. Patients treated nonoperatively completed the questionnaires twice 15 days apart. The correlation between the SAV score, the FAAM score, and the EFAS score was estimated with the Spearman correlation coefficient.

Results:

A total of 209 patients (79 in the operative group, 103 in the nonoperative group, and 27 in the control group) were asked to complete the questionnaire, and all were included. The test-retest reliability of the SAV was excellent (intraclass correlation coefficient, 0.92; 95% CI, 0.88-0.94). No ceiling or floor effect was reported. Strong correlation was found between the SAV and the FAAM and EFAS scores. The SAV was able to discriminate patients from controls (54.18 ± 21.22 and 93.52 ± 9.589; P < .0001); however, SAV was not able to detect change from preoperative to 3 months postoperative (from 54.18 ± 21.22 to 62.53 ± 20.83; P = .44).

Conclusion:

Our study suggests that the SAV is correlated with existing accepted ankle PROMs. Further work with this PROM is needed to validate the questionnaire.
“We Tried to Take Care of Her, but it Got Too Exhausting”: A Study of the Transition From Family Carer to Employer
Authors: Ness Tove Mentsen , Silan Wasiq
Published: October 2023

In Taiwan an increasing number of families are employing live-in carers from abroad to cope with care responsibilities, including the Indigenous Tayal. The aim of this research was to understand the transition from Indigenous family carer to employer with older family members who have extensive care needs. Six Indigenous employers were interviewed, and a narrative hermeneutic analysis was performed. The Tayal caregivers’ cases revealed that their transition to employing live-in carers was complex and filled with ethical dilemmas due to their vulnerable positions. They tried to ensure person-centered care for their family members, but by doing this they risked reproducing vulnerability when transferring their own vulnerability to the live-in carer. The results indicate the interwoven nature of care dependency when it is defined by multiple vulnerabilities, Indigeneity and migration, and the multifaceted components of cultural safety.
Semantic enrichment of building functions through geospatial data integration and ontological inference
Authors: Memduhoglu Abdulkadir , Basaraner Melih
Published: October 2023

The comprehensive definition of buildings in urban spatial databases (SDBs) and geographic information systems (GISs) is crucial for city management, considering their essential role in cities. Modern urban geospatial applications such as smart cities need a rich-information infrastructure, relying upon urban SDBs and GISs, powered by multiple data sources. In this respect, many geospatial techniques are available for acquiring geometric data of buildings, but their semantic definitions require extra effort. Today, volunteered geographic information (VGI) platforms are assumed to be alternative geospatial data sources and their integration with official datasets provides a new opportunity for the enrichment of urban geospatial datasets. In this context, geospatial semantic web technologies can contribute to the semantic enrichment process. This study presents a methodology for enriching various building datasets using GIS and geospatial semantic web technologies, enabling an enhanced definition of building functions. The proposed method makes use of an OpenStreetMap (OSM) dataset to obtain missing semantic information about building features. The enrichment process was implemented by transferring OSM point of interest (POI) values to associated OSM building features through the application of semantic web rule language (SWRL) rules. Furthermore, the same process was also applied to two additional official datasets at different levels of detail (TOPO1K and TOPO25K), which were subsequently incorporated into the geospatial ontology. The resulting geospatial ontology offers new opportunities for functional definition and logical rule-making for buildings, with the potential to uncover new classes and insights. In addition, it allows for the definition of terms and explanations in multiple languages, covering most of the OSM values used worldwide for selected tags to define building functions.
Gravity-based models for evaluating urban park accessibility: Why does localized selection of attractiveness factors and travel modes matter?
Authors: Chen Peng , Wang Wei , Qian Chong , Cao Mengqiu , Yang Tianren
Published: October 2023

Gravity-based models have been extensively utilized in urban studies for measuring geographic disparities in access to urban parks over the past several decades. However, despite methodological advancements incorporating various aspects of accessibility, there has been limited focus on the impact of variable selection (e.g., attractiveness factors) and transport modes on accessibility evaluations. This study investigates the differences in gravity-based models for assessing park accessibility based on varying assumptions about attractiveness factors and travel impedance. Semi-structured interviews with local residents were conducted to identify the reasons for park visits in Shanghai. Our bivariate correlation analyses reveal that factors such as park openness and access to public transport were crucial, in addition to conventional factors identified in the literature (i.e., park size and driving accessibility). This insight led to the development of localized accessibility measurements that incorporate park inclusiveness (i.e., entrance fees and opening hours) and multimodal travel options (based on multinomial logistic mode choice models). The results indicate that the refined model produces lower and more varied accessibility levels, which can better capture accessibility gaps across different geographic contexts. This accurate and practical identification of accessibility gaps can assist local planners and decision-makers in formulating effective policies and strategies to promote equitable access to urban public parks.
Usefulness of Practice-Based Pedagogical Approaches for Nascent Student Entrepreneurs
Authors: Koropogui Siba Théodore , St-Jean Étienne , Zakariya Safaa
Published: October 2023

This article focuses on the impact of an entrepreneurship education program on nascent student entrepreneurs. It is based on the implementation of the French-language program “Étudiant-entrepreneur… Oui, c’est possible” (Student-entrepreneur… Yes, it’s possible) in different faculties at the Hassan I University in Morocco. The study used a pretest-posttest research design with 32 participants trained in the program and 30 participants in the control group. The results show that the program significantly improved knowledge, skills, or competencies about starting a business, entrepreneurial self-efficacy (ESE), and entrepreneurial behavior (marginally), but not entrepreneurial attitudes and intentions. Under the assumption that strong attitudes and intentions are prerequisites for becoming nascent entrepreneurs, the present results suggest that specific content training coupled with pedagogical approaches adapted based on progress in the entrepreneurial process benefits those with insufficient knowledge and ESE as they work to develop their entrepreneurial ideas.
Management of post-keratoplasty ametropia
Authors: Bineshfar Niloufar , Tahvildari Azin , Feizi Sepehr
Published: October 2023

Even after a successful corneal transplant, patients experience severe refractive errors, impeding their rehabilitation and satisfaction. Refractive errors can be caused by recipient pathology and corneal thickness, as well as intraoperative factors such as donor–host discrepancy, recipient’s eccentric trephination, vitreous length, wound apposition, technique of suturing, and suture material. Also, wound healing and the interim between keratoplasty and suture removal contribute to astigmatism. Lamellar keratoplasty outperforms penetrating keratoplasty in terms of endothelial cell loss and endothelial graft rejection, yet the risk of developing refractive errors is comparable. Nonsurgical interventions such as spectacles and lenses fail to provide desirable vision in cases with high astigmatism and corneal irregularity. When these limitations are encountered, surgical interventions including incisional keratotomy, wedge resection, laser refractive surgeries, intracorneal segments, and intraocular lens implantation are employed. However, occasionally, none of these approaches deliver the desired effects, leading to the need for a repeat keratoplasty.
A Pragmatic Approach for Managing Unexplained Neutropenia in a Brain Tumor Patient
Authors: Gokulanathan Narendhar , Sethi Pooja
Published: October 2023

Cancer patients experience a decrease in blood counts either due to the myelosuppressive effect of oncological treatment or bone marrow infiltration due to distant metastases. Oncological interventions, such as chemotherapy, immunotherapy or large-field irradiation, are common causes of neutropenia, thrombocytopenia, or pancytopenia in cancer patients. Non-oncological reasons for the decrease in blood counts can be attributed to drug-induced, autoimmune diseases, or viral infections. Recently, case reports have been published for neutropenia/thrombocytopenia due to the Coronavirus disease (Covid-19) pandemic too. Here, we discuss a case of phenytoin-induced neutropenia in a brain tumor patient and a pragmatic approach for managing unexplained neutropenia, that is, neutropenia unrelated to cancer or oncological intervention. Timely recognition and timely intervention can prevent fatal outcomes.
Characteristic oscillatory brain networks for predicting patients with chronic migraine
Authors: Hsiao Fu-Jung , Chen Wei-Ta , Wu Yu-Te , Pan Li-Ling Hope , Wang Yen-Feng , Chen Shih-Pin , Lai Kuan-Lin , Coppola Gianluca , Wang Shuu-Jiun
Published: October 2023

To determine specific resting-state network patterns underlying alterations in chronic migraine, we employed oscillatory connectivity and machine learning techniques to distinguish patients with chronic migraine from healthy controls and patients with other pain disorders. This cross-sectional study included 350 participants (70 healthy controls, 100 patients with chronic migraine, 40 patients with chronic migraine with comorbid fibromyalgia, 35 patients with fibromyalgia, 30 patients with chronic tension-type headache, and 75 patients with episodic migraine). We collected resting-state magnetoencephalographic data for analysis. Source-based oscillatory connectivity within each network, including the pain-related network, default mode network, sensorimotor network, visual network, and insula to default mode network, was examined to determine intrinsic connectivity across a frequency range of 1–40 Hz. Features were extracted to establish and validate classification models constructed using machine learning algorithms. The findings indicated that oscillatory connectivity revealed brain network abnormalities in patients with chronic migraine compared with healthy controls, and that oscillatory connectivity exhibited distinct patterns between various pain disorders. After the incorporation of network features, the best classification model demonstrated excellent performance in distinguishing patients with chronic migraine from healthy controls, achieving high accuracy on both training and testing datasets (accuracy > 92.6% and area under the curve > 0.93). Moreover, in validation tests, classification models exhibited high accuracy in discriminating patients with chronic migraine from all other groups of patients (accuracy > 75.7% and area under the curve > 0.8). In conclusion, oscillatory synchrony within the pain-related network and default mode network corresponded to altered neurophysiological processes in patients with chronic migraine. Thus, these networks can serve as pivotal signatures in the model for identifying patients with chronic migraine, providing reliable and generalisable results. This approach may facilitate the objective and individualised diagnosis of migraine.
Identification and characterization of differentially expressed circular RNAs in extraocular muscle of oculomotor nerve palsy
Authors: Shi Mingsu , Fang Yanxi , Liang Yu , Hu Yuxiang , Huang Jiaqiu , Xia Weiyi , Bian Hewei , Zhuo Qiao , Wu Lianqun , Zhao Chen
Published: October 2023

Background

Oculomotor nerve palsy (ONP) is a neuroparalytic disorder resulting in dysfunction of innervating extraocular muscles (EOMs), of which the pathological characteristics remain underexplored.

Methods

In this study, medial rectus muscle tissue samples from four ONP patients and four constant exotropia (CXT) patients were collected for RNA sequencing. Differentially expressed circular RNAs (circRNAs) were identified and included in functional enrichment analysis, followed by interaction analysis with microRNAs and mRNAs as well as RNA binding proteins. Furthermore, RT-qPCR was used to validate the expression level of the differentially expressed circRNAs.

Results

A total of 84 differentially expressed circRNAs were identified from 10,504 predicted circRNAs. Functional enrichment analysis indicated that the differentially expressed circRNAs significantly correlated with skeletal muscle contraction. In addition, interaction analyses showed that up-regulated circRNA_03628 was significantly interacted with RNA binding protein AGO2 and EIF4A3 as well as microRNA hsa-miR-188-5p and hsa-miR-4529-5p. The up-regulation of circRNA_03628 was validated by RT-qPCR, followed by further elaboration of the expression, location and clinical significance of circRNA_03628 in EOMs of ONP.

Conclusions

Our study may shed light on the role of differentially expressed circRNAs, especially circRNA_03628, in the pathological changes of EOMs in ONP.
Effect of hemoglobin and oxygen saturation on adverse outcomes in children with tetralogy of fallot: a retrospective observational study
Authors: Liu Qiao , Wu Xie , Li Yinan , Wang Hongbai , An Ran , Dou Dou , Bie Dongyun , Jia Yuan , Yuan Su , Yan Fuxia , Ding Jie
Published: October 2023

Background

Tetralogy of Fallot (TOF) is a common cyanotic congenital heart malformation that carries a high risk of right-to-left shunting. Anemia is characterized by decreased hemoglobin (Hb) levels that can affect tissue oxygen delivery and impact postoperative recovery in patients. Chronic hypoxia caused by right-to-left shunting of TOF could lead to compensatory increases in Hb to maintain systemic oxygen balance. This study aims to investigate whether preoperative Hb and blood oxygen saturation (SpO2) can predict adverse outcomes in children undergoing corrective surgery for TOF.

Methods

This retrospective study included patients under 18 years of age who underwent corrective surgery for TOF at Fuwai Hospital between January 2016 and December 2018. Adverse outcomes, including in-hospital death, extracorporeal membrane oxygenation implantation, ICU stay > 30 days, and severe complications, were considered as the primary outcome. Univariable and multivariable logistic analyses were performed to identify independent risk factors for adverse outcomes. Propensity score-matched (PSM) analysis was also conducted to minimize the confounding factors.

Results

A total of 596 children were included in the study, of which 64 (10.7%) experienced adverse outcomes. Hb*SpO2 < aaHb was identified as an independent risk factor for adverse outcomes (OR = 2.241, 95% CI = 1.276–3.934, P = 0.005) after univariable and multivariable logistic analyses. PSM analysis further confirmed the association between Hb*SpO2 < aaHb and adverse outcomes. Patients with Hb*SpO2 < aaHb had a significantly higher incidence of postoperative adverse outcomes, longer time of mechanical ventilation, and hospital stay, as well as higher in-hospital costs.

Conclusions

Hb*SpO2 < aaHb is significantly associated with adverse outcomes in children undergoing corrective surgery for TOF. Clinicians can use this parameter to early identify high-risk children and optimize their postoperative management.
Serum sodium improvement: change in Comprehensive Geriatric Assessment parameters in geriatric patients with hyponatremia
Authors: Kapoor M. , Pathania M. , Dhar M.
Published: October 2023

Background

Hyponatremia presents with symptoms considered age-associated in the elderly. We assess the change in Comprehensive Geriatric Assessment (CGA) parameters after hyponatremia improvement in hospitalized geriatric patients.

Methods

We took 100 hyponatremic and same number of eunatremic geriatric patients (> 60 years) who were comorbidity, presenting-complaints, and age-matched. Four CGA parameters were utilized, the new Hindi Mental State Examination (HMSE), Barthel’s index of activities of daily living (ADL), Timed up and go Test (TUG), and handgrip strength by hand dynamometer (HG). We analyzed these at admission and discharge, and their relationship with change in sodium levels.

Results

Average age was 68.1 ± 5.8 years, with males constituting 75%. The CGA parameters demonstrated worse values amongst the hyponatremia than the normonatremia group. Severe hyponatremia group showed worse CGA scores in comparison with moderate and mild. With improvement in sodium level, the improvements in ADL, TUG, and HMSE scores were greater in the hyponatremia group (8.8 ± 10.1, 2.2 ± 2.5, and 1.7 ± 2.3 respectively) in comparison to the normonatremia reference group (4.7 ± 9.0, 1 ± 2.0, and 0.7 ± 1.3 respectively, P < 0.05).

Conclusion

Our study is the first utilizing HMSE to assess change in cognitive ability with improvement in serum sodium levels in the Indian elderly. Hyponatremic patients show worse baseline CGA parameters, and hyponatremia severity correlates with worse motor and cognitive function. Improvement in the serum sodium level improves the CGA parameters. Correction of hyponatremia in the geriatric age group significantly impacts life quality.
The efficacy of percutaneous transluminal angioplasty and arteriovenous fistula reconstruction for immature arteriovenous fistula
Authors: Yu Han , Chi Yanqing , Wang Baoxing
Published: October 2023

Background

To access the efficacy of percutaneous transluminal angioplasty and arteriovenous fistula reconstruction for immature arteriovenous fistula, compare the long-term patency and post-operative complications between them.

Materials and methods

The medical records and Hemodialysis record sheets from 44 patients between May 2020 and January 2022 who underwent percutaneous transluminal angioplasty or arteriovenous fistula reconstruction treatment for immature autogenous arteriovenous fistula (AVF) were retrospectively reviewed. The patients were divided into two groups according to the type of surgery they received, including 25 patients in the PTA group and 19 patients in the AVF reconstruction group. Clinical outcomes were included, such as the primary and secondary patency rates following the procedure, maturation time, peak systolic velocity (PSV) of brachial artery, maximum pump-controlled blood flow at initial dialysis, and post-operative complications rates in the two groups.

Results

Technical and clinical success was achieved in 100% of the 44 cases. For patients who underwent percutaneous transluminal angioplasty, the primary patency rate at 3, 6, and 9 months was 84.0%, 68.0%, 60.0%, and the secondary patency rate was 92.0%, 84.0%, 80.0%, respectively. And for patients who underwent arteriovenous fistula reconstruction, the primary patency rate at 3, 6, and 9 months was 89.5%, 73.7%, 68.4%, and the secondary patency rate was 100.0%, 94.7%, 94.7%, respectively. There were no significant differences between the two groups in terms of patency rates (p > .050). In patients whose maturation was successful, the average maturation time of fistula after the PTA procedure was 19.36 ± 13.94 days, and 58.63 ± 18.95 days for the reconstruction procedure (p < .010). The PSV of brachial artery before and after the procedure was 87.64 ± 23.87 cm/s and 153.20 ± 21.69 cm/s in PTA group, for reconstruction group, the number was 86.26 ± 20.59 cm/s and 151.26 ± 29.94 cm/s, respectively. No statistically significant differences (p > .050). The maximum pump-controlled blood flow at initial dialysis was 232.60 ± 16.72 ml/min in PTA group, which was significantly higher than 197.11 ± 10.45 ml/min in reconstruction group (p < .010). Subcutaneous hematoma, restenosis, thrombus formation, and pseudoaneurysm were major complications in PTA group. Restenosis, thrombus formation, and pseudoaneurysm were major complications in reconstruction group, with no statistically significant differences between the two groups (p > .050).

Conclusion

When immature AVFs require reconstruction surgery, the patency outcomes are comparable to AVFs that undergo successful management by PTA. While, when AVFs are successfully managed by PTA, they have significantly less maturation times and higher maximum pump-controlled blood flow rates at initial dialysis AVF use.
Development and validation of a prognosis risk score model for preterm birth among pregnant women who had antenatal care visit, Northwest, Ethiopia, retrospective follow-up study
Authors: Fente Bezawit Melak , Asaye Mengstu Melkamu , Tesema Getayeneh Antehunegn , Gudayu Temesgen Worku
Published: October 2023

Background

Prematurity is the leading cause of neonatal morbidity and mortality, specifically in low-resource settings. The majority of prematurity can be prevented if early interventions are implemented for high-risk pregnancies. Developing a prognosis risk score for preterm birth based on easily available predictors could support health professionals as a simple clinical tool in their decision-making. Therefore, the study aims to develop and validate a prognosis risk score model for preterm birth among pregnant women who had antenatal care visit at Debre Markos Comprehensive and Specialized Hospital, Ethiopia.

Methods

A retrospective follow-up study was conducted among a total of 1,132 pregnant women. Client charts were selected using a simple random sampling technique. Data were extracted using structured checklist prepared in the Kobo Toolbox application and exported to STATA version 14 and R version 4.2.2 for data management and analysis. Stepwise backward multivariable analysis was done. A simplified risk prediction model was developed based on a binary logistic model, and the model’s performance was assessed by discrimination power and calibration. The internal validity of the model was evaluated by bootstrapping. Decision Curve Analysis was used to determine the clinical impact of the model.

Result

The incidence of preterm birth was 10.9%. The developed risk score model comprised of six predictors that remained in the reduced multivariable logistic regression, including age < 20, late initiation of antenatal care, unplanned pregnancy, recent pregnancy complications, hemoglobin < 11 mg/dl, and multiparty, for a total score of 17. The discriminatory power of the model was 0.931, and the calibration test was p > 0.05. The optimal cut-off for classifying risks as low or high was 4. At this cut point, the sensitivity, specificity and accuracy is 91.0%, 82.1%, and 83.1%, respectively. It was internally validated and has an optimism of 0.003. The model was found to have clinical benefit.

Conclusion

The developed risk-score has excellent discrimination performance and clinical benefit. It can be used in the clinical settings by healthcare providers for early detection, timely decision making, and improving care quality.
Fusobacterium nucleatum facilitates proliferation and autophagy by activating miR-361-3p/NUDT1 axis through oxidative stress in hypopharyngeal squamous cell carcinoma
Authors: Lau Hui-Ching , Yuan Xiaohui , Huang Huiying , Zhang Ming , Hsueh Chi-Yao , Gong Hongli
Published: October 2023

Background

To investigate how Fusobacterium nucleatum (Fn) promotes oxidative stress and mediates proliferation and autophagy in hypopharyngeal squamous cell carcinoma (HPSCC).

Methods

The prognosis for 82 HPSCC cases was retrospectively analyzed. HPSCC cell line FaDu was co-cultured with Fn. Knockdown of NUDT1 (shNUDT1 group) was done after observing DNA damage response. CCK8 and tumorigenesis assays for proliferation observation, mitochondria ROS (MitoROS) measurement to examine intracellular oxidative stress, and ELISA to analyze concentration of 8-oxo-2’-deoxyguanosine (8-oxo-dG) in cells. Dual-luciferase reporter assays clarified miR-361-3p connection with NUDT1. Autophagy flow was observed using electron microscopy and related proteins.

Results

Fn was highly associated with NUDT1. The shNUDT1 group experienced lower proliferation compared with normal FaDu (NC group) in vivo and in vitro. The shNUDT1 group showed 8-oxo-dG and γH2AX to be elevated. Intracellular ROS decreased in shNUDT1Fn group when compared to Fn group. Upregulating miR-361-3p could suppress NUDT1 expression and downstream proliferation and autophagy. Fn modulated miR-361-3p via OH−, which could be proven by H2O2 assay and N-acetylcysteine.

Conclusions

Higher Fn in HPSCC patients suggests poorer prognosis. NUDT1 might affect cell proliferation and autophagy and modulate DNA damage response. The oxidative stress induced miR-361-3p/NUDT1 axis is first introduced in microbiome-carcinoma research.
Randomized controlled phase III trial to investigate superiority of robot-assisted gastrectomy over laparoscopic gastrectomy for clinical stage T1-4aN0-3 gastric cancer patients (JCOG1907, MONA LISA study): a study protocol
Authors: Makuuchi Rie , Terashima Masanori , Terada Mitsumi , Mizusawa Junki , Kita Ryosuke , Tokunaga Masanori , Omori Takeshi , Ojima Toshiyasu , Ehara Kazuhisa , Watanabe Masaya , Yanagimoto Yoshitomo , Nunobe Souya , Kinoshita Takahiro , Ito Seiji , Nishida Yasunori , Hihara Jun , Boku Narikazu , Kurokawa Yukinori , Yoshikawa Takaki ,   the Stomach Cancer Study Group of Japan Clinical Oncology Group
Published: October 2023

Background

Laparoscopic gastrectomy (LG) is considered a standard treatment for clinical stage I gastric cancer. Nevertheless, LG has some drawbacks, such as motion restriction and difficulties in spatial perception. Robot-assisted gastrectomy (RG) overcomes these drawbacks by using articulated forceps, tremor-filtering capability, and high-resolution three-dimensional imaging, and it is expected to enable more precise and safer procedures than LG for gastric cancer. However, robust evidence based on a large-scale randomized study is lacking.

Methods

We are performing a randomized controlled phase III study to investigate the superiority of RG over LG for clinical T1-2N0-2 gastric cancer in terms of safety. In total, 1,040 patients are planned to be enrolled from 46 Japanese institutions over 5 years. The primary endpoint is the incidence of postoperative intra-abdominal infectious complications, including anastomotic leakage, pancreatic fistula, and intra-abdominal abscess of Clavien–Dindo (CD) grade ≥ II. The secondary endpoints are the incidence of all CD grade ≥ II and ≥ IIIA postoperative complications, the incidence of CD grade ≥ IIIA postoperative intra-abdominal infectious complications, relapse-free survival, overall survival, the proportion of RG completion, the proportion of LG completion, the proportion of conversion to open surgery, the proportion of operation-related death, and short-term surgical outcomes. The Japan Clinical Oncology Group Protocol Review Committee approved this study protocol in January 2020. Approval from the institutional review board was obtained before starting patient enrollment in each institution. Patient enrollment began in March 2020. We revised the protocol to expand the eligibility criteria to T1-4aN0-3 in July 2022 based on the results of randomized trials of LG demonstrating non-inferiority of LG to open surgery for survival outcomes in advanced gastric cancer.

Discussion

This is the first multicenter randomized controlled trial to confirm the superiority of RG over LG in terms of safety. This study will demonstrate whether RG is superior for gastric cancer.

Trial registration

The protocol of JCOG1907 was registered in the UMIN Clinical Trials Registry as UMIN000039825 (http://www.umin.ac.jp/ctr/index.htm). Date of Registration: March 16, 2020. Date of First Participant Enrollment: April 1, 2020.
Radiation pneumonia predictive model for radiotherapy in esophageal carcinoma patients
Authors: Sheng Liming , Zhuang Lei , Yang Jing , Zhang Danhong , Chen Ying , Zhang Jie , Wang Shengye , Shan Guoping , Du Xianghui , Bai Xue
Published: October 2023

Background

The machine learning models with dose factors and the deep learning models with dose distribution matrix have been used to building lung toxics models for radiotherapy and achieve promising results. However, few studies have integrated clinical features into deep learning models. This study aimed to explore the role of three-dimension dose distribution and clinical features in predicting radiation pneumonitis (RP) in esophageal cancer patients after radiotherapy and designed a new hybrid deep learning network to predict the incidence of RP.

Methods

A total of 105 esophageal cancer patients previously treated with radiotherapy were enrolled in this study. The three-dimension (3D) dose distributions within the lung were extracted from the treatment planning system, converted into 3D matrixes and used as inputs to predict RP with ResNet. In total, 15 clinical factors were normalized and converted into one-dimension (1D) matrixes. A new prediction model (HybridNet) was then built based on a hybrid deep learning network, which combined 3D ResNet18 and 1D convolution layers. Machine learning-based prediction models, which use the traditional dosiomic factors with and without the clinical factors as inputs, were also constructed and their predictive performance compared with that of HybridNet using tenfold cross validation. Accuracy and area under the receiver operator characteristic curve (AUC) were used to evaluate the model effect. DeLong test was used to compare the prediction results of the models.

Results

The deep learning-based model achieved superior prediction results compared with machine learning-based models. ResNet performed best in the group that only considered dose factors (accuracy, 0.78 ± 0.05; AUC, 0.82 ± 0.25), whereas HybridNet performed best in the group that considered both dose factors and clinical factors (accuracy, 0.85 ± 0.13; AUC, 0.91 ± 0.09). HybridNet had higher accuracy than that of Resnet (p = 0.009).

Conclusion

Based on prediction results, the proposed HybridNet model could predict RP in esophageal cancer patients after radiotherapy with significantly higher accuracy, suggesting its potential as a useful tool for clinical decision-making. This study demonstrated that the information in dose distribution is worth further exploration, and combining multiple types of features contributes to predict radiotherapy response.