bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidentality of the civilian harm in international humanitarian law and its Contra Legem antonyms in recent discourses on the laws of war
Authors: Daniele Luigi
Published: April 2024

This article develops an interpretative effort to clarify the meaning of the notion of incidentality of the civilian harm in international humanitarian law (IHL), with particular concern to the role of this concept as normative cornerstone for a systematic reading, and coherent implementation, of the law of targeting. The article begins with a critical analysis of recent discourses on the laws of war, focusing on the emergence and growth of contra legem uses of the concept of ‘collateral damage’. These discourses revolve around proportionality in attacks, commonly re-translating this rule by removing incidentality as legal qualifier of the civilian harm susceptible of proportionality assessments. The article shows that proportionality misconceptions neglecting incidentality have become so common and accepted as to be often confused with structural features of IHL. On the contrary, the analysis highlights the collisions between these conceptions, on the one hand, and IHL targeting prescriptions, their interplay and protective functions, on the other, unveiling how the former result in promoting unlimited expansions of the entity of civilian harm that can be object of proportionality assessments, even when this civilian harm constitutes the largely preponderant, main anticipated result of a given attack. Within a background of unequal relativization of international humanitarian law (IHL) parameters, minimalist understandings of incidentality have also been the basis of questionable orientations about attacks on residential tower buildings, reproducing exponential ‘militarizations’ of civilian objects (and at times of the protected persons therein) for proximity with lawful targets. Cumulatively, these discourses and scholarly orientations contributing to depriving proportionality of its incidentality requirement continue to produce dramatic consequences for civilian protection worldwide and provide aggressive military powers with arguments functional to circumvent the prohibitions of disproportionate and indiscriminate attacks. Against these tendencies, it is proposed that the notion of incidentality of the civilian harm, in homage to letter, object, and protective purpose of IHL, and understood with the interpretative help of mens rea categories, should be strictly construed and urgently re-centralized by laws of war scholars as a fundamental conditio sine qua non for proportionality assessments and as main dividing line between the operative spheres of distinction and proportionality.
Hydraulic tortuosity of porous media: comparison of different modeling methods
Authors: Zhu Yuming , Yue Wenzheng
Published: April 2024

Hydraulic tortuosity is a crucial parameter affecting the movement of fluid in porous media. Currently, researchers have used different methods to construct porous media models and studied the variation of hydraulic tortuosity with porosity. In this paper, we use Monte Carlo random particle, quartet structure generation set (QSGS), and CT-scan reconstruction to construct porous media models with different porosity. The finite element method is used to simulate the fluid passing through the models. The effectiveness of the QSGS algorithm in constructing porous media is verified. The hydraulic tortuosity of the three types of model is computed using the streamline length ratio method, and its variation law with porosity is explored. The results show that the change law of the three models is consistent. The law of power function change is satisfied between the two for all models, which means the increase in porosity causes a decrease in tortuosity. Different models are constructed to explore the effect of tortuosity on permeability. An increase in tortuosity results in a smaller permeability when other conditions are equal. This paper aims to provide effective methods for constructing porous media models and a reference for studying hydraulic tortuosity.
EGFR/CEP7 high polysomy is separate and distinct from EGFR amplification in glioblastoma as determined by fluorescence in situ hybridization
Authors: Wilcock Diane M , Goold Eric , Zuromski Lauren M , Davidson Christian , Mao Qinwen , Sirohi Deepika
Published: April 2024

EGFR amplification in gliomas is commonly defined by an EGFR/CEP7 ratio of ≥2. In testing performed at a major reference laboratory, a small subset of patients had ≥5 copies of both EGFR and CEP7 yet were not amplified by the EGFR/CEP7 ratio and were designated high polysomy cases. To determine whether these tumors are more closely related to traditionally defined EGFR-amplified or nonamplified gliomas, a retrospective search identified 22 out of 1143 (1.9%) gliomas with an average of ≥5 copies/cell of EGFR and CEP7 with an EGFR/CEP7 ratio of <2 displaying high polysomy. Of these cases, 4 had insufficient clinicopathologic data to include in additional analysis, 15 were glioblastomas, 2 were IDH-mutant astrocytomas, and 1 was a high-grade glial neoplasm, NOS. Next-generation sequencing available on 3 cases demonstrated one with a TERT promoter mutation, TP53 mutations in all cases, and no EGFR mutations or amplifications, which most closely matched the nonamplified cases. The median overall survival times were 42.86, 66.07, and 41.14 weeks for amplified, highly polysomic, and nonamplified, respectively, and were not significantly different (p =  0.3410). High chromosome 7 polysomic gliomas are rare but our data suggest that they may be biologically similar to nonamplified gliomas.
Is there a place for friendship in education? Thinking with Arendt on friendship, politics, and education
Authors: Zamotkin Ivan , Leiviskä Anniina
Published: April 2024

In this article, we examine the political and educational relevance of Hannah Arendt’s account of friendship. Drawing from Arendt’s central works on friendship, we offer a novel interpretation of the concept by connecting the notion with the idea of educational ‘love for the world’, amor mundi. With this interpretation, we seek to demonstrate that the concept of friendship has both direct educational and indirect political significance. Thereby, we distinguish our interpretation from two previous understandings of the educational relevance of the Arendtian notion of friendship—those by (1) Aaron Schutz and Marie G. Sandy, and (2) Morten T. Korsgaard—in which friendship is either assigned a specifically political role (as in (1)) or its significance to education is narrowly understood (as in (2)). We argue our interpretation of friendship offers both a new contribution to the understanding of the relationship between education and politics in the context of Arendt scholarship, and a novel way of thinking about the educational significance of friendship in the context of contemporary democratic politics, especially the prevailing political polarization.
Neonatal Herpes Reporting in the United States: Review of Current Policies by State
Authors: Saremi Natalie , Lewis Katherine A , Klausner Jeffrey D
Published: April 2024

Despite its devastating impact, neonatal herpes is not a nationally notifiable condition. As of 2023 it is only reportable in 6 states. A consistently applied case definition with designation as a nationally notifiable condition would optimize surveillance and preventative efforts.
Q&A: Adrian Barnett
Authors: Britten Anna
Published: April 2024

The Queensland University of Technology professor is also a past president of the Statistical Society of Australia
What is data science? A closer look at science’s latest priority dispute
Authors: Auerbach Jonathan , Kepplinger David , Rios Nicholas
Published: April 2024

Jonathan Auerbach, David Kepplinger and Nicholas Rios use two popular data science algorithms – naïve Bayes and eigencentrality – to examine the difference between data scientists, statisticians, and other occupations
Thermal X-ray emission in the western half of the LMC superbubble 30 Dor C
Authors: Chi Yi-Heng , Chen Han-Xiao , Chen Yang , Meng Yi-Fan , Zhou Ping , Sun Lei , Sun Wei
Published: April 2024

While 30 Dor C is a unique superbubble in the Large Magellanic Cloud for its luminous non-thermal X-ray emission, the thermal X-ray emission it emanates has not yet been thoroughly investigated and well constrained. Based on the separate ∼1 Ms deep XMM–Newton and Chandra observations, we report the discovery of the thermally emitting plasma in some portions of the western half of 30 Dor C. The thermal emission can be reproduced by a collisional-ionization-equilibrium plasma model with an average electron temperature of ∼0.4 keV. We find a significant overabundance of the intermediate-mass elements such as O, Ne, Mg, and Si, which may be indicative of a recent supernova explosion in 30 Dor C. Dynamical properties in combination with the information of the OB association LH 90 suggest that the internal post-main-sequence stars dominate the power of the superbubble and blow it out in the past ∼1 Myr.
Both partial inactivation as well as activation of NF-κB signaling lead to hypertension and chronic kidney disease
Authors: Zhang Xiaotan , Wang Guang , Li Ming , Li Yunjin , Luo Xin , Liu Yvonne , Zhang Xiaoli , Hocher Johann-Georg , Krämer Bernhard K , Hocher Berthold , Yang Xuesong
Published: April 2024

Background

Activation of nuclear factor-kappa B (NF-κB) signalling is key in the pathogenesis of chronic kidney disease (CKD). However, a certain level of NF-κB activity is necessary to enable tissue repair.

Methods

The relationship between activated and inactivated NF-κB signaling and the pathogenesis of CKD was investigated using mouse models of NF-κB partial inactivation (mutating cysteine at position 59 of the sixth exon on the NF-κB gene into alanine) and activation (mutating cysteine at position 59 of the sixth exon on the NF-κB gene into serine).

Results

The density of CD3, CD8, CD68 positive cells, as well as the expression of interleukin 6, Tumor necrosis factor receptor associated factor 1 and Nef-associated factor 1 in the kidney tissues of NF-κBC59A mice were reduced, whereas an opposing pattern was observed in the NF-κBC59S mice. Blood pressure, kidney fibrosis (analyzed by periodic acid–Schiff, Masson trichrome and Sirius Red staining, as well as α-SMA immunofluorescence), serum creatinine and urinary albumin-to-creatinine ratio are markedly increased in NF-κB-activated and -inactivated mice compared with controls. Transmission electron microscopy indicated that the glomerular basement membrane was thicker in both NF-κBC59A and NF-κBC59S mice compared with wild-type mice.

Conclusions

Using mice models with partially activated and inactivated NF-κB pathways suggests that there is an apparently U-shaped relationship between blood pressure, kidney function as well as morphology and the activation of the NF-κB pathway. A certain optimal activity of the NF-κB pathway seems to be important to maintain optimal kidney function and morphology.
Psychometric Evaluation of the Modified E-cigarette Evaluation Questionnaire for Use With High School Adolescents and Young Adults
Authors: Morean Meghan E
Published: April 2024

Introduction

The subjective experience of positive and negative effects of e-cigarette use has been shown to relate to e-cigarette use outcomes in adults, but no validated measure of e-cigarette subjective response exists for adolescents and young adults (AYAs). In the current study, the psychometric properties of the Modified E-cigarette Evaluation Questionnaire (MECEQ) were evaluated for use with AYAs.

Aims and Methods

Nine hundred and ninety-seven AYAs who endorsed using nicotine e-cigarettes at least 4 days per week completed an anonymous, online survey in 2022 (51.1% male; 17.39 [1.88] years old; 33.9% Hispanic; 68% White). Analyses included factor analysis to determine the latent structure of the MECEQ, internal consistency, measurement invariance, between-group differences, and test-criterion relationships with vaping frequency and dependence.

Results

The originally proposed, five-factor structure and a novel four-factor structure were supported, and each subscale was internally consistent. Both models reached scalar invariance for all participant subgroups tested (eg, sex and daily vaping status), and several between-group differences were observed. For instance, compared to less frequent vaping, daily vaping was associated with increased craving reduction (five-factor), reduced stimulant effects (four-factor), and reduced Aversion (five-factor; four-factor). Adjusted relationships between both MECEQ versions and vaping frequency and dependence provided evidence of concurrent validity.

Conclusions

Similar to adults, a five-factor and four-factor version of the MECEQ were supported and evidenced internal consistency, scalar measurement invariance, and concurrent relationships with vaping frequency and dependence. Moving forward, researchers are encouraged to include the MECEQ in future studies to better understand the importance of subjective response in AYA vaping behavior.

Implications

The Modified E-cigarette Evaluation Questionnaire (MCEQ), an e-cigarette-adapted version of the Modified Cigarette Evaluation Questionnaire (MCEQ), recently was validated to assess subjective e-cigarette effects among adults. Here, we demonstrate that the MECEQ can be used among AYAs. The MECEQ can be scored using the original, five-factor MCEQ structure or using a novel, four-factor structure. Both versions were internally consistent, reached scalar measurement invariance, and evidenced concurrent relationships with vaping frequency and dependence. In sum, this study provides the field with the first psychometrically sound measure of the subjective effects of e-cigarette use for use with AYAs.
Shallow Meritocracy
Authors: Andre Peter
Published: April 2024

Meritocracies aspire to reward hard work and promise not to judge individuals by the circumstances into which they were born. However, circumstances often shape the choice to work hard. I show that people’s merit judgments are “shallow” and insensitive to this effect. They hold others responsible for their choices, even if these choices have been shaped by unequal circumstances. In an experiment, U.S. participants judge how much money workers deserve for the effort they exert. Unequal circumstances disadvantage some workers and discourage them from working hard. Nonetheless, participants reward the effort of disadvantaged and advantaged workers identically, regardless of the circumstances under which choices are made. For some participants, this reflects their fundamental view regarding fair rewards. For others, the neglect results from the uncertain counterfactual. They understand that circumstances shape choices but do not correct for this because the counterfactual—what would have happened under equal circumstances—remains uncertain.
Surgical Management of Vestibular Schwannomas: The Translabyrinthine Approach
Authors: Tiano Benjamin N. , Stearns Hunter , Weisskopf Peter A. , Turcotte Evelyn L. , Bendok Bernard R. , Deep Nicholas L.
Published: April 2024

A highly specialized team of providers representing many disciplines (ie, otolaryngology, neurosurgery, neurology, and audiology) is necessary to treat patients diagnosed with cerebellopontine angle (CPA) tumors adequately. Surgical management of these tumors is incredibly complex and requires a nuanced understanding of the treatment protocol at every level, from patient selection and preoperative work-up to operative techniques and postoperative recovery. In this article, we strive to give the neurotologist's perspective on resection of CPA tumors via the translabyrinthine approach.
Disparities in Indications and Outcomes Reporting for Spinal Column Shortening for Tethered Cord Syndrome
Authors: Findlay Matthew C. , Tenhoeve Samuel A. , Johansen Chase M. , Kelly Michael P. , Newton Peter O. , Iyer Rajiv R. , Kestle John R.W. , Gonda David D. , Brockmeyer Douglas L. , Ravindra Vijay M.
Published: April 2024

Study Design.

Systematic review.

Objective.

To identify commonly reported indications and outcomes in spinal column shortening (SCS) procedures.

Background.

SCS is a surgical procedure used in patients with tethered cord syndrome—characterized by abnormal attachment of neural components to surrounding tissues—to shorten the vertebral column, release tension on the spinal cord/neural elements, and alleviate associated symptoms.

Patients and Methods.

PubMed and EMBASE searches captured SCS literature published between 1950 and 2023. Prospective/retrospective cohort studies and case series were included without age limit or required follow-up period. Review articles without new patient presentations, meta-analyses, systematic reviews, conference abstracts, and letters were excluded. Studies included adult and pediatric patients.

Results.

The 29 identified studies represented 278 patients (aged 5–76 yr). In 24.1% of studies, patients underwent primary tethered cord syndrome intervention through SCS. In 41.4% of studies, patients underwent SCS after failed previous primary detethering (24.1% of studies were mixed and 10.3% were unspecified). The most commonly reported nongenitourinary/bowel surgical indications were back pain (55.2%), lower-extremity pain (48.3%), lower-extremity weakness (48.3%), lower-extremity numbness (34.5%), and lower-extremity motor dysfunction (34.5%). Genitourinary/bowel symptoms were most often described as nonspecific bladder dysfunction (58.6%), bladder incontinence (34.5%), and bowel dysfunction (31.0%). After SCS, nongenitourinary/bowel outcomes included lower-extremity pain (44.8%), back pain (31.0%), and lower-extremity sensory and motor function (both 31.0%). Bladder dysfunction (79.3%), bowel dysfunction (34.5%), and bladder incontinence (13.8%) were commonly reported genitourinary/bowel outcomes. In total, 40 presenting surgical indication categories and 33 unique outcome measures were reported across studies. Seventeen of the 278 patients (6.1%) experienced a complication.

Conclusion.

The SCS surgical literature displays variability in operative indications and postoperative outcomes. The lack of common reporting mechanisms impedes higher-level analysis. A standardized outcomes measurement tool, encompassing both patient-reported outcome measures and objective metrics, is necessary.

Level of Evidence.

Level IV.
An assessment of the mediating role of hypertension in the effect of long-term air pollution exposure on dementia
Authors: Libby Tanya E. , Ilango Sindana D. , Leary Cindy S. , Semmens Erin O. , Adam Claire E. , Fitzpatrick Annette L. , Kaufman Joel D. , Hajat Anjum
Published: April 2024

Background:

Growing evidence links air pollution exposure to the risk of dementia. We hypothesized that hypertension may partially mediate this effect.

Methods:

We previously documented an association between air pollution and dementia in the Ginkgo Evaluation of Memory Study, a randomized, placebo-controlled trial of 3069 adults ≥75 years across four US sites who were evaluated for dementia every 6 months from 2000–2008. We utilized a two-stage regression approach for causal mediation analysis to decompose the total effect of air pollution on dementia into its natural direct and indirect effect through prevalent hypertension. Exposure to air pollution in the 10 or 20 years before enrollment was assigned using estimates from fine-scale spatial-temporal models for PM2.5, PM10, and NO2. We used Poisson regression models for hypertension and Cox proportional hazard models for time-to-incident all-cause dementia, adjusting for a priori confounders.

Results:

Participants were free of mild cognitive impairment at baseline (n = 2564 included in analyses); 69% had prevalent hypertension at baseline. During follow-up, 12% developed all-cause dementia (Alzheimer’s disease [AD] = 212; vascular dementia with or without AD [VaD/AD mixed] = 97). We did not find an adverse effect of any air pollutant on hypertension. Hypertension was associated with VaD/AD mixed (HR, 1.92 [95% CI = 1.14, 3.24]) but not AD. We did not observe mediation through hypertension for the effect of any pollutant on dementia outcomes.

Conclusions:

The lack of mediated effect may be due to other mechanistic pathways and the minimal effect of air pollution on hypertension in this cohort of older adults.
Diagnostic performance of EUS-guided tissue acquisition for solid pancreatic lesions ≤10 mm
Authors: Kawasaki Yuki , Hijioka Susumu , Nagashio Yoshikuni , Ohba Akihiro , Maruki Yuta , Takeshita Kotaro , Takasaki Tetsuro , Agarie Daiki , Hagiwara Yuya , Hara Hidenobu , Okamoto Kohei , Yamashige Daiki , Kondo Shunsuke , Morizane Chigusa , Ueno Hideki , Mizui Takahiro , Takamoto Takeshi , Nara Satoshi , Ban Daisuke , Esaki Minoru , Saito Yutaka , Hiraoka Nobuyoshi , Okusaka Takuji
Published: April 2024

Background and Objectives

EUS tissue acquisition (EUS-TA) is the standard diagnostic method for solid pancreatic lesions (SPLs); however, there are few reports on EUS-TA results for SPLs ≤10 mm. Furthermore, given the recent advent of fine-needle biopsy, the current diagnostic accuracy of EUS-TA for SPLs ≤10 mm is unknown. This study aimed to evaluate the diagnostic accuracy and efficacy of EUS-TA for SPLs ≤10 mm.

Methods

We retrospectively analyzed the data of 109 patients with SPLs ≤10 mm who underwent EUS-TA. All patients underwent rapid on-site specimen evaluation.

Results

The median tumor diameter was 8 mm (range, 2.5–10 mm), and the technical success rate was 99.1% (108/109). Adverse events were observed in 3 patients (2.8%). The diagnostic performance was as follows: sensitivity, 90.1% (64/71); specificity, 97.3% (36/37); accuracy, 92.6% (100/108); positive predictive value, 98.5% (64/65); and negative predictive value, 83.7% (36/43). Multivariate analysis revealed that the number of punctures (odds ratio, 7.03; 95% confidence interval, 1.32–37.5; P = 0.023) and tumor type (odds ratio, 11.90; 95% confidence interval, 1.38–102.0; P = 0.024) were independent risk factors for inaccurate EUS-TA results. The diagnostic accuracy of EUS-TA for pancreatic ductal adenocarcinoma was 87.5% (14/16). No EUS-TA–related needle-tract seeding was observed in patients with pancreatic ductal adenocarcinoma during the observation period.

Conclusions

EUS-TA for SPLs ≤10 mm showed adequate diagnostic accuracy and was safe for use with rapid on-site specimen evaluation in all cases.
New-onset diabetes is a predictive risk factor for pancreatic lesions in high-risk individuals: An observational cohort study
Authors: Baydogan Seyda , Mohindroo Chirayu , Hasanov Merve , Montiel Maria F. , Quesada Pompeyo , Cazacu Irina M. , Luzuriaga Chavez Adrianna A. , Mork Maureen E. , Dong Wenli , Feng Lei , You Y. Nancy , Arun Banu , Vilar Eduardo , Brown Powel , Katz Matthew H. G. , Chari Suresh T. , Maitra Anirban , Tamm Eric P. , Kim Michael P. , Bhutani Manoop S. , McAllister Florencia
Published: April 2024

Background and Objectives

Pancreatic cancer (PC) is the third cause of cancer-related deaths. Early detection and interception of premalignant pancreatic lesions represent a promising strategy to improve outcomes. We evaluated risk factors of focal pancreatic lesions (FPLs) in asymptomatic individuals at hereditary high risk for PC.

Methods

This is an observational single-institution cohort study conducted over a period of 5 years. Surveillance was performed through imaging studies (EUS or magnetic resonance imaging/magnetic resonance cholangiopancreatography) and serum biomarkers. We collected demographic characteristics and used univariate and multivariate logistic regression models to evaluate associations between potential risk factors and odd ratios (ORs) for FPL development.

Results

A total of 205 patients completed baseline screening. Patients were followed up to 53 months. We detected FPL in 37 patients (18%) at baseline; 2 patients had lesions progression during follow-up period, 1 of them to PC. Furthermore, 13 patients developed new FPLs during the follow-up period. Univariate and multivariate analyses revealed that new-onset diabetes (NOD) is strongly associated with the presence of FPL (OR, 10.94 [95% confidence interval, 3.01–51.79; P < 0.001]; OR, 9.98 [95% confidence interval, 2.15–46.33; P = 0.003]). Follow-up data analysis revealed that NOD is also predictive of lesions progression or development of new lesions during screening (26.7% vs. 2.6%; P = 0.005).

Conclusions

In a PC high-risk cohort, NOD is significantly associated with presence of FPL at baseline and predictive of lesions progression or new lesions during surveillance.
Closing the care gap: combining enhanced recovery with minimally invasive valve surgery
Authors: Gregory Alexander J. , Kent William D.T. , Adams Corey , Arora Rakesh C.
Published: April 2024

Purpose of review

Patients with advanced age and frailty require interventions for structural heart disease at an increasing rate. These patients typically experience higher rates of postoperative morbidity, mortality and prolonged hospital length of stay, loss of independence as well as associated increased costs to the healthcare system. Therefore, it is becoming critically important to raise awareness and develop strategies to improve clinical outcomes in the contemporary, high-risk patient population undergoing cardiac

procedures.

Recent findings

Percutaneous options for structural heart disease have dramatically improved the therapeutic options for some older, frail, high-risk patients; however, others may still require cardiac surgery. Minimally invasive techniques can reduce some of the physiologic burden experienced by patients undergoing surgery and improve recovery. Enhanced Recovery After Cardiac Surgery (ERAS Cardiac) is a comprehensive, interdisciplinary, evidence-based approach to perioperative care. It has been shown to improve recovery and patient satisfaction while reducing complications and length of stay.

Combining minimally invasive cardiac surgery with enhanced recovery protocols may result in improved patient outcomes for a patient population at high risk of morbidity and mortality following cardiac surgery.
Acute hepatic porphyrias—A guide for hepatologists
Authors: Moghe Akshata , McGuire Brendan M. , Levy Cynthia
Published: April 2024

The acute hepatic porphyrias (AHPs) are a group of rare, inherited disorders of the heme biosynthesis pathway, usually manifesting with attacks of acute abdominal pain and other neurovisceral symptoms, with or without cutaneous manifestations. AHPs are characterized by the accumulation of porphyrin precursors, porphobilinogen, and/or aminolevulinic acid, in the blood. The diagnosis is often missed or delayed due to both inadequate testing and the improper use of available laboratory tests. In this review, we describe the various clinical presentations of the 4 AHPs, elucidate the approach to diagnosis, and provide recommendations for immediate and long-term management. We also describe the different complications that can occur with long-standing AHP, including the development of HCC. The AHPs are very treatable conditions, with excellent outcomes if diagnosed and treated early. A high index of suspicion for the presence of these disorders, along with accurate testing and timely treatment, will help reduce the burden of disease and prevent irreversible complications in patients with AHP.
Effectiveness and safety of edaravone dexborneol in acute ischemic stroke (EXPAND): Study protocol for a prospective, multicenter, real-world cohort study
Authors: Ma Gaoting , Mo Ran , Lei Shaoyuan , Yao Xiaoxi , Song Zhiwei , Xie Weizheng , Yuan Guangxiong , Hu Jin , Zhao Yutie , Ju Dongsheng , Yang Xiafeng , Cao Shudong , Guo Jintao , Liu Xiaodong , Cai Chunsheng , Li Jianhua , Wu Yifan , Zuo Yingting , Meng Shujuan , Wu Yue , Jiang Ziying , Zhang Qian , Ren Yi , Ma Qingfeng , Wang Pingping , Zhong Lianmei , Guo Yansu , Song Haiqing ,   on behalf of the EXPAND investigators
Published: April 2024

Background:

Edaravone dexborneol has been confirmed as a novel neuroprotective agent by acting on multiple active targets of antioxidation and anti-inflammation.

Objectives:

This study aims to evaluate the effectiveness and safety of edaravone dexborneol in patients with acute ischemic stroke (AIS) within 14 days of symptom onset in real-world clinical practice.

Methods:

This prospective, multicenter, 2-arm, parallel, real-world cohort study will involve 72 stroke centers in China and plans to recruit 4750 exposed/unexposed patients with a 2:1 ratio to gather additional safety information on edaravone dexborneol. Patients eligible of the Effectiveness and Safety of Edaravone Dexborneol in Acute Ischemic Stroke (EXPAND) are diagnosed with AIS within 14 days of symptom onset. The eligible patients who receive edaravone dexborneol will be assigned to the exposed group, while those without using edaravone dexborneol will be assigned to the unexposed group. All participants will be followed up for 90 days. The primary outcome is a favorable functional outcome as defined by a modified Rankin Scale (mRS) score 0–1 at 90 days. Primary efficacy in the 2 groups will be compared using multivariable logistic regression.

Results:

EXPAND is the first real-world study to elucidate the efficacy and safety of edaravone dexbornel in AIS, which has the potential to extend the therapeutic time window of neuroprotective treatment and propose a multiple-target approach for AIS.

Conclusions:

The protocol was approved by the Ethics Committee at all participating sites [the reference number of central ethic committee: (2022)090] and by the local Institutional Review Board of each participating center. The findings of the study will be published in peer-reviewed scientific journals and presented at national and international conferences. This cohort study only collects real-world patient data during the diagnosis and treatment process. The refusal of a patient to participate or the decision to withdraw from the study will not interfere with the clinical decision-making. Thus, no additional risk will be imposed.

Trial registration number:

NCT05644223.
Higher disease burden and lower utilization in Mongolian with breast cancer: a 9-year retrospective cohort study of 18.19 million adults in China
Authors: Chen Jieying , Qiao Liying , Qi Meng , Zhang Yunjing , Yan Ying , Kang Weiwei , Zhou Huziwei , Yu Yuelin , Ke Yalei , Jiang Yuling , Rao Yingting , Xu Lu , He Guohua , Ren Jing , Yan Xue , Deng Siwei , Yang Xinyu , Song Yutong , Yang Yingzi , Wen Qiaorui , Han Jing , Wu Yiwei , Liu Guozhen , Wang Mingyuan , Zhang Xiaoyu , Xi Yunfeng , Wang Shengfeng
Published: April 2024

Background:

Whether health inequalities of disease burden and medical utilization exist by ethnicity in Asian breast cancer (BC) patients remains unclear. The authors aim to measure ethnic disparities in disease burden and utilization among Mongolian and Han female BC patients in China.

Materials and methods:

Based on data extracted from Inner Mongolia Regional Health Information Platform, a retrospective cohort study was established during 2012–2021. Disease burden including incidence, 5-year prevalence, mortality, survival rate, and medical cost were analyzed and compared between Han and Mongolian patients.

Results:

A total of 34 878 female patients [mean (SD) age, 52.34 (10.93) years] were included among 18.19 million Chinese, and 4315 (12.03%) participants were Mongolian. Age-standardized rates of incidence are 32.68 (95% CI: 20.39–44.98) per 100 000. Higher age-specific incidence and 5-year prevalence were observed in Mongolian than in Han. The cost of BC annually per capita was significantly lower for Mongolian than Han [$1948.43 (590.11–4 776.42) vs. $2227.35 (686.65–5929.59), P<0.001]. Mongolian females showed higher all-cause mortality [30.92 (95% CI: 28.15–33.89) vs. 27.78 (95% CI: 26.77–28.83) per 1000, P=0.036] and BC-specific mortality [18.78 (95% CI: 16.64–21.13) vs. 15.22 (95% CI: 14.47–16.00) per 1000, P=0.002] than Han females. After adjusting covariates, Mongolian were associated with increased all-cause mortality [HR, 1.21, (95% CI: 1.09–1.34); P<0.001] and BC-specific mortality [HR, 1.31, (95% CI: 1.14–1.49); P<0.001].

Conclusion:

The findings of this cohort study highlight a higher level of disease burden with unmet medical demand in Mongolian patients, suggesting that more practical efforts should be made for the minority. Further research is needed to explore the concrete mechanisms of the disparities as well as eliminate health disproportion.
Comparison of patient-controlled analgesia and sedation (PCAS) with remifentanil and propofol versus total intravenous anesthesia (TIVA) with midazolam, fentanyl, and propofol for colonoscopy
Authors: Song Hua-Yong , Shen Li-Jing , Sun Wen , Zhang Lu-Di , Liang Jian-Guo , Zhang Guang-Xin , Lu Xin-Qing
Published: April 2024

Background:

Colonoscopy is a commonly performed gastroenterological procedure in patients associated with anxiety and pain. Various approaches have been used to provide sedation and analgesia during colonoscopy, including patient-controlled analgesia and sedation (PCAS). This study aims to evaluate the feasibility and efficiency of PCAS administered with propofol and remifentanil for colonoscopy.

Methods:

This randomized controlled trial was performed in an authorized and approved endoscopy center. A total of 80 outpatients were recruited for the colonoscopy studies. Patients were randomly allocated into PCAS and total intravenous anesthesia (TIVA) groups. In the PCAS group, the dose of 0.1 ml/kg/min of the mixture was injected after an initial bolus of 3 ml mixture (1 ml containing 3 mg of propofol and 10 μg of remifentanil). Each 1 ml of bolus was delivered with a lockout time of 1 min. In the TIVA group, patients were administered fentanyl 1 μg/kg, midazolam 0.02 mg/kg, and propofol (dosage titrated). Cardiorespiratory parameters and auditory evoked response index were continuously monitored during the procedure. The recovery from anesthesia was assessed using the Aldrete scale and the Observer’s Assessment of Alertness/Sedation Scale. The Visual Analogue Scale was used to assess the satisfaction of patients and endoscopists.

Results:

No statistical differences were observed in the Visual Analogue Scale scores of the patients (9.58 vs 9.50) and the endoscopist (9.43 vs 9.30). A significant decline in the mean arterial blood pressure, heart rate, and auditory evoked response index parameters was recorded in the TIVA group (P < 0.05). The recovery time was significantly shorter in the PCAS group than in the TIVA group (P = 0.00).

Conclusion:

The combination of remifentanil and propofol could provide sufficient analgesia, better hemodynamic stability, lighter sedation, and faster recovery in the PCAS group of patients compared with the TIVA group.
The influencing factors of changes in physical activity levels of pregnant women during pregnancy: From the perspective of continuous care
Authors: Liu Meng , Huang Wenxia , Wen Jiao
Published: April 2024

A comprehensive understanding of physical activity levels (PAL) among Chinese pregnant women and an exploration, from a continuous care perspective, of various factors influencing these activity levels. Investigating the correlations between adverse habits, psychological factors, and PAL in prenatal health management. This study aims to provide substantial guidance for prenatal health management and personalized care, offering recommendations to healthcare professionals and policymakers to enhance the overall health and well-being of pregnant women. This study enrolled 1256 pregnant women as research subjects. Baseline information was collected through a personal information collection form. Subsequently, continuous care was provided during the early, middle, and late stages of pregnancy, documenting the respective influencing factors. Simultaneously, the International Physical Activity Questionnaire (IPAQ) was utilized to assess the PAL of pregnant women across different trimesters. Finally, using the SPSS software version 25.0, a combined approach of generalized linear mixed effects (GLME) models and multivariate logistic regression was used to statistically analyze the collected data, comprehensively exploring the influencing factors of PAL during pregnancy. The proportion of research subjects engaged in low-level physical activity decreased from 60.80% to 40.34% across various stages of pregnancy, while the proportion engaged in moderate-level physical activity ranged from 25.32% to 40.75%. Meanwhile, the proportion engaged in high-level physical activity accounted for 13.88% to 18.91%.There was P = .021 and β = −0.276 for smoking before pregnancy. The P-value of pregnant women who smoke in the second trimester was.035, the Odds Ratio (OR) value was 0.638, and the 95% confidence interval (CI) was (0.406, 0.972). The difference was statistically significant (all P < .05). In China, the physical activity level of pregnant women is generally low, which is related to factors such as smoking, alcohol consumption, sleep disorders, and depression during pregnancy. Medical personnel should improve the living habits of pregnant women and enhance their PAL through measures such as health education and psychological counseling.
Design of a multi-category drug information integration platform for intelligent pharmacy management: A needs analysis study
Authors: Pan Qihong , Liu Yang , Wei Shaofeng
Published: April 2024

A drug store was never just an area to fill personal solution. Patients considered drug specialists to be counsels, somebody who could help them pick an over-the-counter treatment or understanding the portion and directions for a solution. Drug stores, similar to the remainder of the medical services business, are going through changes. Nowadays, one of the main highlights of any structure is the board. The executives give the refinement needed to wrap up any responsibility in a particular way. The executive framework of a drug store can be utilized to deal with most drug store related errands. This report has provided data on the best way to fabricate and execute a Pharmacy Management System. The primary objective of this system is to expand exactness, just as security and proficiency, in the drug shop. This undertaking is focused on the drug store area, determined to offer engaging and reasonable programming answers to assist them with modernizing to rival shops (helping out other equal modules in a similar examination program). This study will clarify the system’s thoughts concerning the board issues and arrangements of a drug store. Likewise, this study covers the main parts of the Pharmacy application’s investigation, execution, and look.
Physical exercise and hypertension: A retrospective study in southern Sichuan
Authors: Diao Pei , Ning Kexue , Wang Shaohua , He Lijuan
Published: April 2024

This study aimed to scrutinize the relationship between physical exercise and hypertension, taking into account multiple variables such as age, body mass index (BMI), family history, smoking, and alcohol consumption in the Southern Sichuan population, China, using a retrospective approach based on hospital record data. This retrospective study analyzed data from 946 participants obtained from a hospital electronic medical record system. The data included information regarding participants’ lifestyle factors, family history, and a clinical diagnosis of hypertension. Univariate and multivariate logistic regression models were employed to identify the association between lifestyle factors and hypertension. The study found a hypertension prevalence of 38.5% in the analyzed population. Multivariate analyses identified significant factors associated with hypertension as age (odds ratio [OR]: 1.045, 95% confidence interval [CI]: 1.036–1.054), BMI (OR: 1.107, 95% CI: 1.084–1.132), smoking (OR: 2.299, 95% CI: 1.674–3.157), alcohol consumption (OR: 0.644, 95% CI: 0.478–0.867), and physical exercise (OR: 0.682, 95% CI: 0.506–0.920). Findings from this hospital record-based retrospective study reinforce the multifactorial nature of hypertension. They highlight the significance of physical exercise, along with maintaining optimal BMI and encouraging healthy habits like nonsmoking and moderate alcohol consumption in hypertension prevention. Our findings also underscore the need for future prospective studies to establish causality and explore the generalizability of these results beyond the Southern Sichuan population.
Coronavirus disease-2019 and orthopedics: A bibliometric analysis of the literature
Authors: Li Xiaobo , Su Jixian , Han Jing , Li Hanlin , Yao Wenhao , Ding Ran , Zhang Chen
Published: April 2024

Background:

The coronavirus disease-2019 (COVID-19) pandemic has had a dramatic impact on global health, with orthopedics among the most affected specialties. An increasing number of COVID-19-related orthopedic studies have been published. The purpose of this study was to analyze the orthopedic literature published during the COVID-19 pandemic to guide future research.

Methods:

The Scopus database was searched for relevant literature published between 2020 and 2022. The keywords used in the retrieval process were (“COVID-19” OR “Coronavirus” OR “2019-nCoV” OR “SARS-CoV-2” OR “Betacoronavirus” OR “novel coronavirus 2019” OR “novel coronavirus” OR “coronavirus-19” OR “COVID 19” OR “nCOV” OR “COVID-2019” OR “COVID 2019”) and (“orthopedic” OR “orthopedics” OR “orthopedic” OR “orthopedical” OR “orthopedical” OR “orthopedics”). Spreadsheet software (Excel, Microsoft Corp., Redmond, WA) was used to analyze the top 10 cited authors, countries, journals, and articles. The top 5 publication types were also analyzed. VOSviewer (Center for Science and Technology Studies, Leiden, Netherlands) was used to network and visualize the literature.

Results:

A total of 1619 publications relevant to COVID-19 and orthopedics were reviewed. Among these publications, the most active country, author, and publication type included the United States, Vaishya R, and original articles, respectively. The most frequently used keywords were human, coronavirus disease-2019, pandemic, and orthopedics. The Journal of Bone and Joint Surgery American Volume was the most cited journal, whereas the greatest number of articles was published in the Journal of Clinical Orthopedics and Trauma.

Conclusions:

This study provides a perspective on the development of orthopedic publications during the COVID-19 pandemic and evidence for researchers worldwide to strengthen global cooperation in fighting the epidemic.
Infertile women of Ethiopia: Psychological challenges and coping strategies
Authors: Adane Tinisaie Biadigie , Berhanu Kelemu Zelalem , Sewagegn Abatihun Alehegn
Published: April 2024

Worldwide, an estimated 48 million couples and 186 million individuals are infertile, according to estimates from the World Health Organization. Ethiopia has a higher rate of infertility than the World Health Organization estimated for the entire world. Though research on the issue of infertility is growing both globally and in Ethiopia, not much has been studied. Therefore, the main objective of this study was to explore the psychological and coping strategies of infertile women in Bichena town, Ethiopia. The study followed a qualitative research approach and a descriptive phenomenological design. Data were collected through in-depth interviews with 15 infertile women using a purpose-sampling technique. Thematic analysis was the method of data analysis. The findings of this study indicated that stress, anxiety, depression, low self-esteem, and sexual dissatisfaction were the main psychological challenges that infertile women experience. Infertile women also used a variety of coping strategies, such as religious strategies, traditional strategies, medical strategies, and other strategies (marital separation and acceptance). The study concluded that infertile women in the study area were challenged by psychological factors and used different coping strategies to manage their ongoing problems. This study also has theoretical implications for the current literature and practical implications for infertile women, non-governmental organizations, community and health professionals.
Exploring Acori Tatarinowii Rhizoma and Polygalae Radix in Alzheimer’s: Network pharmacology and molecular docking analysis
Authors: Tong Tianhao , Cheng Bin , Tie Songyan , Ouyang Dan , Cao Jianzhong
Published: April 2024

Explore Acori Tatarinowii Rhizoma (ATR) and Polygalae Radix (PR) mechanisms in Alzheimer’s disease (AD) treatment through network pharmacology. ATR-PR was investigated in the Traditional Chinese Medicine Systems Pharmacology (TCMSP) database, Batman, and Traditional Chinese Medicines Integrated Database (TCMID) to gather information on its chemical components and target proteins. Target genes associated with AD were retrieved from the GeneCards and National Center for Biotechnology Information (NCBI) databases. The integration of these datasets with potential targets facilitated the construction of an AD and ATR-PR protein-protein interaction (PPI) network using the STRING database. The resulting network identified the core active ingredients and main targets of ATR-PR in AD treatment. Cluster analysis of the PPI network was performed using Cytoscape 3.7.1. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were conducted using the Metascape database. Molecular docking simulations revealed potential interactions between the main active ingredients and core targets. Our analysis identified 8 putative components and 455 targets of ATR-PR. We systematically searched for 1306 genes associated with AD, conducted Venn diagram analysis resulting in 156 common targets, and constructed a PPI network with 57 key targets. GO functional analysis highlighted the primary biological processes associated with oxidative stress. KEGG pathway enrichment analysis revealed the involvement of 64 signaling pathways, with the PI3K/Akt signaling pathway playing a key role. Molecular docking analysis indicated a high affinity between the potential targets of ATR-PR and the main compounds of AD. This study sheds light on the complex network of interactions involving ATR-PR in the context of AD. The identified targets, pathways, and interactions provide a foundation for understanding the potential therapeutic mechanisms. The involvement of oxidative stress-related processes and the crucial role of the PI3K/Akt signaling pathway suggest avenues for targeted therapeutic interventions in Alzheimer’s disease treatment. Our proposition of the combined use of ATR-PR has emerged as a potential treatment strategy for AD, supported by a network pharmacology approach. This framework provides a robust foundation for future clinical applications and experimental research in the pursuit of effective Alzheimer’s disease treatments.
Syphilis seroprevalence and associated factors: A cross-sectional study in formal female sex workers in a province of Peru
Authors: Huamaní-Chavez Vanessa , Rueda-Torres Lenin , Ormeño-Delgado Luis , Li Jair , Rosales-Rimache Jaime
Published: April 2024

Syphilis is a sexually transmitted infection (STI) considered a public health problem that affects vulnerable and at-risk populations, such as sex workers. We designed a retrospective cross-sectional study based on the review of health evaluation records of sex workers who attended consultations to obtain comprehensive health cards at a Health Center in the Province of San Vicente de Cañete in Peru during the year 2020. We obtained sociodemographic and employment information and the RPR (rapid plasma reagin) test results to diagnose syphilis. We evaluated 220 records of sex workers with a mean age of 27.9 ± 6.9 years and the initiation of sexual relations of 16.0 ± 1.6 years, while the accumulated time they had as sex workers was 2.9 ± 2.4 years. 85.9% of those evaluated reported being heterosexual. The prevalence of syphilis was 7.3% (CI95: 4.2%–11.5%). Being a homosexual sex worker was significantly associated with syphilis (OR: 19.6; 95% CI: 4.8–80.0) compared to heterosexuals. The prevalence of syphilis presented a value similar to that reported in other Latin American and national studies, and it is evident that it is a health problem among sex workers.