bluuebunny/crossref_metadata_2025 huggingface dataset:
Femtosecond assisted keratopigmentation (FAK) with a 5-millimeter diameter aperture does not affect ocular examination
Authors: Alafaleq Munirah , Garrido Jaime , Ferrari Francis
Published: March 2023

Aim

to assess the feasibility of performing a screening of ocular pathologies after Femtosecond laser Assisted Keratopigmentation (FAK) procedure in normal eyes with the aid of multimodal imaging technologies.

Design

A Retrospective cohort study.

Participants

Thirty consecutive international patients (60 eyes) who underwent FAK for purely aesthetic reasons were chosen for this study.

Methods

Data from medical records of 30 consecutive patients were retrieved after performing tests 6 months after surgery. Clinical examinations were performed by three ophthalmologists.

Main outcome measures

The main purpose of this study was to see if routine examinations are feasible in patients operated on by the FAK and if the results can be interpreted as easily as in non-operated patients.

Results

Sixty eyes of thirty consecutive patients that underwent a screening of ocular pathologies at 6 months post FAK were included. 60% were female and 40% were males. Mean age was 36 years +/− 12 years. Screening of ocular pathologies using multimodal imaging tests or clinical examination was performed without any difficulties in acquisition or interpretation in 100% of patients (n = 30) except the endothelial cell count of the corneal periphery which was not possible. The direct examination of the iris periphery was possible at the slit lamp through the translucid pigment.

Conclusions

The screening of ocular pathologies after purely aesthetic FAK surgery is feasible, except for pathologies of the peripheral posterior cornea.
DALK rejection following vaccination against SARS-CoV-2: 2 case reports
Authors: Swarup Rishi , Mehta Samip
Published: March 2023

Purpose

To report two cases of deep anterior lamellar keratoplasty (DALK) rejection occurring in association with SARS-CoV-2 vaccination.

Methods

Two patients with prior history of DALK developed immunologic rejection after SARS-CoV-2 vaccination. The first patient, a 15-year-old girl, had a stromal and sub-epithelial rejection nine days after receiving the first dose of the SARS-CoV-2 vaccine BBV152(COVAXINTM, Bharat Biotech, India). The second patient, an 18-year-old male, had a stromal rejection 13 days after receiving the second dose of the ChAdOx1 SARS-CoV-2 vaccine (COVISHIELDTM, Serum Institute of India, India).

Results

Both patients received frequent topical corticosteroids. The first patient recovered within four weeks and the second patient recovered within two weeks of initiating therapy. Both patients experienced complete resolution of corneal edema and had improvement in their visual acuity.

Conclusions

DALK rejection is a rare but distinct possibility in patients following SARS-CoV-2 immunization. Further studies are required before establishing clear guidelines regarding risk, follow-up and treatment strategies in such a scenario.
Optimal design of steering trapezoid considering multiple performances of the whole vehicle
Authors: Gao Jin , Qi Xiaoping
Published: March 2023

As an important component of the steering system, steering trapezoids should be designed to satisfy multiple performances of the vehicle. In this study, theoretical and simulation analysis has been conducted focusing on the influence of the steering tie rod on the Ackermann error, bump steer, forces at the tie rod joints, and frequency characteristics of the whole vehicle. The results show that the Ackermann error is mainly influenced by the position of the outer point of the steering tie rod. The bump steer is mainly influenced by the Z coordinate of the outer point. The impact force at the joint and the frequency characteristics are mainly influenced by the X and Z coordinates of the outer point of the tie rod. The trends of the evaluation indexes for each performance to the hard point coordinates are not completely consistent and some are conflicting. To integrate the vehicle performance, multi-objective optimization is carried out with Archival Micro Genetic Algorithm, Neighborhood Cultivation Genetic Algorithm, and Non-Dominated Sorting Genetic Algorithm-II algorithms considering the hard point coordinates as variables and the evaluation indexes as optimization objectives. The optimization results show that the relative optimal solutions obtained by the three optimization algorithms provide a significant improvement to the Ackermann error, while other performance indexes have differences. In the practical application of steering trapezoid optimization, it is possible to choose the appropriate optimization algorithm based on the focus of the vehicle performance requirements.
Design and development of customized elbow orthosis using additive manufacturing
Authors: Ganesan Sivakumar , Ranganathan Rajesh
Published: March 2023

The orthosis is an assistive device to help people with disabilities. Orthosis, further known as braces, is used to support and modify the characteristics of human neuromuscular and musculoskeletal systems. In this study, elbow hyperextension is considered a significant cause of hand deformity. The elbow hyperextension occurs when the elbow joint in hand is being bend beyond its normal range of motion. Most commonly, orthosis was employed to treat the elbow hyperextension externally. In recent times, elbow orthosis design is customized ergonomically to fit a specific patient. The design is based on the customized profile of the human hand from the three-dimensional (3D) scanner. Sense 3D body scanner is used for scanning the human hand and 3D modeling of orthosis is done in SolidWorks. In order to reduce material consumption, topological optimization was performed. A developed novel mechanism was validated for failure analysis. The developed elbow orthosis is produced by additive manufacturing processes namely fused deposition modeling (FDM) and PolyJet technology. In FDM, acrylonitrile butadiene styrene material has been used whereas in the case of PolyJet printing, vero white material is used. The developed ergonomically designed orthosis can be worn for a long period of time without causing pain and therefore curing time is faster. A significant advantage of this proposed elbow orthosis is a self-operated novel mechanism.
Is It Possible to Place a Pacemaker Lead Through a Bileaflet Mechanical Prosthesis?
Authors: Ríos-Ortega Josías C. , Sisniegas-Razón Josué , Robles-Velarde Víctor , Rodríguez-Urteaga Zoila
Published: March 2023

We present a 64-year-old woman who underwent mitral, aortic, and tricuspid valve (TV) replacement with mechanical prostheses. Two months after TV surgery, she presented third-degree atrioventricular block. After attempting to place a pacemaker lead through the coronary sinus, it was placed through the mechanical valve in the tricuspid position as the last option. At 1 year of follow-up, the device shows no signs of dysfunction, and the prosthesis has moderate regurgitation.
A Novel Technique for Thoracic Endovascular Graft Explantation
Authors: Frydman Asher A. , Paquet Maude , Xing Chuce , Valdis Matthew , Power Adam , Chu Michael W. A.
Published: March 2023

Thoracic endovascular aortic repair (TEVAR) explantation remains a challenge due to endovascular graft ingrowth into the aortic wall with time. Surgical access into the aortic arch can be difficult either via sternotomy or thoracotomy, and proximal barbs become engaged firmly into the aortic wall. Explantation often requires extensive thoracic aortic resection, sometimes from the distal aortic arch to the abdominal aorta, followed by reconstruction, risking injury to surrounding neurovascular structures and even death. In cases of blunt thoracic aortic injury, the original injury is often healed, and failed TEVAR could theoretically be removed when thrombotic complications occur. We present a novel technique to facilitate TEVAR recapture with limited distal thoracic aorta replacement.
Development of an in-vitro model based on patient vessel geometry for simulated use testing in neurointerventional surgery
Authors: Epshtein Mark , Shazeeb Mohammed Salman , Kühn Anna Luisa , Anagnostakou Vania , Raskett Christopher M. , King Robert M. , Goyal Mayank , Mendes Pereira Vitor , Arthur Adam S. , Puri Ajit S. , Fiorella David , Gounis Matthew J
Published: March 2023

Background

Neurointerventionalists use in-vitro vascular models to train for worst-case scenarios and test new devices in a simulated use environment to predict clinical performance. According to the Food and Drug Administration (FDA), any neurovascular navigation device should be able to successfully navigate two 360-degree turns and two 180-degree turns at the distal portion of the anatomical model. Here, we present a device benchmarking vascular model that complies with FDA recommendations.

Methods

Our vascular model was assembled from quantitative characterization of 49 patients who underwent CT angiography either for acute ischemic stroke caused by large vessel occlusion or for aneurysm treatment. Following complete characterization of these data, the vascular segments were 3D reconstructed from CT angiograms of 6 selected patients that presented with challenging anatomy. The curvature and total rotational angle were calculated for each segment and the anatomical parts that complied with FDA recommendations were fused together into a single in-vitro model.

Results

The model was constructed containing two common carotid branches arising from a type two aortic arch and the dimensions of the overall model exceeded the recommendations of the FDA. Two experienced neurointerventionalists tested the model for navigation difficulty using several devices on an in-vitro perfusion system and concluded that the model provided a realistic, challenging scenario.

Conclusions

This model provides a first prototype designed according to FDA recommendations of cumulative angle while also integrating an aggregation of actual patient-specific anatomy. The availability of this clinically relevant benchmark model presents a potential standardized approach for neurovascular device testing.
Prevention of post-ERCP pancreatitis: current strategies and novel perspectives
Authors: Borrelli de Andreis Federica , Mascagni Pietro , Schepis Tommaso , Attili Fabia , Tringali Andrea , Costamagna Guido , Boškoski Ivo
Published: March 2023

Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced endoscopic procedure that might lead to severe adverse events. Post-ERCP pancreatitis (PEP) is the most common post-procedural complication, which is related to significant mortality and increasing healthcare costs. Up to now, the prevalent approach to prevent PEP consisted of employing pharmacological and technical expedients that have been shown to improve post-ERCP outcomes, such as the administration of rectal nonsteroidal anti-inflammatory drugs, aggressive intravenous hydration, and the placement of a pancreatic stent. However, it has been reported that PEP originates from a more complex interaction of procedural and patient-related factors. Appropriate ERCP training has a pivotal role in PEP prevention strategy, and it is not a chance that a low PEP rate is universally considered one of the most relevant indicators of proficiency in ERCP. Scant data on the acquisition of skills during the ERCP training are currently available, although some efforts have been recently done to shorten the learning curve by way of simulation-based training and demonstrate competency by meeting technical requirements as well as adopting skill evaluation scales. Besides, the identification of adequate indications for ERCP and accurate pre-procedural risk stratification of patients might help to reduce PEP occurrence regardless of the endoscopist’s technical abilities, and generally preserve safety in ERCP. This review aims at delineating current preventive strategies and highlighting novel perspectives for a safer ERCP focusing on the prevention of PEP.
Superior survival outcome of blinatumomab compared with conventional chemotherapy for adult patients with relapsed or refractory B-cell precursor acute lymphoblastic leukemia: a propensity score–matched cohort analysis
Authors: Yoon Jae-Ho , Kwag Daehun , Lee Jong-Hyuk , Min Gi June , Park Sung-Soo , Park Silvia , Lee Sung-Eun , Cho Byung-Sik , Eom Ki-Seong , Kim Yoo-Jin , Kim Hee-Je , Min Chang-Ki , Cho Seok-Goo , Wook Lee Jong , Lee Seok
Published: March 2023

Background:

Blinatumomab showed a higher complete remission (CR) rate and a safe bridging to allogeneic hematopoietic cell transplantation (allo-HCT) in adults with relapsed or refractory B-cell precursor acute lymphoblastic leukemia (R/R BCP-ALL).

Objectives:

We tried to analyze the outcome of blinatumomab compared with the real-world historical data. We expected superior outcome of blinatumomab compared with historical conventional chemotherapy.

Design:

We conducted a retrospective study using real-world data in the Catholic Hematology Hospital.

Methods:

Total 197 consecutive cases of R/R BCP-ALL were treated with conventional chemotherapy ( n = 113) or blinatumomab, which was available since late 2016 ( n = 84). Patients who achieved CR underwent allo-HCT if donor was available. We conducted a propensity score–matched cohort analysis using 5 criteria of age, CR duration, cytogenetics, previous allo-HCT, and salvage lines between historical group and blinatumomab.

Results:

Each cohort consisted of 52 patients. In blinatumomab group, CR rate was higher (80.8% versus 53.8%, p = 0.006) and more patients proceeded to allo-HCT (80.8% versus 46.2%, p < 0.001). Among the CR patients with available minimal residual disease (MRD) results, 68.6% in blinatumomab group and 40.0% in conventional chemotherapy group were MRD-negative. Regimen-related mortality during the chemotherapy cycles was significantly higher in the conventional chemotherapy group (40.4% versus 1.9%, p < 0.001). Estimated 3-year overall survival (OS) was 33.2% (median, 26.3 months) after blinatumomab, and 15.4% (median, 8.2 months) after conventional chemotherapy ( p < 0.001). Estimated 3-year non-relapse mortality were 30.3% and 51.9% ( p = 0.004), respectively. In multivariate analysis, CR duration < 12 months showed more relapses and poor OS, and conventional chemotherapy showed higher non-relapse mortality and poor OS.

Conclusions:

Matched cohort analysis showed superior outcomes of blinatumomab compared with conventional chemotherapy. However, large numbers of relapses and non-relapse mortalities continue to occur even after blinatumomab followed by allo-HCT. Novel therapeutic strategies are still needed for R/R BCP-ALL.
Efficacy and safety of venetoclax-based regimens for the treatment of relapsed/refractory multiple myeloma: a systemic review and meta-analysis
Authors: Xu Linchun , Lin Shaoze , Xing Xueyang , Su Yongzhong
Published: March 2023

Background:

Patients with relapsed/refractory multiple myeloma (RRMM) usually have dismal prognostic outcomes. Venetoclax, a selective inhibitor of antiapoptotic protein B-cell lymphoma-2 (BCL-2), demonstrates antimyeloma activity in plasma cells with t(11;14) or high BCL-2 expression.

Objectives:

This meta-analysis aimed to investigate the efficacy and safety of venetoclax-based therapy in RRMM.

Design:

This is a meta-analysis study.

Data Sources and Methods:

PubMed, Embase, and Cochrane were searched for studies published up to 20 December 2021. Overall response rate (ORR), rate of very good partial response or better (≧VGPR), and complete response (CR) rate were pooled with the random-effects model. Safety was evaluated by the incidences of grade ≧3 adverse events. Subgroup analysis and meta-regression were performed to identify the causes of heterogeneities. All the analyses were conducted by STATA 15.0 software.

Results:

A total of 14 studies with 713 patients were included for analysis. The pooled ORR, rate of ≧VGPR, and CR for all patients were 59% [95% confidence interval (CI) = 45–71%], 38% (95% CI = 26–51%), and 17% (95% CI = 10–26%), respectively. The median progression-free survival (PFS) ranged from 2.0 months to not reached (NR), and the median overall survival (OS) ranged from 12.0 months to NR. Meta-regression showed that patients treated with more drugs combined or less heavily pretreated had higher response rates. Patients with t(11;14) had superior ORR [relative risk (RR) = 1.47, 95% CI = 1.05–2.07], ≧VGPR (RR = 1.71, 95% CI = 1.12–2.60), CR (RR = 1.86, 95% CI = 1.34–2.57), PFS [hazard ratio (HR) = 0.47, 95% CI = 0.30–0.65], and OS (HR = 0.30, 95% CI = 0.08–0.52) compared with patients without t(11;14). Most grade ≧3 adverse events were hematologic, gastrointestinal, and infectious related and were manageable.

Conclusion:

Venetoclax-based therapy is an effective and safe option for RRMM patients, especially those with t(11;14).
Practising geography in/with technical worlds
Authors: Lin Weiqiang
Published: March 2023

Over the past decade, geographical scholarship has grown steadily enamoured with all things technical. In some ways, such a focus is an outflow of the recent philosophical turn towards critical realism, which has encouraged a keener eye on more-than-human worlds. It demands careful delineations and understandings of the multi-stranded relationships between humans, technical objects, organisms, energies, and artificial intelligences that exceed anthropocentric epistemologies. This commentary seeks to address the challenges of studying the ‘technical’ in relation to the futures of geographical thought and praxis by proposing three strategies that might be developed in geographical research. These are, namely, the acquisition of a stronger grasp of technoscience expertise, care in following non-human things over time, and openness to interdisciplinary research. As more geographers enter into the fold of investigating ‘technical’ things, developing these skills would be invaluable to producing innovative spatial knowledge about these cryptic worlds.
The impact of “freedom day” on COVID-19 health protective behaviour in England: An observational study of hand hygiene, face covering use and physical distancing in public spaces pre and post the relaxing of restrictions
Authors: Davies Rachel , Martin Alex F , Smith Louise E , Mowbray Fiona , Woodland Lisa , Amlôt Richard , Rubin G James
Published: March 2023

To study the prevalence of COVID-19 health protective behaviours before and after rules eased in England on the 19th July 2021.

Observational study pre (12th-18th July) and post (26th July-1st August) 19th July, and a cross-sectional online survey (26th to 27th July).

Observations occurred in supermarkets (n = 10), train stations (n = 10), bus stops (n = 10), a coach station (n = 1) and a London Underground station (n = 1). The survey recruited a nationally representative sample.

All adults entering the observed locations during a one-hour period (n = 3819 pre- and n = 2948 post-19th July). In the online survey, 1472 respondents reported having been shopping for groceries/visited a pharmacy and 566 reported having used public transport or having been in a taxi/minicab in the last week.

We observed whether people wore a face covering, maintained distance from others and cleaned their hands. We investigated self-reports of wearing a face covering while in shops or using public transport.

In most locations observed, the proportion of people wearing face coverings, cleaning the hands and maintaining physical distance declined post 19th July. Pre 19th July, 70.2% (95% CI 68.7 to 71.7%) of people were observed to be wearing a face covering versus 55.8% (54.2 to 57.9%) post 19th July. Equivalent rates for physical distancing were 40.9% (39.0 to 42.8%) versus 29.5% (27.4 to 31.7%), and for hand hygiene were 4.4% (3.8 to 5.1%) versus 3.9% (3.2 to 4.6%). Self-reports of “always” wearing face coverings were broadly similar to observed rates.

Adherence to protective behaviours was sub-optimal and declined during the relaxation of restrictions, despite appeals to exercise caution. Self-reports of “always” wearing a face covering in specific locations appear valid.
Screening the risk of obstructive sleep apnea by utilizing supervised learning techniques based on anthropometric features and snoring events
Authors: Tsai Cheng-Yu , Liu Wen-Te , Hsu Wen-Hua , Majumdar Arnab , Stettler Marc , Lee Kang-Yun , Cheng Wun-Hao , Wu Dean , Lee Hsin-Chien , Kuan Yi-Chun , Wu Cheng-Jung , Lin Yi-Chih , Ho Shu-Chuan
Published: March 2023

Objectives

Obstructive sleep apnea (OSA) is typically diagnosed by polysomnography (PSG). However, PSG is time-consuming and has some clinical limitations. This study thus aimed to establish machine learning models to screen for the risk of having moderate-to-severe and severe OSA based on easily acquired features.

Methods

We collected PSG data on 3529 patients from Taiwan and further derived the number of snoring events. Their baseline characteristics and anthropometric measures were obtained, and correlations among the collected variables were investigated. Next, six common supervised machine learning techniques were utilized, including random forest (RF), extreme gradient boosting (XGBoost), k-nearest neighbor (kNN), support vector machine (SVM), logistic regression (LR), and naïve Bayes (NB). First, data were independently separated into a training and validation dataset (80%) and a test dataset (20%). The approach with the highest accuracy in the training and validation phase was employed to classify the test dataset. Next, feature importance was investigated by calculating the Shapley value of every factor, which represented the impact on OSA risk screening.

Results

The RF produced the highest accuracy (of >70%) in the training and validation phase in screening for both OSA severities. Hence, we employed the RF to classify the test dataset, and results showed a 79.32% accuracy for moderate-to-severe OSA and 74.37% accuracy for severe OSA. Snoring events and the visceral fat level were the most and second most essential features of screening for OSA risk.

Conclusions

The established model can be considered for screening for the risk of having moderate-to-severe or severe OSA.
Incidence of Acute Neurological Events in Neonates and Infants Undergoing Cardiac Surgery Using a High-Hematocrit/ High-Flow Bypass Strategy
Authors: Chakraborty Abhishek , Ramakrishnan Karthik , Buyukgoz Cihangir , Tadphale Sachin , Allen Jerry , Absi Mohammed , Briceno-Medina Maria , Boston Umar , Knott-Craig Christopher J.
Published: March 2023

Background: The incidence of new acute neurological injury occurring in neonates and infants during cardiac surgery utilizing cardiopulmonary bypass is reportedly 3% to 5%. In 2013, we adopted a high flow rate, and high hematocrit bypass strategy, and sought to assess the incidence of early neurological injuries associated with this strategy. Methods: Neonates and infants undergoing cardiopulmonary bypass between January 2013 and December 2019 (n  =  714) comprise the study. Adverse neurological events (ANEs) were defined as any abnormality of pupils, delayed awakening, seizures, focal neurological deficits, concerns prompting neurological consultation, or any abnormality on neurological imaging in the postoperative period. Our bypass strategy included a high flow rate (150-200 mL/kg/min), without reduction of flow rates during cooling and maintaining a target hematocrit on bypass > 32% with a terminal hematocrit of > 42%. Results: Median weight at the time of the procedure was 4.6 kg (IQR 3.6-6.1 kg) with the smallest patient weighing 1.36 kg. There were 46 premature patients (6.4%). There were 149 patients (20.9%) patients who underwent deep hypothermic circulatory arrest with a median time of 26 min (IQR 21-41 min). Hospital mortality was 3.5% (24/714, 95% CI: 2.28-5.13). The incidence of neurological events as defined above was 0.84% (6/714, 95% CI: 0.31-1.82). Neurological imaging identified ischemic injury in 4 patients and intraventricular hemorrhage in 2. Conclusions: High flow/high hematocrit bypass strategy was associated with a low incidence of ANE in this vulnerable population.
Medial Meniscal Extrusion in Patients With Medial Meniscus Root Tears: A Systematic Review and Meta-analysis
Authors: Fong Francis Jia Yi , Ong Bryan Wei Loong , Lee Yee Han Dave
Published: March 2023

Background:

Medial meniscal extrusion (MME) has received significant interest because of its correlation with medial meniscus root tears (MMRTs), its potential as a diagnostic tool, and its significance in the progression of knee osteoarthritis (OA).

Purpose:

To (1) evaluate if MMRTs significantly increase MME compared with nonroot tears (NRTs) and no tears and (2) determine the clinical outcomes of increased MME.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

Electronic database searches of PubMed, Embase, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were conducted on June 6, 2022, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist criteria. The searches were conducted using the keywords “meniscus tear” and “extrusion.” No restrictions were placed on the date of publication. Quality and sensitivity assessments were conducted on included studies. Major MME was defined as an extrusion ≥3 mm.

Results:

Twenty-two studies involving 7882 knees were included. Compared with patients with NRTs, those with MMRTs had a 1.12-mm greater mean absolute meniscal extrusion (AME) and were 3.45 times more likely to have major MME ( P < .001 for both). Compared with patients with no tears, those with MMRTs had a 2.13-mm greater AME ( P < .001). Within patients with MMRT, those with widely displaced MMRT had a 1.01-mm greater AME compared with nondisplaced MMRT ( P < .001). Patients with OA had a 0.73-mm greater AME and were 3.86 times more likely to have major MME compared with patients without OA ( P < .001 for both). Within patients who were not stratified according to MMRT, NRT, or no tears, those who eventually developed OA had a 0.79-mm greater AME than those who did not have OA ( P = .02).

Conclusion:

Patients with MMRTs had higher MME values compared with those with other types of meniscal tears and those without any meniscal tears. Patients with knee OA were more likely to have higher MME compared with those without OA.
“People are no longer quiet”: Ordinary environmental citizenship in Lago Agrio, Ecuador
Authors: Díaz-Combs Claudia
Published: March 2023

For years, residents in northeastern Ecuador's Amazonian city of Lago Agrio demanded the expansion of water and sanitation services to peri-urban neighborhoods. Community members regularly filed claims, made demands at town hall meetings, spoke directly to policymakers during neighborhood tours, and assembled an extensive quantitative and qualitative database on the everyday challenges of precarious access to water and sanitation. Their demands were clear: municipal and national governments must use state revenue to improve water and sanitation networks. Engaging an ordinary citizenship framework, this article forwards an interpretation of these actions as ordinary environmental citizenship. Residents dictate how they envisage the role of the Ecuadorian state through citizenship practices that respond to their community's environmental conditions. This article posits that the embodiment of socio-environmental citizenship represented in Lago Agrio is reproduced through relationships cultivated in every day, routine, ordinary experiences textured by a shared sense of insecure access to water and sanitation. Lago Agrians contest exclusion and demand the state use broad financial redistribution to improve and expand public water and sanitation infrastructure.
Eligibility criteria from pharmaceutical randomised controlled trials of idiopathic pulmonary fibrosis: a registry-based study
Authors: Khor Yet H. , Schulte Max , Johannson Kerri A. , Marcoux Veronica , Fisher Jolene H. , Assayag Deborah , Manganas Helene , Khalil Nasreen , Kolb Martin , Ryerson Christopher J. ,   for the Austin ILD Registry and CARE-PF Investigators,   the ALLIANCE Study Group, Cox Gerard , Fell Charlene D. , Gershon Andrea S. , Goh Nicole , Halayko Andrew J. , Lok Stacey , Morisset Julie , Sadatsafavi Mohsen , Shapera Shane , To Teresa , Wilcox Pearce G. , Wong Alyson W.
Published: March 2023

Background

Little is known about generalisability of randomised controlled trials (RCTs) for idiopathic pulmonary fibrosis (IPF). We evaluated eligibility criteria for phase III IPF RCTs to determine their representativeness in clinical registries, and calculated forced vital capacity (FVC) changes according to eligibility criteria.

Methods

Common eligibility criteria used in >60% of IPF RCTs were identified from a literature search and applied to patients with IPF from prospective Australian and Canadian registries. Additional pre-specified criteria of 6-min walk distance (6MWD) and different measures of preceding disease progression were also evaluated. Joint longitudinal-survival modelling was used to compare FVC decline according to eligibility for individual and composite criteria.

Results

Out of 990 patients with IPF, 527 (53%) met all common RCT eligibility criteria at the first clinic visit, including 343 with definite IPF and 184 with radiological probable usual interstitial pneumonia pattern without histological confirmation (i.e.provisional IPF). The percentages of eligible patients for landmark RCTs of nintedanib and pirfenidone were 19–50%. Adding 6MWD ≥150 m and different measures of preceding disease progression to the composite common criteria reduced the percentages of patients meeting eligibility to 52% (n=516) and 4–18% (n=12–61), respectively. Patients meeting the composite common criteria had less-rapid 1-year FVC decline than those who did not (−90versus−103 mL, p=0.01). Definite IPF generally had more-rapid 1-year FVC decline compared to provisional IPF.

Conclusions

Eligibility criteria of previous IPF RCTs have limited generalisability to clinical IPF populations, with FVC decline differing between eligible and ineligible populations.
The HARDSHIP databases: a forthcoming free good from the Global Campaign against Headache
Authors: Steiner Timothy J. , Husøy Andreas , Thomas Hallie , Stovner Lars Jacob
Published: March 2023

In order to pursue its purpose of reducing the global burden of headache, the Global Campaign against Headache has gathered data on headache-attributed burden from countries worldwide. These data, from the individual participants in adult population-based studies and child and adolescent schools-based studies, are being collated in two databases, which will be powerful resources for research and teaching and rich information sources for health policy.

Here we briefly describe the structure and content of these databases, and announce the intention to make them available in due course as a free good.
Entanglement generation by strong coupling between surface lattice resonance and exciton in an Al nanoarray-coated WS2 quantum emitter
Authors: Shi Xiaoqi , Wang Zhihang , Xiao Jiamin , Li Lingyao , Wei Shibo , Guo Zhicheng , Wang Yi , Wang Wenxin
Published: March 2023

Strong light–matter interaction plays a central role in realizing quantum photonic technologies. The entanglement state, which results from the hybridization of excitons and cavity photons, forms the foundation of quantum information science. In this work, an entanglement state is achieved by manipulating the mode coupling between surface lattice resonance and quantum emitter into the strong coupling regime. At the same time, a Rabi splitting of 40 meV is observed. A full quantum model based on the Heisenberg picture is used to describe this unclassical phenomenon, and it perfectly explains the interaction and dissipation process. In addition, the observed concurrency degree of the entanglement state is 0.5, presenting the quantum nonlocality. This work effectively contributes to the understanding of nonclassical quantum effects arising from strong coupling and will intrigue more interesting potential applications in quantum optics.
Multi-level integrative analysis of the roles of lncRNAs and differential mRNAs in the progression of chronic pancreatitis to pancreatic ductal adenocarcinoma
Authors: Zhao Zhirong , Luo Qiang , Liu Yi , Jiang Kexin , Zhou Lichen , Dai Ruiwu , Wang Han
Published: March 2023

Background

Pancreatic ductal adenocarcinoma (PDAC) is one of the most malignant tumors and approximately 5% of patients with chronic pancreatitis (CP) inevitably develop PDAC. This study aims explore the key gene regulation involved in the progression of CP to PDAC, with a particular emphasis on the function of lncRNAs.

Results

A total of 103 pancreatic tissue samples collected from 11 to 92 patients with CP and PDAC, respectively, were included in this study. After normalizing and logarithmically converting the original data, differentially expressed lncRNAs (DElncRNAs) and mRNAs (DEGs) in each dataset were selected. To determine the main functional pathways of differential mRNAs, we further annotated DEGs using gene ontology (GO) and analyzed the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment. In addition, the interaction between lncRNA-miRNA-mRNA was clarified and the protein–protein interaction (PPI) network was constructed to screen for key modules and determine hub genes. Finally, quantitative real-time polymerase chain reaction (qPCR) was used to detect the changes in non-coding RNAs and key mRNAs in the pancreatic tissues of patients with CP and PDAC. In this study, 230 lncRNAs and 17,668 mRNAs were included. There were nine upregulated lncRNAs and 188 downregulated lncRNAs. Furthermore, 2334 upregulated differential mRNAs and 10,341 downregulated differential mRNAs were included in the enrichment analysis. From the KEGG enrichment analysis, cytokine–cytokine receptor interaction, calcium signaling pathway, cAMP signaling pathway, and nicotine addiction exhibited significant differences. Additionally, a total of 52 lncRNAs, 104 miRNAs, and 312 mRNAs were included in the construction of a potential lncRNA-miRNA-mRNA regulatory network. PPI network was established and two of the five central DEGs were created in this module, suggesting that lysophosphatidic acid receptor 1 (LPAR1) and regulator of calcineurin 2 (RCAN2) may play significant roles in the progression from CP to PDAC. Finally, the PCR results suggested that LINC01547/hsa-miR-4694-3p/LPAR1 and LINC00482/hsa-miR-6756-3p/RCAN2 play important roles in the carcinogenesis process of CP.

Conclusion

Two signaling axes critical in the progression of CP to PDAC were screened out. Our findings will be useful for novel insights into the molecular mechanism and potential diagnostic or therapeutic biomarkers for CP and PDAC.
Effects of regional cerebral oxygen saturation monitoring on postoperative cognitive dysfunction in older patients: a systematic review and meta-analysis
Authors: Ding Xiahao , Zha Tianming , Abudurousuli Gulibositan , Zhao Cuimei , Chen Zixuan , Zhang Yang , Gui Bo
Published: March 2023

Background:

Postoperative cognitive dysfunction (POCD) is common after surgery and anesthesia, particularly in older patients. It has been reported that regional cerebral oxygen saturation (rSO2) monitoring potentially influences the occurrence of POCD. However, its role in the prevention of POCD remains controversial in older patients. Additionally, the quality of evidence on this topic is still relatively poor.

Methods:

The electronic databases PubMed, EMBASE, Web of Science, and Cochrane Library were systematically searched using the indicated keywords from their inception to June 10, 2022. We limited our meta-analysis to randomized controlled trials (RCTs) that assessed the effects of rSO2 monitoring on POCD in older patients. Methodological quality and risk of bias were assessed. The primary outcome was the incidence of POCD during hospitalization. The secondary outcomes were postoperative complications and the length of hospital stay (LOS). Odds ratios (OR) and 95% confidence intervals (CI) were calculated to determine the incidence of POCD and postoperative complications. The standardized mean difference (SMD) instead of the raw mean difference and 95% CI were calculated for LOS.

Results:

Six RCTs, involving 377 older patients, were included in this meta-analysis. The incidence of POCD ranges from 17 to 89%, with an overall prevalence of 47% in our pooled analysis. Our results demonstrated that rSO2-guided intervention could reduce the incidence of POCD in older patients undergoing non-cardiac surgery (OR, 0.44; 95% CI, 0.25 to 0.79; P = 0.006) rather than cardiac surgery (OR, 0.69; 95% CI, 0.32 to 1.52; P = 0.36). Intraoperative rSO2 monitoring was also associated with a significantly shorter LOS in older patients undergoing non-cardiac surgery (SMD, -0.93; 95% CI, -1.75 to -0.11; P = 0.03). Neither the incidence of postoperative cardiovascular (OR, 1.12; 95% CI, 0.40 to 3.17; P = 0.83) nor surgical (OR, 0.78; 95% CI, 0.35 to 1.75; P = 0.54) complications were affected by the use of rSO2 monitoring.

Conclusion:

The use of rSO2 monitoring is associated with a lower risk of POCD and a shorter LOS in older patients undergoing non-cardiac surgery. This may have the potential to prevent POCD in high-risk populations. Further large RCTs are still warranted to support these preliminary findings.
Quantitative T2 mapping monitoring the maturation of engineered elastic cartilage in a rabbit model
Authors: Yang Guojun , Li Xue , Zhang Weiwei , Wu Nier , Chen Haifeng , Liu Xia , Jiang Haiyue
Published: March 2023

Background

Cartilage tissue engineering provides a promising approach to reconstruct craniofacial defects, and a noninvasive method is needed to assess its effectiveness. Although magnetic resonance imaging (MRI) has been used to evaluate articular cartilage in vivo, few studies focused on its feasibility in monitoring engineered elastic cartilage (EC).

Methods

Auricular cartilage, silk fibroin (SF) scaffold, and EC consisting of rabbit auricular chondrocytes and SF scaffold were transplanted subcutaneously into the rabbit back. In eight weeks after transplantation, grafts were imaged by MRI using PROSET, PDW VISTA SPAIR, 3D T2 VISTA, 2D MIXED T2 Multislice, and SAG TE multiecho sequences, followed by histological examination and biochemical analysis. Statistical analyses were performed to identify the association between T2 values and biochemical indicator values of EC.

Results

In vivo imaging shows that 2D MIXED T2 Multislice sequence (T2 mapping) clearly distinguished the native cartilage, engineered cartilage and fibrous tissue. T2 values showed high correlations with cartilage-specific biochemical parameters at different time points, especially the elastic cartilage specific protein elastin (ELN, r= -0.939, P < 0.001).

Conclusion

Quantitative T2 mapping can effectively detect the in vivo maturity of engineered elastic cartilage after subcutaneously transplantation. This study would promote the clinical application of MRI T2 mapping in monitoring engineered elastic cartilage in the repair of craniofacial defects.
Corneal densitometry: an innovative method to quantitatively evaluate corneal changes after phacovitrectomy
Authors: Liu Xin , Shao Yuting , Lin Hui , Liu Chunyu , Shen Jiaqi , Zhang Li , Bi Yanlong
Published: March 2023

Background

To quantitatively investigate corneal changes and the correlation between corneal densitometry (CD) and endothelial parameters after phacovitrectomy.

Methods

Thirty-eight eyes with idiopathic full-thickness macular holes (iFTMHs) and cataracts underwent phacovitrectomy. Examinations were conducted at baseline and Day 1, Day 7, Month 1, and Month 3 postoperatively. CD and central corneal thickness (CCT) were measured using Pentacam. Corneal endothelial cell density (ECD), coefficient of variation (CV), and hexagonality (HEX) were measured using specular microscopy.

Results

ECD and HEX significantly decreased after surgery and the change in HEX occurred prior to CV. CCT increased immediately after surgery and recovered 3 months postoperatively. CD values increased significantly 1 day after surgery and then gradually decreased. For CD in the 0–2 mm zone, it took 1 month to recover in the central and posterior layers and 3 months in the anterior and total layers. For CD in the 2–6 mm zone, the central layer recovered at Day 7, the anterior and total layers recovered at 1 month, and the posterior layer did not recover until 3 months postoperatively. The CD within all layers in the 0–2 mm zone was positively correlated with CCT. Posterior CD in the 0–2 mm zone was negatively correlated with ECD and HEX.

Conclusions

CD is not only correlated with CCT, ECD, and HEX but also reflects the state of the whole cornea and each layer. CD can be an objective, rapid, and noninvasive tool that reflects corneal health and undetectable edema and monitors the process of lesion repair.

Trial registration

This study was registered with the Chinese Clinical Trial Registry (31/10/2021, ChiCTR2100052554).
Uptake of prostate cancer screening and associated factors among men aged 50 years and above in Lira city, Uganda: a cross-sectional study
Authors: Ekwan Richard , Bua Emmanuel , Nantale Ritah , Opito Ronald , Abingwa Patrick , Sserwanja Quraish , Kuteesa Job , Mukunya David
Published: March 2023

Background

Prostate cancer is the most common cancer among men globally, with over 1.2 million cases reported in 2018. About 90% of men with prostate cancer are diagnosed when the disease is in an advanced stage. We assessed the factors associated with the uptake of prostate cancer screening among men aged ≥ 50 years in Lira city.

Methods

This was a cross-sectional study involving 400 men aged ≥ 50 years in Lira city who were sampled using multistage cluster sampling method. Uptake of prostate cancer screening was defined as the proportion of men who received prostate cancer screening in the past one year prior to the interview. Multivariable logistic regression analyses were performed to assess the factors associated with the uptake of prostate cancer screening. Data were analyzed using Stata version 14.0 statistical software.

Results

Of the 400 participants, only 18.5% (74/400) had ever been screened for prostate cancer. However, 70.7% (283/400) were willing to screen/rescreen if provided with the opportunity. Majority of the study participants, 70.5% (282/400) had ever heard about prostate cancer, mostly from a health worker (40.8% (115/282)). Less than half of the participants had high knowledge of prostate cancer. The factors that were significantly associated with prostate cancer screening were age ≥ 70 years, Adjusted Odds Ratio (AOR) 3.29: 95% Confidence Interval (CI): 1.20-9.00) and having a family history of prostate cancer, AOR 2.48 (95%CI: 1.32–4.65).

Conclusion

There was low uptake of prostate cancer screening among men in Lira City, but majority of men were willing to screen. We encourage policymakers in Uganda to ensure prostate cancer screening services are readily available and accessible by men so as to improve on early identification and treatment of the disease.
An assessment of the performance of the national health research system in Mauritius
Authors: Musango Laurent , Nundoochan Ajoy , Ramful Yogendranath , Kirigia Joses Muthuri
Published: March 2023

Background

The goal of universal health coverage (UHC) is that every individual has access to high-quality health services without running the consequences of financial hardship. The World health report 2013 "Research for universal health coverage" states a performant National Health Research Systems (NHRS) can contribute by providing solutions to challenges encountered in advancing towards UHC by 2030. Pang et al. define a NHRS as the people, institutions, and activities whose primary aim is to generate and promote utilization of high-quality knowledge that can be used to promote, restore, and/or maintain the health status of populations. The WHO Regional Committee for Africa (RC) adopted a resolution in 2015 urging member states to strengthen their NHRS to facilitate production and utilization of evidence in policy development, planning, product development, innovation, and decision-making. This study aimed to calculate NHRS barometer scores for Mauritius in 2020, identify the gaps in NHRS performance, and recommend interventions for boosting the Mauritius NHRS in the pursuit of UHC.

Methods

The study used a cross-sectional survey design. A semi-structured NHRS questionnaire was administered and complemented with a review of documents archived in pertinent Mauritius Government Ministries, universities, research-oriented departments, and non-governmental organizations websites. The African NHRS barometer developed in 2016 for countries to monitor the RC resolution implementation was applied. The barometer consists of four NHRS functions (leadership and governance, developing and sustaining resources, producing and utilizing research, financing research for health [R4H]), and 17 sub-functions, e.g., existence of a national policy on research for health (R4H), presence of a Mauritius Research and Innovation Council (MRIC), existence of knowledge translation platform.

Results

In 2020, Mauritius had an overall average NHRS barometer score of 60.84%. The four NHRS functions average indices were 50.0% for leadership and governance, 77.0% for developing and sustaining resources, 52.0% for producing and utilizing R4H, and 58.2% for financing R4H.

Conclusion

The performance of NHRS could be improved through the development of a national R4H policy, strategic plan, prioritized agenda, and national multi-stakeholder health research management forum. Furthermore, increased funding for the NHRS may nurture the human resources for health research capacities, hence the number of pertinent publications and health innovations.
Determinants of timing, adequacy and quality of antenatal care in Rwanda: a cross-sectional study using demographic and health surveys data
Authors: Uwimana Gerard , Elhoumed Mohamed , Gebremedhin Mitslal Abrha , Nan Lin , Zeng Lingxia
Published: March 2023

Background

Antenatal care (ANC) is a recommended intervention to lessen maternal and neonatal mortality. The increased rate in ANC coverage in most Sub-Saharan African countries is not considerably reducing the maternal and neonatal mortality. This disconnection has raised concerns to study further the trend and determinants of the ANC timing and quality. We aimed to assess the determinants and trend of the timing, the adequacy and the quality of antenatal care in Rwanda.

Method

A population-based cross-sectional study design. We used data from the 2010,2015 and 2020 Rwanda demographic and health surveys (RDHS). The study included 18,034 women aged 15–49 years. High quality ANC is when a woman had her first ANC visit within 3 months of pregnancy, had 4 or more ANC visits, received services components of ANC during the visits by a skilled provider. Bivariate analysis and multivariable logistic regression were used to assess the ANC (timing and adequacy), the quality of the content of ANC services and the associated factors.

Results

The uptake of antenatal services increased in the last 15 years. For instance, the uptake of adequate ANC was 2219(36.16%), 2607(44.37%) and 2925(48.58%) respectively for 2010;2015 and 2020 RDHS. The uptake of high quality ANC from 205(3.48%) in 2010 through 510(9.47%) in 2015 to 779(14.99%) in 2020. Women with unwanted pregnancies were less likely to have timely first ANC (aOR:0.76;95%CI:0.68,0.85) compared to planned pregnancies, they were also less likely to achieve a high-quality ANC (aOR: 0.65;95%CI:0.51,0.82) compared to the planned pregnancies. Mothers with a secondary and higher education were 1.5 more likely to achieve a high-quality ANC (aOR:1.50;95%CI:1.15,1.96) compared to uneducated mothers. Increasing maternal age is associated with reduced odds of update of ANC component services (aOR:0.44;95%CI:0.25,0.77) for 40 years and above when referred to teen mothers).

Conclusion

Low-educated mothers, advanced maternal age, and unintended pregnancies are the vulnerable groups that need to be targeted in order to improve ANC-related indicators. One of the credible measures to close the gap is to strengthen health education, promote family planning, and promote service utilization.