bluuebunny/crossref_metadata_2025 huggingface dataset:
Multityrosine Kinase Inhibitors Alleviate Laser-Induced Choroidal Neovascularization in Non-Human Primates: A Novel Therapy for Diabetic Retinopathy and Age-Related Macular Degeneration
Authors: Dell Steven , Nallakrishnan Ravi , Horn Gerald
Published: June 2023

Age-related macular degeneration (AMD) and diabetic retinopathy (DR) are leading causes of vision impairment worldwide. Both conditions involve retinal neovascularization and choroidal neovascularization (CNV), which can lead to severe vision loss. Current treatment options have limitations, necessitating the development of safer and more effective therapies. This study investigated the efficacy of Cabozantinib (CBZ), a multi-tyrosine kinase inhibitor, in a non-human primate model of retinal neovascularization. Laser-induced CNV was assessed, and CBZ demonstrated effectiveness in reducing CNV leakage and lesion area without intraocular toxicity. The inhibition of MET and VEGFR2 activation, involved in angiogenesis, is believed to be the mechanism of action. The findings support CBZ’s potential as a novel therapeutic agent for AMD and DR. Further investigations and clinical trials are warranted to evaluate CBZ’s long-term safety and efficacy in humans, as well as explore its effect on other pathways involved in CNV. The study supports the growing evidence that multi-tyrosine kinase inhibitors, including CBZ and Axitinib, hold promise in the treatment of ocular neovascularization, particularly in conditions like AMD and DR.
Modeling and predicting cancer clonal evolution with reinforcement learning
Authors: Ivanovic Stefan , El-Kebir Mohammed
Published: June 2023

Cancer results from an evolutionary process that typically yields multiple clones with varying sets of mutations within the same tumor. Accurately modeling this process is key to understanding and predicting cancer evolution. Here, we introduce clone to mutation (CloMu), a flexible and low-parameter tree generative model of cancer evolution. CloMu uses a two-layer neural network trained via reinforcement learning to determine the probability of new mutations based on the existing mutations on a clone. CloMu supports several prediction tasks, including the determination of evolutionary trajectories, tree selection, causality and interchangeability between mutations, and mutation fitness. Importantly, previous methods support only some of these tasks, and many suffer from overfitting on data sets with a large number of mutations. Using simulations, we show that CloMu either matches or outperforms current methods on a wide variety of prediction tasks. In particular, for simulated data with interchangeable mutations, current methods are unable to uncover causal relationships as effectively as CloMu. On breast cancer and leukemia cohorts, we show that CloMu determines similarities and causal relationships between mutations as well as the fitness of mutations. We validate CloMu's inferred mutation fitness values for the leukemia cohort by comparing them to clonal proportion data not used during training, showing high concordance. In summary, CloMu's low-parameter model facilitates a wide range of prediction tasks regarding cancer evolution on increasingly available cohort-level data sets.
Estimating the effect of board independence on innovation efficiency using research quotient: a quasi-natural experiment
Authors: Chatjuthamard Pattanaporn , Treepongkaruna Sirimon , Jiraporn Pornsit , Park Keun Jae
Published: June 2023

Purpose

Exploiting a novel measure of innovation, the authors investigate whether independent directors improve innovation efficiency. This novel measure of innovation captures the extent to which the firm generates revenue from its research & development and is, therefore, more economically meaningful. The authors also use a text-based measure of innovation.

Design/methodology/approach

The authors rely on a quasi-natural experiment based on the passage of the Sarbanes-Oxley Act of 2002 that compelled certain firms to raise board independence. The difference-in-difference analysis is far less vulnerable to endogeneity and is more likely to show a causal influence, rather than a mere association.

Findings

The results show that more independent directors improve innovation efficiency significantly. Specifically, firms forced to raise board independence experienced a much higher increase in innovation than those not required to change their board composition. The authors also explore another novel measure of innovation, a text-based metric of innovation.

Originality/value

The research is original in several ways. First, the authors take advantage of an exogenous regulatory shock as a quasi-natural experiment. This approach is far less susceptible to endogeneity. Second, the authors use a novel measure of innovation efficiency, i.e. research quotient, which is more economically meaningful. Finally, the authors use a unique measure of innovation derived from powerful textual analysis.
Machine learning algorithms applied to the estimation of liquidity: the 10-year United States treasury bond
Authors: Luque Raya Ignacio Manuel , Luque Raya Pablo
Published: June 2023

Purpose

Having defined liquidity, the aim is to assess the predictive capacity of its representative variables, so that economic fluctuations may be better understood.

Design/methodology/approach

Conceptual variables that are representative of liquidity will be used to formulate the predictions. The results of various machine learning models will be compared, leading to some reflections on the predictive value of the liquidity variables, with a view to defining their selection.

Findings

The predictive capacity of the model was also found to vary depending on the source of the liquidity, in so far as the data on liquidity within the private sector contributed more than the data on public sector liquidity to the prediction of economic fluctuations. International liquidity was seen as a more diffuse concept, and the standardization of its definition could be the focus of future studies. A benchmarking process was also performed when applying the state-of-the-art machine learning models.

Originality/value

Better understanding of these variables might help us toward a deeper understanding of the operation of financial markets. Liquidity, one of the key financial market variables, is neither well-defined nor standardized in the existing literature, which calls for further study. Hence, the novelty of an applied study employing modern data science techniques can provide a fresh perspective on financial markets.
Understanding financial professionals' perceptions of their clients' financial behaviors
Authors: Morris Tania , Kamano Lamine , Maillet Stéphanie
Published: June 2023

Purpose

This article describes financial professionals' perceptions of their clients' financial behaviors and the explanatory factors underlying these behaviors.

Design/methodology/approach

In this qualitative research, the authors seek to understand financial professionals' experiences in relation to how their clients manage their own finances. The authors conduct and analyze 26 semi-structured interviews with financial professionals from several industries within the financial sector in Canada.

Findings

The professionals in this study noted that despite their clients' financial knowledge, several other factors can explain these individuals' financial behaviors. They include psychological factors (such as financial bias, the need for instant gratification, and the lack of awareness regarding the long-term effects of certain types of financial behaviors), financial habits (such as lifestyle, financial planning and lack of discipline) and the financial system's flexibility with respect to debt financing and repayment. These perceptions are categorized according to whether they are related to debt financing or repayment, savings or investments.

Originality/value

By using a qualitative methodology that relies on the perceptions of financial professionals, this study aims to better understand the financial behaviors of individuals and households, and these behaviors' underlying factors. This study's findings could be useful to various stakeholders interested, in one way or another, in financial literacy, such as organizations aiming to strengthen and promote financial literacy, educators, researchers, regulatory bodies of financial institutions and financial advisers.
Coaches and teachers co-teaching: exploring the challenges and support of co-teaching as a coaching activity
Authors: Saclarides Evthokia
Published: June 2023

Purpose

Co-teaching is a prevalent and productive coaching activity that coaches can leverage when working with teachers to support teaching and learning. However, there is insufficient research detailing how coaches can and should implement this coaching activity with teachers. Hence, the purpose of this qualitative interview study is to better understand the challenges that make co-teaching coaching cycles difficult for coaches to enact with in-service teachers, as well as the supports that can enhance the co-teaching experience for all involved parties.

Design/methodology/approach

Fourteen semi-structured interviews were completed with one instructional coach and three elementary teachers in one school district in the USA. A combination of emergent as well as literature-driven codes was used to code the data.

Findings

Overall, the participants pointed to six barriers they encountered when engaging in episodes of co-teaching, which spanned the broad categories of management and logistics, pedagogical dilemmas, and teacher learning. Furthermore, participants identified seven supports, spanning the broad categories of coach preparation, contextual factors, and management and logistics, that enabled them to productively engage in co-teaching.

Originality/value

Although coaches may frequently engage teachers in coaching cycles involving co-teaching, there is a lack of research-based guidance for coaches about how to engage teachers most productively in co-teaching episodes. The findings from this study, which shed light on the challenges and support of co-teaching from one coach and three teachers, will enable coaches to more effectively co-teach with teachers as a form of high-quality professional development.
How the second largest shareholder affects cash dividends? An empirical study in China
Authors: Wang Qian , Tang Xiaobo , Liang Huigang , Xue Yajiong , Sun Xiaolin
Published: June 2023

Purpose

In public firms, the largest shareholder can make decisions on cash dividends in favor of its own interests at the expense of other investors. While the second largest shareholder can actively participate in corporate governance and protect the interests of investors, its impact has not been fully understood. This research investigates how shareholding ratio and ownership type of the second largest shareholder moderate the relationship between controlling shareholder's shareholding ratio and cash dividends.

Design/methodology/approach

The authors conducted econometrics analysis based on a panel data of China's A-share listed companies from 2007 to 2017.

Findings

The authors find that the controlling shareholder's shareholding ratio has a significant negative impact on cash dividends. However, this influence is conditional on the shareholding ratio of the second largest shareholder. The negative impact is weakened when the second largest shareholder holds a large proportion of shares or when the shareholding gap between the second largest and the controlling shareholder is small.

Originality/value

This research extends the existing literature by highlighting the nuanced moderating effect of the second largest shareholder on the relationship between the controlling shareholder and cash dividends, thus making a unique contribution to the understanding of corporate governances in the emerging financial market in China.
The impact of COVID-19 on the relationship between auditor industry specialization and audit fees: empirical evidence from Jordan
Authors: Alharasis Esraa Esam , Alhadab Mohammad , Alidarous Manal , Jamaani Fouad , Alkhwaldi Abeer F.
Published: June 2023

Purpose

Motivated by the disastrous impact of COVID-19 on the world’s economies, the purpose of this study is to examine its effect on the association between auditor industry specialization and external audit fees, referring to two time periods: before and during COVID-19.

Design/methodology/approach

A quantitative analysis based on the ordinary least squares regression is performed, using 3,200 company-year observations from 2005 to 2020 in Jordan to test the hypotheses. The qualitative component is a textual analysis of firms’ annual reports that support the quantitative analysis findings.

Findings

The analysis confirms there is a direct positive relationship between COVID-19 and external audit fees, confirming the tough consequences of the crisis on audit complexity and risks. While the results show evidence that the relationship between auditor specialist and audit fees is weakened because of COVID-19, the content analysis explained that COVID-19 led to fewer requests for high-quality audit, given the urgent need to report on firms’ financial circumstances. Jordan’s capital market is controlled by family businesses, and the insolvency of several large firms during COVID-19 led auditors to offer their services at low cost.

Research limitations/implications

The findings of this study have serious implications for policymakers, legislators, regulators and the audit profession, as they examine the arising difficulties during a period of economic uncertainty. The findings can help to improve laws that control the auditing industry in Jordan following the damage caused by COVID-19. As well, the outcomes can be extrapolated to other Middle East nations.

Originality/value

To the best of the authors’ knowledge, the authors believe that this research presents the first evidence on the influence of COVID-19 on the auditing industry.
User innovation in Iran: incentives and barriers
Authors: Sadabadi Ali Asghar , Rahimi Rad Zohreh , Mirzamani Azam
Published: June 2023

Purpose

This study first aims to survey the state of user innovation in Iran and then identified barriers and incentives for user innovation in Iran.

Design/methodology/approach

In this study, a questionnaire (through 1,360 adults from Iran) prepared by De Jong (2016) was used to survey user innovation.

Findings

The results showed: the percentage of user innovators is high in Iran, there is no linear relationship between the income of a country and the percentage of the user innovators, there is a positive relationship between the education level and the percentage of user innovators in Iran, there is no linear relationship between the number of people educated in the scientific and technical fields and the percentage of user innovators. Finally, based on surveying users opinion in questionnaire, four incentives and five barriers in user innovation were identified that can help policymakers to improve their innovation policies.

Originality/value

Literature review in this field showed it was found that in a number of developed countries, the issue of user innovation has been addressed, but in Iran as a developing country, no such research has been conducted so far. In addition, it was found that so far, no comprehensive research has identified barriers and incentives for user innovation, so this study, first surveyed the state of user innovation in Iran and then identified barriers and incentives for user innovation in Iran.
The quality of energy efficiency disclosures: an exploratory study of Australian cities
Authors: Mia Parvez , Hazelton James , Guthrie Am James
Published: June 2023

Purpose

This study aims to evaluate the quality of the energy efficiency disclosures made by Australian cities. As cities are significant energy users, and energy use is a crucial source of greenhouse gas emissions, energy efficiency initiatives can play an essential role in addressing climate change. Yet, little is understood about the energy efficiency disclosures being made.

Design/methodology/approach

The authors developed an original energy efficiency disclosure index to assess the reporting quality of the eight largest Australian cities. The websites of these cities were analysed for information on energy efficiency measures from December 2018 to June 2019. Annual reports, environmental reports, climate action plans and any other material related to energy plans were downloaded and then coded using the index.

Findings

While all cities provided energy efficiency information, little financial information was provided, limited forward-looking information was disclosed, key challenges were not disclosed, and each city provided energy efficiency disclosures differently. Collectively, these findings demonstrate that public accountability is limited.

Research limitations/implications

An important implication is the need to standardise and improve cities’ energy efficiency reporting, especially concerning financial information. Cities, governments and the Carbon Disclosure Project (formerly the CDP) could achieve this, perhaps as part of the broader update of the CDP city-focused guidelines for greenhouse gas (GHG) reporting.

Originality/value

Although some studies on GHG reporting by cities have already been undertaken, including energy efficiency as part of their disclosure index, no study has focused on energy efficiency disclosures. The authors provide original insights concerning these practices. The study also provides an energy efficiency disclosure index that can be used in further research.
The cost of equity to earnings yield differential and dividend policy
Authors: Esqueda Omar , O'Connor Thomas
Published: June 2023

Purpose

The authors measure the cost of equity to earnings yield differential for a sample of 2,035 non-financial firms. In a series of Logit and Tobit regressions, the authors examine if the cost of equity to earnings yield differential is related to dividend policy in the manner predicted by agency theory.

Design/methodology/approach

Agency theory says a firm's optimal dividend policy is partially determined by the relationship between the earnings yield and the cost of equity capital. When the cost of equity is higher (lower) than the earnings yield, firms are motivated to (not) pay dividends as this reduces the cost of capital and holding other things constant, increases corporate valuations. The authors test whether managers set dividend policies to maximize the value of the firm.

Findings

The study’s findings show that when the cost of equity is higher (lower) than earnings yield, firms are more (less) likely to be dividend payers and the payouts are higher (lower). The results are robust to the inclusion of share repurchases as an alternative to cash distributions. The study’s findings support the cost of equity hypothesis and are consistent with alternative dividend theories.

Originality/value

The study’s findings support the cost of equity hypothesis and are consistent with alternative dividend theories. To the authors’ knowledge, this is the first paper testing the cost of equity hypothesis.
How to lead responsibly toward enhanced knowledge sharing behavior and performance: implications for human resource management
Authors: Afshari Leila , Ahmad Muhammad Shakil , Mansoor Talha
Published: June 2023

Purpose

This paper investigates the relationships between responsible leadership and employees' knowledge sharing behavior and performance in the healthcare sector. The present study provides deeper insights into those relationships by uncovering the mechanisms through which relational and ethical dimensions of responsible leadership influence knowledge sharing outcomes. Drawing on the social exchange theory, this study examines the mediating role of trust in the leader and leadership support.

Design/methodology/approach

Data were collected from 445 healthcare professionals in Pakistan. Structural equation modeling was employed to analyze the data.

Findings

The study findings revealed that responsible leaders enhance knowledge worker performance and knowledge sharing behavior through enhancing trusting relationships with followers and providing support. Furthermore, the authors investigated the moderating role of goal orientation, and the results showed that the effect of responsible leadership on knowledge worker performance was stronger for highly goal-oriented employees.

Practical implications

This research suggests that human resource managers interested in fostering knowledge sharing behaviors, must focus on cultivating responsible leadership behavior within their organizations. Furthermore, this study findings propose that HRM practices should foster employee goal orientation in order to enhance knowledge workers' performance.

Originality/value

This study makes a novel contribution to the literature by shifting the research focus from the traditional view of leadership to a leadership style more responsive to the reciprocity nature of the relationships between employees and leaders. By shifting the focus to a relational-ethical based leadership style, the current study was able to fully uncover the underlying mechanisms linking responsible leadership to knowledge sharing outcomes.
Decision-making process of knowledge push service to improve organizational performance and efficiency: developing knowledge push algorithm
Authors: Rubel Rubel , Kushwaha Bijay Prasad , Miah Md Helal
Published: June 2023

Purpose

This study aims to highlight the inconsistency between conventional knowledge push judgements and the price of knowledge push. Also, a three-way decision-based relevant knowledge push algorithm was proposed.

Design/methodology/approach

Using a ratio of 80–20%, the experiment randomly splits the data into a training set and a test set. Each video is used as a knowledge unit (structure) in the research, and the category is used as a knowledge attribute. The limit is then determined using the user’s overall rating. To calculate the pertinent information obtained through experiments, the fusion coefficient is needed. The impact of the push model is then examined in comparison to the conventional push model. In the experiment, relevant knowledge is compared using three push models, two push models based on conventional International classification functioning (ICF), and three push models based on traditional ICF. The average push cost accuracy rate, recall rate and coverage rate are metrics used to assess the push effect.

Findings

The three-way knowledge push models perform better on average than the other push models in this research in terms of push cost, accuracy rate and recall rate. However, the three-way knowledge push models suggested in this study have a lower coverage rate than the two-way push model. So three-way knowledge push models condense the knowledge push and forfeit a particular coverage rate. As a result, improving knowledge results in higher accuracy rates and lower push costs.

Practical implications

This research has practical ramifications for the quick expansion of knowledge and its hegemonic status in value creation as the main methodology for knowledge services.

Originality/value

To the best of the authors’ knowledge, this is the first theory developed on the three-way decision-making process of knowledge push services to increase organizational effectiveness and efficiency.
Efficacy of guselkumab in difficult‐to‐treat psoriasis regions: Data from VOYAGE 1 and VOYAGE 2 Asian subpopulations
Authors: Jo Seong Jin , Huang Yu‐Huei , Tsai Tsen‐Fang , Kim Byung Soo , Reich Kristian , Saadoun Carine , Chang Chia‐Ling , Yang Ya‐Wen , Youn Sang Woong
Published: June 2023

Patients with psoriasis were randomized to guselkumab, placebo or adalimumab in the VOYAGE 1 and VOYAGE 2 studies. In this post hoc analysis, difficult‐to‐treat psoriasis regions in the Asian subpopulation for both the guselkumab and adalimumab groups were compared with placebo at week 16 and the active treatment groups were compared at week 24. Endpoints included patients achieving scores of 0 or 1 (clear or near clear) or 0 (clear) on the scalp‐specific Investigator's Global Assessment (ss‐IGA), Physician's Global Assessment of the hands and/or feet (hf‐PGA), and fingernail PGA (f‐PGA), and percentage improvement in target Nail Psoriasis Severity Index (NAPSI) score through week 24. Efficacy was also assessed by prior biologic experience at baseline. A total of 199 eligible Asian patients were included. The proportion of patients achieving “clear” or “near clear” with guselkumab was superior to adalimumab at week 24 for scalp psoriasis ss‐IGA (Asian patients, 72 [85.7%] vs 35 [67.3%], P = 0.004), hands and/or feet psoriasis hf‐PGA (29 [82.9%] vs 16 [61.5%], P = 0.054), and similar for fingernail psoriasis f‐PGA (28 [63.6%] vs 17 [54.8%], P = 0.412). Guselkumab mean improvements in NAPSI were comparable to adalimumab (39.9% vs 35.9%, P = 0.618). Overall, the complete clearance response of scalp, and hands and/or feet at week 24 occurred in a greater proportion of patients in the guselkumab group, irrespective of baseline biologic status (treatment‐naïve or treatment‐experienced). Guselkumab was superior to adalimumab for the treatment of scalp, and hands and/or feet psoriasis, and proportionally higher for fingernail psoriasis. Findings were comparable to the global study population.
Contrasting mycorrhizal growth responses in native and invasive woody species are associated with distinct root trait syndromes
Authors: Ebert Alexander R. , Frank Douglas A. , Fridley Jason D.
Published: June 2023

Invasive plant species often express resource‐acquisitive leaf traits that support rapid growth, but associated fine root traits and the role of microbial mutualists in invader whole‐plant functioning remain poorly understood.

We performed an experiment of 12 phylogenetically grouped native and non‐native, invasive woody species, grown with or without a common inoculum of arbuscular mycorrhizal fungi (AMF) across two nutrient levels. We measured 10 fine root traits associated with nutrient uptake and suitability of AMF colonization.

The presence of AMF increased the growth rate of all species, but native species were significantly more dependent on AMF than invaders. Furthermore, invaders expressed a distinct syndrome of first‐order root traits, including longer, thinner roots of high specific root length, greater branching intensity and lower tissue density, which are traits associated with rapid nutrient uptake and low AMF association. This syndrome was independent of phylogeny, AMF inoculation and soil fertility.

An acquisitive fine root trait syndrome for invaders supports high photosynthetic and growth rates, linking above‐ and below‐ground functioning. The occurrence of this syndrome across phylogenetic groups indicates that lineages of woody invaders typically associated with arbuscular mycorrhizas may be generally less dependent on AMF than native species.

Read the free Plain Language Summary for this article on the Journal blog.
Trends and patterns of antiseizure medication prescribing during pregnancy between 1995 and 2018 in the United Kingdom: A cohort study
Authors: Madley‐Dowd Paul , Rast Jessica , Ahlqvist Viktor H. , Zhong Caichen , Martin Florence Z. , Davies Neil M. , Lyall Kristen , Newschaffer Craig , Tomson Torbjörn , Magnusson Cecilia , Rai Dheeraj , Lee Brian K. , Forbes Harriet
Published: June 2023

Objective

To examine antiseizure medication (ASM) prescription during pregnancy.

Design

Population‐based drug utilisation study.

Setting

UK primary and secondary care data, 1995–2018, from the Clinical Practice Research Datalink GOLD version.

Population or Sample

752 112 completed pregnancies among women registered for a minimum of 12 months with an ‘up to standard’ general practice prior to the estimated start of pregnancy and for the duration of their pregnancy.

Methods

We described ASM prescription across the study period, overall and by ASM indication, examined patterns of prescription during pregnancy including continuous prescription and discontinuation, and used logistic regression to investigate factors associated with those ASM prescription patterns.

Main Outcome Measures

Prescription of ASMs during pregnancy and discontinuation of ASMs before and during pregnancy.

Results

ASM prescription during pregnancy increased from 0.6% of pregnancies in 1995 to 1.6% in 2018, driven largely by an increase in women with indications other than epilepsy. Epilepsy was an indication for 62.5% of pregnancies with an ASM prescription and non‐epilepsy indications were present for 66.6%. Continuous prescription of ASMs during pregnancy was more common in women with epilepsy (64.3%) than in women with other indications (25.3%). Switching ASMs was infrequent (0.8% of ASM users). Factors associated with discontinuation included age ≥35, higher social deprivation, more frequent contact with the GP and being prescribed antidepressants or antipsychotics.

Conclusions

ASM prescription during pregnancy increased between 1995 and 2018 in the UK. Patterns of prescription around the pregnancy period vary by indication and are associated with several maternal characteristics.
Examination of nursing diagnosis skills of students receiving online education: A cross‐sectional study
Authors: Kurt Ece , Eskimez Zehra , Nazik Evşen
Published: June 2023

Aim

This study aims to examine the nursing diagnosis skills of students who took the case‐based online nursing processes course during the COVID‐19 pandemic.

Methods

The study followed a descriptive and cross‐sectional design. The participants were first‐year students (n = 148) enrolled in the nursing principles course in the spring semester of the 2020–2021 academic year in the nursing department of a university. The course on nursing processes was delivered online due to the COVID‐19 pandemic. At the end of the course, students who volunteered to participate in the study developed nursing diagnoses for the cases assigned to them. The data were collected from the students using two forms and were evaluated using a form developed by the researchers. The data were analyzed with numeric and percentage calculations.

Findings

Although 56.8% of the students stated that they had difficulty making nursing diagnoses, 56.8% of them thought online education was not useful. The most commonly made diagnoses by the students who participated in the study included hyperthermia (66.2%), ineffective breathing pattern (54.7%), risk of falling (39.9%), fatigue (34.5%), and anxiety (33.8%). It was also found that students were able to identify objective data more easily as diagnosis criteria, whereas they were not able to identify abstract concepts.

Conclusions

It was seen that the students who participated in the study had low levels of nursing diagnoses. Based on the findings, it is recommended that different teaching methods be employed in the online nursing processes course, and these methods be evaluated in terms of their effects on students’ learning outcomes.

Implications for nursing practices

The online nursing process course should be made more efficient. First‐year nursing students are not yet ready to identify nursing diagnoses in terms of knowledge and skills.
Management of rectal cancer in the era of total neoadjuvant therapy and watch and wait: A multidisciplinary team discussion at the Australasian Gastro‐Intestinal Trials Group (AGITG) Annual Scientific Meeting 2022
Authors: Jain Ankit , Gormly Kirsten L. , Glyn Tamara , Sammour Tarik , Koay Eugene J. , Oar Andrew , Jameson Michael B. , Smyth Elizabeth C. , Vatandoust Sina
Published: June 2023

Rectal cancer is a common malignancy. The management of rectal cancer has recently evolved and has undergone a paradigm shift with the advent of treatment approaches such as total neoadjuvant therapy and the watch‐and‐wait approach. However, despite the recently available evidence, there is no consensus on the optimal management approach in the setting of locally advanced rectal cancer. To address some of the controversies, a joint multidisciplinary panel discussion was conducted at the Australasian Gastro‐Intestinal Trials Group (AGITG) Annual Scientific Meeting in November 2022. Members from different subspecialties formed two panels and discussed three clinical cases in a debate format. Each case represented some of the complex issues faced by clinicians in this setting. The discussion is now presented in this manuscript, which depicts the different available management approaches and reiterates the importance of a multidisciplinary approach.
Severe hepatitis B flares with hepatic decompensation after withdrawal of nucleos(t)ide analogues: A population‐based cohort study
Authors: Hsu Yao‐Chun , Lin Yi‐Hsian , Lee Teng‐Yu , Nguyen Mindie H. , Tseng Cheng‐Hao , Ho Hsiu J. , Kao Feng‐Yu , Lin Jaw‐Town , Wu Chen‐Yi , Wu Chun‐Ying
Published: June 2023

Background

Finite nucleos(t)ide analogue (NUC) therapy has been proposed as an alternative treatment strategy for chronic hepatitis B (CHB).

Aim

To quantify the incidence of severe hepatitis flares following NUC cessation in everyday clinical practice.

Methods

This population‐based cohort study enrolled 10,192 patients (male 71.7%, median age 50.9 years, cirrhosis 10.7%) who had received first‐line NUCs for at least 1 year before discontinuing treatment. The primary outcome was severe flare with hepatic decompensation. We used competing risk analyses to assess event incidences and associated risk factors.

Results

During a median follow‐up of 2.2 years, 132 patients developed severe flares with hepatic decompensation, yielding a 4‐year cumulative incidence of 1.8% (95% confidence interval [CI], 1.5%–2.2%). Significant risk factors were cirrhosis (adjusted sub‐distributional hazard ratio [aSHR], 2.74; 95% CI, 1.82–4.12), manifestations of portal hypertension (aSHR, 2.46; 95% CI, 1.45–4.18), age (aSHR, 1.21 per 10 years; 95% CI, 1.03–1.42) and male sex (aSHR, 1.58; 95% CI, 1.04–2.38). In patients without cirrhosis or portal hypertension (n = 8863), the 4‐year cumulative incidence of severe withdrawal flares stood at 1.3% (95% CI, 1.0%–1.7%). For those patients with available data confirming adherence to the standard stopping rules (n = 1274), the incidence was 1.1% (95% CI, 0.6%–2.0%).

Conclusions

Severe flares with hepatic decompensation were observed in 1%–2% of patients with CHB after stopping NUC therapy in daily practice. Risk factors included older age, cirrhosis, portal hypertension and male sex. Our findings argue against NUC cessation as part of routine clinical care.
The effect of antiplatelet therapy on outcomes in patients who underwent laparoscopic radical nephrectomy: A Japanese single‐center study
Authors: Nakayama Yuki , Sakano Shigeru , Shinohara Yota , Nishijima Jun , Ban Yoshimasa , Hidaka Yukihiro , Fukuda Masashi , Shiraishi Koji
Published: June 2023

Objectives

The number of patients receiving antiplatelet therapy (APT) who have undergone laparoscopic radical nephrectomy is increasing. However, it is unclear whether APT affects the outcomes of patients undergoing radical nephrectomy. We investigated the perioperative outcomes of radical nephrectomy in patients with and without APT.

Methods

We retrospectively collected data from 89 Japanese patients who underwent laparoscopic radical nephrectomy for clinically diagnosed renal cell carcinoma (RCC) at Kokura Memorial Hospital between March 2013 and March 2022. We analyzed information related to APT. We divided the patients into two groups: the APT group (patients receiving APT) and the N‐APT group (patients not receiving APT). Moreover, the APT group was further divided into the C‐APT group (patients with continuous APT) and the I‐APT group (patients with interrupted APT). We compared the surgical outcomes of these groups.

Results

Among 89 patients eligible for the study, 25 received APT and 10 continued APT. Even though the patients who received APT had a high American Society of Anesthesiologists physical status and many complications, including smoking, diabetes, hypertension, and chronic heart failure, no significant difference in the intra‐ or postoperative outcomes, including bleeding complications, was observed regardless of whether the patients received APT or continued APT.

Conclusions

We concluded that in laparoscopic radical nephrectomy, continuation of APT is an acceptable strategy for patients with thromboembolic risk caused by interruption of APT.
Laparoscopic surgery for rectal cancer with a coexisting Retzius shunt and inferior mesenteric arteriovenous malformation: A case report
Authors: Furukawa Shunsuke , Hiraki Masatsugu , Akashi Michiaki , Kimura Naoya , Takahashi Yukihiko , Samejima Ryuichiro
Published: June 2023

A coexisting short‐circuit from the inferior mesenteric vein (IMV) to the inferior vena cava, known as a Retzius shunt, and arteriovenous malformation (AVM) of the inferior mesentery are extremely rare conditions. We encountered a case of rectal cancer with coexisting Retzius shunt and inferior mesenteric AVM successfully treated with laparoscopic surgery. Contrast computed tomography (CT) in a 62‐year‐old man with rectal cancer showed multiple dilated veins at the mesenterium of the descending sigmoid colon. These dilated veins were connected between the IMV and the left renal vein. A diagnosis of Retzius shunt was made, and laparoscopic low anterior resection with lymph node dissection was performed. A pathological examination of the colonic mesenterium revealed AVM communicating with the dilated IMV and Retzius shunt. The preoperative evaluation of aberrant vessels by three‐dimensional CT is particularly useful for patients with vascular malformations to ensure safe laparoscopic surgery.
Translational screening platform to evaluate chemotherapy in combination with focal therapy for retinoblastoma
Authors: Sinenko Irina L. , Kuttler Fabien , Simeonov Valentin , Moulin Alexandre , Aouad Patrick , Stathopoulos Christina , Munier Francis L. , Berger Adeline , Dyson Paul J.
Published: June 2023

Retinoblastoma is the most common pediatric eye cancer. It is currently treated with a limited number of drugs, adapted from other pediatric cancer treatments. Drug toxicity and relapse of the disease warrant new therapeutic strategies for these young patients. In this study, we developed a robust tumoroid‐based platform to test chemotherapeutic agents in combination with focal therapy (thermotherapy) – a treatment option widely used in clinical practice – in accordance with clinically relevant trial protocols. The model consists of matrix‐embedded tumoroids that retain retinoblastoma features and respond to repeated chemotherapeutic drug exposure similarly to advanced clinical cases. Moreover, the screening platform includes a diode laser (810 nm, 0.3 W) to selectively heat the tumoroids, combined with an on‐line system to monitor the intratumoral and surrounding temperatures. This allows the reproduction of the clinical settings of thermotherapy and combined chemothermotherapy treatments. When testing the two main drugs currently used in clinics to treat retinoblastoma in our model, we observed results similar to those clinically obtained, validating the utility of the model. This screening platform is the first system to accurately reproduce clinically relevant treatment methods and should lead to the identification of more efficient drugs to treat retinoblastoma.
Formula milk companies and allergy healthcare professionals in India
Authors: Allen Hilary , Gupta Arun , Mundell Alexandra , Gupta Neeraj , Thakur Anup , Nagarajan Sowmya , Munblit Daniel , Baker Phillip , Boyle Robert
Published: June 2023

India is a low‐middle income country with a population of 1.4 billion and home to one quarter of the world's children. Exclusive breastfeeding until 6 months and continued breastfeeding until at least 2 years as per global recommendations are common practice. The Indian government and associated organisations have strived to protect breastfeeding, which is important in a country with high under‐5 mortality, malnutrition and stunting. Allergic disease is under‐recognised in India, but despite the absence of a dedicated allergy medical specialty, awareness of allergy is increasing among healthcare practitioners and in the general population. In high‐income countries, overdiagnosis of allergy has become recognised as an issue in recent years. Allergy healthcare professionals have also attracted criticism for close relationships with the formula industry, which appear to have contributed to excessive use of specialised formula products and undermining of breastfeeding. Specialised formula has been used unnecessarily for preventing allergy, based on fraudulent and selectively reported science; and for managing normal infant symptoms which are mislabelled as milk allergy. This forms part of a broader formula industry corporate strategy to widen the boundaries of illness in order to expand sales and markets. In India, allergic disease management is hindered by limited understanding of the disease entity among practitioners, low access to diagnostics, limited healthcare resources, high exposure to air pollution and a large, diverse population. Data specific to India on allergic disease prevalence and interpreting allergy diagnostics are incomplete. The knowledge gaps mean allergy management in India is often extrapolated from guidance developed in high‐income countries with low breastfeeding rates. As the allergy specialty develops in India, local guidance and practice will need to recognise the threat that current allergy practice poses to India's normative infant feeding culture, and ensure that breastfeeding continues to be supported at all levels.
Association of socioeconomic deprivation with sleep health in patients with type 2 diabetes
Authors: Xue Pei , Tan Xiao , Benedict Christian
Published: June 2023

Aims

To investigate the association between socioeconomic deprivation and indicators of sleep health among patients with type 2 diabetes mellitus (T2DM), and additionally, to examine whether socioeconomic deprivation is associated with higher glycated haemoglobin (HbA1c) levels in these patients.

Materials and Methods

We analysed data from the UK Biobank, consisting of 17 206 participants with T2DM, to explore the relationship between socioeconomic deprivation, self‐reported indicators of sleep health, and HbA1c levels. Socioeconomic deprivation was assessed using the Townsend deprivation index. Participants were divided into two groups: low socioeconomic deprivation (n = 8604; reference group) and high socioeconomic deprivation (n = 8602). Logistic regression models were employed, adjusting for covariates such as body mass index (BMI), age, and biological sex.

Results

Patients with high socioeconomic deprivation had higher odds of reporting usual difficulties falling asleep or sleeping through the night (adjusted odds ratio 1.20, 95% confidence interval [CI] 1.12, 1.28), and they were more likely to use at least one hypnotic medication (adjusted odds ratio 1.41, 95% CI 1.09, 1.84). They also had higher odds of reporting snoring and difficulties staying awake during the daytime (adjusted odds ratio 1.09, 95% CI 1.01, 1.18), as well as experiencing short sleep duration (defined as <6 hours of sleep per day; adjusted odds ratio 1.69, 95% CI 1.50, 1.91). Moreover, patients with high socioeconomic deprivation had increased odds of experiencing comorbid sleep problems (P ≤ 0.001). Finally, high socioeconomic deprivation was associated with a 0.1% higher HbA1c level (P < 0.001). Controlling for indicators of poor sleep health did not alter the strength of this association.

Conclusions

Socioeconomic deprivation may represent a risk factor for poor sleep health in patients with T2DM.
Using historical catch data to evaluate predicted changes in fish relative abundance in response to a warming climate
Authors: King Katelyn B. S. , Giacomini Henrique C. , Wehrly Kevin , López‐Fernández Hernán , Thomer Andrea K. , Alofs Karen M.
Published: June 2023

Using models to predict future changes in species distributions in response to projected climate change is a common tool to aid management and species conservation. However, the assumption underlying this approach, that ecological processes remain stationary through time, can be unreliable, and more empirical tests are needed to validate predictions of biotic outcomes of global change. The scarcity of reliable historical and long‐term datasets can make these tests difficult. Moreover, incorporating abundance and multiple sampling methods can improve model predictions and usability for management. Our study 1) provides insight into how well models can predict environmental change under a warming climate, 2) incorporates multiple sampling gears and abundance data in modeling to better capture changes in populations and 3) shows the value of historical datasets for improving predictive models of population change. We used contemporary (2003–2019) and historical (1936–1964) abundance datasets of the North American fish largemouth bass Micropterus salmoides in lakes across the state of Michigan, USA. We developed Bayesian hierarchical models that leverage the use of multiple gears in contemporary lake surveys to estimate the relative catchabilities of largemouth bass for each gear and hindcast the models to predict historical abundance. Our estimates of relative density change over time were correlated with temperature change over time; increasing surface water temperature led to increasing largemouth bass density. Hindcasting models to historical lake temperatures performed similarly in predicting historical density to models predicting contemporary density. Our results suggest that models built using spatial environmental gradients can reliably predict population changes through time. Understanding the sampling methods and the environmental context of observational datasets can help researchers test for potential sampling biases and identify confounding factors that will improve predictions of future impacts of environmental change.
Knowledge of traumatic dental injuries and mouthguard behavior among Croatian soccer players
Authors: Kasum Marin , Gavic Lidia , Mandic Petra , Tadin Antonija
Published: June 2023

Objectives/Aim

Sports‐related dental injuries occur frequently among athletes due to inadequate knowledge and prevention measures. The aim of the study was to assess knowledge, attitudes, and practices of active soccer players from all leagues in Croatia regarding traumatic dental injuries and the use of mouthguards.

Material and Methods

393 respondents completed a questionnaire‐based online survey from March 2022 to April 2022. The questionnaire consisted of 37 questions divided in four sections: demographic characteristics, experience with orofacial injuries, knowledge of emergency therapeutic procedures for dental injuries, and behaviors related to the use of a mouthguard.

Results

Insufficient knowledge was confirmed by a total score of 2.8 ± 2.8 points, with a possible maximum of 11. Respondents' better knowledge can be associated with educational level (p = .002), playing position (p = .046), and personally experienced injuries to the face and jaw (p ≤ .001) and teeth (p = .022). Less than 40% of respondents suffered facial and jaw injuries while playing football and 18.6% suffered dental injuries. Although most respondents (93.9%) were familiar with mouthguards and 68.9% believed that they help prevent injuries while playing football, only 16% used them.

Conclusion

The study revealed significant gaps in knowledge regarding dental injuries and the practice of mouthguard usage among Croatian soccer players. Therefore, it is evident that additional education is needed to prevent dental injuries and take proper procedures when taking care of them among the examined population.