bluuebunny/crossref_metadata_2025 huggingface dataset:
Two-year imaging outcomes from a phase 3 randomized trial of secukinumab in patients with non-radiographic axial spondyloarthritis
Authors: Braun Juergen , Blanco Ricardo , Marzo-Ortega Helena , Gensler Lianne S. , Van den Bosch Filip , Hall Stephen , Kameda Hideto , Poddubnyy Denis , van de Sande Marleen , van der Heijde Désirée , Zhuang Tingting , Stefanska Anna , Readie Aimee , Richards Hanno B. , Deodhar Atul
Published: May 2023

Background

Radiographic progression and course of inflammation over 2 years in patients with non-radiographic axial spondyloarthritis (nr-axSpA) from the phase 3, randomized, PREVENT study are reported here.

Methods

In the PREVENT study, adult patients fulfilling the Assessment of SpondyloArthritis International Society classification criteria for nr-axSpA with elevated CRP and/or MRI inflammation received secukinumab 150 mg or placebo. All patients received open-label secukinumab from week 52 onward. Sacroiliac (SI) joint and spinal radiographs were scored using the modified New York (mNY) grading (total sacroiliitis score; range, 0–8) and modified Stoke Ankylosing Spondylitis Spine Score (mSASSS; range, 0–72), respectively. SI joint bone marrow edema (BME) was assessed using the Berlin Active Inflammatory Lesions Scoring (0–24) and spinal MRI using the Berlin modification of the AS spine MRI (ASspiMRI) scoring (0–69).

Results

Overall, 78.9% (438/555) of patients completed week 104 of the study. Over 2 years, minimal changes were observed in total radiographic SI joint scores (mean [SD] change, − 0.04 [0.49] and 0.04 [0.36]) and mSASSS scores (0.04 [0.47] and 0.07 [0.36]) in the secukinumab and placebo-secukinumab groups. Most of the patients showed no structural progression (increase ≤ smallest detectable change) in SI joint score (87.7% and 85.6%) and mSASSS score (97.5% and 97.1%) in the secukinumab and placebo-secukinumab groups. Only 3.3% (n = 7) and 2.9% (n = 3) of patients in the secukinumab and placebo-secukinumab groups, respectively, who were mNY-negative at baseline were scored as mNY-positive at week 104. Overall, 1.7% and 3.4% of patients with no syndesmophytes at baseline in the secukinumab and placebo-secukinumab group, respectively, developed ≥ 1 new syndesmophyte over 2 years. Reduction in SI joint BME observed at week 16 with secukinumab (mean [SD], − 1.23 [2.81] vs − 0.37 [1.90] with placebo) was sustained through week 104 (− 1.73 [3.49]). Spinal inflammation on MRI was low at baseline (mean score, 0.82 and 1.07 in the secukinumab and placebo groups, respectively) and remained low (mean score, 0.56 at week 104).

Conclusion

Structural damage was low at baseline and most patients showed no radiographic progression in SI joints and spine over 2 years in the secukinumab and placebo-secukinumab groups. Secukinumab reduced SI joint inflammation, which was sustained over 2 years.

Trial registration

ClinicalTrials.gov, NCT02696031.
The mediating role of perceived behavioral control in the relationship between entrepreneurship education and entrepreneurial intentions of university students in Ethiopia
Authors: Aga Messele Kumilachew
Published: May 2023

Unemployment of graduates from higher education institutions has become a common phenomenon in Ethiopia. To minimize this problem, entrepreneurship development and promoting entrepreneurial ecosystems have been considered as a remedy. Among others, this could be achieved through fostering entrepreneurship education. Hence, the purpose of this paper is to investigate the mediating role of perceived behavioral control in the relationship between entrepreneurship education and entrepreneurial intentions in Ethiopian Universities. Explanatory research design was used and data were collected using a self-administered questionnaire from a sample of 335 undergraduate students who have taken the course entrepreneurship in four Ethiopian universities. Structural Equation Modeling (SEM) approach using AMOS software was employed and confirmed both measurement and structural model fit before analysis. Then, the findings revealed that entrepreneurship education has a positive and significant effect on entrepreneurial intentions and perceived behavioral control. Moreover, perceived behavioral control positively predicts entrepreneurial intentions. The findings further explained that perceived behavioral control has a partial mediating effect in the relationship between entrepreneurship education and entrepreneurial intentions. Therefore, universities in Ethiopia should work on different initiatives that enhance knowledge, attitude, and skills of students on entrepreneurship that could help them to develop perceived behavioral control so as to enhance their intentions to become nascent entrepreneur after their graduation.
Geography, not lifestyle, explains the population structure of free-living and host-associated deep-sea hydrothermal vent snail symbionts
Authors: Hauer Michelle A. , Breusing Corinna , Trembath-Reichert Elizabeth , Huber Julie A. , Beinart Roxanne A.
Published: May 2023

Background

Marine symbioses are predominantly established through horizontal acquisition of microbial symbionts from the environment. However, genetic and functional comparisons of free-living populations of symbionts to their host-associated counterparts are sparse. Here, we assembled the first genomes of the chemoautotrophic gammaproteobacterial symbionts affiliated with the deep-sea snailAlviniconcha hesslerifrom two separate hydrothermal vent fields of the Mariana Back-Arc Basin. We used phylogenomic and population genomic methods to assess sequence and gene content variation between free-living and host-associated symbionts.

Results

Our phylogenomic analyses show that the free-living and host-associated symbionts ofA. hesslerifrom both vent fields are populations of monophyletic strains from a single species. Furthermore, genetic structure and gene content analyses indicate that these symbiont populations are differentiated by vent field rather than by lifestyle.

Conclusion

Together, this work suggests that, despite the potential influence of host-mediated acquisition and release processes on horizontally transmitted symbionts, geographic isolation and/or adaptation to local habitat conditions are important determinants of symbiont population structure and intra-host composition.
Differences in sleep patterns between patients with anorexia nervosa and healthy controls: a cross-sectional study
Authors: Kleppe Malin Mandelid , Kessler Ute , Rekkedal Guro Årdal , Skjåkødegård Hanna Flækøy , Danielsen Yngvild Sørebø
Published: May 2023

Background

Sleep difficulties are common in patients with anorexia nervosa (AN), but objective assessments have mostly been performed in hospital and laboratory settings. We aimed to identify differences in sleep patterns between patients with AN and healthy controls (HC) in their free-living environments, and potential associations between sleep patterns and clinical symptoms in patients with AN.

Methods

This cross-sectional study analyzed 20 patients with AN prior to them starting outpatient treatment and 23 HC. Sleep patterns were measured objectively using an accelerometer (Philips Actiwatch 2) for 7 consecutive days. Average sleep onset, sleep offset, total sleep time, sleep efficiency, wake after sleep onset (WASO) and mid-sleep awakenings lasting ≥ 5 min were compared between patients with AN and HC using nonparametric statistical analyses. Associations of sleep patterns with body mass index, eating-disorder symptoms, eating-disorder-associated impairment, and symptoms of depression were assessed in the patient group.

Results

Compared with HC, patients with AN had shorter WASO [median (interquartile range(IQR)): 33 vs. 42 min], but a longer average duration of mid-sleep awakenings lasting ≥ 5 min [median (IQR): 9 vs. 6 min, p = 0.006] and had more nights with no sleep (six nights in four patients with AN vs. zero nights in HC). There were no differences between patients with AN and HC regarding other sleep parameters and no significant correlations between sleep patterns and clinical parameters in patients with AN. However, HC presented a Intraindividual variability pattern that was closer to a normal distribution, whereas patients with AN tended to either have very regular or large variability in sleep onset time (AN; n = 7 < 25th percentile and n = 8 > 75th percentile vs. HC; n = 4 < 25 percentile and n = 3 > 75th percentile) during the week of sleep recordings.

Conclusion

Patients with AN seem to spend more time awake during the night and have more nights without sleep than do HC, even though their average weekly sleep duration did not differ from that in HC. The intraindividual variability in sleep pattern seems to be an important parameter that should be assessed when studying sleep in patients with AN.

Trial registration ClinicalTroals.gov. Identifier: NCT02745067. Registered: April 20, 2016.
Abrupt water temperature increases near seafloor during the 2011 Tohoku earthquake
Authors: Inazu Daisuke , Ito Yoshihiro , Hino Ryota , Tanikawa Wataru
Published: May 2023

We investigated temperature records associated with seafloor pressure observations at eight stations that experienced the 2011 Mw 9 Tohoku earthquake near its epicenter. The temperature data were based on the temperature measured inside the pressure transducer. We proposed a method to estimate ambient water temperature from the internal temperature using an equation of heat conduction. The estimated seafloor water temperature showed remarkable anomalies, especially increases several hours after the Mw 9 earthquake. A station of P03 (sea depth of 1.1 km) showed an abrupt temperature increase of + 0.19 °C that occurred ~ 3 h after the earthquake, which lasted for several hours. At stations of GJT3 (sea depth of 3.3 km) and TJT1 (sea depth of 5.8 km), there were abrupt temperature anomalies of + 0.20 °C and + 0.10 °C that began to occur 3–4 h after the earthquake. These anomalies both decayed to their original levels over a few tens of days. During the decay processes, only TJT1 showed several intermittent temperature rises. A water temperature anomaly within + 0.03 °C was found up to ~ 500 m above TJT1 2 weeks after the earthquake. There was no significant anomaly at the other five stations. Processes to cause these seafloor temperature anomalies were discussed. The temperature anomaly of P03 was reasonably caused by a tsunami-generated turbidity current, as also suggested by a previous study. Meanwhile, we proposed a scenario that the abrupt temperature anomalies of GJT3/TJT1 and the intermittent anomalies of TJT1 were caused by warm water discharges from the subseafloor. The pathways of the warm water were probably composed of the branch normal fault between GJT3 and TJT1, the reverse fault near TJT1, the backstop interface, and perhaps reverse faults at the frontal prism. The proposed scenario was almost compatible with other studies based on epicentral observations. We estimated the heat properties of the initial temperature anomalies of GJT3/TJT1. The estimated heat source might be explained by that most of the geothermal fluids trapped in those fault pathways were discharged to the seafloor immediately after the earthquake. The onsets of the subsequent intermittent anomalies of TJT1 were possibly activated by low or falling ocean tidal loading.
A case of Amyand hernia at the Central Hospital of Yaounde and review of the literature
Authors: Fouda J. C. , Owon’Abessolo Philip Fernandez , Nyanit Bob Dorcas , Mekeme Mekeme Junior Barthelemy , Savom P. , Ranibel A. , Mbassi A. A. , Bwelle G. , Bang G. A. , Fouda P. J. , Mouafo Tambo Faustin , Essomba A.
Published: May 2023

Introduction

Amyand's hernia is defined as an inguinal hernia, containing the appendix in the hernia sac. It is a rare form of hernia. Its management is increasingly codified.

Clinical history

A 5-year-old patient with a non-remarkable past history was brought for consultation with an intermittent inguino-scrotal swelling and discomfort. Clinical examination revealed a non-tender inguino-scrotal swelling with positive transillumination. A conclusion of a communicating hydrocele was made; hence, an indication for surgery. Per operatively, we had as findings the appendix present within, and linked to the hernia sac. We performed an appendectomy and a high ligation of the hernia sac. The post-operative evolution was favourable. Anatomopathological analysis revealed a catarrhal appendix.

Conclusion

Amyand's hernia remains a rare pathology that can be seen in children with a persistent peritoneo-vaginal canal. Dissection of the hernia sac must be carried out carefully since it is most often discovered intraoperatively and accidental injury to the appendix, which is attached to the wall of the hernia sac can lead to serious complications.
Emerging biomaterials for tumor immunotherapy
Authors: Xiao Minna , Tang Qinglai , Zeng Shiying , Yang Qian , Yang Xinming , Tong Xinying , Zhu Gangcai , Lei Lanjie , Li Shisheng
Published: May 2023

Background

The immune system interacts with cancer cells in various intricate ways that can protect the individual from overproliferation of cancer cells; however, these interactions can also lead to malignancy. There has been a dramatic increase in the application of cancer immunotherapy in the last decade. However, low immunogenicity, poor specificity, weak presentation efficiency, and off-target side effects still limit its widespread application. Fortunately, advanced biomaterials effectively contribute immunotherapy and play an important role in cancer treatment, making it a research hotspot in the biomedical field.

Main body

This review discusses immunotherapies and the development of related biomaterials for application in the field. The review first summarizes the various types of tumor immunotherapy applicable in clinical practice as well as their underlying mechanisms. Further, it focuses on the types of biomaterials applied in immunotherapy and related research on metal nanomaterials, silicon nanoparticles, carbon nanotubes, polymer nanoparticles, and cell membrane nanocarriers. Moreover, we introduce the preparation and processing technologies of these biomaterials (liposomes, microspheres, microneedles, and hydrogels) and summarize their mechanisms when applied to tumor immunotherapy. Finally, we discuss future advancements and shortcomings related to the application of biomaterials in tumor immunotherapy.

Conclusion

Research on biomaterial-based tumor immunotherapy is booming; however, several challenges remain to be overcome to transition from experimental research to clinical application. Biomaterials have been optimized continuously and nanotechnology has achieved continuous progression, ensuring the development of more efficient biomaterials, thereby providing a platform and opportunity for breakthroughs in tumor immunotherapy.

Graphical Abstract
Korean language teachers’ vulnerability over English competency in Korean-only classrooms
Authors: Song Juyoung
Published: May 2023

The recent trend of the internationalization of higher education has increased the significance of English as a medium of instruction and communication on campus in non-English speaking countries. Within this context, this study explores emotional vulnerability of teachers of Korean as a second language (KSL) over their foreign language competency, particularly English. Analysis of interviews of twelve KSL teachers demonstrates these teachers’ divergent ways of interpreting and implementing Korean-only instruction, a prevalent norm within the language program, according to their perceived foreign language competency and relevant emotional vulnerability. KSL teachers with proficiency in other foreign language(s) tended to challenge the monolingual norm by utilizing their bilingual skills and experiences as resources for their teaching. Monolingual KSL teachers interpreted Korean-only narrowly and supported a monolingual immersion approach as a way to secure their teacher authority. Regardless of their attitudes towards the Korean-only instruction, however, most teachers experienced various levels of anxiety concerning their perceived lack of adequate English proficiency in the KSL classroom. The results suggest how second language teachers struggle to maintain legitimacy and authority against the hegemony of English in non-English second language contexts, providing implications for the language teacher education.
Virtual reality in the management of patients with low back and neck pain: a retrospective analysis of 82 people treated solely in the metaverse
Authors: Orr Eran , Arbel Tal , Levy Miki , Sela Yaron , Weissberger Omer , Liran Omer , Lewis Jeremy
Published: May 2023

Background

Clinically, neck pain disorders (NPD) and non-specific low back pain (NS-LBP) are respectively the fourth and first most common conditions associated with the greatest number of years lived with disability. Remote delivery of care may benefit healthcare sustainability, reduce environmental pollution, and free up space for those requiring care non-virtual care.

Methods

A retrospective analysis was performed on 82 participants with NS-LBP and/or NPD who received exercise therapy delivered solely in the metaverse using virtually reality. The study was to determine if this was achievable, safe, had appropriate outcome measures that could be collected, and if there was any early evidence of beneficial effects.

Results

The study demonstrated that virtual reality treatment delivered via the metaverse appears to be safe (no adverse events or side effects). Data for more than 40 outcome measures were collected. Disability from NS-LBP was significantly reduced (Modified Oswestry Low Back Pain Disability Index) by 17.8% (p < 0.001) and from NPD (Neck Disability Index) by 23.2% (p = 0.02).

Conclusions

The data suggest that this method of providing exercise therapy was feasible, and safe (no adverse events reported), that complete reports were obtained from a large selection of patients, and that software acquired outcomes were obtainable over a range of time points. Further prospective research is necessary to better understand our clinical findings.
Effect of shipping trade on economic growth in Nigeria: the Vector Error Correction Model (VECM) approach
Authors: Adenigbo Adedotun Joseph , Mageto Joash , Luke Rose
Published: May 2023

The maritime industry is significant to the growth and development of nations. The relationship between shipping trade and economic growth in Nigeria is acknowledged in the literature. Still, the need to emphasise the role of shipping import and export volume and exchange rate volatility in Nigeria’s economic growth remains. The economic growth and development level that a maritime nation will derive from its ocean depends on its import and export volumes in the face of exchange rate volatility. Using the Vector Error Correction Model, this study analyses the effect of shipping trade on economic growth in Nigeria from 1970 to 2020. The study examines the effect of seaport imports, exports, and real exchange rates on GDP to determine if Nigeria’s economic growth is sustainable, that is if the current pattern of shipping imports and exports for economic growth will not hamper future economic development. The cointegration test established a short- and long-term causality from import, export and exchange rates to GDP. The result showed that Nigeria’s economic growth is import-dependent and that, in the long run, import and exchange rates significantly affect GDP. The study further indicates that the present export volume does not significantly contribute to GDP growth. The results imply that building an economic system on an import-dominated trade system is not sustainable for future development. The study recommended strategic initiatives to maintain the economic growth rate while promoting export through local production.
Leafhopper transmits soybean stay-green associated virus to leguminous plants
Authors: Yin Jinlong , Hu Zhuangzhuang , Xu Shuqi , Hong Xin , Qiu Yanglin , Cheng Xinge , Wang Liqun , Shen Weiliang , Zhi Haijian , Li Kai , Xu Kai
Published: May 2023

A novel geminivirus, soybean stay-green associated virus (SoSGV), was previously shown to cause soybean delayed senescence and is associated with the incidence of soybean stay-green syndrome. The modes of SoSGV transmission were not yet known. We captured insects belonging to 24 distinct species in a soybean field with the SoSGV outbreak and detected the presence of SoSGV only in leafhoppers and bean bugs (Riptortus pedestris). Caged feeding experiments using captured leafhoppers and bean bugs from soybean fields showed that leafhoppers, but not bean bugs, are vectors transmitting SoSGV. The common brown leafhopper (Orosius orientalis) is identified as the dominant leafhopper species and can establish colonies feeding on soybean plants in experimental conditions. An investigation of SoSGV defective DNA revealed that soybean genomic DNA fragments could be inserted into the SoSGV genome, while sequences from wild soybean, red bean, and cowpea were also identified. We further showed that the common brown leafhopper could transmit SoSGV to wild soybean and red bean plants, emphasizing a vector’s role of the leafhopper in the transmission of SoSGV in the field.
How does facilitation in healthcare work? Using mechanism mapping to illuminate the black box of a meta-implementation strategy
Authors: Kilbourne Amy M. , Geng Elvin , Eshun-Wilson Ingrid , Sweeney Shannon , Shelley Donna , Cohen Deborah J. , Kirchner JoAnn E. , Fernandez Maria E. , Parchman Michael L.
Published: May 2023

Background

Healthcare facilitation, an implementation strategy designed to improve the uptake of effective clinical innovations in routine practice, has produced promising yet mixed results in randomized implementation trials and has not been fully researched across different contexts.

Objective

Using mechanism mapping, which applies directed acyclic graphs that decompose an effect of interest into hypothesized causal steps and mechanisms, we propose a more concrete description of how healthcare facilitation works to inform its further study as a meta-implementation strategy.

Methods

Using a modified Delphi consensus process, co-authors developed the mechanistic map based on a three-step process. First, they developed an initial logic model by collectively reviewing the literature and identifying the most relevant studies of healthcare facilitation components and mechanisms to date. Second, they applied the logic model to write vignettes describing how facilitation worked (or did not) based on recent empirical trials that were selected via consensus for inclusion and diversity in contextual settings (US, international sites). Finally, the mechanistic map was created based on the collective findings from the vignettes.

Findings

Theory-based healthcare facilitation components informing the mechanistic map included staff engagement, role clarification, coalition-building through peer experiences and identifying champions, capacity-building through problem solving barriers, and organizational ownership of the implementation process. Across the vignettes, engagement of leaders and practitioners led to increased socialization of the facilitator’s role in the organization. This in turn led to clarifying of roles and responsibilities among practitioners and identifying peer experiences led to increased coherence and sense-making of the value of adopting effective innovations. Increased trust develops across leadership and practitioners through expanded capacity in adoption of the effective innovation by identifying opportunities that mitigated barriers to practice change. Finally, these mechanisms led to eventual normalization and ownership of the effective innovation and healthcare facilitation process.

Impact

Mapping methodology provides a novel perspective of mechanisms of healthcare facilitation, notably how sensemaking, trust, and normalization contribute to quality improvement. This method may also enable more efficient and impactful hypothesis-testing and application of complex implementation strategies, with high relevance for lower-resourced settings, to inform effective innovation uptake.
Pulmonary cavernous hemangioma combined with smooth muscle hyperplasia: a case report and review of the literature
Authors: Ibe Takashi , Kosaka Takayuki , Sugano Masayuki , Kakizaki Satoru , Shirabe Ken
Published: May 2023

Background

Cavernous hemangiomas are usually located in the liver, skin, and subcutaneous tissues. Although they can arise from any organ, cavernous hemangiomas rarely occur as a pulmonary tumor. We herein report a rare case of a pulmonary cavernous hemangioma that was surgically resected.

Case presentation

A woman in her 40s was found to have 2 well-defined nodules in the lower lobe of the left lung by computed tomography during following up of bladder cancer. She had a history of surgery for tetralogy of Fallot at 6 years old and pulmonary valve replacement for pulmonary valve insufficiency in her late 30s. She had also undergone surgery for bladder cancer. Although there was no accumulation of 18F-fluorodeoxyglucose on positron emission tomography (PET), the tumor slowly grows. Surgical resection was therefore performed to obtain a definitive diagnosis. The postoperative histological examination revealed an encapsulated nodule comprising large, dilated vessels lined with vascular endothelium and filled with blood, which led to the diagnosis of a pulmonary cavernous hemangioma.

Conclusion

We experienced a rare case of pulmonary cavernous hemangioma and reviewed the previous reports.
Unfolding a composed ensemble of energy spectra using singular value decomposition
Authors: Berkovits Richard
Published: May 2023

In comparing the behavior of an energy spectrum to the predictions of random matrix theory one must transform the spectrum such that the averaged level spacing is constant, a procedure known as unfolding. Once energy spectra belong to an ensemble where there are large realization-to-realization fluctuations the canonical methods for unfolding fail. Here we show that singular value decomposition can be used even for the challenging situations where the ensemble is composed out of realizations originating from a different range of parameters resulting in a non-monotonous local density of states. This can be useful in experimental situations for which the physical parameters cannot be tightly controlled, or for situations for which the local density of states is strongly fluctuating.
Association of Sarcopenia with a Poor Prognosis and Decreased Tumor-Infiltrating CD8-Positive T Cells in Pancreatic Ductal Adenocarcinoma: A Retrospective Analysis
Authors: Masuda Shigeto , Yamakawa Kohei , Masuda Atsuhiro , Toyama Hirochika , Sofue Keitaro , Nanno Yoshihide , Komatsu Shohei , Omiya Satoshi , Sakai Arata , Kobayashi Takashi , Tanaka Takeshi , Tsujimae Masahiro , Ashina Shigeto , Gonda Masanori , Abe Shohei , Uemura Hisahiro , Kohashi Shinya , Inomata Noriko , Nagao Kae , Harada Yoshiyuki , Miki Mika , Irie Yosuke , Juri Noriko , Kanzawa Maki , Itoh Tomoo , Fukumoto Takumi , Kodama Yuzo
Published: May 2023

Background

Sarcopenia, defined as a loss of skeletal muscle mass and quality, is found in 30–65% of patients with pancreatic ductal adenocarcinoma (PDAC) at diagnosis, and is a poor prognostic factor. However, it is yet to be evaluated why sarcopenia is associated with poor prognosis. Therefore, this study elucidated the tumor characteristics of PDAC with sarcopenia, including driver gene alterations and tumor microenvironment.

Patients and Methods

We retrospectively analyzed 162 patients with PDAC who underwent pancreatic surgery between 2008 and 2017. We defined sarcopenia by measuring the skeletal muscle mass at the L3 level using preoperative computed tomography images and evaluated driver gene alteration (KRAS,TP53,CDKN2A/p16, andSMAD4) and tumor immune (CD4+, CD8+, and FOXP3+) and fibrosis status (stromal collagen).

Results

In localized-stage PDAC (stage ≤ IIa), overall survival (OS) and recurrence-free survival were significantly shorter in the sarcopenia group than in the non-sarcopenia group (2-year OS 89.7% versus 59.1%,P= 0.03; 2-year RFS 74.9% versus 50.0%,P= 0.02). Multivariate analysis revealed that sarcopenia was an independent poor prognostic factor in localized-stage PDAC. Additionally, tumor-infiltrating CD8+T cells in the sarcopenia group were significantly less than in the non-sarcopenia group (P= 0.02). However, no difference was observed in driver gene alteration and fib.rotic status. These findings were not observed in advanced-stage PDAC (stage ≥ IIb).

Conclusions

Sarcopenia was associated with a worse prognosis and decreased tumor-infiltrating CD8+T cells in localized-stage PDAC. Sarcopenia may worsen a patient’s prognosis by suppressing local tumor immunity.
Central venous catheters: Which, when and how
Authors: Kehagias Elias , Galanakis Nikolaos , Tsetis Dimitrios
Published: May 2023

Short-term or long-term CVCs are now considered the standard of practice for the administration of chemotherapy, fluid therapy, antibiotic therapy, and parenteral nutrition. Central venous access catheters are broadly divided into tunneled or non-tunneled catheters. Tunneled catheters can be further subdivided into totally implanted and totally not implanted devices. Device selection generally depends on various factors such as availability of peripheral veins, expected duration of therapy, and desired flow rate. Ultrasound-guided access is the safest technique for central venous access compared to the landmark technique and departments should strive to for a 100% ultrasound guided access. This review gives a basic overview of the differences of CVC catheters including PICCs, Hickman-catheters and port-catheters along with the criteria for CVC selection. It will also describe technical tips on placement of CVCs. Finally, it aims to highlight complications which are associated with CVC placement and options to treat or prevent them.
The incremental value of CCTA-derived myocardial radiomics signature for ischemia diagnosis with reference to CT myocardial perfusion imaging
Authors: Zhu Meng-meng , Zhu Xiao-mei , Lin Shu-shen , Dong Si-ting , Liu Wang-yan , zhang Jia-yin , Xu Yi
Published: May 2023

Objectives:

To explore the incremental value of myocardial radiomics signature derived from static coronary computed tomography angiography (CCTA) for identifying myocardial ischemia based on stress dynamic CT myocardial perfusion imaging (CT-MPI).

Methods:

Patients who underwent CT-MPI and CCTA were retrospectively enrolled from two independent institutions, one used as training and the other as testing. Based on CT-MPI, coronary artery supplying area with relative myocardial blood flow (rMBF) value <0.8 was considered ischemia. Conventional imaging features of target plaques which caused the most severe narrowing of the vessel included area stenosis, lesion length (LL), total plaque burden, calcification burden, non-calcification burden, high-risk plaque (HRP) score, and CT fractional flow reserve (CT-FFR). Myocardial radiomics features were extracted at three vascular supply areas from CCTA images. The optimized radiomics signature was added to the conventional CCTA features to build the combined model (radiomics + conventional).

Results:

There were 168 vessels from 56 patients enrolled in the training set, and the testing set consisted of 135 vessels from 45 patients. From either cohort, HRP score, LL, stenosis ≥50% and CT-FFR ≤0.80 were associated with ischemia. The optimal myocardial radiomics signature consisted of nine features. The detection of ischemia using the combined model was significantly improved compared with conventional model in both training and testing set (AUC 0.789 vs 0.608, p < 0.001; 0.726 vs 0.637, p = 0.045).

Conclusions:

Myocardial radiomics signature extracted from static CCTA combining with conventional features could provide incremental value to diagnose specific ischemia.

Advances in knowledge:

Myocardial radiomics signature extracted from CCTA may capture myocardial characteristics and provide incremental value to detect specific ischemia when combined with conventional features.
The correlation of left atrial dysfunction and amyloid load in patients with immunoglobulin light-chain cardiac amyloidosis: a 3T cardiac magnetic resonance study
Authors: Lu Jianyao , Yang Zhaoxia , Tang Dazong , Luo Yi , Xiang Chunlin , Zhou Xiaoyue , Huang Lu , Xia Liming
Published: May 2023

Objective:

To investigate the left atrial (LA) changes in immunoglobulin light-chain cardiac amyloidosis (AL-CA) patients with different risk stratifications and to explore the correlation between LA function and the degree of amyloid load using cardiac magnetic resonance (CMR) imaging.

Methods:

Forty-three AL-CA patients were retrospectively enrolled and were divided into low-to-moderate-risk group (n = 16, increased NT-proBNP or troponin I, or both normal) and high-risk group (n = 27, increased NT-proBNP and troponin I). 20 healthy individuals matched for age and gender were included. The function, myocardial deformation of left heart, and left ventricular (LV) tissue characterization among the three groups were compared. The correlation between LA function and LV tissue characterization was investigated.

Results:

Compared with the controls, the AL-CA patients had a larger LA volume, lower left atrial emptying fraction (LAEF) and impaired left atrial strain (LAS). The high-risk group exhibited lower reservoir and booster function and increased LV extracellular volume (LV-ECV) than the low-to-moderate-risk group (p < 0.05). LV-ECV was significantly correlated with LAS and LAEF (all p < 0.05) but not LAEFconduit. The LAS and LAEF had a good diagnostic ability for risk stratification of AL-CA patients (area under the curve, 0.70 ~ 0.72).

Conclusion:

High-risk AL-CA patients showed more severe LA function impairment than low-to-moderate-risk AL-CA patients. LAS and LAEF were closely associated with LV-ECV in AL-CA patients, LAS and LAEF exhibited good capability to differentiate AL-CA patients of different risk stratifications.

Advances in knowledge:

CMR-derived LAS and LAEF were correlated with amyloid load, allowing for differentiation of AL-CA patients at different risk stages.
Comparing the Denver criteria sets for blunt trauma: a retrospective study of cases in Edmonton, Alberta
Authors: Wagner Mitchell J. , Hussein Imaan , Low Gavin , Samji Karim Bahadurali
Published: May 2023

Objective:

To determine whether a more conservative Denver criterion set could reduce unnecessary CT angiography (CTA) studies when screening for blunt cerebrovascular injury (BCVI) following blunt trauma.

Methods:

Following ethics approval, a retrospective chart review of 447 consecutive patients undergoing emergency CTA at two large teaching hospitals was conducted to determine the presence of risk factors for each Denver criterion set. Imaging studies of adults conducted between January 2016 and June 2020 containing sufficient clinical information for accurate classification were included in the study. Specificity, sensitivity, and predictive values were calculated. A two-sided Fisher exact test was used to evaluate the association between each iteration of the Denver criteria and the presence of BCVI.

Results:

The specificities of the Original, Modified, and Expanded Denver criteria were 43.58%, 34.32%, and 24.85%, respectively. Positive-predictive values (PPV) followed a different trend, with respective values of 2.77%, 3.06%, and 2.78%. Sensitivity and negative-predictive values (NPV) were found to be 100% for each criterion set. Being positive for a criterion set, and the presence of BCVI, was statistically significant for the original Denver criteria (p = 0.021, n = 443), but not the modified (p = 0.100, n = 345) or expanded Denver criteria (p = 0.202, n = 333).

Conclusion:

Use of the modified and expanded Denver criteria leads to the overuse of cerebrovascular imaging on patients suffering blunt force trauma.

Advances in knowledge:

The original Denver criteria may more appropriately identify subjects for further evaluation with CTA than the current standard, while retaining diagnostic efficacy for BCVI.
CT image-based biomarkers acquired by AI-based algorithms for the opportunistic prediction of falls
Authors: Liu Daniel , Binkley Neil C , Perez Alberto , Garrett John W , Zea Ryan , Summers Ronald M , Pickhardt Perry J
Published: May 2023

Objective

Evaluate whether biomarkers measured by automated artificial intelligence (AI)-based algorithms are suggestive of future fall risk.

Methods

In this retrospective age- and sex-matched case–control study, 9029 total patients underwent initial abdominal CT for a variety of indications over a 20-year interval at one institution. 3535 case patients (mean age at initial CT, 66.5 ± 9.6 years; 63.4% female) who went on to fall (mean interval to fall, 6.5 years) and 5494 controls (mean age at initial CT, 66.7 ± 9.8 years; 63.4% females; mean follow-up interval, 6.6 years) were included. Falls were identified by electronic health record review. Validated and fully automated quantitative CT algorithms for skeletal muscle, adipose tissue, and trabecular bone attenuation at the level of L1 were applied to all scans. Uni- and multivariate assessment included hazard ratios (HRs) and area under the receiver operating characteristic (AUROC) curve.

Results

Fall HRs (with 95% CI) for low muscle Hounsfield unit, high total adipose area, and low bone Hounsfield unit were 1.82 (1.65–2.00), 1.31 (1.19–1.44) and 1.91 (1.74–2.11), respectively, and the 10-year AUROC values for predicting falls were 0.619, 0.556, and 0.639, respectively. Combining all these CT biomarkers further improved the predictive value, including 10-year AUROC of 0.657.

Conclusion

Automated abdominal CT-based opportunistic measures of muscle, fat, and bone offer a novel approach to risk stratification for future falls, potentially by identifying patients with osteosarcopenic obesity.

Advances in knowledge

There are few well-established clinical tools to predict falls. We use novel AI-based body composition algorithms to leverage incidental CT data to help determine a patient’s future fall risk.
Are the severity of obstruction and the apnea–hypopnea index related to orofacial anatomy in children with obstructive sleep apnea? a kinetic MRI study
Authors: Savoldi Fabio , Fung Kevin KF , Mak Wing-Sze , Kan Elaine YL , Yang Yanqi , Kwok Ka-Li , Gu Min
Published: May 2023

Objectives:

The proportionality between anatomical characteristics and disease severity in children and adolescents with obstructive sleep apnea (OSA) has not been well characterized. The present study investigated the relationship between the dentoskeletal and oropharyngeal features of young patients with OSA and either the apnea–hypopnea index (AHI) or the amount of upper airway obstruction.

Methods:

MRI of 25 patients (8- to 18-year-old) with OSA (mean AHI = 4.3 events/h) was retrospectively analyzed. Sleep kinetic MRI (kMRI) was used to assess airway obstruction, and static MRI (sMRI) was used to assess dentoskeletal, soft tissue, and airway parameters. Factors related to AHI and obstruction severity were identified with multiple linear regression (significance level α = 0.05).

Results:

As evidenced by kMRI, circumferential obstruction was present in 44% of patients, while laterolateral and anteroposterior was present in 28%; as evidenced by kMRI, obstructions were retropalatal in 64% of cases and retroglossal in 36% (no nasopharyngeal obstructions); kMRI showed a higher prevalence of retroglossal obstructions compared to sMRI(p = 0.037); the main obstruction airway area was not related to AHI; the maxillary skeletal width was related to AHI (β = −0.512, p = 0.007) and obstruction severity (β = 0.625, p = 0.002); and the retropalatal width was related to AHI (β = −0.384, p = 0.024) and obstruction severity (β = 0.519, p = 0.006).

Conclusions:

In children and adolescents, the severity of OSA and obstruction were inversely proportional to the maxillary basal width and retropalatal airway width. Further studies are needed to assess the benefits of targeted clinical treatments widening the transverse dimension of these structures.
Tendências de comunicação e divulgação científica em enfermagem
Authors: Dias Ernandes Gonçalves , Viana Adrielle Cruz Oliveira , Bercio Elaine Martins , Soares Nycolle de Paula Ferreira
Published: May 2023

A enfermagem, como ciência do cuidado humano, desenvolve-se por meio da pesquisa científica em busca da melhor evidência para fundamentar seu cuidado. Nesse sentido, o desenvolvimento tecnológico e os contextos sociais influenciam nas estratégias de comunicação e divulgação do conhecimento produzido pela profissão. Atualmente, as tendências de comunicação científica na enfermagem têm sido a expansão dos periódicos científicos online e aplicação de ferramentas de legitimação do conhecimento possibilitados pela internet, enquanto as tendências de divulgação, além das tradicionais, são o uso das redes sociais, podcast, eventos online e híbridos e os blogs especializados, em favor da socialização do conhecimento.
Health Related Quality of Life (HRQOL) in pediatric population after surgical intervention in traumatic lower limb injuries: A prospective cohort
Authors: Muhammad Mustafa Hashmi  , Muhammad Rehan Akram  , Naumeri Fatima , Muhammad Faizan Akram
Published: May 2023

Objective: To assess health related quality of life (HRQOL) of children who had undergone surgical intervention after lower limb trauma.

Methods: A prospective observational study was conducted at KEMU and UCHS, from September 2021 to June 2022. Fifty children aged 5 to 12 years who had undergone surgical intervention for lower limb trauma were included. Patients whose parents couldn’t understand Urdu or English, or with polytrauma, needing amputation and/or comorbidities were excluded. Another fifty-school going, age matched children were enrolled as controls. After informed consent, two responses from participants and parents on PedsQL questionnaires were recorded, first one week after discharge and second after six months, assessing age specific quality of life in four domains (physical, emotional, social, school). Impaired HRQOL was defined as a score that was more than 1SD below the mean of healthy sample.

Results: Baseline HRQOL scores were significantly lower in patients and parents reported data taken at one week, overall difference of 39.13 in total HRQOL scores (effect size, d 2.76). Difference of 39.86 was observed between baseline and follow-up data taken from parents with the highest effect size (d=3.34) in physical functioning scores. There was a significant difference of 10.07 between the total HRQOL scores of patients on follow up and controls, and HRQOL patients’ scores were higher than controls across all domains. Parent reported scores were less than those reported by children in almost all cases.

Conclusion: HRQOL of children at discharge after management of lower limb trauma was lower than age-matched control group. It, however, significantly exceeded controls’ scores after six months showing complete recovery.

doi: https://doi.org/10.12669/pjms.39.4.7128

How to cite this: Hashmi MM, Akram MR, Naumeri F, Akram MF. Health Related Quality of Life (HRQOL) in pediatric population after surgical intervention in traumatic lower limb injuries: A prospective cohort. Pak J Med Sci. 2023;39(4):---------. doi: https://doi.org/10.12669/pjms.39.4.7128

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
A new promising biological agent for refractory lupus nephritis: Telitacicept
Authors: Liu Shuangyan , Yu Xiangyue , Li Xiaodong
Published: May 2023

doi: https://doi.org/10.12669/pjms.39.4.7542

How to cite this: Liu S, Yu X, Li X. A new promising biological agent for refractory lupus nephritis: Telitacicept. Pak J Med Sci. 2023;39(4):---------. doi: https://doi.org/10.12669/pjms.39.4.7542
Leveraging on digital technology for financial inclusion of women agripreneurs in Southern Nigeria
Authors: Vivian Chinelo Ugwuja , Peter Ayodeji Ekunwe
Published: May 2023

Background

Women are key players in agriculture, but they are under-resourced, particularly in terms of finance. Microfinance has long been recognized as the most effective method of financially empowering these women, but using the benefits of digital technology can help scale it up and ensure its long-term viability.

Methods

The study area was Southern Nigeria. Respondents were women agripreneurs (n=479), from six states. 239 women agripreneurs who accessed digital financial products and 240 women agripreneurs who did not access financial products participated in the survey in 2019.

Results

The tests for significant difference between income of participants and non-participants in digital finance indicated a T-value of 3.214 (P< 0.001), which implies that there was a significant difference in the income of those that are accessing digital financial products (DFPs) and those that are not accessing DFPs. The tests for significant difference between savings of participants and non-participants indicated a T-value of 2.479 (p<0.05), which also implies that there was a significant difference in the women agripreneurs’ savings for participants and non-participants in DFPs. Only 2.5% of  women agripreneurs are participating in micro-insurance in Southern Nigeria.

Conclusions

Women agripreneurs who are accessing digital financial products earned more income and saved more than those who are not accessing digital financial products. This implies that you are more advantaged in using digital finance in business. Micro-insurance is poorly accessed in Nigeria, and awareness of insurance products is moderately low. This study recommends that Central Bank of Nigeria should engage in more outreach programmes to enable all women in Nigeria access digital financial products because of its convenience and contributions to success in business. Insurance companies should capitalize on business models that incorporate mobile technologies in order to increase insurance penetration in rural areas.
Circadian clocks in health and disease: Dissecting the roles of the biological pacemaker in cancer
Authors: Fortin Bridget M. , Mahieu Alisa L. , Fellows Rachel C. , Pannunzio Nicholas R. , Masri Selma
Published: May 2023

In modern society, there is a growing population affected by circadian clock disruption through night shift work, artificial light-at-night exposure, and erratic eating patterns. Concurrently, the rate of cancer incidence in individuals under the age of 50 is increasing at an alarming rate, and though the precise risk factors remain undefined, the potential links between circadian clock deregulation and young-onset cancers is compelling. To explore the complex biological functions of the clock, this review will first provide a framework for the mammalian circadian clock in regulating critical cellular processes including cell cycle control, DNA damage response, DNA repair, and immunity under conditions of physiological homeostasis. Additionally, this review will deconvolute the role of the circadian clock in cancer, citing divergent evidence suggesting tissue-specific roles of the biological pacemaker in cancer types such as breast, lung, colorectal, and hepatocellular carcinoma. Recent evidence has emerged regarding the role of the clock in the intestinal epithelium, as well as new insights into how genetic and environmental disruption of the clock is linked with colorectal cancer, and the molecular underpinnings of these findings will be discussed. To place these findings within a context and framework that can be applied towards human health, a focus on how the circadian clock can be leveraged for cancer prevention and chronomedicine-based therapies will be outlined.