bluuebunny/crossref_metadata_2025 huggingface dataset:
Does It Help or Hinder? The Impact of Population Aging on Industrial Structure Upgrading in Transition Economic Systems
Authors: Zhou Dahui
Published: February 2025

The purpose of this study was to develop a model for integrating data on population aging with the processes of modernization of the industrial structure from the point of view of the influence of spatial dependencies. Based on theoretical and Chinese provincial panel data analysis, this study examined the industrial structure upgrading effect of population aging using a panel threshold model and a dynamic spatial Durbin model. The findings indicate that population aging (OPP) has a significant positive effect on the advancement of industrial structure (AIS) and service structure upgrading (SSU), with a single threshold effect. Economic development was found to promote benefits from the AIS while weakening those from the SSU. The upgrading effect of the industrial structure was noted to vary with economic development. The dynamic effect of industrial structure upgrading was also substantial. OPP was found to meaningfully promote the rationalization of industrial structure (RIS), MSU, and SSU in the eastern region, AIS and RIS in the central region, and RIS in the western region of China, along with positive spatial spillover effects.
Metacognitive Interventions for mental health disorders in adolescents: a scoping review protocol
Authors: Espírito Santo Andreia , Silva Rosa , Balzan Ryan , Pinho Lara Guedes de , Sampaio Francisco
Published: February 2025

Objective:

The aim of this review is to map and summarize metacognitive interventions for adolescents with mental health disorders.

Introduction:

Metacognitive interventions are widely implemented in adults across various types of mental health disorders. Use in adolescents (aged between 10 and 19 years) has already been proposed in the recent literature, despite this knowledge being scattered. Hence, it is necessary to summarize the types of metacognitive interventions, their key characteristics, the mental health disorders they are targeting, and their outcomes.

Inclusion criteria:

This review will consider quantitative and qualitative, as well as mixed methods studies describing metacognitive interventions for adolescents with mental health disorders. All intervention settings will be eligible for inclusion.

Methods:

A 3-step search strategy will be adopted, in line with the JBI methodology for scoping reviews. Databases to search for peer-reviewed papers will include CINAHL Complete (EBSCOhost), PubMed, Web of Science Core Collection, PsycINFO, and Scopus, among others. Gray literature searched on OpenGrey and MedNar will also be included. The reference lists of all selected full-text reviews will be searched. There will be no limitations on the year or language of publication. Screening, selection, and data extraction will be performed by 2 independent reviewers, who will screen titles and abstracts of publications meeting the inclusion criteria as well as review the full text of eligible studies. Disagreements will be resolved through plenary discussion or with the help of an additional reviewer. The extracted data will be summarized narratively and presented in a table.

Detail of this review project can be found in Open Science Framework: https://osf.io/kh2bc
An undergraduate lab experiment on matched filtering as used in gravitational wave detection
Authors: Daam Michael , Bergmann Antje , Rockstuhl Carsten , Nawrodt Ronny
Published: February 2025

The detection of gravitational waves using matched filtering algorithms is just one example of the critical role that computational data analysis plays in contemporary physics. We present an undergraduate laboratory experiment where students apply matched filtering methods to detect weak signals in their noisy measurement data. The experiment is based on a Michelson interferometer and requires little additional equipment. To make the experiment accessible to students without programming skills, we developed an open-source graphical user interface for the matched filter search, which is also presented in this article. Finally, we demonstrate the ability to detect weak signals obtained with the experimental setup described here.
Puerarin combined with
Hericium erinaceus
insoluble dietary fiber alleviates obesity induced by high-fat diet through regulating the glycerophospholipid metabolism pathway influenced by gut microbiota
Authors: Wang Guoze , Wang Binbin , Zhou Qin , Cheng Zhimei , Liu Li , Zhang Shuai , Zhou Shi , Luo Peng
Published: February 2025

The purpose of this study was to evaluate the combined effects of puerarin (Pue) and insoluble dietary fiber from
Hericium erinaceus
(HEIDF) on obesity induced by a high-fat diet (HFD) in mice, focusing on their effects on lipid and glucose metabolism, gut microbiota (GM), and serum metabolites. Glucose tolerance, tissue pathology, and serum biochemical levels were conducted to assess the effects of puerarin combined with
Hericium Erinaceus
insoluble dietary fiber (LH) on glucose and lipid metabolism. 16S rRNA sequencing and untargeted metabonomics were employed to explore the underlying mechanisms. The results showed that the LH group significantly reduced body weight and hepatic and adipose lipid accumulation, and improved glucose tolerance and dyslipidemia compared to the Pue or HEIDF groups alone. Moreover, the LH group exhibited enhanced regulation of GM, including increased microbial diversity, higher abundance of beneficial bacteria such as g__Lactobacillus and g__Bacillus, and a decreased Firmicutes-to-Bacteroidota ratio. In addition, the LH group ameliorated HFD-induced serum metabolite changes and promoted the activation of tryptophan and glycerophospholipid metabolism pathways. The combination of Pue and HEIDF exhibits a synergistic anti-obesity effect by modulating specific GM (g__Lactobacillus and g__Bacillus) and serum metabolites.

IMPORTANCE

The combination of HEIDF and Pue holds significant importance in the context of obesity. This synergistic effect not only aids in weight management but may also enhance metabolic health through various mechanisms, including increased satiety and promotion of fat oxidation. Therefore, incorporating these two components into the daily diet could offer effective strategies for the prevention and intervention of obesity and its related diseases.
Orientia tsutsugamushi
alters the intranuclear balance of cullin-1 and c-MYC to inhibit apoptosis
Authors: Allen Paige E. , Adcox Haley E. , Siff Thomas E. , Gupta Sarika , Hunt Jason R. , Carlyon Jason A.
Published: February 2025

Cullin-1 (Cul1), a cullin–RING ubiquitin ligase component, represses c-MYC activity in the nucleus.
Orientia tsutsugamushi
causes the potentially fatal rickettsiosis, scrub typhus. The obligate intracellular bacterium encodes an arsenal of ankyrin repeat-containing effectors (Anks), many of which carry a eukaryotic-like F-box motif that binds Cul1.
O. tsutsugamushi
reduces Cul1 levels in the nucleus. This phenomenon is not due to an alteration in Cul1 neddylation but is bacterial burden- and protein synthesis-dependent. Five of the 11 Anks capable of binding Cul1 (Ank1, Ank5, Ank6, Ank9, Ank17) sequester it in the cytoplasm when each is ectopically expressed. Ank1 and Ank6 proteins with alanine substitutions in their F-boxes that render them unable to bind Cul1 cannot exclude Cul1 from the nucleus. Coincident with the reduction of Cul1 in the nuclei of
Orientia
-infected cells, c-MYC nuclear levels are elevated, and Cul1 target genes are differentially expressed. Several of these genes regulate apoptosis. The resistance of
O. tsutsugamushi
-infected cells to staurosporine-induced apoptosis is recapitulated in uninfected cells expressing Ank1 or Ank6 but not alanine-substituted versions thereof that cannot bind Cul1. Other F-box-containing Anks that cannot bind or exclude Cul1 from the nucleus also fail to confer resistance to apoptosis. Overall,
O. tsutsugamushi
modulates the Cul1:c-MYC intranuclear balance as an anti-apoptotic strategy that is functionally linked to a subset of its F-box-containing Anks.
Integrating sequence composition information into microbial diversity analyses with k-mer frequency counting
Authors: Bokulich Nicholas A.
Published: February 2025

k-mer frequency information in biological sequences is used for a wide range of applications, including taxonomy classification, sequence similarity estimation, and supervised learning. However, in spite of its widespread utility, k-mer counting has been largely neglected for diversity estimation. This work examines the application of k-mer counting for alpha and beta diversity as well as supervised classification from microbiome marker-gene sequencing data sets (16S rRNA gene and full-length fungal internal transcribed spacer [ITS] sequences). Results demonstrate a close correspondence with phylogenetically aware diversity metrics, and advantages for using k-mer-based metrics for measuring microbial biodiversity in microbiome sequencing surveys. k-mer counting appears to be a suitable and efficient strategy for feature processing prior to diversity estimation as well as supervised learning in microbiome surveys. This allows the incorporation of subsequence-level information into diversity estimation without the computational cost of pairwise sequence alignment. k-mer counting is proposed as a complementary approach for feature processing prior to diversity estimation and supervised learning analyses, enabling large-scale reference-free profiling of microbiomes in biogeography, ecology, and biomedical data. A method for k-mer counting from marker-gene sequence data is implemented in the QIIME 2 plugin q2-kmerizer (
https://github.com/bokulich-lab/q2-kmerizer
).

IMPORTANCE

k-mers are all of the subsequences of length k that comprise a sequence. Comparing the frequency of k-mers in DNA sequences yields valuable information about the composition of these sequences and their similarity. This work demonstrates that k-mer frequencies from marker-gene sequence surveys can be used to inform diversity estimates and machine learning predictions that incorporate sequence composition information. Alpha and beta diversity estimates based on k-mer frequencies closely correspond to phylogenetically aware diversity metrics, suggesting that k-mer-based diversity estimates are useful proxy measurements especially when reliable phylogenies are not available, as is often the case for some DNA sequence targets such as for internal transcribed spacer sequences.
Epidural lymphoma: a rare presentation of extranodal disease
Authors: Alexander Vijay , Lionel Sharon Anbumalar , Ninan George Abraham , George Tina
Published: February 2025

Extranodal involvement in lymphomas is well-documented in the literature. However, certain anatomical sites, such as the epidural space, are rarely affected by lymphoproliferative neoplasms. When lymphomas are confined to the epidural space without other recognisable sites of involvement at diagnosis, they are classified as primary spinal epidural lymphoma. We report the case of a man in his early 30s who presented with lower back pain and progressive quadriparesis. Imaging revealed an extradural mass extending from the sixth to the tenth thoracic vertebrae, with lateral extension into the extrapleural space. A biopsy confirmed diffuse large B-cell lymphoma, and the patient was started on combination chemotherapy.
Burden of five major types of gastrointestinal cancer in the Eastern Mediterranean Region
Authors: Alessy Saleh A , Morgan Eileen , Al-Zahrani Ali S , Zahwe Mariam , Fouad Heba , Bray Freddie , Znaor Ariana , Alqahtani Saleh A
Published: February 2025

Objective

We provide an overview of the latest estimates of five gastrointestinal (GI) cancers in the Eastern Mediterranean Region (EMR) countries to guide cancer control policy.

Methods

We extracted the number of cases and deaths for oesophageal, gastric, liver, colorectal and pancreatic cancers from the GLOBOCAN database produced as estimated by the International Agency for Research on Cancer for the year 2022. Age-standardised incidence and mortality rates (ASR) per 100 000 person-years were estimated for the 22 EMR countries, cancer site and sex.

Results

The estimated 173 000 new cancer cases and 139 000 deaths from the five GI cancers corresponded to 22.2% of the incidence and 28.7% of the mortality burden in the EMR. Across all cancers (for both sexes combined), colorectal cancer ranked third (6.9%; ASR 8.9), followed by liver cancer (6.2%; ASR 8.4) in terms of incidence, while liver cancer (9.6%; ASR 8.1) and gastric cancer (6.4%; ASR 5.5) were the third and fourth leading causes of cancer-related mortality in the region, respectively. Marked differences in cancer incidence and mortality rates were observed between the 22 countries, particularly the 10-fold variations seen in liver cancer incidence.

Conclusion

GI cancers currently account for an important fraction of the cancer burden in the EMR; the present analysis seeks to inform tailored decision-making according to the country-specific GI cancer profiles.
Adherence to mask-wearing and its impact on the incidence and deaths of viral respiratory infectious diseases: a systematic review, meta-analysis and modelling study
Authors: Chen Can , Zhou Wenkai , Qi Jiaxing , Chen Mengsha , Yuan Zhenglin , Miao Jiani , Yang Mengya , Chen Jiaxin , Shen Fang , Cao Kexin , Qu Rongrong , Jiang Daixi , Du Yuxia , Wu Xiaoyue , You Yue , Yan Rui , Zhu Changtai , Yang Shigui
Published: February 2025

Background

This study systematically analysed global and regional adherence to mask-wearing and its impact on the incidence and deaths of viral respiratory infectious diseases (VRIDs).

Methods

Relevant studies were sourced from PubMed, Web of Science, Embase and Scopus. We included observational studies with available raw data on mask-wearing adherence (rates of acceptability of mask-wearing, mask-wearing in public settings and correct mask-wearing) during VRID pandemics/epidemics. The COVID-19-related incidence and deaths were sourced from Global Burden of Diseases 2021. The quality of each study was assessed using the Agency for Healthcare Research and Quality Scale. Pooled rates and effects of mask-wearing were calculated using random effects models and generalised linear models.

Results

We included 448 studies from 70 countries/regions. During the VRID pandemics/epidemics, global pooled rates for the acceptability of mask-wearing, mask-wearing in public settings and correct mask-wearing were 65.27% (95% CI 60.34% to 70.05%), 74.67% (95% CI 69.17% to 79.8%) and 63.63% (95% CI 59.28% to 67.87%), respectively. In individuals with chronic diseases/elderly/pregnant women, the rates of acceptability (42.54%) and correct mask-wearing (60.56%) were both low. Among the general population, the rates of mask-wearing in public settings (68.2%) and correct mask-wearing (57.45%) were the lowest. During the COVID-19 pandemic, countries with a requirement for mask-wearing exhibited a higher rate in public settings (76.10% vs 58.32%), especially in regions with more stringent containment and health measures (β=0.86, p=0.008). The mask-wearing in public settings has been found to significantly reduce the COVID-19 incidence (β=−265.26, p=0.004), COVID-19 deaths (β=−2.04, p<0.001) and other COVID-19 pandemic-related deaths (β=−0.83, p<0.001).

Conclusion

During the VRID pandemics/epidemics, adherence to mask-wearing was relatively low. Implementing policies requiring mask-wearing during the pandemic could enhance the mask-wearing rate, potentially leading to a significant reduction in VRID-related incidence and deaths.

Trial registration number

CRD42024496464.
Evaluating geographic accessibility to COVID-19 vaccination across 54 countries/regions
Authors: Cao Yanjia , Li Tianyu , Chen Huanfa , Zhao Qunshan , Sun Jiashuo , Grépin Karen Ann , Kang Jeon-Young
Published: February 2025

Background

The COVID-19 pandemic has revealed significant disparities in global vaccine accessibility, particularly affecting low and middle-income countries (LMICs). However, current research on COVID-19 vaccine accessibility primarily focuses on individual countries or high-income countries (HIC). We aimed to evaluate geographic accessibility to COVID-19 vaccination on a multicountry scale, covering comparisons across LMICs and HICs. Additionally, we explored the potential economic factors related to accessibility and their impacts on health outcomes.

Methods

We collected population data at a 1 km resolution and geocoded all vaccination sites across the selected countries/regions. Four measures were used to evaluate vaccine accessibility from different perspectives: population coverage with varying travel time thresholds, driving time to vaccination sites, the number of sites within a 30-min threshold and a geographic accessibility index using enhanced two-step floating catchment area method. Finally, we explored the relationships between geographic accessibility and several factors: gross domestic product per capita, vaccination uptake and mortality.

Findings

We found substantial disparities in vaccine accessibility across the selected countries/regions. In 24.07% of these countries/regions, over 95% of the population can access the nearest vaccination services within 15 min. In contrast, in countries/regions such as Manitoba (Canada), Zimbabwe and Bhutan, less than 30% of the population can reach these sites within 60 min. Underserved areas, termed ‘vaccine deserts’, were identified in both HICs and LMICs. We found that countries/regions with higher vaccine accessibility tend to achieve higher vaccination rates, whereas those with lower vaccine accessibility are likely to experience substantial increases in COVID-19 mortality rates.

Conclusion

LMICs require enhanced attention to improve geographic accessibility to vaccination. Additionally, there are internal disparities in accessibility within both HICs and LMICs. National public health officials and global health initiatives are suggested to prioritize ‘vaccine deserts’ and to ensure equitable vaccine access in future pandemics.
Immunisation health workforce capacity building in Southeast Asia: reflections from training programme implementation in Cambodia and Lao PDR
Authors: Saravanos Gemma , Teo Alvin Kuo Jing , Yam Esabelle Lo Yan , Chou Sok Chamreun , Chanlivong Niramonh , Chanthorn Phorng , Thy Chhit , Sayavong Souphon , Leask Julie , Yi Siyan , Danchin Margie , Morgan Chris , Jenkins Kylie , Kirk Martyn , Macartney Kristine , Coghlan Ben , Apostol Michelle , Arora Dinesh , Gray Darren , Smart Tracy , Sheel Meru
Published: February 2025

The Immunization Agenda 2030 emphasises the need for a motivated, skilled and knowledgeable workforce equipped to plan, manage, implement and monitor immunisation programmes at all levels. The rapid introduction of COVID-19 vaccines during the pandemic highlighted the adaptability of the health workforce but also exposed gaps in professional development and learning.

This practice paper describes the implementation of an immunisation training programme in the Kingdom of Cambodia and the Lao People’s Democratic Republic. The programme was developed and delivered by the project team in partnership with local stakeholders and technical experts. A country-centric approach ensured that training programmes met each country’s needs, while input from technical experts ensured an evidence-based programme that aligned with international standards. There were 445 training participants from professional groups across various levels and sectors of the health system. Training curricula included a range of differentiated training modules which aimed to build knowledge and skills to drive increased vaccine demand, improve service delivery and optimise monitoring and evaluation of programmes.

The Gavi Learning and Performance Management framework supported a structured reflection of programme strengths, limitations and opportunities. Strengths were the country-centric and learner-centric approach and the high technical quality of the programme. The pandemic context necessitated agility and adaptation to meet changing country needs and priorities, however, this introduced some limitations. Future training programmes should undertake an enhanced assessment of training needs, workforce and digital capabilities and learning and performance management systems, alongside the development of country-driven immunisation workforce training roadmaps to ensure optimal impact and sustainability.
Chronotherapeutic intervention targeting emotion regulation brain circuitry, symptoms, and suicide risk in adolescents and young adults with bipolar disorder: a pilot randomised trial
Authors: Kim Jihoon A , Sankar Anjali , Marks Rebecca , Carrubba Erin , Lecza Bernadette , Quatrano Susan , Spencer Linda , Constable R. Todd , Pittman Brian , Lebowitz Eli R , Silverman Wendy K , Swartz Holly A , Blumberg Hilary P
Published: February 2025

Background

Mood episodes and high suicide risk of bipolar disorder (BD) are thought to derive from amygdala–ventral prefrontal cortex emotion regulation brain circuitry dysfunction and resulting emotion dysregulation, making these potential intervention targets.

Objective

To assess feasibility, acceptability, and preliminary efficacy in engaging the emotion regulation targets of two Brain Emotion Circuitry-targeted Self-Monitoring and Regulation Therapy (BE-SMART) variations in adolescents and young adults with BD (BDAYA): BE-SMART-ER, which directly targets emotion regulation, and BE-SMART-DR, a social rhythm therapy (SRT)-based chronotherapeutic intervention designed to reduce daily rhythm (DR) irregularities.

Methods

In a single-blind, parallel, pilot-randomised trial, 60 BDAYA(aged 16–29 years) were randomised to 12 weekly sessions (9 telehealth) of BE-SMART-DR or BE-SMART-ER. Nineteen BE-SMART-DR and 16 BE-SMART-ER participants completed the intervention, with 11 and 13, respectively, having pre-intervention and post-intervention functional MRI data.

Findings

In addition to demonstrating feasibility, only BE-SMART-DR showed pre-treatment to post-treatment improvements in DR regularity (Cohen’sd=0.55; 95% CI [0.06, 1.03]), associated with reductions in left amygdala responses to emotional face stimuli (pFWE (family-wise error)-SVC (small volume correction)<0.05), difficulties in emotion regulation (d=0.75; 95% CI [0.23, 1.25]) and suicide risk (d=0.65; 95% CI [0.15, 1.14]). Significant correlations were observed among these changes (p<0.05). Both interventions showed high acceptability and improvements in depression and mania symptoms. No intervention-related adverse events were observed.

Conclusions

Regularising DRs may enhance emotion regulation brain circuitry functioning, emotion regulation, and reduce suicide risk in BDAYA.

Clinical implications

Chronotherapeutic interventions regularising DRs, such as SRT, should be studied further as potential treatment strategies for BDAYA.

Trial registration number

NCT03183388.
Can behavioural science be used to understand factors that influence the prescription choice for Parkinson’s disease? A pan-European focus group study of clinicians’ prescribing practice
Authors: Begley Emma , Thomas Jason Michael , Hind William , Senior Carl
Published: February 2025

Objectives

This study aimed to establish a consensus on key factors that influence medication choices for Parkinson’s disease and to identify the behavioural determinants of these factors using behavioural change theory as a theoretical lens.

Design

This qualitative study used the nominal group technique to conduct structured online focus group meetings. A facilitator guided participants to (1) individually generate a list of factors that influence their decision to prescribe, (2) collectively share these factors, (3) refine and clarify factors and (4) rank the most important factors. Subsequently, the most important factors identified were mapped to the Theoretical Domains Framework (TDF) and the Capability, Opportunity, Motivation–Behaviour (COM-B) model to identify the behavioural determinants that influence medication choice.

Participants

Eighteen healthcare professionals, including neurologists, consultants and specialist nurses/practitioners who prescribe medication, were recruited across Europe and participated in one of seven focus groups.

Results

There was good consensus among the participants about which factors influence their prescribing decisions. Overall, participants identified 60 unique factors that were broadly categorised into the following themes: medical or symptom concern, patient characteristics, side effects, access to treatment, clinical guidelines, social support and patient preference. Factors discussed and prioritised by the participants aligned with seven of the 14 TDF domains: knowledge; memory, attention and decision processes; beliefs about consequences; goals; social/professional role and identity; environment context and resources; and social influences. Together, these were subsequently mapped onto four of the six subdomains of the COM-B model: psychological capability, reflective motivation, physical opportunity and social opportunity.

Conclusions

These findings suggest that prescribing decisions for Parkinson’s disease are determined by a complex range of factors linked to the COM-B components capability, motivation and opportunity. These can be further understood by specific behavioural domains, as identified by the TDF, which should be targeted to help optimise subsequent prescribing decisions.
Effect of statins on neurological functional outcomes in critically ill adult patients with traumatic brain injury: a systematic review and meta-analysis
Authors: Veillette Charles , Umana Mauricio , Gagnon Marc-Aurèle , Costerousse Olivier , Zarychanski Ryan , McAuley Daniel F , Lawler Patrick , Lauzier Francois , English Shane W , Moore Lynne , Isaac Chartelin Jean , Turgeon Alexis F
Published: February 2025

Background

Statins are considered a promising therapy in traumatic brain injury (TBI) because of their role in mediating inflammatory injury and other endothelial properties. Whether they can improve patient outcomes is unknown.

Objectives

To evaluate the effect of statins in critically ill patients with TBI.

Design

Systematic review and meta-analysis of randomised controlled trials.

Eligibility criteria

Trials of adult patients with acute moderate or severe TBI.

Methods

We searched Medline, Embase, Cochrane Central and Web of Science databases for trials comparing the use of any statin with placebo or other interventions. Our primary outcome was the Glasgow Outcome Scale (GOS or GOS extended); secondary outcomes were mortality, intensive care unit (ICU) and hospital length of stay. We used inverse variance random-effects models to calculate risk ratios (RR) and weighted mean differences. We assessed the risk of bias of trials using the Cochrane risk of bias assessment tool and the presence of statistical heterogeneity using the I2index. Levels of evidence for summary effect measures were evaluated using Grading of Recommendations Assessment, Development and Evaluation methodology.1

Results

Of the 2418 retrieved records, 7 trials met our eligibility criteria. Three studied simvastatin, and four studied atorvastatin. The duration of the intervention ranged from 2 to 10 days, and outcomes were assessed between ICU discharge and 6 months. Five trials were considered at high risk of bias. We observed no statistically significant association between statins and the GOS (RR 0.42; 95% CI, 0.14 to 1.22; two trials; n=84, I2=0%; very low certainty) or mortality (RR 0.59; 95% CI, 0.25 to 1.44; three trials; n=160, I2=0%; very low certainty). No significant effect was observed for ICU length of stay, while hospital length of stay was evaluated in one trial showing shorter duration.

Conclusion

We found no conclusive evidence supporting the use of statins in critically ill adult patients with TBI at this time. Nevertheless, the trials were limited, and wide confidence intervals resulted in significant uncertainty of the findings. A potential benefit cannot be ruled out, underscoring the need for a larger, well-designed trial.

PROSPERO registration number

CRD42023421227.
Idiopathic pulmonary fibrosis in the UK: findings from the British Thoracic Society UK Idiopathic Pulmonary Fibrosis Registry
Authors: Fahim Ahmed , Loughenbury Maria , Stewart Iain , Agnew Sarah , Almond Howard , Casimo Leo , Chaudhuri Nazia , Fletcher Sophie V , Haney Sarah , Ho Ling-Pei , Hodkinson Clare , Minnis Paul , Palmer Evelyn , Wilson Andrew M
Published: February 2025

Objectives

Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease (ILD) and the most common idiopathic interstitial pneumonia. The UK IPF Registry was established in 2013 to collect data pertaining to clinical features, therapeutic approaches and outcomes. From February 2023, the Registry expanded to include any ILD with evidence of fibrosis.

Design

The UK IPF Registry is a national, multicentre observational registry, including both prospective and retrospective data of patients with IPF in secondary or tertiary care. Cases eligible for inclusion were those with a diagnosis of IPF, presenting at participating centres from January 2013.

Results

Between January 2013 and February 2023, 5052 IPF cases were registered from 64 participating centres. There was a male preponderance (77.8%) with mean±SD age of 74±8.1 years, 66% were ex-smokers and 76% had at least one comorbidity. Over a third (36.7%) experienced symptoms for more than 24 months prior to their first clinic visit. The majority of cases were discussed at a multidisciplinary team (MDT) meeting and the most common radiological patterns at presentation were probable (54.6%) and definite (42.7%) usual interstitial pneumonia. There was a reduction in surgical lung biopsies from 14% in 2013 to 5.5% in 2022. Antifibrotic therapy prescription rose from 36.0% in 2013 to 55.9% in 2023. The use of nintedanib (approved by National Institute of Clinical Excellence in January 2016) rose from 6.7% in 2013 to 31.5% in 2022 and pirfenidone (approved in April 2013) was initially used in around a third of cases before dropping to between 16.8% and 24.9% after nintedanib was approved.

Conclusion

These data reflect clinical practice across the UK and it is intended the data will have a role in informing the future of IPF care and providing a model for benchmarking, ultimately increasing knowledge and improving clinical care for this devastating disease.
Harmful epistemic dependence on medical machine learning and its moral implications
Authors: Pozzi Giorgia , Buijsman Stefan , van den Hoven Jeroen
Published: February 2025

The advances in machine learning (ML)-based systems in medicine give rise to pressing epistemological and ethical questions. Clinical decisions are increasingly taken in highly digitised work environments, which we call artificial epistemic niches. By considering the case of ML systems in life-critical healthcare settings, we investigate (1) when users’ reliance on these systems can be characterised as epistemic dependence and (2) how this dependence turns into what we refer to as harmful epistemic dependence of clinical professionals on medical ML. The latter occurs when the impossibility of critically assessing the soundness of a system’s outputin situimplies a moral obligation to comply with its recommendation since a failure to do so constitutes a moral risk that cannot be justified then and there. We analyse the epistemic and moral consequences of harmful epistemic dependence on the status of medical professionals. We conclude by assessing how a suitable design of the epistemic niche can address the problem.
Paraneoplastic KLHL11 encephalitis presenting with progressive tinnitus, hearing loss and ataxia
Authors: Mahmoud Azza , Dubey Divyanshu , Goonetilleke Ajith , Lee Gina , Elhabet Suzi , Ahmad Iftikhar , Dogar Mohammad , Jacob Anu
Published: February 2025

Limbic encephalitis is associated with various tumours and antibodies. We describe a 33-year-old man with progressive cochleovestibular symptoms, cerebellar ataxia, myoclonus and antibodies against Kelch-like protein 11 (KLHL11). MR scan of the brain showed hippocampal T2 hyperintensities. FDG PET scan was normal. Biopsy of his enlarged left testes showed fibrosis without neoplasia. Immunotherapy so far has not helped significantly.
Cadaveric study of the obturator nerve: frequency of skin innervation and the optimal site for blocking the cutaneous branch
Authors: Jessen Christian , Moriggl Bernhard , Hörmann Romed , Bendtsen Thomas Fichtner
Published: February 2025

Background

Clinical understanding of the obturator nerve’s cutaneous and motor branches is crucial for performing effective obturator nerve blocks, particularly for procedures involving the thigh and hip. Literature and anatomical references report highly variable patterns of the frequency and cutaneous distribution of obturator nerve innervation.

This study examines the frequency and distribution of the cutaneous branch of the anterior ramus of the obturator nerve (cb-ar-ON) and assesses the most effective anatomical sites for nerve blockade.

Methods

Dissections were conducted on 14 sides from eight cadavers to identify the presence, branching pattern and innervation areas of the cb-ar-ON. Ultrasound-guided injections of low-volume dye were performed proximally between the adductor longus and gracilis muscles and distally near the great saphenous vein to assess optimal targeting.

Results

cb-ar-ON were found in 43% of cadaveric sides, branching off the anterior ramus of the obturator nerve 6–10 cm distal to the inguinal ligament. When present, the cb-ar-ON innervated a 4–9 cm2area in the posteromedial popliteal fossa. Proximal ultrasound-guided blocks targeting the area between the adductor longus and gracilis muscles effectively stained the cb-ar-ON in 100% of cases where the branch was present.

Conclusion

The cb-ar-ON provides variable and limited cutaneous innervation, appearing in 43% of cases, primarily in the posteromedial popliteal fossa. Effective blockade can be achieved with a proximal approach between the adductor longus and gracilis muscles.

These findings suggest that clinical evaluation of obturator nerve block based on cutaneous anesthesia is unreliable.
Dynamical reconstruction of the $$\Lambda $$CDM model in the scalar–tensor representation of $$f\left( Q,T\right) $$ gravity
Authors: Kaczmarek Adam Z. , Rosa João Luís , Szczȩśniak Dominik
Published: February 2025

Motivated by the growing interest in the nonmetricity-matter couplings, we develop the scalar–tensor formulation of recently introduced f(Q, T) gravity, where Q is the nonmetricity and T is the trace of the energy–momentum tensor. The main properties of the scalar–tensor formalism for the Friedmann–Lemaître–Robertson–Walker (FLRW) Universe are discussed, and we introduce an appropriate set of dynamical variables to analyze the cosmic evolution of the scalar–tensor f(Q, T) cosmology as a dynamical system. By considering two distinct cosmic fluids, namely matter and radiation, we have demonstrated that the cosmological phase space exhibits the typical curvature-dominated, radiation-dominated, matter-dominated, and exponentially accelerated fixed points. Furthermore, under an appropriate set of initial conditions compatible with the current observations from the Planck satellite, our analysis shows that the scalar–tensor f(Q, T) successfully yields models indistinguishable from the

$$\Lambda $$

Λ

CDM cosmology and compatible with the weak-field solar system dynamics, without the inclusion of a cosmological constant

$$\Lambda $$

Λ

. Thus, the theory introduced herein may be regarded as a suitable candidate to describe the cosmological dynamics of the Universe.
Horizon quantum mechanics for coherent quantum black holes
Authors: Feng Wenbin , Giusti Andrea , Casadio Roberto
Published: February 2025

The formalism of the horizon quantum mechanics is applied to electrically neutral and spherically symmetric black hole geometries emerging from coherent quantum states of gravity to compute the probability that the matter source is inside the horizon. We find that quantum corrections to the classical horizon radius become significant if the matter core has a size comparable to the Compton length of the constituents, and the system is indeed a black hole with probability very close to one unless the core radius is close to the (classical) gravitational radius.
Therapeutic Ultrasound for Multimodal Cancer Treatment: A Spotlight on Breast Cancer
Authors: Demir Zehra E.F. , Sheybani Natasha D.
Published: February 2025

Cancer remains a leading cause of mortality worldwide, and the demand for improved efficacy, precision, and safety of management options has never been greater. Focused ultrasound (FUS) is a rapidly emerging strategy for nonionizing, noninvasive intervention that holds promise for the multimodal treatment of solid cancers. Owing to its versatile array of bioeffects, this technology is now being evaluated across preclinical and clinical oncology trials for tumor ablation, therapeutic delivery, radiosensitization, sonodynamic therapy, and enhancement of tumor-specific immune responses. Given the breadth of this burgeoning domain, this review places a spotlight on recent advancements in breast cancer care to exemplify the multifaceted role of FUS technology for oncology indications—outlining physical principles of FUS-mediated thermal and mechanical bioeffects, giving an overview of results from recent preclinical and clinical studies investigating FUS with and without adjunct therapeutics in primary or disseminated breast cancer settings, and offering perspectives on the future of the field.
A Holistic View of Climate Sensitivity
Authors: Jeevanjee Nadir , Paynter David J. , Dunne John P. , Sentman Lori T. , Krasting John P.
Published: February 2025

The notion of climate sensitivity has become synonymous with equilibrium climate sensitivity (ECS), or the equilibrium response of the Earth system to a doubling of CO2. But there is a hierarchy of measures of climate sensitivity, which can be arranged in order of increasing complexity and societal relevance and which mirror the historical development of climate modeling. Elements of this hierarchy include the well-known ECS and transient climate response and the lesser-known transient climate response to cumulative emissions and zero emissions commitment. This article describes this hierarchy of climate sensitivities and associated modeling approaches. Key concepts reviewed along the way include climate forcing and feedback, ocean heat uptake, and the airborne fraction of cumulative emissions. We employ simplified theoretical models throughout to encapsulate well-understood aspects of these quantities and to highlight gaps in our understanding and areas for future progress.

▪

There is a hierarchy of measures of climate sensitivity, which exhibit a range of complexity and societal relevance.

▪

Equilibrium climate sensitivity is only one these measures, and our understanding of it may have reached a plateau.

▪

The more complex measures introduce new quantities, such as ocean heat uptake efficiency and airborne fraction, which deserve increased attention.
Ultrafast Events in Electrocyclic Ring-Opening Reactions
Authors: Liu Yusong , Xu Rui , Sanchez David M. , Martínez Todd J. , Wolf Thomas J.A.
Published: February 2025

Electrocyclic reactions are characterized by the concerted formation and cleavage of multiple σ and π bonds in a molecular system and have been extensively studied since they were introduced by Robert Burns Woodward and Roald Hoffmann in 1965. Recent advances and the integration of time-resolved experiments and nonadiabatic quantum molecular dynamics simulations have transformed the traditional understanding of electrocyclic reactions beyond the Woodward–Hoffmann rules. In this review, we focus on recent studies of 1,3-cyclohexadiene and two of its derivatives, α-phellandrene and α-terpinene, to shed light on the underlying mechanisms of electrocyclic photochemical reactions. We highlight recent progress in ultrafast electron diffraction techniques and the simulation approach of ab initio multiple spawning. Together, these approaches can elucidate molecular structure dynamics from femtosecond to picosecond timescales as well as nuclear and electronic responses at conical intersections.
Determinants of Stunting Severity Among Under‐Fives: Comparison of Agricultural and Nonagricultural Households in South Lampung Regency, Indonesia
Authors: Bakri Samsul , Puspaningrum Dewi Ayu , Berawi Khairun Nisa , Zuraida Reni
Published: February 2025

Introduction: One of the efforts to achieve Indonesia Emas, a vision of a prosperous and developed nation by 2045, is to prevent or eliminate stunting in under‐five children due to its long‐term adverse effects. Given the persistent prevalence of stunting in South Lampung Regency, Indonesia, there is a significant need to identify the influence of mother–child variables. Moreover, comparative studies between agricultural and nonagricultural households on stunting remain underresearched.

Methods: An ordinal logistic regression model was applied at a 95% confidence level. The response variables are four levels of stunting under‐fives. The determinant variables tested were from the children’s side (age, gender, and nutritional status), the mother’s side (duration of breastfeeding, age during pregnancy, birth spacing, and livelihood), and household livelihoods (agricultural vs. nonagricultural). Data collection was designed cross‐sectionally and carried out from July to August 2022.

Results: The research results showed that the nutritional status and age of the child and maternal factors such as exclusive breastfeeding, age during pregnancy, and birth spacing were determining risk factors (stunting). In particular, children from nonagricultural households show a lower risk of stunting than children from agricultural households.

Discussion: The determinants of stunting in under‐five children in South Lampung Regency are significantly influenced by child‐specific factors, maternal conditions, and households with agricultural household livelihoods. To address stunting, it is essential to enhance maternal and child health programs and implement targeted nutritional interventions, particularly for agricultural households with farming fathers. Future research should investigate the impact of agricultural practices on child nutrition and assess the efficacy of interventions across various socioeconomic settings. Longitudinal studies are crucial for evaluating and refining stunting prevention strategies, ultimately contributing to the achievement of Indonesia Emas 2045.
Pharmaceutical Insights Into Ammi and Parsley: Evaluating Antioxidant Activity, Total Phenolic Content, and Kidney Stone Disintegration Properties
Authors: Malkawi Ruba , Battah Khairat , Alkhreisat Mohammad
Published: February 2025

This study investigated the pharmaceutical potential of extracts from Ammi visnaga (Ammi) and Petroselinum crispum (Parsley), specifically focusing on their antioxidant activity, total phenolic content, and efficacy in disintegrating calcium oxalate kidney stones. Ammi and Parsley extracts, known for their traditional medicinal uses, contain bioactive compounds with significant antioxidant properties that have attracted attention in pharmaceutical research. Oxidative stress, a key factor in various physiological disorders, underscores the importance of antioxidants in the mitigation of cellular damage. Our investigation revealed concentration‐dependent enhancements in antioxidant activity and total phenolic content in both Ammi and Parsley extracts, indicating their potential as natural antioxidant agents. Furthermore, both extracts were effective in reducing the size of calcium oxalate stones, with the Ammi extract demonstrating superior stone‐disintegration properties. Dissolution studies have provided valuable insights into the release kinetics of phenolic compounds and antioxidant activity, suggesting sustained therapeutic potential. Overall, Ammi and Parsley extracts show promise in pharmaceutical development, offering alternative therapeutic avenues for managing oxidative stress‐related conditions and kidney stone formation.
Multimodal Treatment of a Spontaneously Ruptured Echinococcus Cyst of the Spleen and Its Complications
Authors: Bruijn Sévérine De , Weerdt Annick De , Broeckx Glenn , Spinhoven Maarten , Paep Rudi De , Robert Dominique , Komen Niels , Jorens Philippe G.
Published: February 2025

Introduction: Cystic echinococcosis, also known as hydatid cyst, is a parasitic infection of mammals that can affect any organ. Although the diagnosis of primary splenic echinococcosis is challenging, especially in nonendemic areas, it can be life‐saving because an anaphylactic shock may occur when the cyst ruptures. Recommendations regarding optimal treatment options after rupture are scarce, and the overall prognosis remains poor.

Case Presentation: A patient with a spontaneous rupture of an isolated splenic hydatid cyst was treated with splenectomy and peritoneal lavage with a hypertonic salt solution. The patient survived despite rapidly progressive hypernatremia, which was treated with conventional therapy along with continuous venovenous hemofiltration with gradient sodium replacement.

Discussion: When the decision is made to treat a patient with a spontaneously ruptured splenic echinococcus cyst, splenectomy is the only surgical option. Hypernatremia is a complication to be expected when hypertonic saline is used to rinse the splenic and abdominal cavities.

Conclusion: This case highlights the importance of prompt surgical intervention and the management of hypernatremia in patients with ruptured splenic hydatid cysts.
Associations of Education Attainment With Postpartum Depression and the Mediating Exploration: A Mendelian Randomization Study
Authors: Wang Xuanping , Zhou Fang-Yue , Hao Yanhui , Wu Jiaying , Su Kaizhen , Chen Si-Yue , Yu Wen , Zhang Chen , Wu Yan-Ting , Huang He-Feng
Published: February 2025

Background: Many studies have explored the relationship between education and postpartum depression (PPD), with inconsistent results. Our study is to identify which education‐related factors (education attainment, qualifications, cognitive performance) played the predominant role in PPD using Mendelian randomization (MR) analysis. Then, we explored the factors that may mediate the effect of education on PPD.

Method: We performed two‐sample multivariable Mendelian randomization (MVMR) to assess the independent impact of education‐related factors on PPD. Based on the literature review, three mediating factors that may play a role in the path of education attainment and PPD were involved in mediation analysis, including childbearing age, neuroticism score, and average total household income before tax. Then, we used two‐step MR and MVMR to estimate the indirect effect of these mediators.

Results: We identified genetically predicted 1‐SD (3.71 years) higher education attainment (OR: 0.632; [95% confidential interval (CI): 0.464–0.860]); qualifications (OR: 0.418; [95% CI: 0.245–0.714]); or cognitive performance (OR: 0.770; [95% CI: 0.652–0.909]) was associated with lower risk of PPD, and the causal effects of education attainment (OR: 0.407; [95% CI: 0.214–0.773]) on PPD were independent of qualifications and cognition. Childbearing age (β: −0.497; [95% CI: −0.788−0.238]; p  < 0.001) and neuroticism score (β: −0.07; [95% CI: −0.120−0.030]; p  < 0.001) were identified as mediators of the association between education attainment and PPD.

Conclusions: These results suggested the predominant impact of education attainment on PPD independent of qualifications and cognition. Education level mainly affects PPD by changing the childbearing age.

Trial Registration: Chinese Clinical Trial Registry identifier: ChiCTR2000033433