bluuebunny/crossref_metadata_2025 huggingface dataset:
“A life-changing experience and the beginning of a lifelong commitment”: experiences and impact of Global Health Community Service-Learning in undergraduate dental curriculum in Canada
Authors: Jessani Abbas , Athanasakos Alexia , Kachwinya Samantha
Published: July 2024

Background

Global Health Community Service-Learning (GHCSL) can have a profound professional and personal impact on learners. This pedagogy provides understanding of unfamiliar environments and challenges learners to step out of their comfort zones, adapt to new cultures, and navigate unique situations. Yet, there are relatively few studies exploring the experiences of learners participating in community service-learning placements in global regions as part of undergraduate dental curriculum. This study aimed to explore the experiences and impact of the GHCSL program in East Africa among undergraduate dental learners at the Schulich School of Dentistry.

Methods

Eight undergraduate dental learners were enrolled in GHCSL pilot placements. Placement agreements were established with Makerere University in Kampala, Uganda, and the University of Rwanda in Kigali, Rwanda for the summer of 2022. Stakeholders from both institutions were engaged in the development and implementation of these placements. Learners were required to engage in weekly reflection through a ‘storytelling and incident-based narrative’ while carrying out their placement. A qualitative study design was employed, and an inductive interpretive approach was utilized to thematically analyze the learners’ reflective essays.

Results

Five major themes emerged from the learners’ reflective essays: (1) experiential clinical learning; (2) cultural humility and social awareness; (3) awareness of contrasting healthcare systems; (4) commitment to service; and (5) personal and professional growth. Most learners reflected on their engagement with diverse communities, being exposed to unique patient cases, and witnessing the adaptability exuded in resource-constrained environments. These experiences presented the learners with an opportunity to develop cultural humility and gain a newfound motivation to mitigate global oral health disparities in populations beyond that of their local communities. Learners also reflected on enhanced social awareness experiences and the awareness of contrasting healthcare systems in Canada and their placements, which encouraged the development of empathy, communication, and compassion skills, as well as an understanding of the disproportionate burden of conditions in low-resource settings.

Conclusion

The reflective essays concluded that the GHCSL placements had a positive impact on the learners, encouraging many to develop a heightened desire for lifelong learning to address oral health disparities within a global context.
Based case based learning and flipped classroom as a means to improve international students’ active learning and critical thinking ability
Authors: Yang Wanjing , Zhang Xiaoyan , Chen Xinhuan , Lu Jing , Tian Fang
Published: July 2024

Background

International student education has become an important part of higher education and an important symbol to measure the level of higher education. To change the traditional teaching model, here we introduced a combination of Case-Based Learning (CBL)and Flipped Classroom (FC) into the pathophysiology course for international students. This study aimed to explore whether the active learning ability and critical thinking ability of international students can be improved, based on this new teaching model, improving the innovation ability of teachers’ team and students’ attitude to the reform.

Methods

The two chapters of Cardiac Insufficiency and Apoptosis in Pathophysiology are designed as a CBL + FC teaching method. Distribute the Self-assessment Scale on Active Learning and Critical Thinking (SSACT) and satisfaction questionnaire to international students to evaluate teaching reform based on CBL + FC.

Results

Compared with the traditional classroom, the online flipped classroom based on CBL has significantly improved the learning enthusiasm, as these students are required to independently complete literature review, actively participate in classroom teaching, learn to use multiple learning strategies, and collaborate with other students to complete PowerPoint (PPT)production. At the same time, the students’ ability to raise problems and solve problems has been greatly improved by analyzing clinical cases; By consulting the literature, the theoretical knowledge learned can be better applied to clinical analysis. The results of the satisfaction survey also show that international students are more likely to accept the flipped classroom teaching mode.

Conclusions

This teaching mode will stimulate the learning motivation of international students, enhance teaching attraction and increase teaching interaction; At the same time, the CBL + FC teaching method can strengthen the evaluation of international students’ in and out of class and online learning, enhance students’ active learning ability and critical thinking ability, promote the development of personalized learning, and integrate with international medical education.
Psychometric testing of the training needs for advance care planning scale for clinicians and nurses
Authors: He Chunju , Dong Tiaoxia , Tan Jin , Yang Liu , Qiu Yeyin , Zhang Jianghui , Huang Yi , Zhou Aiting , Wang Xianlin , Huang Yuan , Zhu Minglan , LAM Simon Ching , Deng Renli
Published: July 2024

Background

Studies have shown that Chinese Clinicians and nurses have positive attitudes toward ACP, but no local tools exist to assess their need for ACP knowledge and skills training. resulting in their inability to initiate ACP conversations as well as poor end-of-life care for patients. Therefore, this study aims to assess the needs of Chinese Clinicians and nurses for ACP knowledge and skills training and assess the validity and reliability of a questionnaire on the Training Needs for Advance Care Planning (TNACP) scale.

Methods

From October to November 2021, 170 clinicians and nurses were pre-surveyed using a preliminary draft of the questionnaire. The responses were screened using item analysis, Cronbach’s alpha coefficient, and the intraclass correlation coefficient (ICC) to describe the internal consistency and stability of the questionnaire. The Content validity index (CVI), Exploratory factor analysis (EFA) and Confirmatory factor analysis (CFA) were used to test the validity of the questionnaire.

Results

After independent samples t-test analysis, Except for the entry “A2”, the critical ratio between the two groups of the remaining 23 items was statistically significant (p < 0.05). Based on the above screening methods, the “A2” item was deleted, and the final number of questionnaire items was 23. The I-CVI was 0.79–1.00, and the S-CVI/Ave was 0.90. Three common factors were extracted—the cumulative contribution rate was 69.969%, and the factor loading of all items was 0.506–0.843 (all > 0.40). The results of confirmatory factor analysis showed that the Training Needs for Advance Care Planning (TNACP) scale model fit well(X2/df = 2.504, RMSEA = 0.092, GFI = 0.809, AGFI = 0.745, CFI = 0.931, IFI = 0.932, TLI = 0.916); the Cronbach’s α = 0.888 for the total questionnaire, and the three dimensions of Cronbach’s α were 0.729 to 0.959; and the ICC for the overall scores between the test-retest evaluations was 0.884 (p < 0.001).

Conclusions

The TNACP scale has good reliability and validity and can be used to assess Chinese Clinicians and nurses’ training needs for implementing ACP.
Preliminary investigation of potential links between pigmentation variants and opioid analgesic effectiveness in horses during cerebrospinal fluid centesis
Authors: Bacon Elouise K. , Donnelly Callum G. , Bellone Rebecca R. , Haase Bianca , Finno Carrie J. , Velie Brandon D.
Published: July 2024

Background

The pleiotropic effects of the melanocortin system show promise in overcoming limitations associated with large variations in opioid analgesic effectiveness observed in equine practice. Of particular interest is variation in the melanocortin-1-receptor (MC1R) gene, which dictates pigment type expression through its epistatic interaction with the agouti signalling protein (ASIP) gene. MC1R has previously been implicated in opioid efficacy in other species; however, this relationship is yet to be explored in horses. In this study, analgesic effectiveness was scored (1-3) based on noted response to dura penetration during the performance of cerebrospinal fluid centisis after sedation and tested for association with known genetic regions responsible for pigmentation variation in horses.

Results

The chestnut phenotype was statistically significant (P < 0.05) in lowering analgesic effectiveness when compared to the bay base coat colour. The 11bp indel in ASIP known to cause the black base coat colour was not significant (P>0.05); however, six single nucleotide polymorphisms (SNPs) within the genomic region encoding the ASIP gene and one within MC1R were identified as being nominally significant (P<0.05) in association with opioid analgesic effectiveness. This included the location of the known e MC1R variant resulting in the chestnut coat colour.

Conclusions

The current study provides promising evidence for important links between pigmentation genes and opioid effectiveness in horses. The application of an easily identifiable phenotype indicating variable sensitivity presents a promising opportunity for accessible precision medicine in the use of analgesics and warrants further investigation.
Combination of graduated compression stockings and intermittent pneumatic compression is better in preventing deep venous thrombosis than graduated compression stockings alone for patients following gynecological surgery: a meta-analysis
Authors: Lu Limei , Shen Ya , Pan Yuping
Published: July 2024

Background

Deep vein thrombosis (DVT) is common in patients undergoing gynecological surgery. We aimed to investigate the preventive efficacy in DVT of graduated compression stockings (GCS) alone and in combination with intermittent pneumatic compression (GCS + IPC) after gynecological surgery.

Methods

In November 2022, studies on the use of GCS and GCS + IPC for the prevention of DVT after gynecological surgery were searched in seven databases. After literature screening and data extraction based on specific inclusion and exclusion criteria, preventive efficacies, including the risk of DVT and anticoagulation function, of GCS and GCS + IPC were compared. Finally, sensitivity analysis and Egger’s test were performed to evaluate the stability of the meta-analysis.

Results

Six publications with moderate quality were included in this meta-analysis. The results showed that GCS + IPC significantly reduced DVT risk (P = 0.0002) and D-dimer levels (P = 0.0005) compared with GCS alone. Sensitivity analysis and Egger’s test showed that the combined results of this study were stable and reliable.

Conclusions

Compared with GCS alone, GCS + IPS showed a higher preventive efficacy against DVT in patients following gynecological surgery.
Re-establishing immune tolerance in multiple sclerosis: focusing on novel mechanisms of mesenchymal stem cell regulation of Th17/Treg balance
Authors: Hu Huiru , Li Hui , Li Ruoyu , Liu Peidong , Liu Hongbo
Published: July 2024

The T-helper 17 (Th17) cell and regulatory T cell (Treg) axis plays a crucial role in the development of multiple sclerosis (MS), which is regarded as an immune imbalance between pro-inflammatory cytokines and the maintenance of immune tolerance. Mesenchymal stem cell (MSC)-mediated therapies have received increasing attention in MS research. In MS and its animal model experimental autoimmune encephalomyelitis, MSC injection was shown to alter the differentiation of CD4+T cells. This alteration occurred by inducing anergy and reduction in the number of Th17 cells, stimulating the polarization of antigen-specific Treg to reverse the imbalance of the Th17/Treg axis, reducing the inflammatory cascade response and demyelination, and restoring an overall state of immune tolerance. In this review, we summarize the mechanisms by which MSCs regulate the balance between Th17 cells and Tregs, including extracellular vesicles, mitochondrial transfer, metabolic reprogramming, and autophagy. We aimed to identify new targets for MS treatment using cellular therapy by analyzing MSC-mediated Th17-to-Treg polarization.

Graphical Abstract
Circadian rhythm disruption upregulating Per1 in mandibular condylar chondrocytes mediating temporomandibular joint osteoarthritis via GSK3β/β-CATENIN pathway
Authors: Wei Jiaming , Wang Yuxuan , Tu Shaoqin , Zhang Sai , Feng Yi , Hou Yuluan , Ai Hong , Chen Zheng
Published: July 2024

Background

Temporomandibular joint osteoarthritis (TMJOA) has a high incidence rate, but its pathogenesis remains unclear. Circadian rhythm is an important oscillation in the human body and influences various biological activities. However, it is still unclear whether circadian rhythm affects the onset and development of TMJOA.

Methods

We disrupted the normal rhythm of rats and examined the expression of core clock genes in the mandibular condylar cartilage of the jaw and histological changes in condyles. After isolating rat mandibular condylar chondrocytes, we upregulated or downregulated the clock gene Per1, examined the expression of cartilage matrix-degrading enzymes, tested the activation of the GSK3β/β-CATENIN pathway and verified it using agonists and inhibitors. Finally, after downregulating the expression of Per1 in the mandibular condylar cartilage of rats with jet lag, we examined the expression of cartilage matrix-degrading enzymes and histological changes in condyles.

Results

Jet lag led to TMJOA-like lesions in the rat mandibular condyles, and the expression of the clock gene Per1 and cartilage matrix-degrading enzymes increased in the condylar cartilage of rats. When Per1 was downregulated or upregulated in mandibular condylar chondrocytes, the GSK3β/β-CATENIN pathway was inhibited or activated, and the expression of cartilage matrix-degrading enzymes decreased or increased, which can be rescued by activator and inhibitor of the GSK3β/β-CATENIN pathway. Moreover, after down-regulation of Per1 in mandibular condylar cartilage in vivo, significant alleviation of cartilage degradation, cartilage loss, subchondral bone loss induced by jet lag, and inhibition of the GSK3β/β-CATENIN signaling pathway were observed. Circadian rhythm disruption can lead to TMJOA. The clock gene Per1 can promote the occurrence of TMJOA by activating the GSK3β/β-CATENIN pathway and promoting the expression of cartilage matrix-degrading enzymes. The clock gene Per1 is a target for the prevention and treatment of TMJOA.
Nuclear alpha-synuclein accelerates cell senescence and neurodegeneration
Authors: Du Tingfu , Li Guoxiang , Zong Qinglan , Luo Haiyu , Pan Yue , Ma Kaili
Published: July 2024

Background

The progression of Parkinson’s disease (PD) is related to ageing. The accumulation of nuclear alpha-synuclein (α-syn) may accelerate the occurrence of neurodegenerative diseases, but its role in PD remains poorly understood.

Methods

In the present study, α-syn expression was specifically targeted to the nucleus by constructing an adeno-associated virus (AAV) vector in which a nuclear localization sequence (NLS) was added to the α-syn coding sequence. Virus-mediated gene transfer, behavioural tests, RNA-Seq, immunohistochemistry, western blotting, and quantitative real-time PCR were then performed.

Results

In vivo experiments using a mouse model showed that nuclear α-syn increased the severity of the PD-like phenotype, including the loss of dopaminergic neurons concomitant with motor impairment and the formation of α-syn inclusions. These nuclear inclusions contained α-syn species of high molecular weights and induced strong transcriptional dysregulation, especially induced high expression of p21 and senescence-associated secretory phenotype (SASP)-related genes. In addition, the transcriptional alterations induced by nuclear α-syn were associated with gliosis, inflammation, oxidative and DNA damage, and lysosomal dysfunction, and they eventually accelerated neuronal loss and neurodegeneration.

Conclusions

Our results suggest that nuclear α-syn plays a crucial role in PD pathogenesis.
Establishing evidence criteria for implementation strategies in the US: a Delphi study for HIV services
Authors: McKay Virginia R. , Zamantakis Alithia , Pachicano Ana Michaela , Merle James L. , Purrier Morgan R. , Swan McKenzie , Li Dennis H. , Mustanski Brian , Smith Justin D. , Hirschhorn Lisa R. , Benbow Nanette
Published: July 2024

Background

There are no criteria specifically for evaluating the quality of implementation research and recommending implementation strategies likely to have impact to practitioners. We describe the development and application of the Best Practices Tool, a set of criteria to evaluate the evidence supporting HIV-specific implementation strategies.

Methods

We developed the Best Practices Tool from 2022–2023 in three phases. (1) We developed a draft tool and criteria based on a literature review and key informant interviews. We purposively selected and recruited by email interview participants representing a mix of expertise in HIV service delivery, quality improvement, and implementation science. (2) The tool was then informed and revised through two e-Delphi rounds using a survey delivered online through Qualtrics. The first and second round Delphi surveys consisted of 71 and 52 open and close-ended questions, respectively, asking participants to evaluate, confirm, and make suggestions on different aspects of the rubric. After each survey round, data were analyzed and synthesized as appropriate; and the tool and criteria were revised. (3) We then applied the tool to a set of research studies assessing implementation strategies designed to promote the adoption and uptake of evidence-based HIV interventions to assess reliable application of the tool and criteria.

Results

Our initial literature review yielded existing tools for evaluating intervention-level evidence. For a strategy-level tool, additions emerged from interviews, for example, a need to consider the context and specification of strategies. Revisions were made after both Delphi rounds resulting in the confirmation of five evaluation domains – research design, implementation outcomes, limitations and rigor, strategy specification, and equity – and four evidence levels – best, promising, more evidence needed, and harmful. For most domains, criteria were specified at each evidence level. After an initial pilot round to develop an application process and provide training, we achieved 98% reliability when applying the criteria to 18 implementation strategies.

Conclusions

We developed a tool to evaluate the evidence supporting implementation strategies for HIV services. Although specific to HIV in the US, this tool is adaptable for evaluating strategies in other health areas.
Impact of pericardial calcification on early postoperative outcomes after pericardiectomy: a retrospective observational study
Authors: Lee Soojin , Lee Juhyun , Joo Seohee , Park You Kyeong , Kim Kang Min , Jung Joon Chul , Chang Hyoung Woo , Lee Jae Hang , Kim Dong Jung , Kim Jun Sung , Lim Cheong
Published: July 2024

Background

Owing to the lack of understanding of the clinical significance of pericardial calcification during pericardiectomy, whether pericardial calcification should be considered when determining the optimal timing for pericardiectomy is debatable. We aimed to investigate the effect of pericardial calcification on early postoperative outcomes in patients who underwent pericardiectomy for constrictive pericarditis.

Methods

Altogether, 44 patients who underwent pericardiectomy for constrictive pericarditis were enrolled. After excluding three patients who underwent concurrent surgeries, a total of 41 patients were categorized into two groups based on the presence of pericardial calcification as determined by preoperative computed tomography and pathological examination. Preoperative clinical and imaging characteristics, intraoperative data, and early postoperative outcomes were compared between the two groups. A multivariable analysis was performed to identify the factors associated with postoperative complications.

Results

The group with and without PC comprised 21 and 20 patients, respectively. No significant differences were observed in 30-day mortality (n = 1 [5%]) in the group with pericardial calcification and no mortality in the group without pericardial calcification (p > 0.999). Other early postoperative outcome variables did not demonstrate any significant differences between the two groups. However, the use of cardiopulmonary bypass was associated with postoperative complications (p < 0.009, odds ratio: 63.5, 95% confidence interval: 5.13–3400).

Conclusions

Pericardial calcification did not significantly affect the postoperative outcomes after pericardiectomy. Further comprehensive studies, including those with larger sample sizes and longitudinal designs, are necessary to determine whether pericardial calcification can significantly influence the timing of surgical intervention.
Synthetic datasets for open software development in rare disease research
Authors: Al-Dhamari Ibraheem , Abu Attieh Hammam , Prasser Fabian
Published: July 2024

Background

Globally, researchers are working on projects aiming to enhance the availability of data for rare disease research. While data sharing remains critical, developing suitable methods is challenging due to the specific sensitivity and uniqueness of rare disease data. This creates a dilemma, as there is a lack of both methods and necessary data to create appropriate approaches initially. This work contributes to bridging this gap by providing synthetic datasets that can form the foundation for such developments.

Methods

Using a hierarchical data generation approach parameterised with publicly available statistics, we generated datasets reflecting a random sample of rare disease patients from the United States (US) population. General demographics were obtained from the US Census Bureau, while information on disease prevalence, initial diagnosis, survival rates as well as race and sex ratios were obtained from the information provided by the US Centers for Disease Control and Prevention as well as the scientific literature. The software, which we have named SynthMD, was implemented in Python as open source using libraries such as Faker for generating individual data points.

Results

We generated three datasets focusing on three specific rare diseases with broad impact on US citizens, as well as differences in affected genders and racial groups: Sickle Cell Disease, Cystic Fibrosis, and Duchenne Muscular Dystrophy. We present the statistics used to generate the datasets and study the statistical properties of output data. The datasets, as well as the code used to generate them, are available as Open Data and Open Source Software.

Conclusion

The results of our work can serve as a starting point for researchers and developers working on methods and platforms that aim to improve the availability of rare disease data. Potential applications include using the datasets for testing purposes during the implementation of information systems or tailored privacy-enhancing technologies.
Coronary periarteritis and pericarditis are rare but distinct manifestations of heart involvement in IgG4-related disease: a retrospective cohort study
Authors: Hua Tianrui , Du Juan , Guo Xiaoxiao , Peng Linyi , Zhou Jiaxin , Nie Yuxue , Man Dafu , Li Mengtao , Pan Lili , Zhang Wen
Published: July 2024

Background

The heart can be involved in immunoglobulin (Ig)-G4-related disease (IgG4-RD). This study aimed to summarize the clinical features and efficacy of treatment for IgG4-RD patients with heart involvement.

Methods

We conducted a retrospective study enrolling 42 IgG4-RD patients with heart involvement from the IgG4-RD cohorts of the Peking Union Medical College Hospital and Beijing An Zhen Hospital, from 2010 to 2022. Clinical, laboratory, radiological data were collected, and treatment responses to glucocorticoids and immunosuppressants were analyzed.

Results

IgG4-related cardiac involvement is a rare part of the IgG4-RD spectrum. The incidences of coronary periarteritis and pericarditis were 1.2%(13/1075) and 3.1%(33/1075), respectively in our cohort. Valvular disease possibly related to IgG4-RD was detected in two patients. None of the patients with myocardial involvement were identified. The average age was 58.2 ± 12.8 years, with a male predominance (76.7%). Coronary artery CT revealed that mass-like and diffuse wall-thickening lesions were the most frequently observed type of coronary periarteritis. Pericarditis presented as pericardial effusion, localized thickening, calcification and mass. After treatment with glucocorticoid and immunosuppressants, all patients achieved a reduced IgG4-RD responder index score and achieved radiological remission. Two patients with coronary peri-arteritis experienced clinical relapses during the maintenance period.

Conclusions

Cardiac involvement in IgG4-RD is rare and easily overlooked since many patients are asymptomatic, and the diagnosis relies on imaging. Patients showed a satisfactory response to glucocorticoid based treatment.
Foodborne pathogenic bacteria in wild European hedgehogs (Erinaceus europaeus)
Authors: Fredriksson-Ahomaa Maria , Johansson Venla , Heljanko Viivi , Nuotio Elina , Nihtilä Heini , Heikinheimo Annamari , Kivistö Rauni
Published: July 2024

Background

European hedgehogs (Erinaceus europaeus) are widely distributed across Europe. They may play an important role by spreading zoonotic bacteria in the environment and to humans and animals. The aim of our work was to study the prevalence and characteristics of the most important foodborne bacterial pathogens in wild hedgehogs.

Results

Faecal samples from 148 hospitalised wild hedgehogs originating from the Helsinki region in southern Finland were studied. Foodborne pathogens were detected in 60% of the hedgehogs by PCR. Listeria (26%) and STEC (26%) were the most common foodborne pathogens. Salmonella, Yersinia, and Campylobacter were detected in 18%, 16%, and 7% of hedgehogs, respectively. Salmonella and Yersinia were highly susceptible to the tested antimicrobials. Salmonella Enteritidis and Listeria monocytogenes 2a were the most common types found in hedgehogs. All S. Enteritidis belonged to one sequence type (ST11), forming four clusters of closely related isolates. L. monocytogenes was genetically more diverse than Salmonella, belonging to 11 STs. C. jejuni ST45 and ST677, Y. pseudotuberculosis O:1 of ST9 and ST42, and Y. enterocolitica O:9 of ST139 were also found.

Conclusions

Our study shows that wild European hedgehogs should be considered an important source of foodborne pathogens, and appropriate hygiene measures after any contact with hedgehogs and strict biosecurity around farms are therefore important.
Serum GM-CSF level is a predictor of treatment response to tocilizumab in rheumatoid arthritis patients: a prospective observational cohort study
Authors: Su Jingbo , Hu Wenlu , Ding Yanxia , Zhang Panpan , Li Tianfang , Liu Shengyun , Xing Lihua
Published: July 2024

Background

The aim of this prospective observational cohort study was to unveil the predictors of treatment response to tocilizumab (TCZ) therapy in rheumatoid arthritis (RA) patients, in terms of clinical characteristics and serum proinflammatory cytokines, especially to explore the predictive value of granulocyte macrophage-colony stimulating factor (GM-CSF).

Methods

Active adult RA patients with inadequate response to MTX intending to receive TCZ therapy were recruited prospectively in the study. A total of 174 severe RA patients were included for the identification of the associations between treatment response and the following characteristic features: demographics, medications, disease activity, serum proinflammatory cytokines and so on.

Results

Disease duration (OR = 0.996), tender joint count (TJC)/68 (OR = 0.943), neutrophil ratio (W4/baseline) (OR = 0.224), the high level of GM-CSF > 5 ng/ml (OR = 0.414) at baseline were the independent adverse predictors of good response assessed by clinical disease activity index (CDAI) at week 24 (W24) for TCZ therapy in RA patients. Moreover, DAS28-ESR (OR = 2.951, P = 0.002) and the high level of GM-CSF > 10 ng/ml at baseline (OR = 5.419, P = 0.002) were independent predictors of poor response, but not the high level of GM-CSF > 5 ng/ml (OR = 2.713, P = 0.054). The patients in the high GM-CSF group had significantly higher DAS28-ESR and serum levels of cytokines (IL-17A, IL-1β, IL-6, TNF-α) at baseline, as well as significantly higher rate of non-good response (62.8% vs. 39.4%, P = 0.010) and poor response (27.9% vs. 9.1%, P = 0.004) than the low GM-CSF group at W24. In addition, poor responders had significantly higher levels of GM-CSF with concomitant increase in the serum levels of IL-17A and IL-1β at baseline than those in moderate and good response groups, while serum levels of IL-6 and TNF-α at baseline were not significantly different in three response groups.

Conclusion

The high levels of GM-CSF (> 5 ng/ml and > 10 ng/ml) at baseline were the independent predictors of non-good response and poor response to TCZ at W24 respectively. The high level of GM-CSF at baseline is a marker of high disease activity and a predictor of poor response to TCZ in severe RA patients, which may facilitate the development of individualized treatment strategies for refractory RA.
Does metformin really reduce prostate cancer risk: an up-to-date comprehensive genome-wide analysis
Authors: Zhang Xinxing , Li Zhen
Published: July 2024

Background

The relationship between metformin use and prostate cancer (PCa) risk has yet to be clear despite more than a decade of debate on this topic. Hence, we aimed to investigate the causal role of metformin in reducing PCa risk through an up-to-date comprehensive genome-wide analysis.

Methods

We employed validated instrument variables of metformin use derived from a prior high-quality study, including five potential targets (AMPK, GCG, GDF15, MCI and MG3). Mendelian randomization (MR) analysis was performed to harmonize genetically predicted metformin use and PCa phenotypes. PCa phenotypes were from two large genome-wide association studies (GWAS), the Prostate Cancer Association Group to Investigate Cancer-Associated Alterations in the Genome (PRACTICAL) and the FinnGen cohort. Seven methods were applied to generate MR results: the inverse variance weighted (IVW), IVW with multiplicative random effects, MR-Egger, MR-Egger (bootstrap), weighted median, simple mode and weighted mode. Strict sensitivity analysis was conducted to satisfy core assumptions of MR design.

Results

We enrolled 32 significant single nucleotide polymorphisms (SNPs) that involved with metformin use. Nearly all targets yielded insignificant primary results (IVW with multiplicative random effects), except that AMPK target posed a positive effect on PCa risk from FinnGen cohort [odds ratio (OR): 6.09, 95% confidence interval (CI): 1.10-33.53, P value: 0.038]. The general effect of metformin use, comprising all 5 targets, also yielded negative results (random-effect meta-analysis with OR: 1.09, 95% CI: 0.76–1.58, P value: 0.637 for PRACTICAL; OR: 2.55, 95% CI: 0.58–11.16, P value: 0.215 for FinnGen). None of the sensitivity analyses provided support for a causal association between metformin use and PCa risk.

Conclusion

This up-to-date study did not support the protective role of metformin in reducing PCa risk, considering each target, overall effect, and sensitivity analysis. It is imperative to reflect on the presumed “almighty medicine” and ongoing phase III trials are anticipated to assess the anti-neoplasm effect of metformin.
Correlation between surgical position and neck pain in patients undergoing thyroidectomy: a prospective observational study
Authors: Pagliaro Salvatore , Rossi Leonardo , Meligeni Michela , Catani Letizia , Morganti Riccardo , Materazzi Gabriele , Bakkar Sohail , Montanino Antonia , Pagliaro Danilo , Scateni Monica , Pagnucci Nicola
Published: July 2024

Background

Thyroid diseases are one of the most common health problems worldwide. Although they represent a necessary step in order to perform thyroidectomy, hyperextension of the neck can potentially increase postoperative pain. The aim of this study is to determine a correlation between the degree of neck hyperextension on the operative table and the postoperative pain in patients undergoing open thyroidectomy.

Methods

Patients were prospectively enrolled from the cohort of patients operated at the Endocrine Surgery Unit of the University Hospital of Pisa, between May and July 2021. Both of patients who underwent total thyroidectomy or hemi-thyroidectomy were recruited. The following data were analysed in order to find a correlation with postoperative pain at 24 h: age, gender, type of surgery, BMI, operative time, and degree of neck extension.

Results

Overall, 195 patients were enrolled. A direct, statistically significant correlation emerged between the degree of neck hyperextension and the postoperative pain 24 h after surgery, regardless of the pain of the surgical wound (p < 0.001; beta 0.270).

Conclusions

A direct correlation emerges between neck tilt angle and postoperative neck pain. Moreover, total thyroidectomy (TT) predisposes more to postoperative neck pain, considering the type of surgery.
Effect of dipeptidyl peptidase-4 inhibitors on tumor necrosis factor alpha levels in patients with type 2 diabetes mellitus
Authors: Zhao Lijia , Meng Jie , Bai Xueyan , Zhang Donglei , Yang Xingsheng , Yang Yu , Cai Gaojun , Liu Xin
Published: July 2024

Aims

Dipeptidyl peptidase-4 inhibitors (DPP-4i) served as oral antidiabetic agents for treatment of type 2 diabetes mellitus (T2DM). Although an action on glucose homeostasis was identified, no well-rounded illustration had been established on the changes of tumor necrosis factor alpha (TNF-alpha) levels during DPP-4i treatment. This study aimed to explore the anti-inflammatory effect of DPP-4i on TNF-alpha in patients with T2DM.

Methods

PubMed, Embase and Cochrane Library were systematically searched from inception to May 31, 2024. Randomized controlled trials exploring the impact of DPP-4i on TNF-alpha levels were identified. Risk of bias was assessed according to the Cochrane criteria. A fixed or random-effects model was selected to pool estimate on whether the heterogeneity was present. Subgroup analysis were performed to explore the potential factors that influenced heterogeneity. Related meta-analysis was conducted with the software of Revman 5.3 and STATA 12.0.

Results

Eleven trials involving 884 participants with T2DM were included. Pooled estimates suggested that DPP-4i did not significantly modulate TNF-alpha levels (WMD, − 0.70, 95% CI − 1.94 to 0.53, P = 0.26) in T2DM. DPP-4i produced a significant effect on TNF-alpha (WMD, − 4.50 pg/mL, 95% CI − 4.68 to − 4.32, P < 0.00001) when compared to placebo, and a comparable effect was demonstrated on TNF-alpha (WMD, 0.10 pg/mL, 95% CI − 0.11 to 0.30, P = 0.35) in comparison with active agents. Estimate was stable according to the sensitivity test. Subgroup analysis revealed that heterogeneity might not correlate with baseline glycated hemoglobin (HbA1c), age or treatment duration.

Conclusions

A significant effect of DPP-4i on TNF-alpha levels was present in T2DM when compared to placebo. Administration of DPP-4i produced no significant effect on TNF-alpha in comparison with active comparators. Further studies with large samples should be performed to illustrate the impact of DPP-4i on TNF-alpha levels in T2DM.

Trial registration International Prospective Register for Systematic Review (PROSPERO) number: CRD42020185479
Exploring the inverse relationship between serum total bilirubin and systemic immune-inflammation index: insights from NHANES data (2009–2018)
Authors: Huang Shan-Shan , Ding Yi , Yi Xiao-Na , Mao Hai-Yan , Xie Zhen-Ye , Shen Xing-Kai , Lu Yan , Yan Jing , Wang You-Wei , Yang Zhou-Xin
Published: July 2024

Background

Bilirubin is known for its multifaceted attributes, including antioxidant, anti-inflammatory, immunomodulatory, and antiapoptotic properties. The systemic immune-inflammation index (SII) is a recent marker that reflects the balance between inflammation and immune response. Despite the wealth of information available on bilirubin’s diverse functionalities, the potential correlation between the total bilirubin (TB) levels and SII has not been investigated so far.

Methods

Leveraging data from the National Health and Nutrition Examination Survey spanning 2009–2018, the TB levels were categorized using tertiles. Employing the chi-squared test with Rao and Scott’s second-order correction and Spearman’s rank correlation analysis, the association between TB and SII was examined. The potential nonlinearities between TB and SII were evaluated using restricted cubic spline (RCS) analysis. Weighted linear regression, adjusted for covariates, was used to explore the correlation between TB and SII, with further subgroup analyses.

Results

A total of 16,858 participants were included, and the findings revealed significant SII variations across TB tertiles (p < 0.001). The third tertile (Q3) exhibited the lowest SII level at 495.73 (295.00) 1000 cells/µL. Spearman rank correlation disclosed the negative association between TB and SII. RCS analysis exposed the lack of statistically significant variations in the nonlinear relationship (p > 0.05), thereby providing support for a linear relationship. Weighted linear regression analysis underscored the negative correlation between TB and SII (β 95% CI − 3.9 [− 5.0 to  − 2.9], p < 0.001). The increase in the TB levels is associated with a significant linear trend toward decreasing SII. After controlling for relative covariates, this negative correlation increased (p < 0.001). Subgroup analysis confirmed the significant negative TB–SII association.

Conclusion

A notable negative correlation between TB and SII implies the potential protective effects of bilirubin in inflammation-related diseases.
Enhancing psychological well-being in college students: the mediating role of perceived social support and resilience in coping styles
Authors: Dong Shihong , Ge Huaiju , Su Wenyu , Guan Weimin , Li Xinquan , Liu Yan , Yu Qing , Qi Yuantao , Zhang Huiqing , Ma Guifeng
Published: July 2024

Background

The prevalence of depression among college students is higher than that of the general population. Although a growing body of research suggests that depression in college students and their potential risk factors, few studies have focused on the correlation between depression and risk factors. This study aims to explore the mediating role of perceived social support and resilience in the relationship between trait coping styles and depression among college students.

Methods

A total of 1262 college students completed questionnaires including the Trait Coping Styles Questionnaire (TCSQ), the Patient Health Questionnaire-9 (PHQ-9), the Perceived Social Support Scale (PSSS), and the Resilience Scale-14 (RS-14). Common method bias tests and spearman were conducted, then regressions and bootstrap tests were used to examine the mediating effects.

Results

In college students, there was a negative correlation between perceived control PC and depression, with a significant direct predictive effect on depression (β = -0.067, P < 0.01); in contrast, negative control NC showed the opposite relationship (β = 0.057, P < 0.01). PC significantly positively predicted perceived social support (β = 0.575, P < 0.01) and psychological resilience (β = 1.363, P < 0.01); conversely, NC exerted a significant negative impact. Perceived social support could positively predict psychological resilience (β = 0.303, P < 0.01), and both factors had a significant negative predictive effect on depression. Additionally, Perceived social support and resilience played a significant mediating role in the relationship between trait coping styles and depression among college students, with three mediating paths: PC/NC → perceived social support → depression among college students (-0.049/0.033), PC/NC→ resilience → depression among college students (-0.122/-0.021), and PC/NC → perceived social support → resilience → depression among college students (-0.016/0.026).

Conclusion

The results indicate that trait coping styles among college students not only directly predict lower depression but also indirectly influence them through perceived social support and resilience. This suggests that guiding students to confront and solve problems can alleviate their depression.
An exploration of Irish nutrition educators’ experiences of competency-based assessment in nutrition science education
Authors: O’Donovan Sarah , Palermo Claire , Ryan Lisa
Published: July 2024

Background

Competency-based assessment (CBA) supports the development and attainment of skills required for the workforce. Little is known about educators’ experience in developing or implementing CBA in nutrition science education or their opinions on how well it captures a student’s preparedness for the workforce. The objective of this study was to explore educators’ experience of CBA in nutrition education in Ireland.

Method

Grounded in interpretivism, in-depth, semi-structured, audio-recorded interviews were conducted with 13 educators from five of the ten undergraduate honours degree nutrition programmes across Ireland. Interviews explored experiences of CBA and perception of students training to prepare for the workforce. A reflexive thematic analysis approach was implemented whereby the data were transcribed, inductively coded, and themes identified.

Results

A clear divide was evident between participants who were confident in their understanding of CBA and those who were unsure or had no knowledge of the term. Those with a clear understanding were more involved in programme development and evaluation. Three themes were identified: ‘Assessment process’ including intended learning outcomes, assessment design, and grading systems, ‘Student-centred approach to assessment’ focusing on work-based assessment and preparation for the workforce, and ‘Upskilling educators’ to equip educators with the skills and knowledge for professional development and to foster student success.

Conclusion

The importance of CBA as a student-centred approach, supporting them to meet standards expected to practice as a nutrition professional, was the key experience of educators. Training in CBA and inclusion of more authentic assessment may better prepare students for the workforce.
Standardised integration requirements for naturalisation: less rights and less discretion? A qualitative meta-analysis of ethnographic studies of naturalisation procedures in Europe
Authors: Sredanovic Djordje
Published: July 2024

Since the late 1990s and early 2000s, in what can be called an ‘integrationist wave’, standardised integration requirements for naturalisation have become increasingly common in Europe. To examine the impact of such measures, I combine original ethnographic data on institutions involved in the implementation of citizenship policies in Belgium and the UK with a qualitative meta-analysis of existing ethnographic studies of the implementation of citizenship policies. I show how, in addition to introducing new obstacles to naturalisation, standardised requirements have also reduced the discretion inscribed in earlier procedures, albeit not uniformly across different cases. The integrationist wave could thus be understood not simply as the introduction of restrictive notions of integration, but also as the systemisation of earlier evaluation practices. I further show signs of a more recent tendency for states to retreat from examining the integration of candidates to citizenship, outsourcing the evaluation directly or indirectly to private actors.
What are they considering when they face a fetus with birth defects? A qualitative study on ethical attitudes of health professionals in China
Authors: Liu Yanlin , Wang Xiaomin , Fang Junqun , Zhou Wei , Luo Dan
Published: July 2024

Background

Birth defects are the leading cause of mortality in newborn babies and children under five years old. In response, the Chinese government has implemented a three-tiered prevention strategy, which has brought ethical concerns about fetuses with birth defects. This study aims to explore the attitudes toward fetuses with birth defects among health professionals engaged in maternal and child health services.

Methods

A qualitative study was conducted among 13 health professionals engaged in maternal and child health services in Hunan Province, China. The questions were designed to elicit the participants' work experience and attitudes toward fetuses with birth defects. The data were collected through in-depth semi-structured interviews, and NVivo 12 was used for data coding and analysis. A thematic analysis approach was employed following the SRQR checklist.

Results

Five themes and 13 attributes were generated regarding health professionals' perspectives on fetuses with birth defects. The five themes included: (1) severity and curability of diseases (two attributes), (2) family relations (four attributes), (3) medical assessments (two attributes), (4) social situations (three attributes), (5) self-value orientations (three attributes). The findings showed that the majority of health professionals held the view that a fetus with a curable disease could be born, whereas a fetus with severe disability and teratogenesis should be terminated. Twelve out of the 13 health professionals believed that parents should be the decision-makers, while only one thought that the family should make a decision together.

Conclusions

Attitudes toward birth defects were influenced by various factors, indicating the complexity of real-world cases identified in this study. The findings highlight the dilemmas faced by both families and health professionals regarding birth defects. Adequate medical knowledge and support from society are crucial to inform decision-making among family members. Additionally, standardized norms and policies for birth defects are needed. Establishing an ethics committee for prenatal diagnosis is necessary to address current ethical issues in this field.