bluuebunny/crossref_metadata_2025 huggingface dataset:
Does sleep link child maltreatment to depressive symptoms among incoming first-year college students?
Authors: Rojo-Wissar Darlynn M , Parade Stephanie H , Barker David H , Van Reen Eliza , Sharkey Katherine M , Gredvig-Ardito Caroline , Carskadon Mary A
Published: June 2024

Study Objectives

We examined whether sleep (i.e. quality, regularity, and duration) mediated associations between child maltreatment (CM) and depressive symptoms among emerging adults undergoing the major life transition of starting college.

Methods

Students (N = 1400; 44% male; 48% non-Hispanic white, 20% non-Hispanic Asian, 15% Hispanic all races, 7% non-Hispanic black, and 10% non-Hispanic other races) completed daily sleep diaries for 9 weeks, followed by the Childhood Trauma Questionnaire-Short Form, Pittsburgh Sleep Quality Index, and the Center for Epidemiologic Studies Depression Scale (CES-D). DSD data were used to compute participants’ Sleep Regularity Index and average 24-hour total sleep time. We used a nonparametric structural equation modeling bootstrap approach and full information maximum likelihood to account for missing data. In model 1, we controlled for sex and race and ethnicity. In model 2, we further adjusted for baseline CES-D scores.

Results

The prevalence of self-reported moderate-to-severe CM was 22%. Small but significant indirect effects of CM on greater depressive symptoms through worse sleep quality (β = 0.06, 95% CI = 0.04, 0.09) and lower sleep regularity (β = 0.02, 95% CI = 0.005, 0.03) were observed in model 1. In model 2, only the indirect effect of sleep quality remained significant (β = 0.03, 95% CI = 0.01, 0.06).

Conclusions

Poorer sleep quality may partially account for associations between CM and depressive symptoms during the first semester of college. Including sleep as a target in student health interventions on college campuses may not only help buffer against poor mental health outcomes for students with CM, but also poor academic and socioeconomic outcomes long-term.
Private Foundations in the United Arab Emirates: Empowering Family Wealth Management Strategies
Authors: Mrazek Yann , Zagatti Kath
Published: June 2024

Private Foundations have become an indispensable tool for ultra-high-net-worth individuals (“UHNWIs”) and their families in the United Arab Emirates (“UAE”) seeking to optimize their wealth and legacy planning strategies. In the dynamic landscape of wealth management, Middle Eastern entrepreneurial families have long relied on foreign offshore Trusts and Foundations as an essential tool for safeguarding assets and preserving intergenerational continuity. These structures, while effective for assets located abroad, have encountered limitations when it comes to regionally based assets such as shares in core businesses or real estate. However, following a dramatic revamp and expansion of its regulatory framework during the past decade, the United Arab Emirates currently offers arguably the most comprehensive and sophisticated tool chest of wealth structuring/business continuity solutions in the world. Private Foundations in the UAE have marked a significant milestone in the UAE legal framework with over 1,000 Foundations under management. This article delves into the landscape of Private Foundations in the UAE, focusing on their role in asset protection and portfolio restructuring for family wealth preservation. Drawing upon the unique characteristics of Trusts & Trustees’ approach, the authors provide valuable insights into the recognition, regulation and operational dynamics of Private Foundations within the country’s business-oriented framework.
Improving retrospective intervention descriptions: Lessons learned from research on type 2 diabetes programmes in the United Kingdom and the Republic of Ireland
Authors: Carvalho Márcia , Hawkes Rhiannon E , Hadjiconstantinou Michelle , Byrne Molly , French David P , McSharry Jenny
Published: June 2024

In recent years, multiple countries worldwide have implemented behavioural interventions within national healthcare systems. Describing the content of these interventions is critical to improve their implementation, replication, and effectiveness, as well as to advance behavioural science. Tools, such as the Behaviour Change Technique Taxonomy, can enhance the quality of intervention description and reporting. As interventions are frequently developed without the use of such tools, retrospective coding of existing interventions to accurately characterise their content is becoming more common. However, the use of these tools for retrospective coding poses various challenges, the discussion of which has been neglected to date. This commentary discusses the challenges encountered when retrospectively describing the content of five nationally implemented programmes for type 2 diabetes in the United Kingdom and the Republic of Ireland and suggests recommendations to tackle these challenges. We present important methodological, practical, and ethical considerations for researchers to reflect on, relevant to the retrospective description of existing interventions. Specifically, we discuss (i) the importance of positive relationships and collaboration with intervention stakeholders, (ii) the practical and ethical considerations when analysing the content of implemented interventions, (iii) the independence of research teams and the potential for misclassification of intervention content, and (iv) the challenges associated with the analysis of intervention content using behavioural science tools. There is a growing demand for more robust approaches to address the methodological, practical, and ethical challenges associated with such studies. The present commentary describes key issues to be considered by research teams, as well as concrete recommendations to improve the retrospective characterisation of intervention content.
Tall Fescue and Endophyte Genetics Influence Vertical Transmission and Seed Characteristics Under Climate Change Scenarios
Authors: McGrail Rebecca K. , Carlisle A. Elizabeth , Nelson Jim A. , Dinkins Randy D. , McCulley Rebecca L.
Published: June 2024

Cool season grasses, including tall fescue, are dominant plants within managed grassland systems. A symbiotic relationship between tall fescue ( Lolium arundinaceum) and the fungal endophyte Epichloë coenophiala can affect grassland response to perturbations, including changing rainfall patterns and increasing temperatures associated with climate change. Because E. coenophiala reproduces asexually, there is concern that climate change may negatively impact vertical transmission, resulting in subsequent fescue stands with lower infection frequencies and reduced grassland resiliency. This 3-year field study evaluated the impact of increased temperature, altered precipitation, and their combination on vertical transmission, seed number, and seed weight in tall fescue clones containing common toxic (CTE) or novel nonmammalian toxic (NTE) E. coenophiala. NTE clones exhibited greater transmission than CTE clones. Temperature did not affect transmission, but altered precipitation reduced transmission in CTE clones. On average, NTE clones responded to increased temperatures by reducing seed number, while CTE clones responded oppositely. NTE clones produced seeds of similar masses across all growing years, suggesting greater stability under varying environmental conditions. Our work illustrates that both plant and endophyte genetics influence vertical transmission and that climate change is unlikely to significantly impact endophyte transmission in the southeastern transition zone of the United States.

[Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Identifying Children and Adolescents at Elevated Mental Health Risk Before and During COVID-19
Authors: Jellinek Michael , Benheim Talia S. , Dutta Anamika , Bergmann Paul , Sturner Raymond , Howard Barbara , Murphy J. Michael
Published: June 2024

Objective:

To determine whether the prevalence of psychosocial risk in children and adolescents changed from before to during the COVID-19 pandemic and whether these changes differed by age group, sex, and season, based on a standardized psychosocial measure completed as a routine part of primary care.

Methods:

Children and adolescents aged 5.5 to 17.9 years were screened with a parent report Pediatric Symptom Checklist-17 (PSC-17P) between November 2017 and June 2022. Changes in the prevalence of psychosocial risk (global, internalizing, externalizing, and attention scales) from before to during the pandemic were compared by age group, sex, and season.

Results:

In a sample of 459,767 health supervision visits, the prevalence of PSC-17P global, internalizing, and attention risk worsened significantly from before to during the pandemic, especially among female adolescents (ages 12.0–17.9). For a pediatrician seeing a hypothetical sample of 1000 adolescent girls, the expected number at risk would have increased from 103 to 131 on the global scale (26.6% increase), from 189 to 231 on the internalizing subscale (22.0% increase), and from 60 to 82 on the attention subscale (35.7% increase). Seasonality had a large effect, with significantly lower PSC-17P risk in the summer every year.

Conclusion:

Data from a large, national sample of pediatric visits suggested that global, internalizing, and attention concerns increased slightly overall from before to during the COVID-19 pandemic, with different patterns by age group and sex. Adolescent girls showed substantially increased global, internalizing, and attention problems. These increases support the need for further research and additional individual and system-level interventions.
Food Insecurity and Children's Problem Behaviors: The Mediating Role of Parental Relationship Quality and Parenting Stress
Authors: Gong Qiujie , Ju Sehyun
Published: June 2024

Objective:

Food insecurity, identified as a critical stressor for many families, can directly and indirectly influence children's development through interparental relationships and parenting. This study examines how food insecurity relates to children's problem behaviors and the mediating roles of interparental relationship quality and parenting stress. It also investigates the association between parents' perception of relationship quality and both their own and their partner's parenting stress.

Method:

The study included 2095 children from the Future of Families and Child Wellbeing Study. The actor partner interdependence model was used to explore the actor and partner influence of relationship quality on parents' parenting stress. To examine the association pathways from food insecurity to children's problem behaviors, a structural equation model was conducted.

Results:

Results suggest that fathers' perception of couple relationship quality predicted both their own and their partner's parenting stress while mothers' perception of couple relationship quality only predicted their own, but not fathers', parenting stress. In the positive association between food insecurity and children's problem behaviors, there was a serial mediation through mothers' perception of relationship quality and mothers' parenting stress. In addition, food insecurity was negatively correlated with mothers' perception of relationship quality, but not with that of fathers.

Conclusion:

This study highlights the pathway from food insecurity to children's problem behaviors through mothers' perceptions of interparental relationship quality and parenting stress. Results provide support for the family stress theory and offer valuable insights for the formulation of potential prevention and intervention programs.
Comprehensive profiling of lipid metabolic reprogramming expands precision medicine for HCC
Authors: Liu Qingbin , Zhang Xiangyu , Qi Jingjing , Tian Xinchen , Dovjak Eva , Zhang Jiaqi , Du Honghuan , Zhang Ni , Zhao Jing , Zhang Yiming , Wang Lijuan , Wei Yangang , Liu Chenqiao , Qian Ruikun , Xiang Longquan , Li Weiyang , Xiu Peng , Ma Changlin , Yu Yong , Jiang Shulong
Published: June 2024

Background and Aims:

Liver HCC is the second leading cause of cancer-related deaths worldwide. The heterogeneity of this malignancy is driven by a wide range of genetic alterations, leading to a lack of effective therapeutic options. In this study, we conducted a systematic multi-omics characterization of HCC to uncover its metabolic reprogramming signature.

Approach and Results:

Through a comprehensive analysis incorporating transcriptomic, metabolomic, and lipidomic investigations, we identified significant changes in metabolic pathways related to glucose flux, lipid oxidation and degradation, and de novo lipogenesis in HCC. The lipidomic analysis revealed abnormal alterations in glycerol-lipids, phosphatidylcholine, and sphingolipid derivatives. Machine-learning techniques identified a panel of genes associated with lipid metabolism as common biomarkers for HCC across different etiologies. Our findings suggest that targeting phosphatidylcholine with saturated fatty acids and long-chain sphingolipid biosynthesis pathways, particularly by inhibiting lysophosphatidylcholine acyltransferase 1 (LPCAT1) and ceramide synthase 5 (CERS5) as potential therapeutic strategies for HCC in vivo and in vitro. Notably, our data revealed an oncogenic role of CERS5 in promoting tumor progression through lipophagy.

Conclusions:

In conclusion, our study elucidates the metabolic reprogramming nature of lipid metabolism in HCC, identifies prognostic markers and therapeutic targets, and highlights potential metabolism-related targets for therapeutic intervention in HCC.
Evening dosing versus morning dosing of antihypertensive medications for nocturnal hypertension: a systematic review and meta-analysis of 107 randomized controlled trials
Authors: Lee Eric Kam-Pui , Wang S , Ng WL , Ramdzan SN , Tse ETY , Chan L , Rashid AA , Chin WY , Yu CP , Sit R , Poon P ,   the Asia-Pacific Academic Primary Care Group
Published: June 2024

Since the effects of once-daily antihypertensive (HT) medications are more pronounced within the first few hours of ingestion, evening administration of anti-HT medications can be a feasible treatment for nocturnal HT. However, no relevant meta-analysis has been conducted in patients with nocturnal HT. This meta-analysis included randomized controlled trials involving patients with elevated mean nocturnal blood pressure (BP) and compared evening anti-HT administration with morning administration. Multiple databases, including grey literature (e.g. clincialtrial.gov), were searched. Study selection and data extraction were conducted by two independent authors. Risk of bias assessment and overall quality of evidence were conducted using Cochrane risk-of-bias tool and GRADE by two independent authors. A total of 107 studies were included, 76 of which were investigated in China and had not been identified in previous reviews. Only one trial was ranked low risk-of-bias. Evening administration of anti-HT medications was effective in reducing nocturnal systolic BP (4.12–9.10 mmHg; I
2 = 80.5–95.2%) and diastolic BP (3.38–5.87 mmHg; I
2 = 87.4–95.6%). Subgroup analyses found that the effectiveness of evening administration was contributed by data from the Hermida group and China. Evening administration did not provide additional nocturnal/daytime/24-h BP reduction in non-Hermida/non-China studies (I
2 = 0) and in meta-analyses that included studies with unclear or low risk of bias. The effectiveness of nocturnal BP reduction was similar across different types, doses, and half-lives of medications. Evening administration of anti-HT medications may reduce proteinuria, left ventricular hypertrophy (LVH), nondipping and morning surge. The overall quality of evidence was ranked as very low to low. Our results highlight the scarcity of low risk-of-bias studies and emphasize the need for such trials to evaluate the efficacy of evening dosing of anti-HT medications as a standard treatment for patients with nocturnal HT across diverse populations.
Medical Equipment Aging
Authors: Wang Binseng , Rui Torgeir , Skinner Scott , Ayers-Comegys Morgan , Gibson Jason , Williams Steve
Published: June 2024

As demonstrated in the first article of this series, some medical equipment types exhibit clear, progressive deterioration with age, whereas some others do not. Regardless of its aging behavior, equipment will eventually be replaced and disposed of for a variety of reasons—eg, its repair cost has become unjustifiable, it is no longer possible to repair, or its usefulness has been superseded by newer technologies. Although it is not possible to pinpoint the exact cause of each replacement or disposal, it is useful to understand when such action takes place during the equipment’s lifespan because this can help healthcare delivery organizations to better plan and conserve its capital resources while satisfying the needs and desires of their staff to provide safe and high-quality care. The results of an analysis of the disposal pattern of ~340 thousand pieces of equipment in the period of 30+ years show age is not the primary determinant for replacement or disposal. Most equipment is deployed well past the respective depreciation period and the end-of-life or end-of-support dates declared by their respective manufacturers, without significant negative impacts on patient care. In fact, the life expectancies estimated from the disposal data are typically double of American Hospital Association’s estimated useful lives. Such accomplishment is a testimony of the extraordinary efforts made by clinical engineering/healthcare technology management professionals in keeping equipment safe and reliable in the most cost-effective manner for a very long time.
Development and validation of a deep learning model for predicting gastric cancer recurrence based on CT imaging: a multicenter study
Authors: Cao Mengxuan , Hu Can , Li Feng , He Jingyang , Li Enze , Zhang Ruolan , Shi Wenyi , Zhang Yanqiang , Zhang Yu , Yang Qing , Zhao Qianyu , Shi Lei , Xu Zhiyuan , Cheng Xiangdong
Published: June 2024

Introduction:

The postoperative recurrence of gastric cancer (GC) has a significant impact on the overall prognosis of patients. Therefore, accurately predicting the postoperative recurrence of GC is crucial.

Methods:

This retrospective study gathered data from 2813 GC patients who underwent radical surgery between 2011 and 2017 at two medical centers. Follow-up was extended until May 2023, and cases were categorized as recurrent or nonrecurrent based on postoperative outcomes. Clinical pathological information and imaging data were collected for all patients. A new deep learning signature (DLS) was generated using pretreatment computed tomography images, based on a pretrained baseline (a customized Resnet50), for predicting postoperative recurrence. The deep learning fusion signature (DLFS) was created by combining the score of DLS with the weighted values of identified clinical features. The predictive performance of the model was evaluated based on discrimination, calibration, and clinical usefulness. Survival curves were plotted to investigate the differences between DLFS and prognosis.

Results:

In this study, 2813 patients with GC were recruited and allocated into training, internal validation, and external validation cohorts. The DLFS was developed and assessed for its capability in predicting the risk of postoperative recurrence. The DLFS exhibited excellent performance with AUCs of 0.833 (95% CI: 0.809–0.858) in the training set, 0.831 (95% CI: 0.792–0.871) in the internal validation set, and 0.859 (95% CI: 0.806–0.912) in the external validation set, along with satisfactory calibration across all cohorts (P>0.05). Furthermore, the DLFS model significantly outperformed both the clinical model and DLS (P<0.05). High-risk recurrent patients exhibit a significantly poorer prognosis compared to low-risk recurrent patients (P<0.05).

Conclusions:

The integrated model developed in this study, focusing on GC patients undergoing radical surgery, accurately identifies cases at high-risk of postoperative recurrence and highlights the potential of DLFS as a prognostic factor for GC patients.
Association of triglyceride glucose index with stroke: from two large cohort studies and Mendelian randomization analysis
Authors: Jiang Yong’An , Shen Jing , Chen Peng , Cai JiaHong , Zhao YangYang , Liang JiaWei , Cai JianHui , Cheng ShiQi , Zhang Yan
Published: June 2024

Introduction:

The triglyceride glucose index (TyG) is associated with cardiovascular diseases; however, its association with stroke remains unclear. This study aimed to elucidate this relationship by examining two extensive cohort studies using two-sample Mendelian randomization (MR).

Methods:

Using data from the 1999–2018 National Health and Nutrition Examination Survey (NHANES) and the Medical Information Mart for Intensive Care (MIMIC)-IV, the correlation between TyG (continuous and quartile) and stroke was examined using multivariate Cox regression models and sensitivity analyses. Two-sample MR was employed to establish causality between TyG and stroke using the inverse variance weighting method. Genome-wide association study catalog queries were performed for single nucleotide polymorphism-mapped genes, and the STRING platform used to assess protein interactions. Functional annotation and enrichment analyses were also conducted.

Results:

From the NHANES and MIMIC-IV cohorts, we included 740 and 589 participants with stroke, respectively. After adjusting for covariates, TyG was linearly associated with the risk of stroke death (NHANES: hazard ratio [HR] 0.64, 95% CI: 0.41–0.99, P=0.047; Q3 vs. Q1, HR 0.62, 95% CI: 0.40–0.96, P=0.033; MIMIC-IV: HR 0.46, 95% CI: 0.27–0.80, P=0.006; Q3 vs. Q1, HR 0.32, 95% CI: 0.12–0.86; Q4 vs. Q1, HR 0.30, 95% CI: 0.10–0.89, P=0.030, P for trend=0.017). Two-sample MR analysis showed genetic prediction supported a causal association between a higher TyG and a reduced risk of stroke (odds ratio 0.711, 95% CI: 0.641–0.788, P=7.64e-11).

Conclusions:

TyG was causally associated with a reduced risk of stroke. TyG is a critical factor for stroke risk management.
Three-dimensional deep learning model complements existing models for preoperative disease-free survival prediction in localized clear cell renal cell carcinoma: a multicenter retrospective cohort study
Authors: Xv Yingjie , Wei Zongjie , Jiang Qing , Zhang Xuan , Chen Yong , Xiao Bangxin , Yin Siwen , Xia Zongyu , Qiu Ming , Li Yang , Tan Hao , Xiao Mingzhao
Published: June 2024

Background:

Current prognostic models have limited predictive abilities for the growing number of localized (stage I–III) ccRCCs. It is, therefore, crucial to explore novel preoperative recurrence prediction models to accurately stratify patients and optimize clinical decisions. The purpose of this study was to develop and externally validate a computed tomography (CT)-based deep learning (DL) model for presurgical disease-free survival (DFS) prediction.

Methods:

Patients with localized ccRCC were retrospectively enrolled from six independent medical centers. Three-dimensional (3D) tumor regions from CT images were utilized as input to architect a ResNet 50 model, which outputted DL computed risk score (DLCR) of each patient for DFS prediction later. The predictive performance of DLCR was assessed and compared to the radiomics model (Rad-Score), the clinical model the authors built and two existing prognostic models (UISS and Leibovich). The complementary value of DLCR to the UISS, Leibovich, as well as Rad-Score were evaluated by stratified analysis.

Results:

Seven hundred seven patients with localized ccRCC were finally enrolled for models’ training and validating. The DLCR the authors established can perfectly stratify patients into low-risks, intermediate-risks, and high-risks, and outperformed the Rad-Score, clinical model, UISS and Leibovich score in DFS prediction, with a C-index of 0.754 (0.689–0.821) in the external testing set. Furthermore, the DLCR presented excellent risk stratification capacity in subgroups defined by almost all clinic-pathological features. Moreover, patients classified as low-risk by the UISS/Leibovich score/Rad-Score but as intermediate - or high-risk by DLCR were significantly more likely to experience ccRCC recurrence than those stratified as intermediate- or high-risk by UISS/Leibovich score/Rad-Score but as low-risk by DLCR (all Log-rank P-values<0.05).

Conclusions:

Our DL model, derived from preoperative CT, is superior to radiomics and current models in precisely DFS predicting of localized ccRCC, and can provide complementary values to them, which may assist more informed clinical decisions and adjuvant therapies adoptions.
Anatomical predispositions for silent cerebral infarction postcarotid artery stenting: a retrospective cohort
Authors: Li Tianhua , Yang Renjie , Wang Jie , Wang Tao , Liu Guangjie , Jin Jiaqi , Bai Xuesong , Xu Ran , Lu Taoyuan , Wang Yabing , Dmytriw Adam A. , Yang Bin , Jiao Liqun
Published: June 2024

Background:

Silent cerebral infarction (SCI) that manifests following carotid artery stenting (CAS) has been postulated to correlate with cognitive decline, the onset of dementia, and an increased risk of subsequent cerebrovascular events. This investigation aimed to thoroughly examine the potential anatomical predispositions that are linked to the occurrence of SCI post-CAS, and further develop a predictive nomogram that could accurately forecast the risk of SCI post-CAS.

Methods:

The present investigation conducted a retrospective examination of datasets from 250 individuals presenting with carotid artery stenosis who had been subjected to CAS within a tertiary healthcare institution from June 2020 to November 2021. Stratified by the procedural date, participants were allocated into a training cohort and a validation cohort. A nomogram was constructed predicated on salient prognostic determinants discerned via a multivariate logistic regression analysis.

Results:

An aggregate of 184 patients were incorporated into the study, of which 60 (32.6%) manifested SCI, whereas 124 (67.4%) did not. Within the training cohort (n=123), age (OR 1.08, 95% CI: 1.01–1.16; P=0.034), aortic arch type (Type III vs. I: OR 10.79, 95% CI: 2.12–54.81; P=0.005), aortic arch variant (OR 47.71, 95% CI: 6.05–376.09; P<0.001), common carotid artery (CCA) ostium lesions (OR 6.93, 95% CI: 1.49–32.32; P=0.014), and proximal tortuosity index (TI) (OR 1.01, 95% CI: 1.00–1.02; P=0.029) were demarcated as standalone risk predispositions for SCI subsequent to CAS. The concordance index (C-index) for the training cohort's nomogram stood at 0.89 (95% CI: 0.84–0.95). Moreover, the said nomogram exhibited commendable efficacy within the validation cohort (C-index=0.94) as well as the entire participant base (C-index=0.90). Furthermore, the decision curve analysis illustrated the exemplary clinical applicability of the nomogram.

Conclusions:

The findings of this inquiry underscore that age, aortic arch type, aortic arch variant, CCA ostium lesions, and proximal TI serve as independent determinants linked with SCI post-CAS. The formulated nomogram, predicated on these risk factors, possesses robust prognostic significance, and might serve as a valuable adjunct to inform clinical decision-making.
Electronic symptom monitoring after lung cancer surgery: establishing a core set of patient-reported outcomes for surgical oncology care in a longitudinal cohort study
Authors: Yu Hongfan , Lei Cheng , Wei Xing , Wang Yaqin , Xu Wei , Tang Li , Dai Wei , Liao Jia , Pu Yang , Gong Ruoyan , Su Xueyao , Yu Qingsong , Zhang Jiayuan , Zhang Lijun , Huang Yanyan , Zhuang Xiang , Bai Jin , Wang Zhibiao , Li Qiang , Shi Qiuling
Published: June 2024

Background:

Electronic symptom monitoring via patient-reported outcomes in surgical oncology is limited owing to lengthy instruments and non-specific items in common patient-reported outcome instruments. To establish electronic symptom monitoring through a clinically relevant and fit-for-purpose core set of patient-reported outcome in patients undergoing lung cancer surgery.

Materials and methods:

One qualitative (Cohort 1) and two prospective studies (Cohorts 2 and 3) were conducted between 2018 and 2022. Patients undergoing lung cancer surgery were recruited. Items of symptoms and daily functioning were generated through extensive interviews in Cohort 1 and incorporated into a smartphone-based platform to establish the electronic Perioperative Symptom Assessment for Lung surgery (ePSA-Lung). This instrument was finalized and validated in Cohort 2. Patients in Cohort 3 were longitudinally monitored for the first-year post-surgery using the validated ePSA-Lung.

Results:

In total, 1037 patients scheduled for lung cancer surgery were recruited. The 11-item draft PSA-Lung was generated based on qualitative interview with 39 patients and input from a Delphi study involving 42 experts. A 9-item ePSA-Lung was finalized by assessing 223 patients in the validation cohort; the results supported the instrument’s understandability, reliability, sensitivity, and surgical specificity. In Cohort 3 (n=775), compliance ranged from 63.21 to 84.76% during the 1-year follow-up after discharge. Coughing, shortness of breath, and disturbed sleep were the most severe symptoms after discharge. Longitudinally, patients who underwent single-port video-assisted thoracic surgery had a lower symptom burden than those who underwent multi-port video-assisted thoracic surgery or thoracotomy (all symptoms, P<0.001).

Conclusions:

The ePSA-Lung is valid, concise, and clinically applicable as it supports electronic symptom monitoring in surgical oncology care. The need for long-term extensive care was identified for patients after discharge, even in early-stage cancer with potential curative treatment.
Unaccounted for Pitch Volume Among Adolescent Baseball Pitchers During a Travel Baseball Season
Authors: Salamh Paul A. , Entler Kalie , Parks Meredith , Vrbancic Cassandra , Usui Takumi , Hegedus Eric J. , Cook Chad E. , Bullock Garrett S.
Published: June 2024

Objective:

The primary aim was to compare differences in live game pitch counts (LGPCs) with all pitch counts (APCs) over the course of a youth baseball season.

Design:

Prospective longitudinal study.

Setting:

Midwest youth travel baseball.

Participants:

Ten male baseball players part of a youth baseball travel team.

Variables:

Demographic data, pitch counts (practice, game, warm-up, and bullpen), innings pitched, and recommended rest days.

Main Outcome Measures:

Live pitch counts compared with APCs and the relationship to recommended rest days.

Results:

During the season, 7866 pitches were recorded among 9 pitchers. By using the LGPC method alone, 42.5% of the pitches were unaccounted for. When considering age-specific rest days suggested by Pitch Smart Guidelines (PSGs), there were 104 rest days unaccounted for by using the live game pitch method.

Conclusion:

There is a high number of unaccounted for pitches and an underestimation of rest days per outing when using live game methods. Revisions to the PSGs that include all pitches should be considered to accurately reflect pitching volume, which may be associated with the rising rate of injuries among these athletes.
Inflammatory Cytokines in Middle Ear Effusion of Patients With Asthma, Chronic Rhinosinusitis With Nasal Polyps With or Without NSAID Intolerance
Authors: Suikkila Anna , Lyly Annina , Savinko Terhi , Vento Seija I. , Saarinen Riitta , Hafrén Lena
Published: June 2024

Objective

To measure the inflammatory cytokines of middle ear effusion (MEE) in otitis media (OM) associated with asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) with or without nonsteroidal anti-inflammatory drug (NSAID) sensitivity to strengthen our assumption that OM is part of the same inflammatory entity. The potential individual differences between MEE inflammatory cytokines could be used in clinical practice for more individual characterization of the inflammation.

Study Design

Case-control study.

Setting

Tertiary referral center

Patients

Convenience sample of 24 case patients with otitis media with effusion (OME) or chronic otitis media (COM), asthma, and CRSwNP, 14 of whom had NSAID intolerance, and 8 controls with OME but no history of asthma, CRSwNP, or NSAID intolerance.

Intervention

Diagnostic

Main Outcome and Measure

Inflammatory cytokines including interleukins (IL)-4, IL-5, IL-6, IL-13, and interferon gamma (IFN-γ) in middle ear effusion.

Results

The MEE mass fractions of IL-5 (p = 0.003) and IFN-γ (p = 0.048) were higher among our case patients with OME/COM than among the controls. For IL-4 and IL-13, the mass fractions were also higher among the case patients than the controls, but this difference was not statistically significant (p = 0.199 and p = 0.617, respectively). We found no difference between the IL-6 mass fractions of the groups. We found notable heterogeneity in individual patients' cytokine levels.

Conclusions

According to our findings, OM, when present, should be considered part of the respiratory inflammatory process associated with asthma and CRSwNP. The individual differences in MEE cytokine levels could be useful as biomarkers.
The Use of Impella 5.5 Reduces Pulmonary Vascular Resistance as Bridge to Heart Transplant in a Pediatric Patient
Authors: Oelkers Bradley , Schumer Erin , Lambert Andrea N. , Alsoufi Bahaaldin , Kozik Deborah , Wilkens Sarah J.
Published: June 2024

This case report explores the successful use of the Impella 5.5 (Abiomed Inc., Danvers, MA) device in a 22 kg, 0.89 body surface area (BSA) pediatric patient with longstanding dilated cardiomyopathy and elevated pulmonary vascular resistance. The article details the device selection, management, and outcome demonstrating the feasibility and potential benefits of the Impella 5.5 as a device within the pediatric population.
New Right Ventricular Dysfunction in Pediatric Acute Respiratory Distress Syndrome on Venovenous Extracorporeal Membrane Oxygenation
Authors: Holton Caroline , Shah Sanket , Miller Jenna O.
Published: June 2024

The development of new right ventricular (RV) dysfunction after cannulation to venovenous (VV) extracorporeal membrane oxygenation (ECMO) and its association with worse outcomes is increasingly recognized in adult patients, however, no studies have evaluated this phenomenon in pediatric patients. We report results of a single-center retrospective cohort study at a large academic children’s hospital. New RV systolic dysfunction was present in 48% (12/25) of pediatric patients on VV ECMO for acute respiratory distress syndrome (ARDS). There was no statistically significant difference in survival, duration of mechanical ventilation, or hospital length of stay between those with and without RV dysfunction. Over half (5/9, 56%) of survivors with RV dysfunction on ECMO had RV dilation or RV hypertrophy on post-ECMO echocardiograms, and in two patients the RV dysfunction persisted for months following decannulation. Cardiac catheterization and autopsy reports suggested that echocardiographic assessment of RV systolic function alone may not be sufficient to diagnose clinically relevant RV injury. This is the first study to report the prevalence of RV dysfunction on VV ECMO for pediatric ARDS. Future multicenter collaboration is needed to create a clinically relevant definition of pediatric “RV injury” and to further evaluate risk factors and outcomes of RV dysfunction.
The Lactulose Breath Test Can Predict Refractory Gastroesophageal Reflux Disease by Measuring Bacterial Overgrowth in the Small Intestine
Authors: Xu Jing , Qu Qiu , Yang Yu , Yang Jie , Fang Ting , Yin Jiajia , Mo Qiquan , Wu Zihan , Zeng Linran , He Huiping , Fu Jinxiao , Zhou Hongjian , Huang Wei , Yang Hong Ju
Published: June 2024

Objective:

The diagnosis of RGERD in patients typically involves 24-hour esophageal pH monitoring, but due to its invasiveness and low patient compliance, new screening methods are needed. In this study, a lactulose breath test (LBT) was conducted to detect the growth of small intestine bacteria (SIBO) and explore the potential relationship between LBT and RGERD to identify a new treatment method for RGERD.

Methods:

A total of 178 patients with gastroesophageal reflux were enrolled from June 2020 to December 2022 in the Gastroenterology Department, Building 3, the First Affiliated Hospital of Kunming Medical University; these patients included 96 patients with nonrefractory GERD (NRGERD) and 82 patients with RGERD. The Gerd Q score, reflux symptom index (RSI) score, gastroscopy results, clinical symptoms, and other related indicators were collected. Statistical methods were used to analyze the gathered data.

Results:

The incidence of acid reflux and heartburn in patients with RGERD was significantly greater than that in patients with NRGERD (67.10% vs. 42.70%, P<0.01 and 65.00% vs. 34.40%, P<0.01). The CH4 values of patients with RGERD were significantly greater than those of patients with NRGERD at each time point, and there was a correlation between the CH4 values at 60 min and RGERD (P<0.05). For patients with RGERD, the incidence of abdominal pain, acid regurgitation, and heartburn was greater in the CH4-positive group than in the CH4-negative group (61.90% vs. 57.50%, 69.05% vs. 65.00%, 69.05% vs. 57.50%, P>0.05). The incidence of nausea was also greater in the CH4-positive group than in the CH4-negative group (61.90% vs. 35.00%, P<0.05).

Conclusion:

Increased CH4 levels are correlated with RGERD. In addition, patients with RGERD may develop SIBO after long-term use of PPIs, and interventions involving SIBO could provide new ideas for the treatment of RGERD.
Syndromic genetic causes of pulmonary fibrosis
Authors: Borie Raphaël , Ba Ibrahima , Debray Marie-Pierre , Kannengiesser Caroline , Crestani Bruno
Published: June 2024

Purpose of review

The identification of extra-pulmonary symptoms plays a crucial role in diagnosing interstitial lung disease (ILD). These symptoms not only indicate autoimmune diseases but also hint at potential genetic disorders, suggesting a potential overlap between genetic and autoimmune origins.

Recent findings

Genetic factors contributing to ILD are predominantly associated with telomere (TRG) and surfactant-related genes. While surfactant-related gene mutations typically manifest with pulmonary involvement alone, TRG mutations were initially linked to syndromic forms of pulmonary fibrosis, known as telomeropathies, which may involve hematological and hepatic manifestations with variable penetrance. Recognizing extra-pulmonary signs indicative of telomeropathy should prompt the analysis of TRG mutations, the most common genetic cause of familial pulmonary fibrosis. Additionally, various genetic diseases causing ILD, such as alveolar proteinosis, alveolar hemorrhage, or unclassifiable pulmonary fibrosis, often present as part of syndromes that include hepatic, hematological, or skin disorders.

This review explores the main genetic conditions identified over the past two decades.
Effects of Sudarshan Kriya Yoga (SKY) on the stress and self-esteem of medical doctors in a tertiary care hospital: a prospective analytical study
Authors: Khadka Bharat , Dhakal Bishal , Dhakal Binaya , Adhikari Purushottam , Piya Utsav , Ghimire Shreejan , Dawadi Sagun , Pasakhala Kshitiz , Mahat Krish , Adhikari Suman Prasad , Manandhar Pradeep , Mansingh Yujal
Published: June 2024

Objectives:

Sudarshan Kriya Yoga (SKY) is a unique yoga practice incorporated into the Art of Living course. It is found to have a beneficial effect on different psychiatric disorders. This study was conducted to investigate the impact of SKY practice on stress and self-esteem among medical doctors.

Materials and methods:

A prospective study was conducted among medical doctors (interns, residents, and consultants) in a tertiary care center. The Perceived Stress Scale and Rosenberg Self-Esteem Scale were used for the assessment of stress and self-esteem levels, respectively. The parameters were assessed at baseline, 3-day and 40-day follow-up of SKY practice. The statistical analysis was performed using Statistical Package for Social Sciences, version 25.

Results:

A total of 58 participants were included in the study. The scores for stress decreased (19.07 to 18.62 to 16.33) and self-esteem levels increased (19.09 to 19.64 to 20.81) after the practice signifying the beneficial impact. It was statistically significant (P<0.05) with considerable effect sizes (Cohen’s d 0.2–0.5 and >0.5 for self-esteem and stress levels, respectively). On MANOVA, gender (more in male participants) was significantly associated with stress levels even after the practice of SKY (P=0.042).

Conclusion:

Amid the hectic schedule, regular practice of SKY is proven beneficial for medical doctors with its positive impact on stress, and self-esteem levels by our study.
Coexisting trichorrhexis nodosa and pili annulati: a case report of hair shaft abnormalities in a Syrian family
Authors: Roumi Jamal Bakri , Breim Fatima , Zakour Joud , Marachli Besher , Abubakir Malaka , Abdul Rahman Noura , Ishkhanian Silva
Published: June 2024

Introduction:

Pili annulati (PA) and trichorrhexis nodosa (TN) are rare genetic hair disorders. PA presents with sparkly, spotted hair due to air-filled cavities in the cortex, mainly affecting the scalp. TN causes brittle, breakable hair shafts, often due to physical or chemical damage.

Case Presentation:

A 23-year-old Syrian woman presented with glistening, brittle hair and whitish nodules since puberty, reminiscent of TN. Trichoscopy confirmed TN alongside PA, displaying characteristic dark-light bands. Interestingly, TN breakage occurred within the PA bands. Her aunt displayed similar TN patterns. Microscopy revealed ring-like structures and a ‘thrust paint brush’ appearance, indicative of TN, within PA-affected regions. Management included avoidance of hair treatments and prescription of vitamins and minoxidil to enhance hair strength and density.

Discussion:

PA is usually congenital and autosomal dominant, often without causing hair fragility. However, some cases report fragility, particularly in light bands. While PA is typically benign, its combination with TN underscores the complexity of hair shaft disorders. Only five such cases exist. Proposed causes for PA and TN include genetic factors and hair shaft abnormalities. PA’s fragility may stem from band stiffness differences and lower cysteine content. Treatment is typically unnecessary, but avoiding excessive heat styling is advised.

Conclusion:

This case highlights the rare co-occurrence of PA and TN, emphasizing the need for further research into their relationship and potential systemic associations. Understanding the underlying mechanisms is crucial for informing treatment and counseling patients effectively, especially considering the rarity of this association.
Soluble platelet selectin and platelets in COVID-19: a multifaceted connection
Authors: Obeagu Emmanuel Ifeanyi , Obeagu Getrude Uzoma , Aja Patrick Maduabuchi , Okoroiwu G.I.A. , Ubosi N.I. , Pius Theophilus , Ashiru Muhammad , Akaba Kingsley , Adias Teddy Charles
Published: June 2024

The COVID-19 pandemic has brought to light the intricate relationship between platelets, soluble platelet selectin (sP-selectin), and disease pathogenesis. Platelets, traditionally recognized for their role in hemostasis, have emerged as key contributors to the immunothrombotic complications observed in COVID-19 patients. Concurrently, elevated levels of sP-selectin, indicative of platelet activation and endothelial injury, have been consistently identified in COVID-19 patients and have shown associations with disease severity and adverse outcomes. This multifaceted connection underscores the pivotal role of platelets and sP-selectin in orchestrating thromboinflammation, vascular dysfunction, and disease progression in COVID-19. Platelet activation triggers the release of inflammatory mediators and promotes platelet-leukocyte interactions, amplifying the systemic inflammatory response and exacerbating endothelial injury. Additionally, platelet-derived factors contribute to microvascular thrombosis, further exacerbating tissue damage and organ dysfunction in severe COVID-19. Elevated sP-selectin levels serve as biomarkers for disease severity and prognostication, aiding in risk stratification and early identification of patients at higher risk of adverse outcomes. Therapeutic strategies targeting platelet dysfunction and sP-selectin-mediated pathways hold promise in mitigating thromboinflammation and improving outcomes in COVID-19 patients. Antiplatelet agents, platelet inhibitors, and anti-inflammatory therapies represent potential interventions to attenuate platelet activation, inhibit platelet-leukocyte interactions, and alleviate endothelial dysfunction. A comprehensive understanding of the multifaceted connection between platelets, sP-selectin, and COVID-19 pathogenesis offers opportunities for tailored therapeutic approaches aimed at mitigating thromboinflammation and improving patient outcomes in this complex and challenging clinical setting.
Post-cholecystectomy clip migration: an unusual nidus of choledocholithiasis: a case report
Authors: Kafle Pradip Kumar , Pokhrel Biraj , Bhattrai Tulsiram , Lamsal Manoj , Kafle Brindeswari , Jha Anurag , Hamal Rabin , Pathak Rahul
Published: June 2024

Introduction and importance:

Laparoscopic cholecystectomy is one of the common surgeries occurring worldwide and the gold standard for the management of gallstone disease. The non-absorbable surgical clips may slip and can migrate causing a variety of problems as such, choledocholithiasis.

Case presentation:

The authors report a case of 43-year-old female who presented with the complaint epigastric pain. She had undergone cholecystectomy 7 years back for symptomatic cholelithiasis. Ultrasonography of the abdomen showed a dilated common bile duct following which endoscopic retrograde cholangiopancreatography was done. A single black-colored stone with the metal clip was retrieved.

Clinical discussion:

Post-cholecystectomy clip migration should be considered as one of the differentials for choledocholithiasis. Ultrasonography of the abdomen shows the dilated common bile duct. Further management is done by endoscopic retrograde cholangiopancreatography.

Conclusion:

Surgical clips acting as nidus for choledocholithiasis is rare these days but should be considered as one of the differentials for pain abdomen.