bluuebunny/crossref_metadata_2025 huggingface dataset:
Depression in the Schistosomiasis japonica Population Based on the PHQ-9 Scale: A Cross-Sectional Survey from Jiangxi Province, China
Authors: Hu Aizhen , Liu Dele , Xie Huiqun , Wu Xia , Liu Kexing , Zhang Xuyun , Li Linlin , Zhou Xing , Hu Fei
Published: February 2024

Depression is the second leading-cause of disability in China. Although studies have shown that more than 80% of patients with advanced schistosomiasis (AS) suffer from anxiety and depression, these study groups are all hospitalized patients with AS and do not represent the extent of the disease in the whole group. To our knowledge, there are no studies assessing the severity of depression in patients with other forms of schistosomiasis japonicum. Therefore, it is necessary to evaluate the occurrence and potential risk factors of depression in the schistosomiasis endemic population. This cross-sectional study was conducted in Jiangxi Province, where schistosomiasis is relatively common in China, as the investigation site. The Patient Health Questionnaire-9 (PHQ-9) scale was selected to assess the depressive symptoms in the study population. At the same time, basic personal information of the research subjects and relevant socio-economics and schistosomiasis endemic area indicators were collected. The survey results show that AS has the highest incidence of depression (34.35%), while non-advanced schistosomiasis (N-AS) and control group (CG) have 22.35% and 22.24% respectively; the incidence of depression in AS is significantly higher than in N-AS and CG, while there is no statistical significance in the comparison between N-AS and CG; the incidence of mild depressive symptoms accounts for 61.08%-75.54% of the total incidence of depression in different groups; Multivariate analysis shows that the occurrence of moderate/severe depressive symptoms in the AS group was significantly related to above 60 years old, male, the combination of other serious diseases, personal financial difficulties, and marshland and lake endemic areas. In the N-AS group, the occurrence of moderate/severe depressive symptoms was significantly related to the combination of other serious diseases, personal financial difficulties, marshland and lake endemic areas and the degree of schistosomiasis epidemic control. In conclusion, depression is still relatively common among patients with schistosomiasis patients, especially those with AS. It is recommended that the government and relevant departments consider mental health care when developing prevention and control work in schistosomiasis-endemic areas, in order to effectively protect the physical and mental health of schistosomiasis patients and residents in endemic areas.
Rare Variants Analyses Suggest Novel Cleft Genes in the African Population
Authors: Alade Azeez , Mossey Peter , Awotoye Waheed , Busch Tamara , Oladayo Abimbola , Aladenika Emmanuel , Olujitan Mojisola , Gowans J.J Lord , Eshete Mekonen A. , Adeyemo Wasiu L. , Zeng Erliang , Otterloo Eric , O’Rorke Michael , Adeyemo Adebowale , Murray Jeffrey C. , Cotney Justin , Lachke Salil A. , Romitti Paul , Butali Azeez , Wentworth Emma , Anand Deepti , Naicker Thirona
Published: February 2024

Non-syndromic orofacial clefts (NSOFCs) are common birth defects with a complex etiology. While over 60 common risk loci have been identified, they explain only a small proportion of the heritability for NSOFC. Rare variants have been implicated in the missing heritability. Thus, our study aimed to identify genes enriched with nonsynonymous rare coding variants associated with NSOFCs. Our sample included 814 non-syndromic cleft lip with or without palate (NSCL/P), 205 non-syndromic cleft palate only (NSCPO), and 2150 unrelated control children from Nigeria, Ghana, and Ethiopia. We conducted a gene-based analysis separately for each phenotype using three rare-variants collapsing models: (1) protein-altering (PA), (2) missense variants only (MO); and (3) loss of function variants only (LOFO). Subsequently, we utilized relevant transcriptomics data to evaluate associated gene expression and examined their mutation constraint using the gnomeAD database. In total, 13 genes showed suggestive associations (p = E-04). Among them, eight genes (ABCB1, ALKBH8, CENPF, CSAD, EXPH5, PDZD8, SLC16A9, and TTC28) were consistently expressed in relevant mouse and human craniofacial tissues during the formation of the face, and three genes (ABCB1, TTC28, and PDZD8) showed statistically significant mutation constraint. These findings underscore the role of rare variants in identifying candidate genes for NSOFCs. Main documents (excluding the methods section) word count: 2145
Isotopologues of Potassium 2,2,2-Trifluoroethoxide for Applications in Positron Emission Tomography and Beyond
Authors: Pike Victor , Zhao Qunchao , Telu Sanjay , Jana Susovan , Morse Cheryl
Published: February 2024

The 2.2.2-trifluoroethoxy group increasingly features in drugs and potential tracers for biomedical imaging with positron emission tomography (PET). Herein, we describe a novel rapid and metal-free conversion of fluoroform with paraformaldehyde into highly reactive potassium 2,2,2-trifluoroethoxide (CF3CH2OK) and demonstrate robust applications of this synthon in one-pot, two-stage 2,2,2-trifluoroethoxylations of both aromatic and aliphatic precursors. Moreover, we show that these novel transformations translate easily to fluoroform that has been labeled with either carbon-11 (t1/2 = 20.4 min) or fluorine-18 (t1/2 = 109.8 min), so allowing the appendage of complex molecules with a no-carrier-added 11C- or 18F- 2,2,2-trifluoroethoxy group. This provides enormous scope to provide new candidate PET tracers with radioactive and metabolically stable 2,2,2-trifluoroethoxy moieties. We also exemplify syntheses of isotopologues of potassium 2,2,2-trifluoroethoxide and show their utility for stable isotopic labeling which can be of further benefit for drug discovery and development.
Willingness to participate in a personalized health cohort – Insights from the Swiss Health Study pilot phase
Authors: Bühler Nolwenn , Frahsa Annika , Jaramillo Nathalia González , Bourqui Réjane Morand , Nusslé Semira Gonseth , Zuppinger Claire , Bochud Murielle , Goetz Natalie
Published: February 2024

Background
This paper explores the feasibility of establishing a personalized health cohort by assessing potential participants’ needs, expectations, and concerns.
Methods
Employing a participatory approach, we utilized a scenario-based questionnaire in the Swiss Health Study pilot phase (2020-2021involving 1349 adults aged 20–69 from the cantons Vaud and Bern. We conducted descriptive statistics supported by R and qualitative content analysis for open responses related to attitude towards research. We highlight the benefits and challenges of the scenario-based approach, discuss the sample represented in the pilot phase, and implications for building a full cohort, and present participants’ attitudes towards and previous experience with health research. We analyze references regarding informed consent and feedback, attitudes towards a Swiss Health Study, and recommendations on how to improve its scope, design, and instruments.
Results
Results indicate a high interest (90%) in participating in a national health study, with 85% of a random population sample willing to join a long-term cohort. Only 43% were familiar with biobanks, and 44% preferred general consent. Trust was high for Swiss-based public research but lower for researchers outside the country or in the private sector. Over 95% expressed willingness to complete online questionnaires, undergo physical examination, and donate biosamples. Almost all participants wanted to know the outcomes of medical visits (99.5%), and environmental exposure assessments (95%). Preferred tools for monitoring sleep, physical activity, and diet were known smartphone apps with automatic data management.
Conclusion
Overall, the study reveals a positive attitude towards personalized health research, with a strong willingness to share data and samples. Key insights focus on informed consent variations, cohort participation and representativeness, and the significance of personalized feedback —especially regarding environmental health concerns. Findings emphasize participants’ supportive yet reflexive stances, underscoring the importance of aligning research values with individual values in personalized health research. These insights contribute valuable considerations for refining the scope, design, and instruments of future cohort studies.
Evaluating the Effect of Some Commonly Used Idealizations on the Nonlinear Seismic Response of Steel Buildings
Authors: Llanes-Tizoc Mario D. , Valenzuela-Beltrán Federico , Baca-Machado Victor E. , Felix Alfredo , Bojorquez Eden , Bojórquez Juan , Reyes-Salazar Alfredo
Published: February 2024

There have been significant advances concerning seismic analysis and design procedures for steel buildings. Emerging procedures as the performance-based seismic design and the resilient seismic design, are examples of such advances. However, there is a long road ahead before these new concepts can be widely accepted and implemented by structural engineers, government officials and owners. In addition, many simplifications are commonly adopted in seismic analysis, the effects of which on the seismic response, and consequently on the structural performance, are overlooked. Some of these issues are addressed in this paper. Toward this goal, the seismic responses of 3 models of moment-resisting steel frames subject to 20 strong motion records are estimated. Results indicate that the ductility reduction factors for SDOF systems can be up to 95% greater than those of MDOF systems. Bending moments on columns and interstory shears can be underestimated by up to about 30% and 15%, respectively, when using the lumped mass matrix formulation. Underestimates of up to 18% are observed for bending moments on beams if just one element is used to model the beams. Overestimates can be up to 210% for lateral damping forces when using the first two modes of lateral vibration to generate the Rayleigh damping matrix; underestimations of up to 40% are observed for axial loads and flexural moments, while those of lateral shears and drifts can be of up to 20%. The contribution of local rotations and vertical displacements modes to axial loads on columns can be up to 38%, while for bending moments, interstory shears and drifts it can be up to 18%. A damping ratio of 3% to express the yielding effect is very conservative; a value of 7% can be reasonably used. The above results clearly indicate that more accurate structural models (MASM) should be used. One of the justifications for not using more accurate structural models (MDOF systems, consistent mass matrix and the Superposition of the Modal Damping Matrices to derive the damping matrix) has been the high demand on computing time; using modern computers, however, this justification is no longer valid.
Intramuscular pulsed radiofrequency upregulate the BNDF-TrKB expression in the spinal cord and may be an alternative treatment for complicated pain
Authors: Liang Cheng-Loong , Yen Cheng-Yo , Wang Hao-Kuang , Tsai Yu-Duan , Wang Kuo-Wei , Chye Cien-Leong
Published: February 2024

Objective
Two cases of complicated pain exist: posterior screw fixation and myofascial pain. Intramuscular pulsed radiofrequency (PRF) may be an alternative treatment for such patients.
Methods
In the first stage, two muscle groups and two nerve groups were subdivided into a high-temperature group with PRF at 58°C and a regular temperature with PRF at 42°C. In the second stage, two nerve injury groups were subdivided into nerve injury with PRF 42°C on the sciatic nerve and muscle. Blood and spinal cord samples were collected.
Results
In the first stage, immunohistochemical analysis showed that PRF upregulated brain-derived neurotrophic factor (BDNF) in the spinal cord in both groups. In the second stage, immunohistochemical analysis showed significant BDNF and tropomyosin receptor kinase B (TrkB) expression within the spinal cord after PRF in muscle and nerve after nerve injury. The blood biomarkers showed a significant increase in BDNF levels.
Conclusion
PRF in the muscle could upregulate BDNF- TrkB in the spinal cord, similar to PRF during nerve injury for pain relief. It may be applied in patients with complicated pain and could reveal the role of BDNF in pain modulation. The optimal temperature for PRF was 42°C.
Contribution of Millet Cultivation in Tribal Women's Farming Systems to Enhanced Nutritional Food Availability at the Household Level: A Case Study from Hazaribagh, India
Authors: Rathour Sachin , Megha Kumari , Badal Prakash Singh
Published: February 2024

Millets, a varied assortment of small-grained cereal grasses, hold a central position in ensuring nutritional stability by furnishing a steady and well-rounded food reservoir. They have become vital agents in ensuring nutritional stability, especially in areas where access to varied food options is constrained. Eleusine coracana L., commonly known as finger millet, assumes a significant staple crop status among tribal farming communities in developing nations like India. This study delves into the awareness levels of nutritional aspects related to millets among tribal women. The study employed an unplanned approach, in Hazaribagh district of Jharkhand, India, utilizing random sampling methods to ensure representation from marginal, small, and medium farmer. Descriptive analytical tools were employed to analyze data collected through personal interviews using a carefully designed questionnaire. Findings indicate notable awareness (72%) of millets' potential to enhance metabolism and widespread recognition (93%) of their superior nutrient content compared to rice and wheat. However, knowledge gaps exist, particularly regarding antioxidant properties (1%) and the lower glycaemic index for managing blood sugar levels (0%). The study emphasizes the necessity for targeted educational initiatives to augment tribal women's awareness, fostering informed dietary choices and positively impacting overall well-being, thereby contributing to nutritional security.
Low to moderate dose 137 Cs (γ) radiation enhances M2 type macrophages function at short term associated with reduced inflammation at long term exposure in ApoE (-/-) mice
Authors: Rey N. , Ebrahimian T. , Gloaguen C . , Kereselidze D. , Elie C. , Brizais C. , Bachelot F. , Riazi G. , Monceau V. , Demarquay C . , Zineddine I. Garali , Klokov D . , Lehoux S. , Ebrahimian T.G.
Published: February 2024

Effects of low doses of ionizing radiation on atherosclerosis are still a source of many uncertainties, and in particular whether these effects generate anti or pro-inflammatory responses. Furthermore, the delay of occurrence of such effects upon irradiation are unknown. Atheroprone ApoE(−/−)mice were exposed to single doses of 0, 0.05, 0.5 and 1 Gy of137Cs (γ) at 10.35 mGy.min− 1dose rate. Short term (24 hours) effects on bone marrow-derived macrophage polarization and long term (100 days) consequences on atherosclerotic plaques were investigated. We found a significant dose-dependent increase of Chil3 and Retnla anti-inflammatory markers gene expression in M0 and M2 type macrophages upon 24 hours exposure and no effects on M1 types. These effects were associated with a dose-dependent increase of IL-10 and a reduction of IL-1beta secretions in M0 and M2 and an increase of IL-6 in M1 type macrophages. Circulating pro-inflammatory Ly6CHighmonocytes were reduced at 24 hours and anti-inflammatory Ly6Clowmonocytes were notably increased in the spleen 100 days upon irradiation. Long term exposures to any doses did not affect atherosclerotic plaque size determined by OilredO. However, a tendency in plaque stability, determined by collagen and alpha-smooth muscle actin increase was observed, associated with a significant reduction of plaque macrophage content at 1Gy. Taking together these findings show an increase of anti-inflammatory behavior of M2 macrophages with low to moderate doses of ionizing radiation at short term after irradiation, at long term these changes could influence atheromatous plaques after irradiation with decreased macrophages contents. These results suggest that the mechanisms that lead to on atheroprotective response after low and moderate doses of ionizing radiation would involve early effects on circulating monocytes and the macrophages polarization towards an anti-inflammatory profile.
Assessing the Visual Afferent Pathway with the Multifocal Visual Evoked Potentials in the Radiologically Isolated Syndrome
Authors: Roldán María Isabel , Caballé Nuria , Sainz Carolina , Perez-Rico María Consuelo , Ayuso Lucía , Blanco Román
Published: February 2024

Background: The early identification of individuals with radiologically isolated syndrome (RIS) who are at an elevated risk of progressing to multiple sclerosis (MS) is essential for making informed treatment decisions.
Objective: This study aimed to evaluate the predictive potential of multifocal Visual Evoked Potentials (mfVEP) measures in individuals with RIS with respect to their conversion to MS.
Methods: A prospective observational cohort study was conducted, involving 21 individuals with RIS recruited from a MS center. Baseline assessments, including mfVEP, magnetic resonance imaging (MRI), and clinical examinations, were performed, and participants were longitudinally followed for up to 24 months. The primary outcome measures were the conversion to MS.
Results: Over a clinical follow-up period of 24 months, five individuals (5/21) with RIS progressed to MS. MfVEP amplitude responses (interocular and monocular probability analysis) demonstrated abnormal cluster visual field defects in 47.6% of RIS eyes at baseline, whereas multifocal VEP latency analysis showed significant delays in 38.4%. A reduction in interocular amplitude [OR= 0.036, (95% CI, 0.003 - 0.503); P= 0.014], monocular amplitude [OR= 0.083, (95% CI, 0.007 - 0.982); P= 0.048], and a prolonged interocular latency [OR= 0.095, (95% CI, 0.009 - 0.972); P= 0.047] were associated with a higher relative risk of clinical conversion at the two-year follow-up.
Conclusion: Multifocal VEP may serve as a novel and independent risk factor for predicting the conversion to MS in individuals with Radiologically Isolated Syndrome.
A Novel Alm Based Security Framework for Block Chain in Healthcare Platform
Authors: Anjelin D. Praveena , Kumar S. Ganesh
Published: February 2024

Blockchain technology may be a recent advancement and offers a ground-breaking technique for keeping the knowledge for an extended time and completing transactions like knowledge management, knowledge handling, performing arts functions, associated establishing trust in an open atmosphere. Most of them are considering block chain as a technology innovation significantly for cryptography and cyber security with systems like bitcoin, IoT, sensible Grids and etc., albeit this technology proofs its name and has received ton and ton of growing interests in multiple dimensions, the safety and security of the block chains are still in analysis whereas deploying block chain in versatile domains and environments. This work elaborates a comprehensive summary of the safety and privacy of block chain from knowledge management perspective. attention platform is employed for implementation and testing. Around 20,000 records are being taken and valid mistreatment the projected algorithmic program. Initially, a block chain is created using distributed information, which tracks an ever-changing list of trading records by organising them into a hierarchic chain of block. Because attention knowledge necessitates greater security, a peer-to-peer overlay network is used to create and maintain the block chain, which is secured through the intelligent and suburbanized use of cryptography with crowd computing. ALM algorithmic program projected has been increased with applicable knowledge possession by providing 2 issue authentications with an accuracy of 95%.The projected system may be a decentralized system and thence guaranteeing higher knowledge transparency and auditability. Security and privacy properties are being ensured by providing fine grained access management on the highest of the ALM encoding. Hence, Security and privacy problems with current scenario are addressed well with a high-level access management rulesets.
Advancing Medical Laboratory Practice in Pakistan: Insights from a Focus Group Study on Technologists' Training Needs
Authors: Khan Fatima Muhammad Asad , Majid Hafsa , Rehman Javeria , Zeeshan Mohammad , Moiz Bushra , Jafri Lena , Khan Aysha Habib
Published: February 2024

Background:
The realm of medical laboratory technology (MLT) training and education has been severely neglected in Pakistan. The primary challenges currently confronting the workforce in MLT include a lack of opportunities for career advancement, the absence of standardized curricula and assessments, and limited access to continuing education and training. Inthis study, we aimedto evaluate the 1-year medical technologist training (MTT) program at Aga Khan University Hospital (AKUH) and conduct a targeted needs assessment.
Methods:
As part of a qualitative study, three focus group discussions (FGDs) were held at the Section of Clinical Chemistry, Department of Pathology and Laboratory Medicine, AKUH. In the absence of a validated reference tool, a team of pathologists and educationists developed questionnaires as interview guides. FGDs were transcribed verbatim and coded using thematic analysis.
Results:
A total of 29 participants were engaged; theseincluded current MLT trainees (n=10), alumni (n=10), and teaching/learning coordinators andsectional supervisors (n=9). Five main themes emerged from the analysis of FGDs: (1) Recognition of key features of the MTT programme, (2) Evaluating curriculum design, (3) Teaching and learning strategies, (4) Addressing the need to improve assessment methods, and (5) Navigating the transition from a trainee to a competent technologist.
Conclusion:
Our investigation demonstrated its potential as a valuable needs assessment study, highlighting key strengths, drawbacks, and challenges of the existing MTT program at AKUH. Importantly, these findings can inform further research efforts to design competency-based MLT education and training programs in Pakistan.
Longitudinal Assessment of Medical Students' Perceptions of Social Isolation and Wellbeing: A 5-Year Analysis of FRAME Surveys (2017-2022)
Authors: Lee Minha , Doyle Zelda , McFarlane Tracy , Bailie Jodie , Simmons Peter , Dewi Sari , Osuagwu Uchechukwu Levi
Published: February 2024

Background
The geographical remoteness of rural clinical school (RCS) placements presents unique challenges to medical students, detrimentally impacting their well-being and potentially leading to social isolation. Understanding these challenges is essential for medical institutions to implement effective support mechanisms.
Objective
This study investigated the perceptions of rural medical students regarding well-being and social isolation during a five-year period (2017 to 2022) during their RCS placements.
Methods
Data from approximately 600 medical students (mostly females n = 2025, 57.7%) collected annually across 17 Australian universities, through self-administered FRAME (Federation of Rural Australian Medical Educators) surveys were extracted. Sociodemographic variables, their feelings of academic isolation and support, and the effect of COVID during their RCS were assessed. The main outcomes were social isolation and well-being which were derived from students’ responses to the statement, ‘I felt socially isolated during my RCS placement’, and ‘Overall, my RCS placement impacted positively on my well-being’, respectively. Data was analyzed using descriptive statistics and binomial logistic regressions to identify factors associated with their perception of social isolation and well-being during RCS placement.
Results
Over half of Australian rural medical students reported experiencing social isolation, with one-fifth expressing that rural placement had no positive impact on their wellbeing. Although the majority perceived a positive impact, this proportion decreased by 11.0% from 2017 to 2019, before rising again in subsequent years. Factors contributing to social isolation and negative impacts on well-being included academic isolation, non-rural background, preference to practice in a capital or major urban city upon entry to the RCS, and lack of academic, financial, or general support from the RCS. Positive influences were associated with active self-care role modeling and informal information regarding rural career options Notably, the years affected by the COVID-19 pandemic did not significantly alter perceived social isolation and well-being.
Conclusions
Addressing the challenges faced by medical students in rural placements is imperative to foster positive well-being and combat social isolation. These findings underscore the importance of tailored support mechanisms and educational programs to enhance resilience among future healthcare professionals. Moreover, improving the experiences of medical students in RCS placements may contribute to increased retention of doctors in rural and remote areas, thereby alleviating the nationwide shortage in these regions.
Development and validation of peritumoral vascular and intratumoral radiomics to predict pathologic complete responses to neoadjuvant chemotherapy in patients with triple-negative breast cancer
Authors: Xie Tianwen , Gong Jing , Zhao Qiufeng , Wu Chengyue , Wu Siyu , Peng Weijun , Gu Yajia
Published: February 2024

Background
To develop and validate a peritumoral vascular and intratumoral radiomics model to improve pretreatment predictions for pathologic complete responses (pCRs) to neoadjuvant chemoradiotherapy (NAC) in patients with triple-negative breast cancer (TNBC).
Methods
A total of 282 TNBC patients (93 in the primary cohort, 113 in the validation cohort, and 76 in The Cancer Imaging Archive [TCIA] cohort) were retrospectively included. The peritumoral vasculature on the maximum intensity projection (MIP) from pretreatment DCE-MRI was segmented by a Hessian matrix-based filter and then edited by a radiologist. Radiomics features were extracted from the tumor and peritumoral vasculature of the MIP images. The LASSO method was used for feature selection, and the k-nearest neighbor (k-NN) classifier was trained and validated to build a predictive model. The diagnostic performance was assessed using the ROC analysis.
Results
One hundred of the 282 patient (35.5%) with TNBC achieved pCRs after NAC. In predicting pCRs, the combined peritumoral vascular and intratumoral model (fusion model) yields a maximum AUC of 0.82 (95% confidence interval [CI]: 0.75, 0.88) in the primary cohort, a maximum AUC of 0.67 (95% CI: 0.57, 0.76) in the internal validation cohort, and a maximum AUC of 0.65 (95% CI: 0.52, 0.78) in TCIA cohort. The fusion model showed improved performance over the intratumoral model and the peritumoral vascular model, but not significantly (p > 0.05).
Conclusion
This study suggested that combined peritumoral vascular and intratumoral radiomics model could provide a non-invasive tool to enable prediction of pCR in TNBC patients treated with NAC.
Towards Inclusive Healthcare: Evaluating knowledge, confidence and awareness of LGBTQ+ health among Internal Medicine Trainees in London
Authors: Crowe Andrew , Hogan Patrick , Morrison Christoper , Meads Catherine , Bailey Daniel
Published: February 2024

Background
Patients from the lesbian, gay, bisexual, transgender, queer plus (LGBTQ+) community face various health inequalities and report poor healthcare experiences. Little is known about how knowledgeable and confident UK doctors are around LGBTQ+ health, and previous research demonstrates that UK medical schools rarely deliver teaching on this area. This research evaluated the level of knowledge, awareness and confidence of LGBTQ+ health among Internal Medical Trainees (IMTs) in London.
Methods
London IMTs were invited to complete an online questionnaire evaluating knowledge, awareness and confidence in LGBTQ+ health. Stratified analysis of results by demographics was performed.
Results
Three hundred and fifteen surveys were analysed from 796 eligible trainees (40%). Confidence in caring for LGBTQ+ patients was variable. Confidence in discussing gender identity was lower than for sexual orientation. Knowledge of health issues affecting LGBTQ+ patients varied. Most participants had never received training on LGBTQ+ health at undergraduate (n=201, 64%) or postgraduate level (n=252, 80%), but the majority of participants felt that training would be useful (n=233, 74%). Stratified analysis revealed that IMTs who received previous LGBTQ+ teaching at undergraduate or postgraduate level were considerably more confident discussing sexual orientation with patients, compared to those who received no previous teaching.
Conclusions
There is a clear need for education on LGBTQ+ health, given the varied levels of knowledge and confidence identified. A significant majority of IMTs in London have never received teaching on LGBTQ+ health, although there exists a strong desire for this. LGBTQ+ health topics should be integrated into undergraduate and postgraduate training and examinations for IMTs. This would support IMTs in delivering high quality and inclusive care for all patients, particularly those of sexual orientation and gender identity minorities. There are relatively few published studies exploring competency in LGBTQ+ health among doctors, and this is the first among UK Internal Medicine Trainees.
Examining the Intersection of Inflammatory Bowel Disease and COVID-19: Insights from a National Inpatient Database Study
Authors: Dhillon Rubaid Azhar , Haider Maryam Bilal , Chaudhary Ahmed Jamal , Abbas Zahra
Published: February 2024

Background: This study aimed to investigate the clinical indicators and outcomes of COVID-19-positive patients with inflammatory bowel disease (IBD), focusing on age, sex, socioeconomic status, and geographic location. The objective of this study was to fill the knowledge gap regarding determinants influencing outcomes in individuals with and without IBD who contracted COVID-19, thus impacting healthcare provision.Methods: This study utilized the nationwide inpatient sample (NIS) database for the period from January to December 2020. Patients were categorized into those with COVID-19 alone (controls) and those with both COVID-19 and IBD (cases). Demographic, clinical, and hospital-related variables were analyzed using statistical methods, including t tests and chi-square tests. Logistic and multivariate regression analyses were performed to assess factors affecting mortality.Results: Among COVID-19 patients with IBD, a sex disparity was observed, with more females in the IBD group than in the non-IBD group. The mean age was similar in both groups. Hospitalizations were concentrated in the age group of 65–84 years. Ethnically, Caucasians dominated both cohorts, and Medicare was the primary payer for a greater proportion of hospitalizations in the IBD group. Hospitalizations were prevalent in urban teaching hospitals, primarily in the southern and mid-western regions of the US. There were no significant differences in mortality rates, and clinical symptoms were comparable between the two groups. Factors associated with mortality included sex, age, and specific existing health conditions.Conclusion: Contrary to the initial hypothesis, the presence of IBD among COVID-19 patients did not significantly impact mortality rates. However, certain clinical indicators and outcomes are influenced by individual factors such as age, sex, and underlying health conditions. This study emphasizes the need for careful monitoring of COVID-19 patients with IBD, particularly those with additional risk factors. Further research is necessary to fully understand the biochemical interactions and implications of IBD in the context of COVID-19. This comprehensive study contributes valuable insights to healthcare authorities, aiding in patient management and outcome optimization.
Prognostic and predictive value of tertiary lymphoid structures in TURBT materials; Should it be seated in routine pathological examination and can it be used in deciding on the treatment method?
Authors: Yilmaz Fatih , Sagir Suleyman
Published: February 2024

Purpose: This study aims to reveal the importance of tertiary lymphoid structures (TLS) in TURBT materials with a practical and applicable method in which the effect of a certain threshold value on survival and treatment response can be implicated.
Methods: TURBT materials that had not previously received any treatment (chemotherapy, radiotherapy, or immunotherapy) and were diagnosed for the first time at Mardin Training and Research Hospital between 2014 and 2022 were included in the study. The maximum number of TLS per 4x magnification field (Field diameter: 4,5 mm) was recorded.Grouping and statistical analysis of the TLS number were performed using threshold values of “≥1”, “≥2” and “≥3”.
Results
TLSs were more frequently found in high-grade tumors (p=0,008) and showed a strong association with stage progression (p<0,001). It was also significantly associated with many adverse histopathological parameters. Conversely,high TLS (≥1, ≥2, and ≥3) appeared to be associated with fewer recurrences (p=0,032, p=0,001, and p=0,018, respectively), and cases with higher TLS showed longer recurrence-free survival (p=0,089, p=0,023, p=0,037, respectively). TLS≥3 was found to be an independent parameter associated with favoarable RFS (p=0,019, HR=0,401) and multifocality was found to be an independent risk factor for RFS (p=0,023, HR=2,302).
Conclusion
This study is the first to demonstrate the relationship between the presence and specific thresholds of TLS in TURBT materials with prognostic parameters. Including this information in the routine pathological examination of TURBT materials will allow a more accurate approach to treatment and follow-up, especially in patients with NMIBC.
Meta-analysis and Systematic Review of Medical Errors Across Specialties: Bridging the Gap with International Perspectives and Recommendations
Authors: Hemeda Mohamed S. , Ibrahim Mohamed Mohamed-Aly , Salim Almaza Ali , Abdelmola Omran Mohamed , Shemy Gamal Galal , Ahmed Samer S , Arafa Ibrahim Arafa Reyad , Saqr Yasser M , Abdelkhalek Hesham Hafez , Bastawisy Amir , Elazeem Mostafa A. , Rashed Khalid A. , Abdalla Hytham , Dawood Yahia Mohmmed Ahmed , Elawamry Mahmoud Ibrahim M , Elbahrawy Mahmoud Mohamed Mahmoud , Eid Gaber , Ali Emadeldeen , Elaziz Abd Elaziz Shokry Abd , Alsaid Aldosoky Abd Elaziz , Ahmed Nashwa , Elfadle Amr Abu , Mohamed Mohamed Hafez , Ramadan Alaa , Sawy Safwat Salama , Fayed Badr , Mohamed Refaat R. , Abdelrazzak Emad , Fakhry Mohamed , Elyamany Mona Ibrahim , Hassan Adel Ali , Abouzid Mohamed , Sayed Heba Youssef
Published: February 2024

Background
Medical errors refer to professional negligence or wrongdoing by healthcare providers that could harm patients. It can vary significantly across different specialties due to variations in patient populations, diagnostic challenges, treatment complexity, and procedural risks.
Methods
We conducted an electronic search of PubMed, Scopus, Web of Science, and Embase databases to identify all relevant published records till 11th August 2023. The analyses were carried out in R studio using the meta package. The mean difference (MD) was used to pool continuous outcomes, while the odds ratio (OR) was used to pool dichotomous outcomes, both with 95% confidence intervals (CI). We used the New Castle Ottawa (NOS) Scale for the observational studies.
Results
Encompassing diverse specialties, the 63 included studies with 376,574 participants, with a mean age of approximately 40.9 years. Conducted in various countries, the United States was the most reported location. The meta-analysis revealed pooled proportional effect estimates for medication errors in different specialties: neurosurgery 24%, orthopedic surgery 24%, cardiology 20%, general surgery 16%, OB/GYN 15%, internal medicine 12%, anesthesia 10%, cardiothoracic surgery 10%, urology 10%, otolaryngology 8%, pediatrics 8%, family medicine 5%, oncology 5%, ophthalmology 5%, chest 4%, neurology 4%, radiology 4%, dermatology 3%, vascular surgery 3%, gastroenterology 2%, endocrinology 1%, tropical medicine 1%, and rheumatology 0%.
Conclusion
The distribution of medical specialties exhibited diverse occurrence rates: ≥20% for neurosurgery, orthopedic surgery, and cardiology; <20% and ≥ 10% for general surgery, OB/GYN, internal medicine, anesthesia, cardiothoracic surgery, and urology. Further research is required to investigate the causative factors in different regions and specialties, particularly those with high medical error rates.
Mesenchymal Stromal Cell Transplantation Ameliorates Fibrosis and Dysregulated microRNA Signature Associated with Ischaemic Skeletal Muscle Damage.
Authors: Sanz-Nogués Clara , Keane Alan , Creane Michael , Hynes Sean , Chen Xizhe , Lyons Caomhán , Horan Emma , Elliman Stephen , Goljanek-Whysall Katarzyna , O'Brien Timothy
Published: February 2024

Peripheral arterial disease (PAD) is strongly associated with lower-extremity muscle wasting. Hallmark features of PAD associated skeletal muscle pathology include a loss of skeletal muscle mass, reduced strength and physical performance, as well as increased inflammation, fibrosis and adipocyte infiltration, among others. At a molecular level, skeletal muscle ischaemia has also been associated with gene and microRNA (miRNA) dysregulation. Mesenchymal stromal cells (MSCs) have been previously reported to enhance muscle regeneration and improve muscle function in a variety of skeletal muscle injuries. The aim of this study was to evaluate the effects of intramuscularly delivered human umbilical cord-derived MSCs (hUC-MSCs) on skeletal muscle regeneration in a preclinical model of acute skeletal muscle ischaemia. Herein, we report an hUC-MSC-mediated amelioration of ischaemia-induced skeletal muscle atrophy and function via enhancement of myofibre regeneration, reduction of tissue inflammation, adipocyte accumulation, and tissue fibrosis. These changes were observed in the absence of a cell-mediated enhancement of blood flow recovery measured by laser doppler imaging. Furthermore, the reduced tissue fibrosis in the cell-treated group was associated with an upregulation of miR-1, miR-133a and miR-29b and downregulation of targeted pro-fibrotic genes such as Col1a1 and Fn1. Our results support the use of hUC-MSC as a potential novel approach to reduce fibrosis and promote skeletal muscle regeneration after ischaemic injury in patients with PAD.
Epidemiology and outcomes of critically ill patients in the Emergency Department of a tertiary teaching hospital in Rwanda
Authors: B. Laurent Gamy Kamunga , Bearnot Courtney J , Martin Kyle D , Uwamahoro Doris L , Cattermole Giles N
Published: February 2024

Background
The introduction of Emergency Medicine in Rwanda in 2015 has been associated with a mortality reduction in patients presenting to Kigali University Teaching Hospital (KUTH). In the context of increasing numbers of critically ill patients presenting to EDs globally, the aim of this study was to describe the characteristics of critically ill patients, the critical care interventions performed, and the outcomes of critically ill patients presenting to the KUTH ED with the goal of informing future research into the root causes of mortality of critically ill ED patients and of identifying high yield topics for didactic and procedural training.
Methods
A descriptive prospective cohort pilot study analyzed all patients ≥15 years who presented to KUTH between April and June 2022 with modified South African Triage Scores of Red with alarm, Red without alarm, and Orange.
Results
Of 320 patients, 66.9% were male and median age was 40 years. Patients were triaged as Orange (65.3%), Red without alarm (22.8%), and Red with alarm (11.9%). Presentations were categorized as: medical emergencies (48.0%), traumatic injury (44.5%), and surgical emergencies (7.6%). Median length of stay was 31 hours (IQR 28, 56) and boarding was 23 hours (IQR 8, 48). Overall mortality was 12.2% and highest among medical emergencies (16.5%, p = 0.048) and increased significantly with triage color: Red with alarm (47.4%), Red without alarm (16.4%), and Orange (4.3%, p < 0.0001). Cardiopulmonary resuscitation (CPR) (10.3%), endotracheal intubation (8.8%), and vasopressor administration (3.1%) were the most frequent critical interventions performed. Survival after cardiac arrest was 9.1% and 32.1% after intubation. Mortality was associated with the following interventions: CPR, intubation, and use of vasopressors (p < 0.05).
Conclusions
This pilot study identified the most common critical care interventions performed and a high mortality among patients who required these interventions in the ED of a tertiary teaching hospital in Rwanda. These findings will inform didactics and procedural training for emergency care providers. Future research should focus on the root causes of mortality in these specific patient populations and identify areas of system strengthening to reduce mortality.
Tislelizumab plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy for elderly patients with inoperable locally advanced esophageal squamous cell carcinoma: a multicenter, randomized, parallel-controlled, phase II clinical trial
Authors: Zhang Ke , Wang Qifeng , Cao Jianzhong , Fan Chengcheng , Shen Wenbin , Xiao Qin , Ge Xiaolin , Zhang Tian , Liu Xiao , Chen Xi , Dong Jie , Li Zewei , Zheng Zhunhao , Yan Cihui , Wang Ping , Pang Qingsong , Zhang Wencheng
Published: February 2024

Background
The standard treatment for elderly patients with unresectable locally advanced esophageal squamous cell carcinoma (ESCC) is definitive chemoradiotherapy based on S-1. However, 3-year overall survival (OS)is limited about 40%. Tislelizumab has been the first-line and second-line standard treatment for advanced ESCC with tolerable toxicity. In the study we aimed to explore a new curative strategy for locally advanced unresectable elderly ESCC by combining tislelizumab with chemoradiotherapy.
Methods
The study is an open label, multicenter, investigator-initiated phase II clinical trial in older patients with inoperable locally advanced ESCC evaluating tislelizumab plus concurrent chemoradiotherapy compared to concurrent chemoradiotherapy. The main inclusion criteria are pathological confirmation of locally advanced inoperable ESCC at clinical cT1N2-3M0 or cT2-4bN0-3M0(stage II–IVA), aged ≥ 70 years, without any previous systemic anti-tumor therapy, and adequate organ function. A total of 136 patients will be recruited from approximately 6 centers over a period of 1 year and randomized in a 1:1 ratio to receive tislelizumab in combination with concurrent chemoradiotherapy(tislelizumab + S-1 + radiotherapy) or concurrent chemoradiotherapy (S-1 + radiotherapy). The efficacy and safety of treatment will be evaluated during the therapy and follow-up period until disease progression or death or the end of the trial. The primary study endpoint is investigator-assessed progression free survival (PFS), and the secondary study endpoints are OS, objective response rate (ORR), duration of remission (DOR), and safety. Fresh or archival tumor tissues and peripheral blood samples will be used in the exploratory studies.
Discussion
The synergistic efficacies of combined definitive concurrent chemoradiotherapy with tislelizumab are expected to result in survival benefit for elderly patients with inoperable locally advanced ESCC. As S-1 plus concurrent radiotherapy is the standard treatment option for locally advanced ESCC older patients, the combination of definitive concurrent chemoradiotherapy and tislelizumab has the potential to change the standard ESCC therapeutic strategy with comparable safety.
Trial registration
ClinicalTrials.gov NCT06061146.Registered 9/10/2023
Interpretation of coefficients in segmented regression for interrupted time series analyses
Authors: Wang Yongzhe , Nonzee Narissa J. , Zhang Haonan , Ashing Kimlin T. , Song Gaole , Crespi Catherine M.
Published: February 2024

Background
Segmented regression, a common model for interrupted time series (ITS) analysis, primarily utilizes two equation parametrizations. Interpretations of coefficients vary between the two segmented regression parametrizations, leading to occasional user misinterpretations.
Methods
To illustrate differences in coefficient interpretation between two common parametrizations of segmented regression in ITS analysis, we derived analytical results and present an illustration evaluating the impact of a smoking regulation policy in Italy using a publicly accessible dataset. Estimated coefficients and their standard errors were obtained using two commonly used parametrizations for segmented regression with continuous outcomes. We clarified coefficient interpretations and intervention effect calculations.
Results
Our investigation revealed that both parametrizations represent the same model. However, due to differences in parametrization, the immediate effect of the intervention is estimated differently under the two approaches. The key difference lies in the interpretation of the coefficient related to the binary indicator for intervention implementation, impacting the calculation of the immediate effect.
Conclusions
Two common parametrizations of segmented regression represent the same model but have different interpretations of a key coefficient. Researchers employing either parametrization should exercise caution when interpreting coefficients and calculating intervention effects.