bluuebunny/crossref_metadata_2025 huggingface dataset:
Invasive Hemodynamic Changes Associated With Sodium‐Glucose Cotransporter‐2 Inhibitors: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials
Authors: Idowu Abiodun , Adebolu Olayinka , Bruce Casipit , Nriagu Bede , Evbayekha Endurance , Lo Kevin Bryan , Afolabi-Brown Olayinka , Rangaswami Janani
Published: May 2024

Sodium‐glucose cotransporter‐2 inhibitors (SGLT2is) have been shown to lower incident heart failure (HF) and HF hospitalizations, but the mechanisms of benefit in relation to invasive hemodynamics remain unclear. Using PRISMA guidelines, we systematically reviewed multiple online databases for randomized trials evaluating the effect of SGLT2i on invasive hemodynamics. Rest and peak exercise invasive hemodynamics were measured via right heart catheterization pre‐ and postintervention. Random effects model meta‐analysis at a 95% confidence interval was done using RevMan 5.0. A total of 3 studies with a total of 145 patients were included in the meta‐analysis. SGLT2i was significantly associated with a reduction in pulmonary capillary wedge pressure at rest and peak exercise. Similarly, SGLT2i reduced mean pulmonary artery pressure at rest and peak exercise, respectively; however, this was not statistically significant. This hypothesis‐generating study offers mechanistic insights into the central hemodynamic effects of SGLT2i underpinning the HF benefits of SGLT2i.
Exploring the Formulation and Approaches of Injectable Hydrogels Utilizing Hyaluronic Acid in Biomedical Uses
Authors: Mashaqbeh Hadeia , Al-Ghzawi Batool , BaniAmer Fatima
Published: May 2024

The characteristics of injectable hydrogels make them a prime contender for various biomedical applications. Hyaluronic acid is an essential component of the matrix surrounding the cells; moreover, hyaluronic acid’s structural and biochemical characteristics entice researchers to develop injectable hydrogels for various applications. However, due to its poor mechanical properties, several strategies are used to produce injectable hyaluronic acid hydrogel. This review summarizes published studies on the production of injectable hydrogels based on hyaluronic acid polysaccharide polymers and the biomedical field’s applications for these hydrogel systems. Hyaluronic acid-based hydrogels are divided into two categories based on their injectability mechanisms: in situ-forming​ injectable hydrogels and shear-thinning injectable hydrogels. Many crosslinking methods are used to create injectable hydrogels; chemical crosslinking techniques are the most frequently investigated technique. Hybrid injectable hydrogel systems are widely investigated by blending hyaluronic acid with other polymers or nanoparticulate systems. Injectable hyaluronic acid hydrogels were thoroughly investigated and proven to demonstrate potential in various medical fields, including delivering drugs and cells, tissue repair, and wound dressings.
Low‐Cost Portable Road Smoothness Testing Method Based on Pseudo‐Vibration Velocity Range
Authors: Jiang Hongwei , Tong Xinlong , Zhang Yanhong , Ye Zhoujing , Li Junqing , Wang Yu , Miao Yinghao
Published: May 2024

Road smoothness not only directly affects the safety and comfort of vehicle travel but also relates to the efficiency and cost‐effectiveness of road maintenance. Traditional road smoothness detection methods usually require professional equipment and personnel, leading to high costs and cumbersome operations. Therefore, finding a low‐cost, simple, and accurate method for detecting road smoothness is of great significance. This study uses vehicle‐mounted acceleration sensors to detect road smoothness, establishing a correlation between driving vibration acceleration data and the international roughness index (IRI). For this research, a driving vibration acceleration data acquisition device was developed, and the driving acceleration data from the test sections were denoised and their feature values extracted. The pseudo‐vibration velocity range was used as the characteristic index representing the road surface smoothness IRI value. Testing with different vehicle types showed that the method is applicable to both sedans and SUV models, yielding a relative error of 8.9% for the sedan smoothness test model and 6.7% for the SUV smoothness test model. This study contributes to conducting large‐scale road smoothness detection at a low cost, improving the efficiency of road maintenance and operations.
Investigation of the Effect of Laughter Yoga on Stress-Coping Behaviors in Nursing Students’ Starting University
Authors: Alan Nurten , Ugur Ozlem , Bedez Gulsah , Tuna Oran Nazan
Published: May 2024

Aim. This study was aimed to investigate whether the practice of laughter yoga in nursing students who just started university can help them cope with stress. Design. An experimental randomized controlled study was conducted. Methods. The research was conducted with first-year students (n = 38) who were willing to participate in the study. The intervention group took part in six 45–50 minute laughter yoga sessions twice a week for three weeks. Results. The comparison of the mean and total scores obtained from the Coping Behavior Inventory and Physio-Psycho-Social Response Scale by the participants in the control and intervention groups before and after the implementation of the laughter yoga practices demonstrated that there was a statistically significant difference between the two tests in the intervention group and the difference was especially evident between the pre- and posttest scores obtained from the Coping Behavior Inventory. Conclusions. In this study, laughter yoga practice helped the participating nursing students who just started university to cope with stress. It can be recommended that laughter yoga should be integrated into the curriculum in schools where nursing education is provided as a way of coping with stress, that its use should be expanded, and that randomized controlled experimental studies in which its physiological and psychological effects in different groups are investigated with objective and subjective parameters should be conducted.
Percutaneous Microaxial Ventricular Assist Device Versus Intra‐Aortic Balloon Pump for Nonacute Myocardial Infarction Cardiogenic Shock
Authors: Watanabe Atsuyuki , Miyamoto Yoshihisa , Ueyama Hiroki , Gotanda Hiroshi , Tsugawa Yusuke , Kuno Toshiki
Published: May 2024

Background

Evidence on the comparative outcomes following percutaneous microaxial ventricular assist devices (pVAD) versus intra‐aortic balloon pump for nonacute myocardial infarction cardiogenic shock is limited.

Methods and Results

We included 704 and 2140 Medicare fee‐for‐service beneficiaries aged 65 to 99 years treated with pVAD and intra‐aortic balloon pump, respectively, for nonacute myocardial infarction cardiogenic shock from 2016 to 2020. Patients treated using pVAD compared with those treated using intra‐aortic balloon pump were more likely to be concurrently treated with mechanical ventilation, renal replacement therapy, and blood transfusions. We computed propensity scores for undergoing pVAD using patient‐ and hospital‐level factors and performed a matching weight analysis. The use of pVAD was associated with higher 30‐day mortality (adjusted odds ratio, 1.92 [95% CI, 1.59–2.33]) but not associated with in‐hospital bleeding (adjusted odds ratio, 1.00 [95% CI, 0.81–1.24]), stroke (adjusted odds ratio, 0.91 [95% CI, 0.56–1.47]), sepsis (OR, 0.91 [95% CI, 0.64–1.28]), and length of hospital stay (adjusted mean difference, +0.4 days [95% CI, −1.4 to +2.3]). A quasi‐experimental instrumental variable analysis using the cross‐sectional institutional practice preferences showed similar patterns, though not statistically significant (adjusted odds ratio, 1.38; 95% CI, 0.28–6.89).

Conclusions

Our investigation using the national sample of Medicare beneficiaries showed that the use of pVAD compared with intra‐aortic balloon pump was associated with higher mortality in patients with nonacute myocardial infarction cardiogenic shock. Providers should be cautious about the use of pVAD for nonacute myocardial infarction cardiogenic shock, while adequately powered high‐quality randomized controlled trials are warranted to determine the clinical effects of pVAD.
STEM Pathway and College Progression: The Link Between Engineering CTE and Postsecondary Outcomes for Students With Learning Disabilities
Authors: Plasman Jay , Myles Desmond
Published: May 2024

Despite growing calls to increase diversity in science, technology, engineering, and mathematics (STEM) fields, students with learning disabilities (SWLDs) remain underrepresented in STEM at the postsecondary level. Considering this call for increased diversity as a means to expand and strengthen STEM success, we used the High School Longitudinal Study of 2009 to explore how participation in engineering career and technical education (E-CTE) links to postsecondary educational outcomes for SWLDs. Particularly, we examined how E-CTE participation relates to postsecondary remedial course taking, enrollment in a 4-year postsecondary institution, and declaration of a STEM major. Results from school fixed-effects estimations suggest that each credit of E-CTE earned is associated with fewer remedial college courses, a higher likelihood of enrolling in a 4-year as opposed to sub-baccalaureate institution, and increased odds of declaring a STEM major. To conclude, we discuss the implications of our findings for both policymakers and practitioners.
Investigating Canadian Radiology Residents’ Personal Financial Literacy: A Nation-Wide Assessment
Authors: Dehmoobad Sharifabadi Anahita , Bellini Jonathan , Alabousi Abdullah , Monteiro Sandra , Mensinkai Arun , Al-Arnawoot Basma
Published: May 2024

Purpose: Canadian resident physicians carry large debt to finance their education, which impacts their wellness and their future decision making. The objective of this observational study is to assess the financial literacy of Canadian radiology residents through testing their financial knowledge and examining their current financial status. Methods: A survey was designed to assess the financial literacy and current financial status of radiology residents, which was distributed to Canadian radiology residents via Google Forms. Descriptive analyses on preliminary data and the association between level of training and financial quiz scores were obtained. Results: 104 valid responses from 16 universities were received. The majority (53%) of residents indicated that their debt was greater than $150 000. Residents on average scored 71% on the financial quiz and the scores were not associated with training level ( P = .71). The majority (89%) of residents indicated a strong interest in a formal financial literacy curriculum, with 80% preferring a physician-led curriculum. Conclusion: Overall, residents face a high debt burden. Current resident physicians value a formal financial literacy curriculum as a part of their residency program despite existing financial knowledge. Most importantly, residents feel that a curriculum created with involvement of other physicians would be optimal.
“It's a Valuable Service but a Hard Place to Be:” Women's Views About Violence Against Women Shelters
Authors: Tutty Leslie M. , Nixon Kendra L. , Thurston Wilfreda (Billie)
Published: May 2024

This mixed-methods secondary analysis examined VAW shelter use by 662 Canadian women abused by partners (50.5% Indigenous, 43.4% White, and 6.1% visible minority). Women who had never resided in shelters ( n = 242) had less Severe Combined and Total IPV on the Composite Abuse Scale and fewer PTSD symptoms. More nonresidents worked full time and had higher incomes and no children. The 420 women residents mentioned strengths (70.4%) such as supportive staff and safety, and concerns (29.6%) about unsupportive staff and the shelter rules or facility. Some Indigenous women reported racist attitudes by shelter staff and child apprehensions. Practice implications are presented.
Decolonizing the Global North university: Host-guest dynamics and the limits of hospitality
Authors: Lau Lisa , Mendes Ana Cristina
Published: May 2024

This article critically assesses the hospitality premise on which the project-practice of decolonizing the curriculum rests, investigating the texture and limitations of the hospitality that Global North universities seem willing to offer their many Others, including students, staff, and stakeholders, particularly in the form of knowledges and pedagogies. It investigates how the guests-strangers are treated within the Global North Universities, their knowledges posited as a separate category within the epistemic system rather than integrated into being a part of the system; guests relegated to unpaid servants when obliged to shoulder the lion's share of the work in addressing the unfair, racist systems which devalue them and their knowledges. Embedding the discourse of decolonizing the university in and with postcolonial concepts, the article highlights the profoundly unequal power relationships between hosts and guests that continue to inform even the best-intentioned Global North higher education institutions, self-declaredly dedicated to decolonization efforts. It argues for pressing need on the part of the Global North universities to deepen their awareness of the historical legacies of coloniality and its matrix of power, and consequently reflect on the treatment of Global South guests and knowledges. This long, hard look at their role of host is necessary for a true committment to decolonising the university spaces and rendering them genuinely hospitable, and to transforming the unequal power dynamics and the impacts on guests-stranger Others.
Pediatric Interventional Neuroradiology: “How I Do It” v. I – Diagnostic Angiography
Authors: Jones Jesse , Deveikis John
Published: May 2024

Pediatric neurointervention differs from the adult in several important respects. Here we describe a modern approach to readily acquire diagnostic quality images of children. Preparation, access, angiogragraphy and closure have evolved along with new knowledge and technology. This timely “how I do it” series addresses each topic utilizing literature review and our own experience over 35 years.
Management of the Nasolacrimal Duct in Expanded Endoscopic Approaches to the Maxillary Sinus: A Systematic Review with Evidence-based Recommendations
Authors: Godse Neal Rajan , Sreenath Satyan , Lobo Brian C. , Sindwani Raj
Published: May 2024

Background

Utilizing expanded endoscopic approaches to the maxillary sinus for the endonasal management of a variety of tumors is increasing in popularity. The nasolacrimal duct (NLD) may be injured inadvertantly or need to be removed during tumor resection or to augment visualization. Management of the NLD can take the form of transection alone, transection with stenting, or performing a formal dacryocystorhinostomy to avoid postoperative sequelae of injury. The purpose of this study was to review the literature and determine the optimal management of the NLD during expanded maxillary sinus approaches.

Methods

A systematic review of Ovid, Embase, Medline, and Cochrane databases was performed to identify studies involving expanded approaches to the maxillary sinus and that explicitly reported the status of the NLD and postoperative outcomes.

Results

Nineteen studies were included in the analysis and divided into two groups: NLD-preserving (n = 9 studies; n = 191 patients in aggregate) and NLD-involving (n = 10 studies; n = 296 patients in aggregate). In the NLD-preserving subgroup, one patient out of a subgroup aggregate of 191 patients (0.5%) developed epiphora. In the NLD-involving subgroup, sharp transection alone was the most common method of NLD removal and was associated with a low rate of epiphora (study rates: 0 to 18.2%; aggregated subgroup rate: 7.0%, 21 / 296). Spontaneous resolution of symptoms was common (60%-100% cases).

Conclusions

The NLD should be preserved when feasible from an exposure and tumor-control perspective. When pathology or approach requires the removal of the NLD, rates of persistent epiphora are very low, regardless of surgical technique. When expanded maxillary approaches are employed, particularly for benign tumors, and require removal of the NLD, sharp transection is the simplest method of removal, provides a low rate of postoperative epiphora, and is supported by the available literature.
Packaging of supplemented urokinase into alpha granules of in vitro–grown megakaryocytes for targeted nascent clot lysis
Authors: Poncz Mortimer , Zaitsev Sergei V. , Ahn Hyunsook , Kowalska M. Anna , Bdeir Khalil , Dergilev Konstantin V. , Ivanciu Lacramioara , Camire Rodney M. , Cines Douglas B. , Stepanova Victoria
Published: May 2024

Fibrinolytics delivered into the general circulation lack selectivity for nascent thrombi, reducing efficacy and increasing the risk of bleeding. Urokinase-type plasminogen activator (uPA) transgenically expressed within murine platelets provided targeted thromboprophylaxis without causing bleeding but is not clinically feasible. Recent advances in generating megakaryocytes prompted us to develop a potentially clinically relevant means to produce “antithrombotic” platelets from CD34+ hematopoietic stem cell–derived in vitro–grown megakaryocytes. CD34+ megakaryocytes internalize and store in alpha granules (α-granules) single-chain uPA (scuPA) and a plasmin-resistant thrombin-activatable variant (uPAT). Both uPAs colocalized with internalized factor V (FV), fibrinogen and plasminogen, low-density lipoprotein receptor–related protein 1 (LRP1), and interferon-induced transmembrane protein 3, but not with endogenous von Willebrand factor (VWF). Endocytosis of uPA by CD34+ megakaryocytes was mediated, in part, via LRP1 and αIIbβ3. scuPA-containing megakaryocytes degraded endocytosed intragranular FV but not endogenous VWF in the presence of internalized plasminogen, whereas uPAT-megakaryocytes did not significantly degrade either protein. We used a carotid artery injury model in nonobese diabetic-severe combined immunodeficiency IL2rγnull (NSG) mice homozygous for VWFR1326H (a mutation switching binding VWF specificity from mouse to human glycoprotein Ibα) to test whether platelets derived from scuPA- or uPAT-megakaryocytes would prevent thrombus formation. NSG/VWFR1326H mice exhibited a lower thrombotic burden after carotid artery injury compared with NSG mice unless infused with human platelets or megakaryocytes, whereas intravenous injection of uPA-megakaryocytes generated sufficient uPA-containing human platelets to lyse nascent thrombi. These studies describe the use of in vitro–generated megakaryocytes as a potential platform for delivering uPA or other ectopic proteins within platelet α-granules to sites of vascular injury.
Scientific competence during medical education - insights from a cross-sectional study at a German Medical School
Authors: Vogt Maximilian , Schuchardt Nadja , Geissler Mark Enrik , Bereuter Jean-Paul , Geissler Rona Berit , Glauche Ingmar , Gerdes Sebastian , Deußen Andreas , Günther Lydia
Published: May 2024

Background

Medical knowledge regarding the pathophysiology, diagnosis and treatment of diseases is constantly evolving. To effectively incorporate these findings into professional practice, it is crucial that scientific competencies are a central component of medical education. This study seeks to analyse the current state of scientific education and students’ desires for integration into the curriculum.

Methods

From October to December 2022, a survey was distributed at the Medical Faculty Dresden to all medical students from the 1st to 5th academic year (AY). The survey investigates current expectations of applying scientific competencies later in professional life, and the students were asked to self-assess various scientific skills and in relation to the National Competence Based Catalogue of Learning Objectives for Undergraduate Medical Education. The self-assessments were objectified through a competence test with ten multiple-choice questions. The desire for curricular teaching was inquired.

Results

860 students completed the survey. This corresponds to a response rate of 64%. In the 5th AY, approximately 80% of the participants stated that they expected to work with scientific literature on a daily to monthly basis in future professional life and to communicate corresponding scientific findings to patients. Only 30–40% of the 5th AY rate their scientific competencies as sufficient to do this appropriately. This corresponds with the self-assessed competencies that only slightly increased over the 5 AYs from 14.1 ± 11.7 to 21.3 ± 13.8 points (max. 52) and is also reflected in the competence test (1st AY 3.6 ± 1.75 vs. 5th AY 5.5 ± 1.68, max. 10 points). Half of the students in the 4th and 5th AYs were dissatisfied with the current teaching of scientific skills. The majority preferred the implementation of a science curriculum (56%), preferably as seminars dealing with topics such as literature research, analysis, and science communication.

Conclusions

The results show discrepancies between expectations of using scientific knowledge in everyday professional life, self-rated and objectively recorded competencies, and the current state of curricular teaching of scientific competencies. There is a strong need for adequate practical training, particularly in critical analyses of scientific literature, which enables the communication of scientific knowledge to patients.
The development of a serious game for laser applications in dentistry and the evaluation of dental students' satisfaction
Authors: Khorasanchi Maryam , Hoseinzadeh Melika , Khadem Rezaeian Majid , Kazemian Ali , Moradi Ali , Sarabadani Javad
Published: May 2024

Background

This study aimed to design and implement a gamified application about the theoretical aspects of laser applications in dentistry and investigate students' satisfaction with their learning experience.

Methods

An engaging educational program named Essential Skills and Knowledge in Learning Laser (ESKILLD) was developed to teach laser applications in dentistry. The program comprises two primary components: a “Tutorial and Quiz” section and a “Games” section. Final-year dental students were tasked with installing and using this application. A 29-item validated questionnaire (Cronbach's alpha = 0.97, ICC = 0.94) was used to evaluate students' perceptions of the applications' design and functionality. The influence of participants' gender and Grade Point Average (GPA) on their satisfaction levels was examined via the student t-test and Pearson's correlation, with a significance level of 0.05.

Results

The study had 56 participants, of which 37 were female (66.07%), and 19 were male (33.92%). The students' average GPA was 15.16 out of 20. The mean rating for ESKILLD's design and functionality was 1.39 ± 0.47 and 1.37 ± 0.46, respectively, signifying a high satisfaction level. Female students rated the application's coherence and learning perception significantly higher than their male counterparts (p < 0.05). However, gender did not significantly influence scores on other perception aspects or overall scores. Students' GPAs and their perception scores did not have a significant correlation.

Conclusions

The results indicate that the participants were generally satisfied with the game's features and attitudes towards it, which underscores the potential effectiveness of gamification in dental courses focused on laser applications.
Determining capacity of people with dementia to take part in research: an electronic survey study of researcher confidence, competence and training needs
Authors: Griffiths Sarah , Shepherd Victoria , Volkmer Anna
Published: May 2024

Background

Researchers are required to determine whether a person has capacity to consent to a research study before they are able to participate. The Mental Capacity Act and accompanying Code of Practice for England and Wales provide some guidance on this process, but researchers have identified that it can be difficult to determine capacity to consent when a person has complex cognitive or communication needs. This study aimed to understand the experiences and opinions of researchers who recruit people with dementia to research projects, to inform the future development of training resources.

Methods

A mixed method, cross-sectional, electronic survey was circulated via social media and research networks in England and Wales. The survey remained open for ten weeks and included open and closed questions exploring respondents’ confidence in determining capacity in the context of recruiting people with dementia to consent, their views on training and support they have experienced and their suggestions for future training and support needs.

Results

60 respondents completed the survey from across England and Wales. Although 75% of respondents had experience of determining capacity to consent with people with dementia to research, only 13% rated themselves as feeling ‘very confident’ in this. Qualitative content analysis of open responses led to the generation of six themes, explaining researchers’ confidence, competence and future training needs in this area: (1) Researcher uncertainties, (2) Lack of time, (3) Balancing information complexity with accessibility, (4) Gatekeepers, (5) Existing enablers and (6) Envisioning future training.

Conclusions

Researchers would benefit from specific training in undertaking conversations around consent with people with dementia. People with dementia may have fluctuating capacity, and despite support from caregivers, researchers have little practical guidance on methods of determining a person’s ability to understand or appreciate the information they have provided during the consent process. Given the development of large complex trials within dementia research, there is an urgency to develop specific and practical guidance and training for researchers working with people with dementia and their families.
Neonatal jaundice detection in low-resource Mexican settings: possibilities and barriers for innovation with mobile health
Authors: Jiménez-Díaz Gabriela , Aune Anders , Elizarrarás-Rivas Jesús , Gierman Lobke M. , Keitsch Martina , Marcuzzi Anna , Infanti Jennifer J.
Published: May 2024

Background

Neonatal jaundice is a common condition that can lead to brain damage and disabilities when severe cases go undetected. Low- and middle-income countries often lack accurate methods for detecting neonatal jaundice and rely on visual assessment, resulting in a higher incidence of adverse consequences. Picterus Jaundice Pro (Picterus JP), an easy-to-use and affordable smartphone-based screening device for the condition, has demonstrated higher accuracy than visual assessment in Norwegian, Philippine and Mexican newborns. This study aimed to identify the barriers and facilitators to implementing Picterus JP in public health services in low-income settings in Mexico by exploring the current process of neonatal jaundice detection and stakeholders’ perspectives in that context.

Methods

Qualitative data collection techniques, including one focus group, 15 semi-structured interviews and four observations, were employed in urban and rural health facilities in Oaxaca, Mexico. The participants included medical doctors, nurses and health administrators. The data were analysed by thematic analysis guided by the Consolidated Framework for Implementation Research.

Results

The analysis yielded four main themes: (I) the current state of neonatal care and NNJ detection, (II) the needs and desires for enhancing NNJ detection, (III) the barriers and facilitators to implementing Picterus JP in the health system and (IV) HCWs’ expectations of Picterus JP. The findings identify deficiencies in the current neonatal jaundice detection process and the participants’ desire for a more accurate method. Picterus JP was perceived as easy to use, useful and compatible with the work routine, but barriers to adoption were identified, including internet deficiencies and costs.

Conclusions

The introduction of Picterus JP as a supporting tool to screen for neonatal jaundice is promising but contextual barriers in the setting must be addressed for successful implementation. There is also an opportunity to optimise visual assessment to improve detection of neonatal jaundice.
Blood metabolites and chronic kidney disease: a Mendelian randomization study
Authors: Hou Yawei , Xiao Zhenwei , Zhu Yushuo , Li Yameng , Liu Qinglin , Wang Zhenguo
Published: May 2024

Background

Human blood metabolites have demonstrated close associations with chronic kidney disease (CKD) in observational studies. Nonetheless, the causal relationship between metabolites and CKD is still unclear. This study aimed to assess the associations between metabolites and CKD risk.

Methods

We applied a two-sample Mendelian randomization (MR) analysis to evaluate relationships between 1400 blood metabolites and eight phenotypes (outcomes) (CKD, estimated glomerular filtration rate(eGFR), urine albumin to creatinine ratio, rapid progress to CKD, rapid decline of eGFR, membranous nephropathy, immunoglobulin A nephropathy, and diabetic nephropathy). The inverse variance weighted (IVW), MR-Egger, and weighted median were used to investigate the causal relationship. Sensitivity analyses were performed with Cochran’s Q, MR-Egger intercept, MR-PRESSO Global test, and leave-one-out analysis. Bonferroni correction was used to test the strength of the causal relationship.

Results

Through the MR analysis of 1400 metabolites and eight clinical phenotypes, a total of 48 metabolites were found to be associated with various outcomes. Among them, N-acetylleucine (OR = 0.923, 95%CI: 0.89–0.957, PIVW = 1.450 × 10–5) has a strong causal relationship with lower risk of CKD after the Bonferroni-corrected test, whereas Glycine to alanine ratio has a strong causal relationship with higher risk of CKD (OR = 1.106, 95%CI: 1.063–1.151, PIVW = 5.850 × 10–7). No horizontal pleiotropy and heterogeneity were detected.

Conclusion

Our study offers groundbreaking insights into the integration of metabolomics and genomics to reveal the pathogenesis of and therapeutic strategies for CKD. It underscores 48 metabolites as potential causal candidates, meriting further investigation.
Clinical efficacy and complications of MIS-TLIF and TLIF in the treatment of upper lumbar disc herniation: a comparative study
Authors: An Bochen , Ren Bowen , Liu Yihao , Han Zhenchuan , Wu Jianhui , Mao Keya , Liu Jianheng
Published: May 2024

Background

The optimal treatment modality for upper lumbar disc herniation remains unclear. Herein, we compared the clinical efficacy and application value of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and transforaminal lumbar interbody fusion (TLIF) for upper lumbar disc herniation. We aimed to provide new evidence to guide surgical decisions for treating this condition.

Methods

We retrospectively analyzed the clinical data of 81 patients with upper lumbar disc herniation admitted between January 2017 and July 2018, including 41 and 40 patients who underwent MIS-TLIF and TLIF, respectively. Demographic characteristics, preoperative functional scores, perioperative indicators, and postoperative complications were compared. We performed consecutive comparisons of visual analog scale (VAS) scores of the lumbar and leg regions, Oswestry disability index (ODI), Japanese Orthopaedic Association scores (JOA), and MacNab scores at the final follow-up, to assess clinical outcomes 5 years postoperatively.

Results

VAS scores of the back and legs were significantly lower in the MIS-TLIF than the TLIF group at 3 months and 1 year postoperatively (P < 0.05). Intraoperative bleeding and postoperative hospitalization time were significantly lower, and the time to return to work/normal life was shorter in the MIS-TLIF than in the TLIF group (P < 0.05). The differences in JOA scores and ODI scores between the two groups at 3 months, 1 year, and 3 years postoperatively were statistically significant (P < 0.05).

Conclusion

The early clinical efficacy of MIS-TLIF was superior to that of TLIF, but no differences were found in mid-term clinical efficacy. Further, MIS-TLIF has the advantages of fewer medical injuries, shorter hospitalization times, and faster postoperative functional recovery.
Zinc deficiency deteriorates ovarian follicle development and function by inhibiting mitochondrial function
Authors: Liu Wen-Jiao , Li Li-Shu , Lan Meng-Fan , Shang Jian-Zhou , Zhang Jin-Xin , Xiong Wen-Jie , Lai Xin-Le , Duan Xing
Published: May 2024

Zinc (Zn) is a crucial trace element essential for human growth and development, particularly for reproductive health. Previous research has shown a decrease in serum zinc concentration with age and individuals with conditions such as polycystic ovary syndrome (PCOS) and diabetes mellitus. However, the specific effects of zinc deficiency on the female reproductive system, especially ovarian function, are not fully understood. In our study, we observed a significant reduction in the total number of follicles and mature follicles in the zinc deficiency group. This reduction correlated with decreased level of anti-Mullerian hormone (AMH) and abnormal gene expression affecting hormone secretion regulation. Furthermore, we found that zinc deficiency disrupted mitochondrial dynamics, leading to oxidative stress in the ovaries, which further inhibited autophagy and increased ovarian apoptosis. These changes ultimately resulted in the failure of germinal vesicle breakdown (GVBD) and reduced oocyte quality. Meanwhile, administration of zinc glycine effectively alleviated the oocyte meiotic arrest caused by dietary zinc deficiency. In conclusion, our findings demonstrated that dietary zinc deficiency can affect hormone secretion and follicle maturation by impairing mitochondrial function and autophagy.
A scoping review of machine learning for sepsis prediction- feature engineering strategies and model performance: a step towards explainability
Authors: Bomrah Sherali , Uddin Mohy , Upadhyay Umashankar , Komorowski Matthieu , Priya Jyoti , Dhar Eshita , Hsu Shih-Chang , Syed-Abdul Shabbir
Published: May 2024

Background

Sepsis, an acute and potentially fatal systemic response to infection, significantly impacts global health by affecting millions annually. Prompt identification of sepsis is vital, as treatment delays lead to increased fatalities through progressive organ dysfunction. While recent studies have delved into leveraging Machine Learning (ML) for predicting sepsis, focusing on aspects such as prognosis, diagnosis, and clinical application, there remains a notable deficiency in the discourse regarding feature engineering. Specifically, the role of feature selection and extraction in enhancing model accuracy has been underexplored.

Objectives

This scoping review aims to fulfill two primary objectives: To identify pivotal features for predicting sepsis across a variety of ML models, providing valuable insights for future model development, and To assess model efficacy through performance metrics including AUROC, sensitivity, and specificity.

Results

The analysis included 29 studies across diverse clinical settings such as Intensive Care Units (ICU), Emergency Departments, and others, encompassing 1,147,202 patients. The review highlighted the diversity in prediction strategies and timeframes. It was found that feature extraction techniques notably outperformed others in terms of sensitivity and AUROC values, thus indicating their critical role in improving sepsis prediction models.

Conclusion

Key dynamic indicators, including vital signs and critical laboratory values, are instrumental in the early detection of sepsis. Applying feature selection methods significantly boosts model precision, with models like Random Forest and XG Boost showing promising results. Furthermore, Deep Learning models (DL) reveal unique insights, spotlighting the pivotal role of feature engineering in sepsis prediction, which could greatly benefit clinical practice.
HybOff: a Hybrid Offloading approach to improve load balancing in fog environments
Authors: Sulimani Hamza , Sulimani Rahaf , Ramezani Fahimeh , Naderpour Mohsen , Huo Huan , Jan Tony , Prasad Mukesh
Published: May 2024

Load balancing is crucial in distributed systems like fog computing, where efficiency is paramount. Offloading with different approaches is the key to balancing the load in distributed environments. Static offloading (SoA) falls short in heterogeneous networks, necessitating dynamic offloading to reduce latency in time-sensitive tasks. However, prevalent dynamic offloading (PoA) solutions often come with hidden costs that impact sensitive applications, including decision time, networks congested and distance offloading. This paper introduces the Hybrid Offloading (HybOff) algorithm, which substantially enhances load balancing and resource utilization in fog networks, addressing issues in both static and dynamic approaches while leveraging clustering theory. Its goal is to create an uncomplicated low-cost offloading approach that enhances IoT application performance by eliminating the consequences of hidden costs regardless of network size. Experimental results using the iFogSim simulation tool show that HybOff significantly reduces offloading messages, distance, and decision-offloading consequences. It improves load balancing by 97%, surpassing SoA (64%) and PoA (88%). Additionally, it increases system utilization by an average of 50% and enhances system performance 1.6 times and 1.4 times more than SoA and PoA, respectively. In summary, this paper tries to introduce a new offloading approach in load balancing research in fog environments.
Integration of feature enhancement technique in Google inception network for breast cancer detection and classification
Authors: Admass Wasyihun Sema , Munaye Yirga Yayeh , Salau Ayodeji Olalekan
Published: May 2024

Breast cancer is a major public health concern, and early detection and classification are essential for improving patient outcomes. However, breast tumors can be difficult to distinguish from benign tumors, leading to high false positive rates in screening. The reason is that both benign and malignant tumors have no consistent shape, are found at the same position, have variable sizes, and have high correlations. The ambiguity of the correlation challenges the computer-aided system, and the inconsistency of morphology challenges an expert in identifying and classifying what is positive and what is negative. Due to this, most of the time, breast cancer screen is prone to false positive rates. This research paper presents the introduction of a feature enhancement method into the Google inception network for breast cancer detection and classification. The proposed model preserves both local and global information, which is important for addressing the variability of breast tumor morphology and their complex correlations. A locally preserving projection transformation function is introduced to retain local information that might be lost in the intermediate output of the inception model. Additionally, transfer learning is used to improve the performance of the proposed model on limited datasets. The proposed model is evaluated on a dataset of ultrasound images and achieves an accuracy of 99.81%, recall of 96.48%, and sensitivity of 93.0%. These results demonstrate the effectiveness of the proposed method for breast cancer detection and classification.
Examining pancreatic stone protein response in ICU-acquired bloodstream infections: a matched event analysis
Authors: Verlaan Diede , Derde Lennie P. G. , van der Poll Tom , Bonten Marc J. M. , Cremer Olaf L.
Published: May 2024

Background

Pancreatic stone protein (PSP) exhibits potential as a plasma biomarker for infection diagnosis and risk stratification in critically ill patients, but its significance in nosocomial infection and intensive care unit (ICU)-acquired bloodstream infection (BSI) remains unclear. This study explores the temporal responses of PSP in ICU-acquired BSI caused by different pathogens.

Methods

From a large cohort of ICU patients, we selected episodes of ICU-acquired BSI caused by Gram-negative rods (GNRs), enterococci, or Candida species. Events were matched on length of ICU stay at infection onset, Severe Organ Failure Assessment (SOFA) score, presence of immune deficiency, and use of renal replacement therapy. PSP concentrations were measured at infection onset (T0) and at 24, 48 and 72 h prior to infection onset as defined by the first occurrence of a positive blood culture. Absolute and trend differences in PSP levels between pathogen groups were analysed using one-way analysis of variance. Sensitivity analyses were performed in events with a new or worsening systematic inflammatory response based on C-reactive protein, white cell count and fever.

Results

We analysed 30 BSI cases per pathogen group. Median (IQR) BSI onset was on day 9 (6–12). Overall, PSP levels were high (381 (237–539) ng/ml), with 18% of values exceeding the assay’s measurement range. Across all 90 BSI cases, there was no clear trend over time (median change 34 (− 75–189) ng/ml from T-72 to T0). PSP concentrations at infection onset were 406 (229–497), 350 (223–608), and 480 (327–965) ng/ml, for GNR, enterococci, and Candida species, respectively (p = 0.32). At every time point, absolute PSP levels and trends did not differ significantly between pathogens. PSP values at T0 correlated with SOFA scores. Eighteen (20%) of 90 BSI events did not exhibit a systemic inflammatory response, primarily in Candida species. No clear change in PSP concentration before BSI onset or between-group differences were found in sensitivity analyses of 72 cases.

Conclusions

Against a background of overall (very) high plasma PSP levels in critically ill patients, we did not find clear temporal patterns or any pathogen-specific differences in PSP response in the days preceding onset of ICU-acquired BSI.
Does raising awareness about inequality decrease support for school closures? An information treatment survey experiment during the COVID-19 pandemic
Authors: Bellani Luna , Bertogg Ariane , Kulic Nevena , Strauss Susanne
Published: May 2024

The increase in inequalities during the ongoing COVID-19 pandemic has been the topic of intense scholarly and public debate. School closures are one of the containment measures that have been debated most critically in this regard. What drives support for closures of schools and pre-school services (daycare/kindergarten) during a public health crisis such as the current COVID-19 pandemic? More specifically, does inequality awareness affect this support? Theoretically, we assume that providing information on current levels of inequality can change policy preferences, as it increases awareness of their consequences for inequality. Moreover, we assume that the strength of the association between information provision and policy support varies across individuals—depending on their exposure to these policies, and the political attitudes that they hold. To identify causal linkages between awareness of inequalities and support for school and daycare/kindergarten closures, we use a survey experiment with information treatment, in which we randomly assign information designed to prime the respondents to think about either education inequality, gender inequality, or both. The experiment, involving more than 3,000 respondents, was conducted in the spring of 2021 at the end of a prolonged lockdown in Germany when a new piece of legislation was enacted, enabling or restricting school reopenings based on local infection rates. Using Probit Regression models for dichotomous dependent variables, we show that raising awareness of education inequality and gender inequality via an information treatment is associated with decreasing support for preschool and primary school closures. We also find that past exposure to school-closure policies strengthens the effects of information treatments, whereas previous political attitudes do not moderate the association between information treatments and support for preschool and school closures.
Diagnostic biomarkers for ST-segment elevation myocardial infarction using RNA methylation regulators
Authors: Li Yeting , Ma Kai , Zhao Chuanxin , Li Nannan , Li Shanshan , Zheng Man
Published: May 2024

Aims

Additional evidence has indicated a correlation between N6-methyladenosine (m6A) RNA methylation and cardiovascular disease. Nevertheless, the alterations in RNA methylation modification and the expression of numerous genes remains unclear. This study aimed to identify the role of m6A in ST-segment elevation myocardial infarction (STEMI).

Methods

Two microarray datasets (GSE123342 and GSE59867) were downloaded from the GEO database. After merging the data and batch normalization, differentially expressed regulators were identified using the limma package. Subtyping consistency analysis was performed to group samples. The random forest algorithm and support vector machine were used to identify diagnostic biomarkers. Immune infiltration and inflammation levels among the subtypes were assessed using a single-sample gene set enrichment analysis.

Results

A total of 15 key differential m6A regulators (RBM15B, ELAVL1, ALKBH5, METTL16, ZC3H13, RBM15, YTHDC1, YTHDC2, YTHDF3, HNRNPC, FMR1, LRPPRC, HNRNPA2B1, RBMX, FTO) were identified using the random forest classifier and were found to be highly correlated by PPI analysis. Two distinct RNA modification patterns (cluster A and B) were validated based on the expression levels of the 15 key m6A regulators. GO and KEGG annotations showed that immunity and inflammation pathways were enriched. Immune infiltration analysis revealed that cluster 2 had higher immune activation than cluster 1. Further analysis showed that cluster 2 had a higher inflammation level, with IL-4 and IL-33 showing differential expression (p < 0.05).

Conclusion

A set of 15 m6A RNA methylation regulators could alter the STEMI microenvironment to improve risk stratification and clinical treatment.
Plasma exchange is the hope for critically ill children with life-threatening autoimmune hemolytic anemia
Authors: El-Anwar Noha , Bazaraa Hafez , Maksoud Fatma Abdel , Ramadan Yasmin
Published: May 2024

Background

Autoimmune hemolytic anemia (AIHA) is a rare disease in children, sometimes associated with acute, life-threatening, rapidly progressive course requiring prompt management. The aim of our study is to describe the role and outcome of plasma exchange in the acute management of pediatric patients with AIHA requiring transfusion and refractory to high doses of corticosteroids.

Methods

This was a descriptive retrospective report of all patients admitted to the pediatric intensive care unit (PICU) of Children’s University Hospital who received PE for acute intractable AIHA resistant to management with pulse steroids starting from June 2017 to June 2022. The demographic data, vitals, and laboratory investigations at PICU admission and upon discharge were gathered. The number of PE sessions needed for each patient, volume used for exchange, type of replacement, IV access used, complications, and outcome were reported.

Results

This series included 19 patients, 10 males, and 9 females, with a median age and weight of 76 months (IQR 18–121), and 20.9 kg. Improvement of the mean hemoglobin was observed from 5.3 ± 1.8 to 9.9 ± 2.6 g/dl at discharge. The average number of PE sessions was 2.4 sessions with no adverse effects encountered. The mean PICU stay was 16.6 days. Mortality occurred in 2 patients (10.5%) due to their primary illness, while 7 patients (36.8%) were in need of further immunotherapy, and 5 patients (28%) showed relapse.

Conclusion

PE may be used as a safe and successful therapy in children with severe acute life-threatening AIHA not responding to steroids, or if well-matched PRBCs are unavailable for transfusion.