bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of lymph node dissection during surgery on the efficacy of pembrolizumab in patients with metastatic urothelial carcinoma
Authors: Kanno Toru , Ito Katsuhiro , Kita Yuki , Mochizuki Takanori , Sano Tomoyasu , Yokomizo Akira , Abe Takashige , Tsuchihashi Kazunari , Tatarano Shuichi , Inokuchi Junichi , Takahashi Atsushi , Matsui Yoshiyuki , Nishiyama Hiroyuki , Kitamura Hiroshi , Saito Ryoichi , Kobayashi Takashi ,   the Japan Urological Oncology Group
Published: February 2025

Objectives

The impact of lymph node dissection (LND) on the efficacy of pembrolizumab in patients with urothelial carcinoma (UC) who develop metastasis after surgery remains unclear. This study aimed to investigate the efficacy of pembrolizumab in patients with metastatic UC who underwent primary tumor resection with LND.

Patients and methods

This retrospective study included patients who initially underwent radical surgery with or without LND for non‐metastatic UC and later received pembrolizumab for recurrent lesions. Data were collected from a retrospective nationwide Japanese cohort study in patients with metastatic UC treated with pembrolizumab. The primary endpoints were overall response rate (ORR) and overall survival (OS). Multivariate analysis was performed to identify predictors of OS.

Results

A total of 393 patients (273 [69.5%] underwent LND, and 120 (30.5%) did not) were included in this study. The ORRs for patients with and without LND were 30.8% and 27.3%, respectively (p = 0.460). No significant difference in OS was observed between the two groups (p = 0.471). Multivariate Cox regression analysis revealed that a neutrophil‐to‐lymphocyte ratio ≥3.0, Eastern Cooperative Oncology Group performance status ≥2, hemoglobin <11, and liver metastasis were associated with worse OS. However, LND was not associated with OS.

Conclusions

LND during primary tumor resection did not affect the efficacy of pembrolizumab in patients with metastatic UC.
First‐principles’ study of surface adsorption behaviors of oxygen on Nb2C MXenes and their modification by PANI
Authors: Wang Ming Lei , Zhou Yunkai , Yin Ziyue , Zhang Yanhui , Wang Li‐Min , Zhang Xinyu , Liu Ri‐Ping
Published: February 2025

Large‐scale application of MXene are mainly limited by their easy oxidation behavior, which destroys their structure stabilities and thereby deteriorates their electrochemical properties as well. In order to understand the mechanism of chemical stability of Nb2C–X2 (X = O or OH) against oxygen attack and the modification effects of three types of polyaniline (PANI) [pernigraniline polyaniline (oxid‐PANI), leucoemeraldine polyaniline (red‐PANI), emeraldine polyaniline (rmid‐PANI)], the oxygen adsorption behaviors on surface slabs of Nb2C–X2, PANI and PANI‐modified Nb2C–X2 are systematically investigated and compared by applying density functional theory (DFT) calculations in this work. Among the 42 adsorption systems studied, the nanocomposite of oxid‐PANI/Nb2CO2 stands out due to the oxidation resistance and the structure stability owing to the effects of PANI modification. This is demonstrated by the decreased adsorption activity on the end of Nb2CO2 compared with the original Nb2CO2. Furthermore, the Bader charge analysis and the electron density difference maps illustrate that around 0.11 e transfers from the PANI‐end to the MXene‐end, which explains the physics behind the improvement of oxidation resistance in the MXene matrix. Therefore, our studies here indicate that the improvement of the oxidation resistance and the structure stability of Nb2C‐type MXenes can be effectively qualified by the PANI‐modification, which gives theoretical guidelines for the preparation and the applications of MXene materials.
Effects of heat treatment on mechanical and thermophysical properties of KD‐SA SiCf/SiC composites
Authors: Zhang Jin , Wang Yanfei , Chen Xiangjian , Gou Yanzi , Li Duan , Liu Rongjun
Published: February 2025

The mechanical and thermophysical properties of KD‐SA SiCf/SiC composites manufactured by the hybrid chemical vapor infiltration (CVI)–precursor impregnation and pyrolysis (PIP) technique were systematically studied at 1400, 1600, and 1800°C, respectively, under argon atmosphere for 1 h. The results show that Si element in SiC fiber escapes and diffuses to pyrolytic carbon (PyC) interphase after 1400°C heat treatment, forming a Si‐rich line in PyC interphase. With a further increase of heat treatment temperature, the Si sublimation in the Si‐rich line leads to the cracking of the PyC interphase as well as the increase of the order degree of the PyC interphase, resulting in a significant decrease in the interfacial shear strength of the composite. Due to the decomposition of PIP SiC matrix and Si sublimation of SiC fiber, the flexural strength of the composite decreases after heat treatment at 1400°C. When the heat treatment temperature increases to 1600 and 1800°C, the flexural strength of the composite is slightly increased compared with 1400°C. Moreover, the thermal conductivity of the composites has been improved significantly by raising temperatures due to an increase of the crystallinity of the PIP SiC matrix.
Association Between Body Image, Fear of Childbirth and Maternal‐Fetal Attachment: The Relative Mediation Analysis
Authors: Zhao Fei , Zhang Xinhan , Yue Chenying , Zhang Zixuan , Yuan Miao , Chen Xinxia
Published: February 2025

Aims

To explore the association between body image, fear of childbirth and maternal‐fetal attachment and the mediating effects of fear of childbirth among different body image profiles.

Design

A cross‐sectional study.

Methods

Pregnant women were recruited from obstetric outpatient clinics between February 2022 and October 2023. Face‐to‐face data were collected using validated questionnaires. First, the mediating role of fear of birth was examined between body image and maternal‐fetal attachment by calculating the total scores. Then, latent analysis was performed to identify body image profiles, and the relative mediation effects were examined for fear of childbirth in the association between body image profiles and maternal‐fetal attachment.

Results

This study included 676 pregnant women, most of whom were in their third trimester. Using the total score, fear of childbirth was found to partially mediate the relationship between body image and maternal‐fetal attachment. Latent profile analysis revealed three body image profiles in pregnant women: positive, moderate and negative. Using positive body image as the reference, pregnant women with moderate body image experienced a higher fear of childbirth, resulting in lower maternal‐fetal attachment. Notably, the relative mediating effect of fear of childbirth was more pronounced in women with more negative body image profiles.

Conclusion

Body image affected maternal‐fetal attachment directly and indirectly through fear of childbirth, with stronger mediating effects among women with more negative body image profiles.

Implications

The findings provide evidence on the underlying pathways between body image and maternal‐fetal attachment and suggest body image and fear of childbirth as potential intervention targets to improve maternal‐fetal attachment. Pregnant women with more negative body image may benefit more from such interventions.

Impact

Little is known about the pathway between body image and maternal‐fetal attachment in pregnant women. Body image affects maternal‐fetal attachment directly and indirectly through fear of childbirth. The mediating effects of fear of childbirth were more pronounced among women with more negative body image profiles. These findings highlight fear of childbirth in the association between body image and maternal‐fetal attachment and identify women with a more negative body image as high‐risk populations, which provides insights for developing personalised interventions to improve perinatal psychological health.

Reporting Method

The study has followed the STROBE checklist for reporting method.

Patient or Public Contribution

No patient or public contribution.
Peripheral Intravenous Catheter Care at Australian Emergency Departments: A Cross‐Sectional Observational Study
Authors: Xu Hui (Grace) , Doubrovsky Anna , Rickard Claire M. , Rockliff Lauryn , Tang Christopher , Ullman Amanda J.
Published: February 2025

Background

Peripheral intravenous catheters (PIVCs) serve as crucial devices for essential care administration in emergency departments (ED). In Australia, to standardise clinical practice, the national PIVC Clinical Care Standard was introduced in 2021, however adherence to the Standard has not been adequately explored. Therefore, this study aims to investigate ED clinicians' adherence to the Standard via prospective audit.

Method

This cross‐sectional observational study of PIVCs was conducted in three Australian EDs between 2022 and 2023. Data were collected in alignment with the quality indicators in the PIVC Clinical Care Standard. Research nurses collected the data from bedside observation and chart audit, with data analysed descriptively.

Findings

Out of 1568 episodes of PIVC care recorded, there were notable shortcomings. ED nurses and doctors provided minimal patient partnership during insertion episodes: PIVC self‐care education (n = 4, 1.4%), discussion of potential risks/benefits (n = 8, 2.9%), and reporting of concerns (n = 16, 5.8%). Insertions primarily occurred at the antecubital fossa (n = 225, 81.2%), with a common issue being inadequate time for antiseptic solution to air dry (n = 156, 56.3%). Ongoing needs assessment was unable to be assessed due to documentation limitations, which were generally incomplete. Idle catheters (inserted but not used) were prevalent (n = 115, 41.8%), and only a quarter of inpatient ward admissions (n = 75, 27.3%) had clear indications for PIVC use.

Conclusion

These findings highlight the suboptimal ED PIVC practices that require attention and improvement. Innovative interventions and technology are necessary to address some of these suboptimal practices due to their complexity and persistent challenges, despite previous efforts by clinicians and researchers.

Implications for the Profession and Patient Care

The findings underscore the need for well‐resourced efforts to ensure adherence to evidence‐based practices in dynamic clinical settings.

Reporting Method

The study is reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement.

Patient or Public Contribution

None.
Exploring the Axis of Gut Microbiota‐Inflammatory Cytokine‐Atrial Fibrillation in the Pathogenesis of Atrial Fibrillation
Authors: Chen Jun , Wang Yucheng , Wang Kangnan , Mei Ziwei , Wang Lihong
Published: February 2025

A relationship may exist between the gut microbiota, inflammatory factors and atrial fibrillation (AF); however, the precise biological mechanisms linking these components remain uncertain.In this study, 211 single‐nucleotide polymorphisms associated with the gut microbiota were collected from the MiBioGen consortium. Summary data for AF were sourced from large‐scale genome‐wide association studies. Two‐step Mendelian randomization (MR) was applied to estimate the possible mediating effect of inflammatory cytokines on the causality between the gut microbiota and AF. MR confirmed the effects of class Lentisphaeria, family Bifidobacteriaceae, family XIII, genus Anaerostipes, genus Howardella, genus Intestinibacter, genus Lachnospiraceae (NK4A136 group), genus Odoribacter, genus Ruminococcus gnavus, order Bifidobacteriales, order Victivallales and phylum Lentisphaerae on AF prevention. Moreover, MR revealed the role of Fms‐related tyrosine kinase 3 ligand, interleukin‐6, interleukin‐7, leukaemia inhibitory factor receptor, sulfotransferase 1A1 and tumour necrosis factor ligand superfamily member 12 in protecting against AF. Fibroblast growth factor 5, interleukin‐2 receptor subunit β, and tumour necrosis factor had a causal effect, increasing AF risk. The mediation exploration indicated that the indirect effect of genus Rikenellaceae (RC9 gut group)(id.11191) on AF mediated by interleukin‐6 was OR 1.011 (95% confidence interval 1.002–1.024; mediation proportion=23.913%). This study supplies genetic insights into the potential causal association between the gut microbiota and AF. These causal associations and mediating effects are useful for managing AF through manipulation of the gut microbiota.
Determining the Relationship Between Perceived Social Support and Immunosuppressive Medication Adherence After Kidney Transplantation: A Descriptive Correlational Study
Authors: Karazeybek Ebru
Published: February 2025

Background

What is known about how the level of social support, which is among the factors affecting medication adherence, affects medication adherence is limited.

Objectives

This study investigated the relationship between perceived social support and immunosuppressive medication adherence among kidney recipients.

Design

This study was conducted using a descriptive correlational research method.

Participants

The study conducted research with 168 kidney transplant recipients who agreed to participate between April and June 2021. Participants completed the Immunosuppressive Medication Adherence Scale (IMAS) and the Multidimensional Scale of Perceived Social Support (MSPSS).

Measurements and Results

Participants had a mean IMAS and MSPSS score of 50.24 ± 3.71 and 57.21 ± 13.96, respectively. Participants' MSPSS total (r = 0.209, p = 0.006) and ‘family’ (r = 0.248, p = 0.001) and ‘friends’ (r = 0.226, p = 0.003) subscale scores were weakly and positively correlated with their IMAS total score.

Conclusion

Understanding the effect of perceived social support on immunosuppressive medication adherence is important for designing future interventions to increase immunosuppressive medication adherence.
The West Catching Up With the East: High‐Magnification NBI Is Accurate for the Diagnosis of Gastric Neoplasia in a Western Population
Authors: Young Edward , Wan Nicholas , Philpott Hamish , Singh Rajvinder
Published: February 2025

Background and Aim

Accurate endoscopic prediction of histology is key to recognition of early gastric neoplasia and selection of appropriate resection techniques. Narrow‐band imaging with magnification (M‐NBI) has proven to be highly accurate for gastric lesions in eastern countries; however, we sought to examine whether it can be effectively utilized in the west where evidence is scarce.

Methods

This is an analysis of a prospective database of gastric lesions at a single Australian center from 2009 to 2023. All lesions were assessed endoscopically using M‐NBI and a determination made whether the lesion was neoplastic or non‐neoplastic, as well as prediction of histological subtype. This was then correlated with final histology.

Results

A total of 232 lesions in 183 patients were included: 135 non‐neoplastic and 97 neoplastic lesions. Thirty‐five were adenomas, 29 early gastric cancers, and 6 advanced adenocarcinomas. For differentiating neoplastic versus non‐neoplastic lesions, M‐NBI had a sensitivity of 97.9% (CI 92.6%–99.7%) and specificity of 97.1% (CI 92.7%–99.2%). M‐NBI was also highly accurate (97.0%, CI 93.9%–98.8%) for identifying lesions suitable for endoscopic resection. The observed agreement between the M‐NBI predicted histology and the final pathology was 91.8% with a derived kappa statistic of 0.87, indicating excellent agreement. Comparatively, prior biopsies had an observed agreement of 40.4% with final histology, with a derived kappa statistic of 0.27.

Conclusions

M‐NBI can be used with a high degree of accuracy in a western population. M‐NBI can effectively differentiate neoplastic from non‐neoplastic gastric lesions and delineate histological subtypes with superior accuracy to previous biopsies.
Evaluation of a Trauma‐Informed Nutrition Curriculum for Women With Children Living in Transitional Housing
Authors: Milton Austin , Frech Natalie , Shadid Anna , Hollman Nicholas , Bell Sarah Beth , Wetherill Marianna S.
Published: February 2025

Objective

This study describes the implementation of a 6‐week nutrition and culinary education curriculum at a transitional housing facility for single mothers in Tulsa, Oklahoma, United States.

Methods

Using a novel, trauma‐informed approach to nutrition education, we delivered the Around the Table: Nourishing Families curriculum across three, small group cohorts (n = 15) over a period of 2 years. Lessons emphasized small group dialogue and group‐directed learning on the topics of toxic stress, food as nourishment and family resilience combined with hands‐on recipe preparation by the group. We evaluated process measures of participation and attrition and outcome measures of self‐reported food skills, dietary intake, emotional well‐being, and other indicators of nutrition self‐care using a pre–post design.

Results

Food skills significantly improved post‐curriculum (p = 0.026) with additional improvement in several areas of dietary intake, mindful eating, nutrition self‐care and greater use of healthy foods at family mealtimes.

Conclusions

Hands‐on, participatory nutrition and cooking education that emphasizes mind–body connections to food can be a feasible strategy for teaching introductory food skills and may also support socioemotional healing in this population.
Dietary Energy and Nutrient Intake Among Pregnant Women in Sri Lanka: Findings From the Sri Lanka Mother and Newborn Growth Cohort Study
Authors: Pathirathna Malshani Lakshika , Haruna Megumi , Sasaki Satoshi , Yonezawa Kaori , Usui Yuriko , Hagiwara Yasuhiro
Published: February 2025

Background

Maternal nutrition during pregnancy is crucial to ensure positive outcomes for both the mother and newborn. Despite its importance, maternal nutritional status remains poor, particularly in low‐ and middle‐income countries, where social, cultural and economic factors play a pivotal role. This study assessed the adequacy of energy and dietary nutrient intake among Sri Lankan pregnant women compared to their dietary reference intakes.

Methods

This study was part of the Sri Lanka Mother and Newborn Growth study, a nationwide prospective cohort of 2000 pregnant women. We prospectively investigated maternal dietary intake using a validated food frequency questionnaire during the first, second and third trimesters.

Results

We observed an imbalanced macronutrient distribution, with carbohydrates contributing over 67% of total median energy intake, while protein and fat contributed approximately 11% and 17%, respectively. Ethnic and socio‐economic disparities in energy and macronutrient intake were notable. The Sinhalese ethnic group showed the highest median percentage of energy consumption derived from carbohydrates at 68.0% (IQR: 64.6%‒71.1%), significantly exceeding the intake of Tamil and Moor groups. Estate residents reported the lowest proportion of energy from protein (10.6%, IQR: 10.1%‒11.3%), which was significantly lower than the intakes of urban and rural residents. Additionally, women in the lowest income group had a lower total energy intake (1871 kcal/day, IQR: 1464–2392) than those in higher income groups, highlighting socio‐economic influences on maternal nutrition. Micronutrient deficiencies were pervasive, particularly for vitamin B2 (88.6%–91.0%), folate (99.3%–99.8%), vitamin B12 (97.8%–99.5%), calcium (80.8%–91.4%) and iron (91.1%–96.5%). Sodium intake exceeded recommended levels for over 75% of women across all trimesters.

Conclusion

Imbalances in macronutrient intake and widespread micronutrient deficiencies among Sri Lankan pregnant women underscore the urgent need for interventions targeting maternal nutrition. Addressing socio‐economic disparities is critical to improving maternal and neonatal health outcomes.
Exploring Midwives’ Experiences Within Canada's First Alongside Midwifery Unit: Impacts and Implications for Midwifery Practice
Authors: Murray‐Davis Beth , Grenier Lindsay N. , Malott Anne M. , Mattison Cristina A. , Cameron Carol , Hutton Eileen K. , Darling Elizabeth K.
Published: February 2025

Introduction

Although midwifery‐led units in hospitals are associated with positive outcomes, little is known about the experiences of the midwives who work within this model. Despite the increase in midwifery‐led units globally, the first unit of this kind opened its doors in Canada in 2018. The Alongside Midwifery Unit (AMU) is staffed by a hospitalist midwife (a novel role in this country) and community midwives, working in a caseload model, who attend their clients’ labor and birth on the unit. The AMU is a low‐risk birthing unit located adjacent to the obstetric unit, offering midwifery‐led care, in a homelike setting. Our aim was to explore and describe the experiences of midwives working in this model of care on the AMU.

Methods

Qualitative semistructured interviews and one focus group with community and hospitalist midwives working at the AMU were conducted and analyzed using a grounded theory approach.

Results

We identified that midwives were able to maintain the midwifery philosophy of care, strengthen relationships, amplify hospital integration, and grow midwifery leadership in this model.

Discussion

Implementation of an AMU supports best practice, intra‐ and interprofessional relationships, and integration of midwives. Our findings demonstrate a positive impact of this model along with the absence of detrimental impact on midwifery values and philosophy. An improved understanding of the impact of the AMU on midwives and their practice is useful for refining the model of care and informing implementation in other settings. This research contributes to the growing evidence demonstrating the benefits of midwifery‐led units.
Ischemic stroke risk in patients with dopamine agonist‐treated hyperprolactinemia
Authors: Akirov Amit , Rudman Yaron , Sharon Yael , Shimon Ilan , Kushnir Shiri , Diker‐Cohen Talia
Published: February 2025

Data on the risk of stroke in patients with hyperprolactinemia are limited. This study aimed to evaluate the association between hyperprolactinemia and ischemic stroke in a large cohort and identify predictors of stroke in this population. This was a retrospective cohort study comparing the incidence of ischemic stroke in patients with dopamine agonist‐treated hyperprolactinemia to matched controls in a 1:5 ratio. The primary outcome was the diagnosis of ischemic stroke. The cohort included 2440 patients with DA‐treated hyperprolactinemia patients (mean age ± SD: 38.42 ± 14.57 years, 60.2% women) matched to 12,022 controls (mean age ± SD: 38.15 ± 14.36 years, 60.8% women). Ischemic stroke occurred in 195 patients with hyperprolactinemia (8.0%) and 747 controls (6.21%) (adjusted HR 1.24, 95% CI 1.06–1.46). Patients with hyperprolactinemia developed stroke at a younger age (57.75 ± 15.88 years vs. 60.18 ± 15.20 years, p = .05). Patients with PRL levels >5× ULN at diagnosis had a higher stroke incidence than those with lower levels (9.73% vs. 6.85%; HR 1.48, 95% CI 1.11–1.97). Longer time to prolactin normalization was associated with a higher incidence of stroke (median 21.88 vs. 13.78 months; p = .0005). In multivariate analysis, age ≥60 years, male gender, hypertension, type 1 or type 2 diabetes mellitus, and ischemic heart disease were significant predictors of stroke in patients with hyperprolactinemia. Dopamine agonist‐treated hyperprolactinemia is associated with an increased risk of ischemic stroke compared to well‐matched controls from the general population. Higher prolactin levels at diagnosis and a longer time to normalization were linked to a greater risk of stroke.
The cortisol awakening response in very preterm born adults compared to term born adults
Authors: Albayrak Bilge , Batsikadze Giorgi , Jablonski Lara , Felderhoff‐Müser Ursula , Hörbelt‐Grünheidt Tina , Friedel Anna Lena , Hirtz Raphael , Heuser‐Spura Katharina , Dewan Monia V.
Published: February 2025

Very preterm infants are at higher risk of long‐term neurodevelopmental and psychiatric impairments, including anxiety. Prematurity is also linked to altered programming of the hypothalamus–pituitary–adrenal (HPA) axis, associated with stress‐related diseases. The cortisol awakening response (CAR), marked by a rapid cortisol increase after waking, is a biomarker of HPA reactivity and is linked to psychiatric disorders. This study aimed to evaluate for the first time the CAR in adults born very preterm and to explore its association with anxiety and stress. Twenty‐five young adults born very preterm and 24 age‐ and sex‐matched term‐born controls collected saliva samples on two consecutive mornings at 0, 30, 45, and 60 min after awakening. Anxiety was measured using the State–Trait Anxiety Inventory, and stress was assessed with the Perceived Stress Scale. The CAR was analyzed using the sample at 0 min (S1), total cortisol output (AUCg), and actual CAR (AUCi). There were no significant differences in AUCi. The preterm group exhibited lower S1 levels and a reduced AUCg. Preterm‐born participants reported higher trait anxiety and stress, though no consistent link with the CAR was identified. Findings suggest long‐term neuroendocrine changes in adults born very preterm, warranting further research.

Clinical Trial Registration: Duetsche Register Klinischer Studien (DRKS): 00020235.
Incidence of gastroenteropancreatic neuroendocrine neoplasms (GEP‐NENs): An updated systematic review of population‐based reports from 2010 to 2023
Authors: Nordstrand Magnus Andreas , Lea Dordi , Søreide Jon Arne
Published: February 2025

There is a general perception that the incidence of neuroendocrine neoplasms (NENs) has been increasing. Nevertheless, reports of actual population‐based studies are scarce, and pertinent data from some geographical regions still need to be available. In this systematic literature review of population‐based studies, we aimed to evaluate the available data to provide updated figures on the incidence of gastroenteropancreatic neuroendocrine neoplasms (GEP‐NENs). Guided by the PRISMA 2020 statement reporting items for systematic reviews, this study conducted a systematic search using Ovid in the bibliographic databases Embase, Medline, and Web of Science Core Collection. Only incidence‐reporting studies were included. In total, 847 articles were identified, and through a strict evaluation process using predefined inclusion and exclusion criteria, we found 19 papers that reported the general incidence of GEP‐NENs from all sites. In addition, we considered another 15 papers that focused on the epidemiologic aspects of single‐organ studies. While the incidence rates of GEP‐NEN vary across similar countries, the general incidence of GEP‐NEN has been increasing worldwide in recent decades. The incidence of GEP‐NENs has increased worldwide over the last two decades, and reliable figures from new regions add to this pattern. Nevertheless, variations in the classification, grading, and reporting of GEP‐NENs in various studies make direct comparisons difficult.
Multi‐Plant Concentrated Powder Improved Skin Whitening: A Double‐Blinded, Randomized, and Placebo‐Controlled Clinical Study
Authors: He Yuxiang , Bu Yongshi , Chiang Chi‐Fu , Lin Yung‐Hsiang , Liang Chia‐Hua , Chan Leong‐Perng , Sun Jiawen
Published: February 2025

Introduction

With the growing demand for skin‐enhancing products in the market, research into edible plants has expanded significantly. Numerous studies have shown that plant extracts rich in phytochemicals can effectively improve skin issues such as wrinkles, pigmentation, and dullness. However, clinical studies focusing on the effects of combined ingredients are still limited.

Objective

This study combined three plant ingredients known for their skin‐beautifying effects and clinically tested their functional properties.

Methods

Sixty healthy subjects were screened and randomly divided into two groups: a test group (TG) and a placebo group (PG). TG took two tablets of multi‐plant concentrated powder daily, while PG took placebo tablets without active ingredients. The study lasted 12 weeks. Plasma Trolox equivalent antioxidant capacity (TEAC), superoxide dismutase (SOD), and glutathione peroxidase (GPx) were measured at week 0 (W0), week 8 (W8), and week 12 (W12). Skin brightness (L* value), skin tone (Individual Typological Angle (ITA°)), erythema (a* value), skin spots, and wrinkles were assessed at week 0 (W0), week 4 (W4), week 8 (W8), and week 12 (W12).

Results

The study showed significant improvements in all three antioxidant markers in the blood after consuming the compound ingredient tablets compared to the PG (p < 0.01). L* value and ITA° significantly increased from 8 weeks (p < 0.1). Skin spots significantly decreased at W8 and W12 (p < 0.1). While a* value and skin wrinkles showed noticeable reductions within the group in week 12 (p < 0.1), there were no significant differences compared to the PG.

Conclusions

Consumption of multi‐plant concentrated powder improved skin whitening, brightened skin tone, reduced skin spots, and showed some improvement in wrinkles and erythema.

Trial Registration

ClinicalTrials.gov identifier: NCT05988567
Struggles of Fatherhood: A Prospective Study on the Incidence of Paternal Postpartum Depression and Associated Factors
Authors: Chua Jing Shi , Ng Jamie Qiao Xin , Chee Cornelia Yin Ing , Shen Liang , Dennis Cindy‐Lee , Chong Yap Seng , Shorey Shefaly
Published: February 2025

Aim

To investigate the incidence and the factors associated with paternal postpartum depression amongst new fathers in Singapore.

Design

A prospective repeated measures study was conducted from September 2023 to March 2024.

Methods

A total of 200 fathers aged 21 years and above who had a neonate born at full term and no serious health events for both mother and neonate were recruited from a local hospital via convenience sampling. Fathers completed questionnaires at the third trimester of pregnancy (baseline) and 1 month postpartum. Multiple regression analyses were used to identify significant factors associated with postpartum depression in fathers.

Results

The incidence of paternal postpartum depression was 5.26% at 1 month post‐childbirth, using the Edinburgh Postpartum Depression Scale (EPDS). Using the Gotland Male Depression Scale (GMDS), 7% of the fathers were identified with high risk of depression and 14.3% of the fathers had moderate depressive symptoms. Paternal postpartum depression at 1 month post‐childbirth could be predicted by paternal postpartum depression scores at baseline measured by EPDS and GMDS, as well as by baseline perceived social support and parental self‐efficacy at 1 month post‐childbirth.

Conclusion

This study found that a considerable number of fathers in Singapore are at risk of postpartum depression. There is an urgent need for the development of more comprehensive tools to measure postpartum depression in fathers that are culturally adapted to the local context.

Implications

Early screening during antenatal visits enables timely intervention and access to support, benefiting the entire family. Nurses could help fathers to be more involved by extending patient education and teaching infant care skills to both parents. When counselling patients, the involvement of extended family members and navigating new roles as caregivers of a new baby and breadwinners are important considerations for new parents.

Impact

This study is the first of its kind to measure the incidence of postpartum depression amongst new fathers in an urban multicultural Asian setting, like Singapore. The study found that the incidence of postpartum depression in fathers were 5.26% when measured using EPDS and 14.3% when measured using GMDS at 1 month postpartum. These findings could inform future family‐centred and father‐specific interventions to improve the mental health outcomes of new parents.

Reporting Method

This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.

Patient or Public Contribution

No patient or public contribution.
Repo over the Financial Crisis
Authors: COPELAND ADAM , MARTIN ANTOINE
Published: February 2025

This paper uses new data to provide a comprehensive view of repo activity during the 2007 global financial crisis. We show that activity declined much more in the bilateral segment of the market than in the tri‐party segment. Surprisingly, a large share of the decline in activity is driven by repos backed by Treasury securities. Further, a disproportionate share of the decline in repo activity is connected to securities dealer's market‐making activity. In particular, the evidence suggests that at least part of the decline is not driven by clients pulling away from securities dealers because of counterparty credit concerns.
Law and conspiracy theory: sovereign citizens, freemen on the land, and pseudolaw
Authors: KOCHI TARIK
Published: February 2025

This article examines the ‘sovereign citizen’ and ‘freemen on the land’ movements and the operation of ‘pseudolaw’. Against a predominant judicial, governmental, and academic approach that portrays sovereign citizen beliefs as ‘irrational’ and ‘nonsensical’, I argue that such beliefs should be understood in terms of conflicts within the socio‐historical production of ‘legitimate’ knowledge across the public sphere and popular culture. Conspiratorial sovereign citizen beliefs articulate, albeit very problematically, social concerns and suspicions in relation to transnational economic, political, and legal power. Further, such beliefs should be understood within the context of the rise to prominence and contemporary normalization of neoliberal, authoritarian populism, and a discourse of ‘inverted oppression’. Through this, a range of anti‐egalitarian, ethno‐nationalist, and racist beliefs are hidden behind and justified via a conspiratorial worldview that uses a supposedly ‘neutral’ pseudolegal rhetoric to defend individual liberty against a perceived social reality constituted by ongoing and extreme oppression.
Technical Considerations in the TCD Evaluation of Cerebral Circulatory Arrest in Death by Neurological Criteria
Authors: Reynolds Alexandra S. , Suh Jimmy , Hasan Ahmedyar , Upadhyaya Parth , Rajajee Venkatakrishna , Hirzallah Mohammad I. , Greer David M. , Sarwal Aarti ,   American Society of Neuroimaging Brain Death Task force
Published: February 2025

Background and Purpose

Ancillary testing is essential for diagnosing brain death/death by neurologic criteria (BD/DNC) when clinical determination (neurologic exam and apnea testing) cannot be fully or safely performed. Transcranial Doppler ultrasound (TCD) has been recommended as an ancillary test; however, the technical descriptions have been heterogeneous. We aimed to consolidate the technical considerations related to the use of TCD as an ancillary test in the evaluation of BD/DNC.

Methods

We performed a scoping review of the available literature from inception to December 2024. Articles describing TCD as an ancillary test for BD/DNC were included using appropriate Medical Subject Headings terms. The focus was on technical details and clinimetric properties of TCD (e.g., signal quality, frequency, gate, probe location, etc.). Technical categories were curated as full‐text reviews were completed.

Results

We reviewed 181 articles to extract technical descriptions of TCD under several categories. Image acquisition was divided into machine‐related factors (59 studies, four questions), exam‐related aspects (82 studies, 13 questions), and patient anatomical factors (19 studies, three questions). Image interpretation concerns were addressed in 50 studies (three questions). Patient‐related clinical factors affecting TCD utility were addressed in 44 studies (seven questions). Legislative priorities were discussed in 19 studies; in 13 studies, authors commented on their recommendations for research priorities.

Conclusion

We found significant inconsistencies and a lack of technical details described in the literature. Next steps include a national survey of current TCD protocols for BD/DNC evaluation, and an expert consensus guidelines report on the technical use of TCD as an ancillary test.
Swallowing and Oral‐Sensorimotor Characteristics in a Sample of Young Hospitalised Children With Severe Acute Malnutrition
Authors: Eslick Casey Jane , Kritzinger Alta , Graham Marien Alet , Krüger Esedra
Published: February 2025

Aim

To describe swallowing and oral‐sensorimotor characteristics in a sample of young hospitalised children with severe acute malnutrition (SAM).

Methods

The Schedule of Oral‐motor Assessment was used to compare oral‐sensorimotor skills of 45 hospitalised patients with SAM (M = 15.98 months; SD = 8.03), to pairwise‐matched controls (M = 15.96 months; SD = 8.08). Participants were matched for age, gender, TB, HIV‐status, socio‐economic status including maternal education, paternal employment, housing and transport access. Caregivers reported demographic information, feeding practices and behaviours during feeding.

Results

In comparison to controls (n = 6; 13.3%), participants with SAM (n = 25; 55.6%) presented with significantly more oral‐sensorimotor difficulties (p < 0.001), across all consistencies except liquids from the trainer cup and bottle. Difficulties included jaw opening and stabilisation, tongue and lip control for chewing, bolus formation and transport, sustained bite and uncoordinated swallowing. Delayed sitting development significantly correlated with uncoordinated swallowing and head extension on puree and cup drinking, and multiple swallows on puree and semi‐solids. Force‐feeding and slow swallow initiation in semi‐solids significantly correlated. Disruptive feeding behaviours and higher levels of food refusal at the beginning of meals were reported. Clinical signs of aspiration were identified.

Conclusions

Oral‐sensorimotor dysfunction and possible aspiration were observed in 55.6% of participants with SAM. Safe swallowing function for overall health and nutritional recovery is emphasised. Under‐identification of oral‐sensorimotor difficulties, lack of referral to speech‐language therapists and disruption to continuity of care warrants further research.
Improved Convolutional Network With Transfer Learning and Texture Feature Extractor for Plant Disease Detection
Authors: Kafare Tushar V. , Sharma Nirmal , Wanare Anil L.
Published: February 2025

Global agriculture is seriously threatened by plant diseases, which have an effect on output and food security. For disease care to be effective, prompt detection and precise diagnosis are essential. Traditional methods reliant on the visual inspection are labour‐intensive and subjective. Recent technological advances in computer vision and machine learning offer promising solutions. This paper introduces the Transfer Learning‐based Plant Disease Detection (TL‐PDD) framework, which integrates preprocessing, segmentation, feature extraction and disease prediction stages. Initial preprocessing employs median filtering for data refinement. Segmentation, utilising the Adaptive Pixel Integration in Joint Segmentation (APIJS) approach, isolates disease‐affected regions in plant images through a variant of DJS. Feature extraction includes the extraction of critical attributes such as Multi‐texton, PHOG and Niblack's Method Assisted in Local Gabor Increasing Pattern (NMA‐LGIP). Disease prediction employs a novel Double Convolutional Activation in Convolutional Neural Network‐Transfer Learning (DCA‐CNN‐TL) model, facilitating disease classification and severity assessment based on extracted features. The efficiency and precision of plant disease detection systems can be improved by this framework, supporting efforts to ensure global food security and sustainable agriculture.
An Empirical Study of the Actual Conditions, Current Attitudes, and Psychological Outcomes of Tattooing Among Japanese People
Authors: Suzuki Tomohiro , Okubo Tomoo
Published: February 2025

In Western countries, more people are being tattooed than in the past, and this may also be the case in Japan. This study aimed to clarify the actual conditions, current attitudes, and psychological outcomes of tattooing among Japanese people, using a sample comparing traditional Japanese and Western tattoos. A total of 174 participants (124 men and 50 women), 76 of whom had traditional Japanese tattoos and 98 Western tattoos, participated in this study. Results indicated that the participants were tattooed at a relatively young age. More than 80% of the respondents answered that their tattoos were hidden. Participants who had traditional Japanese tattoos were more satisfied with them, expressed less regret, and had a higher desire to have more tattoos than those participants with Western tattoos. Furthermore, relationships between the current attitude towards getting tattooed, the expected psychological outcomes for getting tattooed, and the obtained psychological outcomes expected after getting tattooed were different for the two participant groups above.
Cognitive and psychological factors associated with treatment response in ACT‐I and CBT‐I for insomnia
Authors: Linares Ila Marques Porto , Jernelöv Susanna , El Rafihi‐Ferreira Renatha
Published: February 2025

Cognitive behavioural therapy for insomnia is the treatment of choice for patients with insomnia, but not all patients benefit, and novel psychological treatment approaches have emerged (e.g. acceptance and commitment therapy). Thus, the aim of the present study was to evaluate whether treatment modality, adherence, insomnia severity, anxiety, depression, beliefs about sleep or acceptance of sleep problems are factors associated with response to psychological insomnia treatment. The sample consisted of 152 adults (115 women; mean age = 40.6 years, SD = 10.2) with chronic insomnia, and they participated in a randomized clinical trial comparing acceptance and commitment therapy for insomnia (as a standalone) with cognitive behavioural therapy for insomnia. The outcome measure was proportion of treatment responders (8 points reduction or more) on the Insomnia Severity Index, assessed at pre‐ and post‐treatment and 6‐month follow‐up. The predictor variables were assessed at pre‐treatment. The final multivariate model showed that undergoing cognitive behavioural therapy for insomnia increased the chances of treatment response at post‐treatment by 2.70 times when compared with acceptance and commitment therapy for insomnia (odds ratio = 2.70 [1.14–6.38]). In addition, each additional point in pre‐treatment insomnia severity (odds ratio = 1.15 [1.01–1.30]) and dysfunctional beliefs about sleep (odds ratio = 1.02 [1.00–1.05]) scores increased the chances of response at post‐treatment. Treatment adherence increased the chances of treatment response at post‐treatment by 3.07 times (odds ratio = 3.07 [1.28–7.34]). Finally, each additional point on the Insomnia Severity Index pre‐treatment increased the chances of treatment response at the 6‐month follow‐up (odds ratio = 1.14 [1.01–1.29]). In conclusion, cognitive behavioural therapy for insomnia increases the chance of treatment response compared with acceptance and commitment therapy for insomnia. Moreover, higher adherence, insomnia severity and dysfunctional beliefs about sleep predict treatment outcome in both treatments.
Analysis of survival among biopsy‐determined categories of kidney disease in dogs
Authors: Schultz Devyn M. , Rivera Carolina , Jeffery Nicholas , Cianciolo Rachel E. , Hokamp Jessica A. , Labato Mary Anna , Nabity Mary B.
Published: February 2025

Background

There are many causes of kidney disease in dogs. The association of the diagnostic category with survival is unknown.

Objective

Determine survival outcomes for biopsy‐determined diagnostic categories of kidney disease in dogs.

Animals

Six hundred forty‐nine dogs were biopsied for evaluation of kidney disease.

Methods

Retrospective study. Survival information was obtained for dogs whose kidney biopsy was submitted to the International Veterinary Renal Pathology Service between 2008 and 2018. Signalment, serum creatinine (sCr), urine protein : creatinine ratio (UPCR), and serum albumin (sAlb) were reported at the time of biopsy. Cox proportional hazards analysis was performed for the 14 categories with >10 cases having follow‐up to determine hazard ratios (HR), using focal segmental glomerulosclerosis (FSGS) as baseline.

Results

The median survival time (MST) for all dogs with follow‐up (n = 649) was 608 days (interquartile range [IQR]: 109‐1475 days). The most follow‐up was obtained for FSGS (n = 138, MST 536 days). Dogs with renal amyloidosis (n = 80) had the shortest survival (MST 76 days, IQR 8‐299 days) and, in the multivariate analysis including age, sCr, sAlb, and UPCR, an increased risk of death (HR 1.79 [95% CI: 1.22‐2.65], P < .01). Dogs with podocytopathy, membranous glomerulonephritis (MGN), mixed MGN, membranoproliferative GN (MPGN), and mixed MPGN had decreased risk of death. Regardless of category, increasing age, sCr, and UPCR and decreased sAlb were associated with a greater risk of death.

Conclusions

The diagnostic category is associated with survival in dogs with kidney disease. Survival of individual dogs within each category was highly variable.
Emergence of Aeromonas dhakensis‐linked motile Aeromonas septicemia in Pangasius hypophthalmus biofloc systems in Pakistan
Authors: Hassan Ahmad , Ali Shahzad , Xu Tingbi , Liles Mark R. , Mohammed Haitham H.
Published: February 2025

This study reports on an outbreak of motile Aeromonas septicemia (MAS) that caused significant mortalities in iridescent shark catfish (Pangasius hypophthalmus) in biofloc systems in the Punjab province of Pakistan. Clinical symptoms observed on the affected fish included anal fin hemorrhaging, mouth area bleeding, skin ulcerations, interstitial nephritis, and focal fusion of secondary lamellae. According to necropsy findings and a molecular phylogenetic analysis based on gyrB gene sequences, the etiologic agent of the disease was identified as Aeromonas dhakensis Ali.Pk01. The new isolate displayed resistance to multiple antibiotics such as ampicillin, cefuroxime sodium, meropenem, and penicillin, but remained susceptible to several antibiotics including amikacin, ceftazidime, chloramphenicol, ciprofloxacin, levofloxacin, and oxytetracycline. To fulfill Koch's postulates, fish were challenged by intraperitoneal injection with A. dhakensis Ali.Pk01, revealing its high virulence. Also, this isolate was found to encode multiple virulence genes including act, ela, alt, lip, and hyl. This study offers crucial information for local catfish farmers, highlighting the potential spread of virulent multidrug‐resistant pathogens and the need for better biosecurity and disease control measures without reliance on antibiotics.
Drug‐Induced Liver Injury in Patients With Chronic Liver Disease
Authors: Ghabril Marwan , Vuppalanchi Raj , Chalasani Naga
Published: February 2025

Objective

Drug‐induced liver injury (DILI) is a global problem and can develop from exposure to prescription or over‐the‐counter medications as well as herbal and dietary supplements. The diagnosis of DILI is clinically challenging, and liver injury can be severe leading to liver failure, death, or liver transplantation. Patients with underlying chronic liver diseases (CLD) may be at increased risk for DILI, which is associated with factors related to drug or liver disease.

Methods

This review summarises current knowledge on the risk and outcomes of DILI in patients with CLD.

Results

Patients with CLD may be at an increased risk for DILI. Additionally patients with underlying CLD are at risk for more severe liver injury and worse outcomes after DILI.

Discussion

The risk for and poor outcomes from DILI are accentuated in patients with CLD and potentially leading to the worst‐case scenario of acute‐on‐chronic liver failure. We highlight the key observations on DILI with a broad range of underlying liver diseases and the high‐DILI risk agents implicated in those populations.