bluuebunny/crossref_metadata_2025 huggingface dataset:
Combined Technique for Internal Carotid Artery Terminus or Middle Cerebral Artery Occlusions in the ASTER2 Trial
Authors: Sgreccia Alessandro , Desilles Jean-Philippe , Costalat Vincent , Dargazanli Cyril , Bourcier Romain , Tessier Guillaume , Rouchaud Aymeric , Saleme Suzana , Spelle Laurent , Caroff Jildaz , Marnat Gaultier , Barreau Xavier , Clarençon Frédéric , Shotar Eimad , Eugene François , Houdart Emmanuel , Gory Benjamin , Zhu François , Labreuche Julien , Piotin Michel , Lapergue Bertrand , Consoli Arturo , Blanc Raphael , Redjem Hocine , Ciccio Gabriele , Smajda Stanislas , Mazighi Mikael , Fahed Robert , Rodesch Georges , Coskun Oguzhan , Di Maria Federico , Bourdain Frédéric , Decroix Jean Pierre , Wang Adrien , Tchikviladze Maya , Evrard Serge , Turjman Francis , Labeyrie Paul Emile , Riva Roberto , Mounayer Charbel , Saleme Suzana , Costalat Vincent , Bonafé Alain , Eker Omer , Gascou Grégory , Bracard Serge , Tonnelet Romain , Derelle Anne Laure , Anxionnat René , Desal Hubert , Daumas-Duport B. , Berge Jérome , Barreau Xavier , Djemmane Lynda , Labreuche Julien , Duhamel. Alain
Published: December 2023

BACKGROUND:

The aim of this study was to report the results of a subgroup analysis of the ASTER2 trial (Effect of Thrombectomy With Combined Contact Aspiration and Stent Retriever vs Stent Retriever Alone on Revascularization in Patients With Acute Ischemic Stroke and Large Vessel Occlusion) comparing the safety and efficacy of the combined technique (CoT) and stent retriever as a first-line approach in internal carotid artery (ICA) terminus±M1-middle cerebral artery (M1-MCA) and isolated M1-MCA occlusions.

METHODS:

Patients enrolled in the ASTER2 trial with ICA terminus±M1-MCA and isolated M1-MCA occlusions were included in this subgroup analysis. The effect of first-line CoT versus stent retriever according to the occlusion site was assessed on angiographic (first-pass effect, expanded Treatment in Cerebral Infarction score ≥2b50, and expanded Treatment in Cerebral Infarction score ≥2c grades at the end of the first-line strategy and at the end of the procedure) and clinicoradiological outcomes (24-hour National Institutes of Health Stroke Scale, ECASS-III [European Cooperative Acute Stroke Study] grades, and 3-month modified Rankin Scale).

RESULTS:

Three hundred sixty-two patients were included in the postsubgroup analysis according to the occlusion site: 299 were treated for isolated M1-MCA occlusion (150 with first-line CoT) and 63 were treated for ICA terminus±M1-MCA occlusion (30 with first-line CoT). Expanded Treatment in Cerebral Infarction score ≥2b50 (odds ratio, 11.83 [95% CI, 2.32–60.12]) and expanded Treatment in Cerebral Infarction score ≥2c (odds ratio, 4.09 [95% CI, 1.39–11.94]) were significantly higher in first-line CoT compared with first-line stent retriever in patients with ICA terminus±M1-MCA occlusion but not in patients with isolated M1-MCA.

CONCLUSIONS:

First-line CoT was associated with higher reperfusion grades in patients with ICA terminus±M1-MCA at the end of the procedure.

REGISTRATION:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT03290885.
Diversity of wood colour in tropical timber species and its relationship with wood density and anatomical features
Authors: Bessa Fernanda , Sousa Vicelina , Quilhó Teresa , Pereira Helena
Published: December 2023

The wood colour variability of 98 tropical species from India (Goa), Mozambique and East Timor was described using CIELab colour parameters and related to wood density and anatomical features. Wood colours were mostly light and yellowish, ranging from 24.0–84.4 for wood lightness, 2.6–20.4 for redness, 1.8–36.6 for yellowness, 2.1–35.9 for chromaticity and 27.5–81.6 for hue angle. Among the colour parameters, the positive correlation between L* and b* was the most significant, followed by a negative correlation between L* and a*, while the positive correlation between a* and b* was non-significant. Positive correlations between L* and both h and C* were also highly significant. CIELab colour parameters were significantly correlated to wood density, the stronger negative correlation was found with L*, followed by the negative correlation with b*. Wood colour was not strongly correlated with the quantitative anatomical features studied showing only weak negative correlations between L* and the fibre wall thickness/fibre width ratio and between b* and fibre length. Wood density was correlated to almost all anatomical features showing the strongest correlations with fibre wall thickness/fibre width ratio and fibre width. The darker-coloured tropical woods showed high wood density, high fibre wall proportion, high vessel frequency and narrow vessels compared to the lighter coloured woods. Overall, wood colour diversity of tropical species could contribute to increase the international timber market by including lesser-known species, which would enhance local development and sustainability of endangered tropical species.
Expanding donor options: haploidentical transplant recipients are also highly likely to have a 7/8-matched unrelated donor
Authors: Fingerson Stephanie , Maiers Martin , Bolon Yung-Tsi , Devine Steven M. , Spellman Stephen R.
Published: December 2023

The use of haploidentical related donor (HRD) hematopoietic cell transplants (HCTs) in the United States grew by more than fourfold in the last decade, driven mainly by use of posttransplant cyclophosphamide (PTCy)-based graft-versus-host-disease prophylaxis. However, not all patients have a suitable HRD available. In this study, we explored the existence of unrelated donors (URDs) on the National Marrow Donor Program (NMDP) registry at the 8/8- or 7/8-match level for patients receiving HRD HCT in the United States and reporting to the Center for International Blood and Marrow Transplant Research between 2013 and 2020. The data consist of 9696 HRD HCT recipients. The NMDP search prognosis score and a search simulation were used to estimate counts of URD matches on the registry. NMDP search prognosis varied by patient ancestry, with 27.5% non-Hispanic White having a good score compared with 4.6% of African American HRD HCT recipients. Overall, 34% of recipients had ≥1 8/8-matched URDs and 84% had ≥1 7/8 URDs. Recipients of older HRDs (≥35 years) had a likelihood of between 20%- 65% of having ≥5 existing 7/8-matched URDs who were aged ≤35 years. Donor-selection practices varied among the 10 highest-volume HRD centers: 6 had >20% chance of an existing 8/8-matched URD for their HRD recipients, whereas 4 centers had low likelihood of identifying an 8/8-matched URD. In conclusion, although most US patients undergoing HRD HCT do not have an existing 8/8 URD, the majority have an existing 7/8-matched URD. Studies comparing outcomes in patients receiving either HRD or 7/8-matched URD HCT and PTCy-based graft-versus-host disease prophylaxis may be warranted.
Longitudinal genomic analyses of automatically-recorded vaginal temperature in lactating sows under heat stress conditions based on random regression models
Authors: Wen Hui , Johnson Jay S. , Freitas Pedro H. F. , Maskal Jacob M. , Gloria Leonardo S. , Araujo Andre C. , Pedrosa Victor B. , Tiezzi Francesco , Maltecca Christian , Huang Yijian , Schinckel Allan P. , Brito Luiz F.
Published: December 2023

Background

Automatic and continuous recording of vaginal temperature (TV) using wearable sensors causes minimal disruptions to animal behavior and can generate data that enable the evaluation of temporal body temperature variation under heat stress (HS) conditions. However, the genetic basis of TVin lactating sows from a longitudinal perspective is still unknown. The objectives of this study were to define statistical models and estimate genetic parameters for TVin lactating sows using random regression models, and identify genomic regions and candidate genes associated with HS indicators derived from automatically-recorded TV.

Results

Heritability estimates for TVranged from 0.14 to 0.20 over time (throughout the day and measurement period) and from 0.09 to 0.18 along environmental gradients (EG, − 3.5 to 2.2, which correspond to dew point values from 14.87 to 28.19 ˚C). Repeatability estimates of TVover time and along EG ranged from 0.57 to 0.66 and from 0.54 to 0.77, respectively. TVmeasured from 12h00 to 16h00 had moderately high estimates of heritability (0.20) and repeatability (0.64), indicating that this period might be the most suitable for recording TVfor genetic selection purposes. Significant genotype-by-environment interactions (GxE) were observed and the moderately high estimates of genetic correlations between pairs of extreme EG indicate potential re-ranking of selection candidates across EG. Two important genomic regions on chromosomes 10 (59.370–59.998 Mb) and16 (21.548–21.966 Mb) were identified. These regions harbor the genesCDC123,CAMK1d,SEC61A2, andNUDT5that are associated with immunity, protein transport, and energy metabolism. Across the four time-periods, respectively 12, 13, 16, and 10 associated genomic regions across 14 chromosomes were identified for TV. For the three EG classes, respectively 18, 15, and 14 associated genomic windows were identified for TV, respectively. Each time-period and EG class had uniquely enriched genes with identified specific biological functions, including regulation of the nervous system, metabolism and hormone production.

Conclusions

TVis a heritable trait with substantial additive genetic variation and represents a promising indicator trait to select pigs for improved heat tolerance. Moderate GxE for TVexist, indicating potential re-ranking of selection candidates across EG. TVis a highly polygenic trait regulated by a complex interplay of physiological, cellular and behavioral mechanisms.
Inferring circRNA-drug sensitivity associations via dual hierarchical attention networks and multiple kernel fusion
Authors: Lu Shanghui , Liang Yong , Li Le , Liao Shuilin , Zou Yongfu , Yang Chengjun , Ouyang Dong
Published: December 2023

Increasing evidence has shown that the expression of circular RNAs (circRNAs) can affect the drug sensitivity of cells and significantly influence drug efficacy. Therefore, research into the relationships between circRNAs and drugs can be of great significance in increasing the comprehension of circRNAs function, as well as contributing to the discovery of new drugs and the repurposing of existing drugs. However, it is time-consuming and costly to validate the function of circRNA with traditional medical research methods. Therefore, the development of efficient and accurate computational models that can assist in discovering the potential interactions between circRNAs and drugs is urgently needed. In this study, a novel method is proposed, called DHANMKF , that aims to predict potential circRNA-drug sensitivity interactions for further biomedical screening and validation. Firstly, multimodal networks were constructed by DHANMKF using multiple sources of information on circRNAs and drugs. Secondly, comprehensive intra-type and inter-type node representations were learned using bi-typed multi-relational heterogeneous graphs, which are attention-based encoders utilizing a hierarchical process. Thirdly, the multi-kernel fusion method was used to fuse intra-type embedding and inter-type embedding. Finally, the Dual Laplacian Regularized Least Squares method (DLapRLS) was used to predict the potential circRNA-drug sensitivity associations using the combined kernel in circRNA and drug spaces. Compared with the other methods, DHANMKF obtained the highest AUC value on two datasets. Code is available at https://github.com/cuntjx/DHANMKF.
An extranodal Richter’s syndrome presenting with cardiac diffuse large B-cell lymphoma: a case report
Authors: Wang Hua , Yan Wei-hong , Sun Jun-jie , Dong Mei , Zhang Nan , Liu Tong , Song Nian-peng , Zhong Lin
Published: December 2023

Background

Richter’s syndrome (RS) defines the transformation of chronic lymphocytic leukemia into high-grade lymphoma, which usually involves lymph nodes and bone marrow. Extranodal involvement of the heart is an extremely rare condition. Patients with heart involvement tended to have a low response to chemotherapy and relative poor prognosis. The transformation process of RS is often insidious and nonspecific making it challenging to diagnose.

Case presentation

A 64-year-old woman wih a history of chronic lymphocytic leukemia (CLL) presented with intermittent chest pain and was diagnosed with non-ST-elevation myocardial infarction (NSTEMI). However, the contrast enhanced echocardiography revealed a large irregular mass, measuring about 75.4 mm × 37.5 mm, located on the lateral and posterior wall of the right ventricle. Biopsy of the cardiac mass and the results revealed diffuse large B-cell lymphoma.

Conclusions

We present a case of a 64-year-old woman with aggressive diffuse large B-cell lymphoma involving the heart. This case could provide some insights in the diagnosis of cardiac lymphoma.
Recruiting patients for falls prevention in the emergency department – worth the challenge
Authors: Stuckenschneider Tim , Schmidt Laura , Speckmann Elisa-Marie , Koschate Jessica , Zieschang Tania
Published: December 2023

Background

Severe falls escalate the risk of future falls and functional decline as indicated by recent global guidelines. To establish effective falls prevention, individuals at highest risk must be thoroughly studied and, therefore, successfully recruited.

Objective

Recruiting from an emergency department (ED) may mitigate common selection biases, such as overrepresentation of individuals with a higher social status and healthier lifestyle. However, this approach presents unique challenges due to ED-specific conditions. Hence, we present the successes and challenges of an ED-based recruitment for an observational study.

Methods

The SeFallED study targets older adults aged ≥60 years, who present to either of two hospitals in Oldenburg after a fall without subsequent admission. A study nurse addressed individuals in the EDs. Subsequently, potential participants were contacted by phone to arrange a home visit for obtaining written consent. Data of participants were compared with total admissions during the recruitment period to determine recruitment rate and compare patients’ characteristics.

Results

Over 1.500 individuals met the inclusion criteria. Of these, 288 participants were successfully recruited. Most patients presented to the ED outside of the study team’s working hours, and some opted not to participate (main reason: too unwell (40%)). Compared to working hours, a participant was recruited every 14 h. Comparing characteristics, a trend towards better health and younger age was observed.

Conclusion

ED-based recruitment offers the opportunity to include more diverse individuals in falls prevention. To achieve adequate sample sizes, flexibility in working days and hours of the research team are obligatory.

Trial registration

DRKS00025949.
Health literacy and cultural responsiveness of primary health care systems and services in Australia: reflections from service providers, stakeholders, and people from refugee backgrounds
Authors: Peprah Prince , Lloyd Jane , Harris Mark
Published: December 2023

Background

Primary health care [PHC] services with general practitioners (GPs) as the first point of access to health care services for people from refugee backgrounds in Australia can play a crucial role in building health literacy and promoting access to culturally appropriate services. To achieve equitable access and engagement, services and systems must be responsive to diverse health literacy and cultural needs. This study aims to explore how primary health services respond as a system and organisation to the health literacy and cultural needs of people from refugee backgrounds in Australia.

Methods

This exploratory qualitative study involved 52 semi-structured interviews among 19 Africans from refugee backgrounds, 14 service providers, including GPs and nurses, and 19 other stakeholders, such as service managers/directors. Participants resided in New South Wales, Victoria, and Queensland. Interviews were audio-recorded, transcribed, and coded into QSR NVivo 12. Data analysis was guided by reflexive thematic analysis.

Findings

Three interrelated themes were identified from the data relating to the health literacy and cultural responsiveness of PHC systems and services. The first theme, ‘variable and ad hoc organisational response to health literacy and culturally responsive care,’ demonstrated that some organisations did not systematically address the inherent complexity of navigating the health system nor the capacity of services and providers to respond to the cultural needs of people from refugee backgrounds. The second theme, ‘individual provider responsibility,’ captured the individual providers’ interpersonal and relational efforts in supporting the health literacy and cultural needs of people from refugee backgrounds based on their motivation and adaptation. The third theme, ‘refugee patient responsibility,’ encapsulated people from refugee backgrounds’ adaptations to and learning of the health system to navigate and access services.

Conclusion

Health literacy and culturally responsive practices need to be systematised by PHC organisations to be implemented and sustained over time. There is a need for diversity in the organisational leadership and health care workforce, organisational commitment, health literacy and culturally responsive care policies, provider training, and auditing practice as essential components of the change process. Engaging with refugee communities would allow services to focus on people from refugee backgrounds’ needs by design.
A scoring model based on clinical factors to predict postoperative moderate to severe acute respiratory distress syndrome in Stanford type A aortic dissection
Authors: Wang Maozhou , Jia Songhao , Pu Xin , Sun Lizhong , Liu Yuyong , Gong Ming , Zhang Hongjia
Published: December 2023

Background

Postoperative acute respiratory distress syndrome (ARDS) after type A aortic dissection is common and has high mortality. However, it is not clear which patients are at high risk of ARDS and an early prediction model is deficient.

Methods

From May 2015 to December 2017, 594 acute Stanford type A aortic dissection (ATAAD) patients who underwent aortic surgery in Anzhen Hospital were enrolled in our study. We compared the early survival of MS-ARDS within 24 h by Kaplan–Meier curves and log-rank tests. The data were divided into a training set and a test set at a ratio of 7:3. We established two prediction models and tested their efficiency.

Results

The oxygenation index decreased significantly immediately and 24 h after TAAD surgery. A total of 363 patients (61.1%) suffered from moderate and severe hypoxemia within 4 h, and 243 patients (40.9%) suffered from MS-ARDS within 24 h after surgery. Patients with MS-ARDS had higher 30-day mortality than others (log-rank test: p-value <0.001). There were 30 variables associated with MS-ARDS after surgery. The XGboost model consisted of 30 variables. The logistic regression model (LRM) consisted of 11 variables. The mean accuracy of the XGBoost model was 70.7%, and that of the LRM was 80.0%. The AUCs of XGBoost and LRM were 0.764 and 0.797, respectively.

Conclusion

Postoperative MS-ARDS significantly increased early mortality after TAAD surgery. The LRM model has higher accuracy, and the XGBoost model has higher specificity.
Efficacy of various surgical approaches in treating hematospermia using transurethral seminal vesiculoscopy
Authors: Yao Rui-Jie , Xiao Hong , Chen Shu-Shen , Feng Zhi-Hao , Ding Yi-Lang , Chen Xi , Tang Song-Xi , Zhou Hui-Liang
Published: December 2023

Purpose

To explore the efficacy of different approaches of seminal vesiculoscopy surgery and the predictive factors of good treatment outcome.

Materials and Methods

A retrospective analysis of 68 patients who underwent seminal vesiculoscopy for hematospermia in our hospital from January 2015 to January 2021. According to different surgical approaches, they were divided into three groups: natural ejaculatory ducts (method A, 45 cases), assisted transurethral resection/incision of ejaculatory ducts (method B, 14 cases), fenestration in prostatic utricle (method C, 9 cases). We analyzed the recurrence rate of the three surgical approaches and the predictive factors of treatment efficacy.

Results

The total recurrence rate after the seminal vesiculoscopy for hematospermia in this group was 32.35%. The postoperative recurrence rates of the three methods were 24.44% for method A, 50.00% for method B and 44.44% for method C, and there was no significant difference among the three methods (P > 0.05). The data of five predictors of 45 cases in method A group were included in the Univariate Logistic analysis, the results suggest that whether complicated with seminal tract stones/cysts was an effective predictor (OR 0.250, P = 0.022), which was still an effective predictor in the Multivariate Logistic analysis model (OR 0.244, P = 0.010).

Conclusions

The Transurethral seminal vesiculoscopy technique demonstrates a low postoperative recurrence rate in treating hematospermia. Among the various approaches, the intraoperative use of natural orifices through the ejaculatory duct exhibits the lowest recurrence rate. Additionally, seminal tract stones/cysts effectively predict favorable postoperative outcomes.
Trends in maternal oral health services at primary healthcare centers in Saudi Arabia: a cross-sectional study
Authors: Al Agili Dania
Published: December 2023

Background

During pregnancy, many complex physiological changes and increased levels of pregnancy hormones are associated with adverse oral health and increased prevalence of periodontal disease. Our study aimed to assess the oral health needs of pregnant women and describe the patterns of dental services provided to them before, during, and after pregnancy. Assessing the oral health needs of pregnant women and understanding the patterns of dental services provided to them are important to facilitate efficient utilization of oral health services to promote better health outcomes for the mother and baby.

Methods

Our study utilized a cross-sectional design to examine the prevalence of dental problems and use of dental services among a sample of postpartum women who visited primary healthcare centers (PHCs) in Jeddah for antenatal care, between 2018 and 2019. A link to a questionnaire adapted from the Pregnancy Risk Assessment Monitoring System (PRAMS) was sent to participants via the WhatsApp messaging platform. A total of 1350 postpartum women responded to the online survey. We estimated the prevalence of dental problems among women before and during pregnancy and assessed the association between their dental problems and their respective demographic characteristics. We calculated the prevalence of each dental service received before, during, and after pregnancy and examined the trends in dental services over these three periods. All bivariate associations were tested using Pearson’s chi-squared test.

Results

We found that significantly fewer women visited a dental clinic during pregnancy (31.0%) compared to pre-pregnancy (38.2%) and post-pregnancy (47.3%). The prevalence of toothache, dental caries, gum disease, and dental extraction need before pregnancy was 45.9%, 57.0%, 27.3%, and 40.0%, respectively. These percentages remained the same during pregnancy, except for the need for dental extraction, which significantly decreased to 35.3%. Check-up dental visits increased significantly to 70.6% during pregnancy compared to pre-pregnancy (51.7%) and post-pregnancy (59.9%).

Conclusion

Increasing women’s awareness of the importance and safety of oral healthcare during pregnancy, training dental students and primary healthcare dentists in the practice guidelines for the dental management of pregnant women, and developing and monitoring key performance indicators for maternal oral healthcare are the starting steps for improving the oral health and well-being of women and their children.
Comprehensive evaluation of disease coding quality in gastroenterology and its impact on the diagnosis-related group system: a cross-sectional study
Authors: Yuan Baiyang , Quan Lili
Published: December 2023

Objective

According to the diagnosis-related group (DRG) requirement, issues of diagnosis and procedure coding in the gastroenterology department of our hospital were analyzed and improvement plans were proposed to lay the foundation for effective implementation of DRGs.

Methods

The title page of case-history of 1600 patients admitted to the Department of Gastroenterology of this hospital from January 1, 2021 to December 31, 2021 was sampled as a data source, and the primary and other diagnostic codes, operation or procedure codes involved in the title page of case-history were categorized and statistically analyzed.

Results

Of the 531 cases treated with gastrointestinal endoscopy in our hospital in 2021, coding errors were identified in 66 cases and unsuccessful DRG enrollment in 35 cases, including 14 cases with incorrect coding of the primary diagnosis (8 cases with unsuccessful DRG enrollment), 37 cases with incorrect coding of the primary operation (23 cases with unsuccessful DRG enrollment), and 8 cases with incorrect coding of both the primary diagnosis and the primary operation (4 cases with unsuccessful DRG enrollment). Analysis of 66 inpatient cases with coding problems showed a total of 167 deficiencies, including 36 deficiencies in major diagnoses, 84 deficiencies in other diagnoses, and 47 deficiencies in surgery or operation coding.

Conclusion

The accuracy of coding of disease diagnosis and surgical operation is the basis for the smooth implementation of DRGs. The medical staff of this hospital has poor cognition of DRGs coding and fails to recognize the important role of the title page of case-history quality to DRGs system, and their attention to DRGs and knowledge base of disease classification coding should be improved. In addition, the high incidence of coding errors, especially the omission of disease diagnosis, requires increased training of physicians and nurses on clinical knowledge and requirements for DRGs medical records, thereby improving the quality of medical cases and ensuring the accuracy of DRGs information.
An iterative approach to developing a multifaceted implementation strategy for a complex eHealth intervention within clinical practice
Authors: IJzerman Renée V.H. , van der Vaart Rosalie , Breeman Linda D. , Arkenbout Karin , Keesman Mike , Kraaijenhagen Roderik A. , Evers Andrea W.M. , Scholte op Reimer Wilma J.M. , Janssen Veronica R.
Published: December 2023

Background

The number of complex eHealth interventions has increased considerably. Despite available implementation theory outlining well-designed strategies, implementing complex interventions within practice proves challenging and often does not lead to sustainable use. To improve sustainability, theory and practice should be addressed during the development of an implementation strategy. By subsequently transparently reporting the executed theory-based steps and their corresponding practice findings, others can learn from these valuable lessons learned. This study outlines the iterative approach by which a multifaceted implementation strategy for a complex eHealth intervention in clinical practice was developed, tested and refined.

Methods

We implemented the BENEFIT program, an advanced eHealth platform with Personal Health Portal facilitating healthy living in cardiac patients. In six iterative phases alternating between theory and practice, the implementation strategy was developed, tested and refined. The initial implementation strategy (phase 1) was drawn up using the Implementation model and RE-AIM. Subsequently, this strategy was further updated in brainstorming sessions and group discussions with twenty key stakeholders from three cardiac care centres and then evaluated in a pilot (phases 2 and 3).

Results

The pilot of the program led to the identification of (context-specific) key challenges in practice (phase 4), which were subsequently connected back to broader theory (phase 5) using the Consolidated Framework of Implementation Research (CFIR). In the final phase, practice recommendations tackling the key challenges were formulated (phase 6) based on CFIR theory, the CFIR-ERIC Matching Tool, and stakeholders’ input and feedback. These recommendations were then added to the refined strategy. Thus, executing this approach led to the realisation and use of a multifaceted theory-informed practice-based implementation strategy.

Conclusion

This case study gives an in-depth description of an iterative approach to developing an evidence-based, practice-tailored strategy for implementing a complex eHealth intervention in cardiac care. As such, this study may serve as a blueprint for other researchers aspiring to implement complex eHealth interventions within clinical practice sustainably.
Geospatial analysis and participant characteristics associated with colorectal cancer screening participation in Alberta, Canada: a population-based cross-sectional study
Authors: Jessiman-Perreault Geneviève , Law Jessica , Adhikari Kamala , Machado Amanda Alberga , Moysey Barbara , Xu Linan , Yang Huiming , Scott Lisa K. Allen , Teare Gary , Li Alvin
Published: December 2023

Background

Colorectal cancer (CRC) is a leading cause of death in Canada and early detection can prevent deaths through screening. However, CRC screening in Alberta, Canada remains suboptimal and varies by sociodemographic and health system characteristics, as well as geographic location. This study aimed to further the understanding of these participant and health system characteristics associated with CRC screening in Alberta and identify clusters of regions with higher rates of overdue or unscreened individuals.

Methods

We included Albertans aged 52 to 74 as of December 31, 2019 (index date) and we used data from administrative health data sources and linked to the Alberta Colorectal Cancer Screening Program database to determine colorectal cancer screening rates. We used multivariable multinomial logistic regression analysis to investigate the relationship between sociodemographic, health system characteristics and participation in CRC screening. We used optimized Getis-Ord Gi* hot-spot analysis to identify hot and cold-spots in overdue for and no record of CRC screening.

Results

We included 919,939 Albertans, of which 65% were currently up to date on their CRC screening, 21% were overdue, and 14% had no record of CRC screening. Compared to Albertans who were currently up to date, those who were in older age groups, those without a usual provider of care, those who were health system non-users, and those living in more deprived areas were more likely to have no record of screening. Areas with high number of Albertans with no record of screening were concentrated in the North and Central zones.

Conclusions

Our study showed important variation in colorectal cancer screening participation across sociodemographic, health system and geographical characteristics and identified areas with higher proportions of individuals who have no record of screening or are under-screened in Alberta, Canada.
Mutations in PGRN gene associated with the risk of psoriasis in Pakistan: a case control study
Authors: Saleem Saima , Imran Zunaira , Samdani Azam , Khoso Bahram , Zehra Sitwat , Azhar Abid
Published: December 2023

Background

Psoriasis is a chronic, autoimmune, papulosquamous skin disorder, characterized by the formation of drop-like papules and silvery-white plaques surrounded by reddened or inflamed skin, existing predominantly on the scalp, knees and elbows. The characteristic inflammation and hyperproliferation of keratinocytes in psoriasis is regulated by progranulin (PGRN), which suppresses the expression and release of inflammatory cytokines, such as TNF-α.

Methodology

In this study mutation analysis of the PGRN gene was performed by extracting the genomic DNA from blood samples of 171 diagnosed psoriasis patients and controls through standard salting-out method, followed by amplification and sequencing of the targeted region of exon 5–7 of PGRN gene.

Results

Three single nucleotide polymorphisms, rs25646, rs850713 and a novel point mutation 805A/G were identified in the PGRN gene with significant association with the disease. The variant alleles of the polymorphisms were significantly distributed among cases and controls, and statistical analysis suggested that the mutant genotypes conferred a higher risk of psoriasis development and progression. Multi-SNP haplotype analysis indicated that the CAA (OR = 8.085, 95% CI = 5.16–12.66) and the CAG (OR = 3.204, 95% CI = 1.97–5.21) haplotypes were significantly associated with psoriasis pathogenesis.

Conclusions

These findings demonstrate that polymorphisms in PGRN might act as potential molecular targets for early diagnosis of psoriasis in susceptible individuals.
SARS-CoV-2 spike protein accelerates systemic sclerosis by increasing inflammatory cytokines, Th17 cells, and fibrosis
Authors: Jeong Ha Yeon , Park Jin-Sil , Woo Jin Seok , Lee Kun Hee , Choi Jeong Won , Kang Hye Yeon , Na Hyun Sik , Lee Yeon Su , Um In Gyu , Park Sung-Hwan , Cho Mi-La
Published: December 2023

Background

Coronavirus disease 2019 (COVID-19) induces a dysfunctional immune response, inflammation, autoantibody production, and coagulopathy, which are symptoms that bear resemblance to those of autoimmune diseases, including systemic sclerosis (SSc).

Methods

While there is a single case report suggesting an association between COVID-19 and SSc, the effects of COVID-19 on SSc are not yet fully understood. Human embryonic kidney 293 (HEK293) cells were transfected with the SARS-CoV-2 spike protein gene, in the presence of TGF-β. The expression levels of fibrosis-related proteins were measured via Western blotting. A bleomycin (BLM)-induced SSc mouse model was employed, wherein mice were injected with the gene encoding the SARS-CoV-2 spike protein and the ACE2 receptor. The levels of fibrosis, autoantibodies, thrombotic factors, and inflammatory cytokines in tissues and serum were analyzed.

Results

In vitro, the expression levels of fibrosis marker proteins were elevated in the spike protein group compared to the control group. In vivo, the skin thickness of SSc mice increased following exposure to the SARS-CoV-2 spike protein. Furthermore, the levels of autoantibodies and thrombotic factors, such as anti-phospholipid antibodies (APLA), were significantly increased in the presence of the protein. Flow cytometry analysis revealed increased expression of the proinflammatory cytokine IL-17 in the skin, lungs, and blood. Moreover, tissue fibrosis and levels of inflammatory cytokines in skin and lung tissues were markedly escalated in SSc mice subjected to the protein.

Conclusion

COVID-19 may accelerate the development and progression of SSc by intensifying fibrosis through the upregulation of inflammation, autoantibody production, and thrombosis.
Maternal disability and initiation and duration of breastfeeding: analysis of a Canadian cross-sectional survey
Authors: Brown Hilary K. , Pablo Lesley , Scime Natalie V. , Aker Amira M. , Dennis Cindy-Lee
Published: December 2023

Background

The World Health Organization recommends breastfeeding as the best method for infant feeding. Known risk factors for breastfeeding non-initiation and early cessation of breastfeeding are diverse and include low breastfeeding self-efficacy, poverty, smoking, obesity, and chronic illness. Although women with disabilities experience elevated rates of these risk factors, few studies have examined their breastfeeding outcomes. Our objective was to examine breastfeeding non-initiation and early cessation of breastfeeding in women with and without disabilities.

Methods

We used data from the 2017–2018 Canadian Community Health Survey. Included were n = 4,817 women aged 15–55 years who had a birth in the last five years, of whom 26.6% had a disability, ascertained using the Washington Group Short Set on Functioning. Prevalence ratios (aPR) of breastfeeding non-initiation, and of early cessation of any and exclusive breastfeeding before 6 months, were calculated for women with versus without disabilities. We also examined disability by severity (moderate/severe and mild, separately) and number of action domains impacted (≥ 2 and 1, separately). The main multivariable models were adjusted for maternal age, marital status, level of education, annual household income level, and immigrant status.

Results

There were no differences between women with and without disabilities in breastfeeding non-initiation (9.6% vs. 8.9%; aPR 0.88, 95% CI 0.63, 1.23). Women with disabilities were more likely to have early cessation of any (44.4% vs. 35.7%) and exclusive breastfeeding before 6 months (66.9% vs. 61.3%), with some attenuation in risk after adjustment for sociodemographic factors (aRR 1.15, 95% CI 0.99, 1.33 and aRR 1.07, 95% 0.98, 1.16, respectively). Disparities were larger for women with moderate/severe disabilities and disabilities in ≥ 2 domains, with differences attenuated by adjustment for socio-demographics.

Conclusions

Women with disabilities, and particularly those with moderate/severe and multiple disabilities, could benefit from tailored, accessible breastfeeding supports that attend to the social determinants of health.
Sex-based differences in clinical and radiological presentation of patients with degenerative lumbar scoliosis: a cross-sectional study
Authors: Liang Xiao , Yang Puxin , Yuan Hongru , Huo Yachong , Yang Dalong , Wang Hui , Ding Wenyuan
Published: December 2023

Background

To evaluate the sex-based differences in clinical and radiological presentation of patients with degenerative lumbar scoliosis (DLS) and to explore whether the difference is helpful in investigating the etiology and progression of DLS.

Method

A retrospective review of 199 patients (41 males, 158 females) with DLS was included. Patient demographics including age, gender, bone mineral density were collected. Back and leg pain was assessed by visual analog scale, and general physical condition was assessed by Oswestry Disability Index. Cobb’s angle was measured, and direction of scoliosis, position of the superior, inferior and apex vertebrae, number of vertebrae included in the scoliosis, rotation of apex vertebrae (Nash-Mo index), translation of apex vertebrae were recorded. Sagittal longitudinal axis, thoracolumbar kyphosis, lumbar lordosis (LL), pelvic incidence angle (PI), sacral slope, apex of lumbar lordosis and coronal balance distance were measured by whole spine lateral radiographs, and type of coronal imbalance was evaluated in all patients. Fat infiltration rate (FIR) of the paraspinal muscles at the vertebral apex was measured by MRI.

Result

Compared to female patients, male patients showed more back and leg pain on clinical presentation and smaller Cobb angle, less parietal rotation, larger LL, smaller PI-LL and lower paravertebral muscle FIR on radiologic features.

Conclusion

Gender differences do exist in DLS patients with regard to clinical and radiological presentation, low back pain was more pronounced in male patients, and scoliosis was more severe in female patients based on this cross-sectional study.
Effect of intranasal insulin administration on postoperative delirium prevention in elderly cardiac surgery patients: study protocol for a multicenter, double-blind, randomized, controlled trial
Authors: Nakadate Yosuke , Yamada Mariko , Kusuyama Natsuyo , Ishii Ryota , Sato Hiroaki , Schricker Thomas , Tanaka Makoto
Published: December 2023

Background

Postoperative delirium (POD) is a complication after surgery which leads to worse outcomes. The frequency of this syndrome is increasing as more elderly patients undergo major surgery. The frequency is around 10–25% but reaches as high as 50% for cardiac surgery. Although intranasal insulin (INI) administration of up to 160 units in patients with cognitive dysfunction and delirium has been shown to improve memory function and brain metabolism without complications such as hypoglycemia, it remains unknown whether INI prevents POD after cardiac surgery

Methods

A multicenter, double-blind, randomized, controlled trial will be conducted at University of Tsukuba Hospital and Tsukuba Medical Center Hospital, Japan, from July 1, 2023, to December 31, 2025. A total of 110 elderly patients (65 years old or older) undergoing cardiac surgery requiring cardiopulmonary bypass will be enrolled and randomly allocated to intranasal insulin or intranasal saline groups. The primary outcome is the incidence of POD within 7 days after surgery. Secondary outcomes include days and times of delirium, screening tests of cognitive function, pain scores, duration of postoperative tracheal intubation, and length of ICU stay.

Discussion

The present objective is to assess whether 80 IU INI administration during surgery prevents POD after cardiac surgery. The results may provide strategic choices to prevent POD in patients with cardiac surgery requiring cardiopulmonary bypass.

Trial registration

The trial was registered with the Japan Registry for Clinical Trials with identifier jRCTs031230047 on April 21, 2023.
Univariate and multivariate sex differences and similarities in gray matter volume within essential language-processing areas
Authors: Sanchis-Segura Carla , Wilcox Rand R. , Cruz-Gómez Alvaro Javier , Félix-Esbrí Sonia , Sebastián-Tirado Alba , Forn Cristina
Published: December 2023

Background

Sex differences in language-related abilities have been reported. It is generally assumed that these differences stem from a different organization of language in the brains of females and males. However, research in this area has been relatively scarce, methodologically heterogeneous and has yielded conflicting results.

Methods

Univariate and multivariate sex differences and similarities in gray matter volume (GMVOL) within 18 essential language-processing brain areas were assessed in a sex-balanced sample (N = 588) of right-handed young adults. Univariate analyses involved location, spread, and shape comparisons of the females’ and males’ distributions and were conducted with several robust statistical methods able to quantify the size of sex differences and similarities in a complementary way. Multivariate sex differences and similarities were estimated by the same methods in the continuous scores provided by two distinct multivariate procedures (logistic regression and a multivariate analog of the Wilcoxon–Mann–Whitney test). Additional analyses were addressed to compare the outcomes of these two multivariate analytical strategies and described their structure (that is, the relative contribution of each brain area to the multivariate effects).

Results

When not adjusted for total intracranial volume (TIV) variation, “large” univariate sex differences (males > females) were found in all 18 brain areas considered. In contrast, “small” differences (females > males) in just two of these brain areas were found when controlling for TIV. The two multivariate methods tested provided very similar results. Multivariate sex differences surpassed univariate differences, yielding "large" differences indicative of larger volumes in males when calculated from raw GMVOLestimates. Conversely, when calculated from TIV-adjusted GMVOL, multivariate differences were "medium" and indicative of larger volumes in females. Despite their distinct size and direction, multivariate sex differences in raw and TIV-adjusted GMVOLshared a similar structure and allowed us to identify the components of the SENT_CORE network which more likely contribute to the observed effects.

Conclusions

Our results confirm and extend previous findings about univariate sex differences in language-processing areas, offering unprecedented evidence at the multivariate level. We also observed that the size and direction of these differences vary quite substantially depending on whether they are estimated from raw or TIV-adjusted GMVOLmeasurements.
Metabolic syndrome and breast cancer risk
Authors: Mohammed Amira M. , Hamed Hosney B. , Noaman Maisa K. , Alieldin Nelly
Published: December 2023

Background

Limited data are available on metabolic syndrome and its relation to breast cancer risk in Egypt. We aimed to study metabolic syndrome and its individual components as risk of breast cancer.

Methods

This case–control study recruited 112 breast cancer cases and 112 age-matched controls from Assiut University. In addition to demographic, clinical, and anthropoemetric characteristics, blood samples were collected from both study groups to evaluate metabolic syndrome and its individual components.

Results

Mean age of breast cancer cases and control groups was 46.10 ± 4.34 and 45.66 ± 4.68 years, respectively. According to Joint Interim Statement (JIS) criteria for clinical diagnosis of metabolic syndrome, the overall prevalence of metabolic syndrome in all participants was 42.9%, and prevalence in breast cancer cases and control group was 57.14% and 28.6%, respectively, OR 33.33, 95% CI (1.91–5.81). BMI was more likely to be higher in breast cancer patients with a linear trend, p < 0.001. For individual components of metabolic syndrome, breast cancer cases were more likely to have high fasting blood glucose level, systolic and/or diastolic blood pressure, high triglycerides level, and low HDL-C as compared to the control group.

Conclusion

Metabolic syndrome and its components were found to be associated with the risk of breast cancer. We believe that prevention or reversal of metabolic syndrome by raising community awareness for lifestyle changes could be an effective way in minimizing the toll of the disease.
Vitamin and Mineral Supplementation, Weight Gain, and Poor Appetite in Patients With Cancer: Many Questions and Fewer Answers
Authors: Haemmerle Robert J. , Jatoi Aminah
Published: December 2023

Patients with cancer or with a history of cancer often seek nutritional advice. In turn, cancer health care providers are often asked questions related to nutrition and cancer. Should I take high-dose vitamins or other high-dose supplements? Should I take a regular-dose vitamin or other regular-dose nutritional supplements? Will I experience weight loss during postoperative chemotherapy? What should be my weight goals during and after adjuvant therapy? In the setting of advanced cancer, what should I do to keep my appetite and weight up? This review attempts to provide data-driven answers to some of these commonly posed questions.