bluuebunny/crossref_metadata_2025 huggingface dataset:
Cost-effectiveness of left atrial appendage closure for stroke prevention in atrial fibrillation: a systematic review appraising the methodological quality
Authors: Hewage Sumudu A. , Noviyani Rini , Brain David , Sharma Pakhi , Parsonage William , McPhail Steven M. , Barnett Adrian , Kularatna Sanjeewa
Published: October 2023

Background

The increasing global prevalence of atrial fibrillation (AF) has led to a growing demand for stroke prevention strategies, resulting in higher healthcare costs. High-quality economic evaluations of stroke prevention strategies can play a crucial role in maximising efficient allocation of resources. In this systematic review, we assessed the methodological quality of such economic evaluations.

Methods

We searched electronic databases of PubMed, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and Econ Lit to identify model-based economic evaluations comparing the left atrial appendage closure procedure (LAAC) and oral anticoagulants published in English since 2000. Data on study characteristics, model-based details, and analyses were collected. The methodological quality was evaluated using the modified Economic Evaluations Bias (ECOBIAS) checklist. For each of the 22 biases listed in this checklist, studies were categorised into one of four groups: low risk, partial risk, high risk due to inadequate reporting, or high risk. To gauge the overall quality of each study, we computed a composite score by assigning + 2, 0, − 1 and − 2 to each risk category, respectively.

Results

In our analysis of 12 studies, majority adopted a healthcare provider or payer perspective and employed Markov Models with the number of health states varying from 6 to 16. Cost-effectiveness results varied across studies. LAAC displayed a probability exceeding 50% of being the cost-effective option in six out of nine evaluations compared to warfarin, six out of eight evaluations when compared to dabigatran, in three out of five evaluations against apixaban, and in two out of three studies compared to rivaroxaban. The methodological quality scores for individual studies ranged from 10 to − 12 out of a possible 24. Most high-risk ratings were due to inadequate reporting, which was prevalent across various biases, including those related to data identification, baseline data, treatment effects, and data incorporation. Cost measurement omission bias and inefficient comparator bias were also common.

Conclusions

While most studies concluded LAAC to be the cost-effective strategy for stroke prevention in AF, shortcomings in methodological quality raise concerns about reliability and validity of results. Future evaluations, free of these shortcomings, can yield stronger policy evidence.
An MRI-based grading system for preoperative risk estimation of positive surgical margin after radical prostatectomy
Authors: Xu Lili , Zhang Gumuyang , Zhang Daming , Zhang Jiahui , Zhang Xiaoxiao , Bai Xin , Chen Li , Peng Qianyu , Xiao Yu , Wang Hao , Jin Zhengyu , Sun Hao
Published: October 2023

Objective

To construct a simplified grading system based on MRI features to predict positive surgical margin (PSM) after radical prostatectomy (RP).

Methods

Patients who had undergone prostate MRI followed by RP between January 2017 and January 2021 were retrospectively enrolled as the derivation group, and those between February 2021 and November 2022 were enrolled as the validation group. One radiologist evaluated tumor-related MRI features, including the capsule contact length (CCL) of lesions, frank extraprostatic extension (EPE), apex abutting, etc. Binary logistic regression and decision tree analysis were used to select risk features for PSM. The area under the curve (AUC), sensitivity, and specificity of different systems were calculated. The interreader agreement of the scoring systems was evaluated using the kappa statistic.

Results

There were 29.8% (42/141) and 36.4% (32/88) of patients who had PSM in the derivation and validation cohorts, respectively. The first grading system was proposed (mrPSM1) using two imaging features, namely, CCL ≥ 20 mm and apex abutting, and then updated by adding frank EPE (mrPSM2). In the derivation group, the AUC was 0.705 for mrPSM1 and 0.713 for mrPSM2. In the validation group, our grading systems showed comparable AUC with Park et al.’s model (0.672–0.686 vs. 0.646, p > 0.05) and significantly higher specificity (0.732–0.750 vs. 0.411, p < 0.001). The kappa value was 0.764 for mrPSM1 and 0.776 for mrPSM2. Decision curve analysis showed a higher net benefit for mrPSM2.

Conclusion

The proposed grading systems based on MRI could benefit the risk stratification of PSM and are easily interpretable.

Critical relevance statement

The proposed mrPSM grading systems for preoperative prediction of surgical margin status after radical prostatectomy are simplified compared to a previous model and show high specificity for identifying the risk of positive surgical margin, which might benefit the management of prostate cancer.

Key points

• CCL ≥ 20 mm, apex abutting, and EPE were important MRI features for PSM.

• Our proposed MRI-based grading systems showed the possibility to predict PSM with high specificity.

• The MRI-based grading systems might facilitate a structured risk evaluation of PSM.

Graphical Abstract
Cardiovascular metrics on CT pulmonary angiography in patients with pulmonary hypertension — re-evaluation under the updated guidelines of pulmonary hypertension
Authors: Liu Anqi , Xu Wenqing , Xi Linfeng , Deng Mei , Yang Haoyu , Huang Qiang , Gao Qian , Zhang Peiyao , Xie Wanmu , Huang Zhenguo , Liu Min
Published: October 2023

Purpose

To re-assess cardiovascular metrics on computed tomography pulmonary angiography (CTPA) in predicting pulmonary hypertension (PH) under the 2022 ESC/ERS guidelines.

Materials and methods

This observational study retrospectively included 272 patients (female 143, mean age = 54.9 ± 12.5 years old) with suspected PH. 218 patients were grouped to evaluate cardiovascular metrics on CTPA and develop a binary logistic regression model. The other 54 patients were grouped into the validation group to assess the performance of the prediction model under the updated criteria. Based on mean pulmonary artery pressure (mPAP), patients were divided into three groups: group A consisted of patients with mPAP ≤ 20 mmHg, group B included patients with 20 mmHg < mPAP < 25 mmHg, and group C comprised patients with mPAP ≥ 25 mmHg. Cardiovascular metrics among the three groups were compared, and receiver operating characteristic curves (ROCs) were used to evaluate the performance of cardiovascular metrics in predicting mPAP > 20 mmHg.

Results

The main pulmonary arterial diameter (MPAd), MPAd/ascending aorta diameter ratio (MPAd/AAd ratio), and right ventricular free wall thickness (RVFWT) showed significant differences among the three groups (p < 0.05). The area under curve (AUC) of MPAd was larger than MPAd/AAd ratio and RVFWT. A MPAd cutoff value of 30.0 mm has a sensitivity of 83.1% and a specificity of 90.4%. The AUC of the binary logistic regression model (Z =  − 12.98187 + 0.31053 MPAd + 1.04863 RVFWT) was 0.938 ± 0.018. In the validation group, the AUC, sensitivity, specificity, and accuracy of the prediction model were 0.878, 92.7%, 76.9%, and 88.9%, respectively.

Conclusion

Under the updated criteria, MPAd with a threshold value of 30.0 mm has better sensitivity and specificity in predicting PH. The binary logistic regression model may improve the diagnostic accuracy.

Critical relevance statement

Under the updated criteria, the main pulmonary arterial diameter with a threshold value of 30.0 mm has better sensitivity and specificity in predicting pulmonary hypertension. The binary logistic regression model may improve diagnostic accuracy.

Key points

• According to 2022 ESC/ERS guidelines, a MPAd cutoff value of 30.0 mm has better sensitivity and specificity in predicting mPAP > 20 mmHg

• A binary logistic regression model (Z = − 12.98187 + 0.31053 MPAd + 1.04863 RVFWT) was developed and had a sensitivity, specificity, and accuracy of 92.7%, 76.9%, and 88.9% in predicting mPAP > 20 mmHg.

• A binary logistic regression prediction model outperforms MPAd in predicting mPAP > 20 mmHg.

Graphical Abstract
A predictive model combining clinical characteristics and nutritional risk factors for overall survival after umbilical cord blood transplantation
Authors: Tu Meijuan , Huang Aijie , Ning Lijuan , Tang Baolin , Zhang Chunli , Sun Guangyu , Wan Xiang , Song Kaidi , Yao Wen , Qiang Ping , Wu Yue , Zhu Xiaoyu
Published: October 2023

Background

Umbilical cord blood transplantation (UCBT) is a curable therapy for hematological disease; however, the impact of nutritional status on UCBT outcomes remains controversial. To evaluate the joint effect of clinical characteristics and nutritional status on the prognosis of patients who underwent UCBT, we screened various factors to establish a predictive model of overall survival (OS) after UCBT.

Methods

We performed an integrated clinical characteristic and nutritional risk factor analysis and established a predictive model that could be used to identify UCBT recipients with poor OS. Internal validation was performed by using the bootstrap method with 500 repetitions.

Results

Four factors, including disease status, conditioning regimen, calf skinfold thickness and albumin level, were identified and used to develop a risk score for OS, which showed a positive predictive value of 84.0%. A high-risk score (≥ 2.225) was associated with inferior 3-year OS post-UCBT [67.5% (95% CI 51.1–79.4%), P = 0.001]. Then, we built a nomogram based on the four factors that showed good discrimination with a C-index of 0.833 (95% CI 0.743–0.922). The optimism-corrected C-index value of the bootstrapping was 0.804. Multivariate analysis suggested that a high calf skinfold thickness (≥ 20.5 mm) and a low albumin level (< 33.6 g/L) conferred poor disease-free survival (DFS).

Conclusion

The predictive model combining clinical and nutritional factors could be used to predict OS in UCBT recipients, thereby promoting preemptive treatment.
Post-harvest biocontrol of Fusarium infection in tomato fruits using bio-mediated selenium nanoparticles
Authors: Manaa Howaida M. , Hamza Ebtsam M. , Sorour Noha M.
Published: October 2023

The protection of post-harvest infection by Fusarium spp. is a major worldwide demand, especially using effective natural alternatives to chemical fungicides. In this respect, selenium nanoparticles (SeNPs) were biosynthesized using Fenugreek seeds aqueous extract. Bio-mediated SeNPs were characterized using XRD, FTIR, UV–Vis, TEM, and EDX. XRD confirmed the crystalline nature with six characteristic peaks corresponding to Se-nanocrystals. TEM showed spherical-shaped SeNPs with 34.02–63.61 nm diameter. FTIR verified the presence of different bio-functional groups, such as, N–H, O–H, C–N, and C–NH2 acting as stabilizing/reducing agents during the biosynthesis. Bio-mediated SeNPs exhibited excellent biocidal activity against F. oxysporum and F. moniliforme, with MIC of 0.25 and 1.7 mg/mL, respectively. Direct treatment of F. oxysporum with SeNPs led to significant deformation and lysis of the fungal hyphae within 18 h. The treatment of infected fruits with MIC of SeNPs reduced the infection signs by 100% and preserved the fresh-like appearance of treated fruits for 25 and 35 days when stored at 25 °C and 5 °C, respectively. Therefore, SeNPs is considered efficacious fungicidal against Fusarium spp. in-vitro and in-vivo. The treatment of tomato fruits with MIC of SeNPs positively affected its chemical properties, as well as decreased weight loss %, confirming the barrier effect of SeNPs, thus increasing fruits’ shelf-life. Bio-mediated SeNPs appeared safe towards normal HSF and OEC cell lines with IC50> 300 μg/mL. Overall results recommend the usage of bio-mediated SeNPs as safe powerful bioagent against Fusarium infection, maintaining tomato quality, and providing protection from post-harvest invasion and/or destroying existing infections.

Graphical Abstract
Existence and nonexistence of solutions for an approximation of the Paneitz problem on spheres
Authors: Ould Bouh Kamal
Published: October 2023

This paper is devoted to studying the nonlinear problem with slightly subcritical and supercritical exponents $(S_{\pm \varepsilon}): \Delta ^{2}u-c_{n}\Delta u+d_{n}u = Ku^{ \frac{n+4}{n-4}\pm \varepsilon}$
(

S

±
ε

)
:

Δ
2

u
−

c
n

Δ
u
+

d
n

u
=
K

u

n
+
4

n
−
4

±
ε

, $u>0$
u
>
0
on $S^{n}$

S
n

, where $n\geq 5$
n
≥
5
, ε is a small positive parameter and K is a smooth positive function on $S^{n}$

S
n

. We construct some solutions of $(S_{-\varepsilon})$
(

S

−
ε

)
that blow up at one critical point of K. However, we prove also a nonexistence result of single-peaked solutions for the supercritical equation $(S_{+\varepsilon})$
(

S

+
ε

)
.
Exploration of interoceptive capabilities in avoidant/restrictive food intake disorder and anorexia nervosa
Authors: Datta Nandini , Lock James D.
Published: October 2023

Objective

This proof-of-concept study explores the role of aberrant interoception as a possible mechanism underlying restrictive eating symptoms in avoidant/restrictive food intake disorder (ARFID) compared to anorexia nervosa (AN) and healthy comparisons (HC).

Method

We report preliminary normative adolescent interoceptive data in HCs (n = 100) compared to adolescents with ARFID (n = 30) and AN (N = 23). Adolescents (12–18) participated in a one-time virtual visit to assess heartrate guessing accuracy (interoceptive accuracy), correlation between confidence in heartrate guess and accuracy (interoceptive awareness), and self-reported interoception (interoceptive sensibility).

Results

HC adolescents had comparable interoceptive outcomes relative to published adult norms, consistent with existing literature. Data suggest that adolescents with ARFID have poor heartbeat guessing accuracy and experience challenges deciphering interoceptive signals, possibly contributing to symptoms. While adolescents with AN have greater heartbeat guessing accuracy, they cite difficulty trusting body cues, perhaps contributing to their lack of confidence in interoceptive cue detection.

Conclusions

Preliminary results reflect differences in interoception between the three groups.
Determinants of problem sports betting among college students: moderating roles of betting frequency and impulsive betting tendency
Authors: Shen Yawen
Published: October 2023

Purpose

Given the risk and increased incidence of problem betting for young adults, the purpose of the current study was to understand what influences college students’ problem sports betting behavior using the theory of planned behavior (TPB).

Methods

An institutional-based cross-sectional study was conducted. Data were collected from 311 college students in the U.S. using a survey questionnaire and primarily analyzed using the partial least squares structural equation modeling (PLS-SEM) technique to investigate the relationships between the study variables. In addition, multi-group SEM analyses were conducted to investigate the moderating roles of betting frequency and impulsive betting tendencies regarding sports betting.

Results

The results suggested that college students’ sports betting intentions (SBI) were associated with attitude towards sports betting, motivation to comply with others, and subjective norm, in this order, but not with perceived behavioral control (PBC). Problem sports betting (PSB) was significantly positively related to their SBI and negatively correlated with PBC. In addition, multigroup analyses found the moderating roles of betting frequency and impulsive betting tendency, especially in the relationship between SBI and PSB. The SBI-PSB relationship was stronger with the infrequent/low-betting group and low-impulse betting group, compared to the frequent/high-betting and high-impulse betting group.

Conclusion

Overall, the results highlighted the importance of peer influence and attitude formation concerning sports betting. Recognizing what influences PSB and the roles of habitual and impulse sports betting in this population are recommended in developing proper public health programs to mitigate PSB issues.
Test review: a general academic English summative test
Authors: Liu Yunlong , Cui Yaqiong , Yu Hua
Published: October 2023

Many Chinese universities are implementing an educational reform to transform their general English courses into academic English courses. Accordingly, how to assess students’ English ability should also be reformed. In this test review, we introduce a school-based general academic English summative test developed by English instructors. An argument-based approach was adopted to analyze the test validity by obtaining students’ test data and their reflective responses to the test. This review can provide a practical reference for the development of a valid general academic English summative test by including practices of course instructors and voices of students, two important test stakeholders, in test design.
Outcomes of management of primary benign aggressive or malignant bone tumors around the elbow by limb‐salvage surgery
Authors: Ebeid Walid Atef , Badr Ismail Tawfeek , Mesregah Mohamed Kamal , Hasan Bahaa Zakarya
Published: October 2023

Purpose

Bone tumors around the elbow are rare, with frequently delayed diagnosis. The current study aimed to assess the functional and oncological outcomes of limb salvage surgery for primary benign aggressive or malignant bone tumors around the elbow.

Methods

We conducted a retrospective review of patients with primary aggressive benign and malignant bone tumors around the elbow treated with limb salvage surgery between 1995 and 2020 at a single musculoskeletal oncology center. The minimum follow‐up period was 24 months. Functional results were assessed using the Musculoskeletal Tumor Society (MSTS) scoring system at the last follow‐up visit. Local recurrence, chest metastasis, and complications were recorded.

Results

This study included 30 patients, 19 males and 11 females, with a mean age of 25.4 ± 14.2 years. The tumor location was the distal humerus (n = 21), proximal radius (n = 5), and proximal ulna (n = 4). Reconstruction was done by elbow fusion using fibular graft (n = 10), mobile endoprosthesis (n = 9), excision arthroplasty (n = 7), and extracorporeal freezing and reimplantation (n = 4). The mean follow‐up period was 36.2 ± 21.3 months. The median follow‐up MSTS score was 27 [Interquartile range (IQR): 26–30]. Skeletally immature patients had a significantly higher MSTS score. The rate of postoperative complications was 26.7%.

Conclusion

Limb salvage surgery with different reconstructive options for benign aggressive and malignant bone tumors around the elbow can achieve good functional and oncological outcomes.

Level of evidence

Level IV.
Trends and determinants of anemia in children 6–59 months and women of reproductive age in Chad from 2016 to 2021
Authors: Zavala Eleonor , Adler Sarah , Wabyona Edgar , Ahimbisibwe Martin , Doocy Shannon
Published: October 2023

Background

Hemoglobin assessments in children and women have been conducted annually in Chad since 2016 through the Standardized Monitoring and Assessment of Relief and Transitions (SMART) cross-sectional surveys. This analysis aims to characterize national and sub-national trends in anemia among children under five and women of reproductive age from 2016 to 2021 and to compare risk factors for anemia before and during the COVID-19 pandemic.

Methods

Hemoglobin concentrations were measured in approximately half of the 12,000 to 15,000 included households each year, except for 2020 when hemoglobin tests were omitted. For children 6 to 59 months of age, anemia was defined as hemoglobin less than 11.0 g/dL. Anemia was defined as hemoglobin less than 11.0 g/dL and 12.0 g/dL for pregnant women and non-pregnant women, respectively. Trends were stratified by agroecological zone, and tests of proportions were used to assess statistical significance. Simple and multivariate logistic regression models were conducted for 2019 and 2021 to identify risk factors for anemia.

Results

Reductions in anemia over the 6-year period were significant among women (47.6–30.8%, p = 0.000) and children (68.6–59.6%, p = 0.000). The Sudanian zone had consistently higher rates, particularly in children, compared to the Sahelian and Saharan zones. Significant declines in women’s anemia were observed in all zones from 2019 to 2021, but this global decline was not observed among children, where rates in the Saharan zone significantly increased. In 2019, only minimum dietary diversity significantly reduced the odds of anemia in children (AOR: 0.65, 95%CI: 0.46–0.92), whereas in 2021, improvements in all diet indicators were associated with lower odds of anemia. Improved household socio-economic factors, including head of household literacy, were associated with lower odds of anemia in children (2019 AOR: 0.76, 95%CI: 0.67, 0.88) and women (2019 AOR: 0.75, 95%CI: 0.65, 0.87; 2021 AOR: 0.81, 95%CI: 0.70, 0.93).

Conclusions

Anemia declined significantly in Chad among women of reproductive age and children from 2016 to 2021, but the national prevalence of 60% among children remains unacceptably high. Sub-national differences in anemia rates underline the need to identify and address regional causes of anemia while strengthening national level programs.
GM-CSF augmented the photothermal immunotherapeutic outcome of self-driving gold nanoparticles against a mouse CT-26 colon tumor model
Authors: Dai Jie , Li Jianmei , Zhang Yuqin , Wen Qian , Lu Yun , Fan Yu , Zeng Fancai , Qian Zhiyong , Zhang Yan , Fu Shaozhi
Published: October 2023

Background

Hypoxia is a frequent characteristic observed in solid tumors and is strongly associated with tumor metastasis, angiogenesis, and drug resistance. While the vasculature of hypoxic tumor tissues poses obstacles to the efficient administration of conventional drugs, it may prove advantageous in sustaining hyperthermia. Photothermal therapy (PTT) offers a promising treatment strategy that utilizes the activation of photosensitizers to produce heat, thus facilitating the selective ablation of tumor tissues.

Method

To enhance the accumulation of photothermal agents in tumor tissue and improve the effectiveness of PTT, we developed a self-propelled hybrid called Bif@PAu-NPs. This hybrid consists of polydopamine (PDA)-coated gold nanoparticles (Au-NPs) loaded onto the anaerobic
Bifidobacterium infantis
(Bif).

Results

The Bif@PAu-NPs actively aggregated at the tumor site because the ability of Bif can target hypoxic regions, and PAu-NPs achieved precise PTT due to their high photothermal conversion efficiency (η = 67.8%). The tumor tissues were ablated by PTT, resulting in the release of antigens through immunogenic cell death (ICD), which stimulates an immune response. The inclusion of GM-CSF enhanced the immune response by recruiting dendritic cells and initiating long-term anti-tumor immunity.

Conclusion

The Bif@PAu-NPs hybrid effectively suppressed the growth of both primary tumors and re-challenged tumors. The utilization Bif@PAu-NPs in conjunction with GM-SCF exhibits great potential as a photothermal-immunotherapeutic strategy for precisely treating solid tumors.

Graphical Abstract

In this study, the bacterial Bif@PAu-NPs biohybrid is exploited the self-driving ability of anaerobic Bifidobacterium infantis to deliver polydopamine-modified gold nanoparticles to hypoxic region of tumor. Under irradiation with 808 nm NIR laser, the hybrid exerts precise photothermal therapy to stimulate the immune response, which is further enhanced by GM-CSF, leading to recruitment of dendritic cells and initiation of a long-term anti-tumor immunity remember to prevent tumor recurrence.
Dosimetry of [18F]TRACK, the first PET tracer for imaging of TrkB/C receptors in humans
Authors: Thiel Alexander , Kostikov Alexey , Ahn Hailey , Daoud Youstina , Soucy Jean-Paul , Blinder Stephan , Jaworski Carolin , Wängler Carmen , Wängler Björn , Juengling Freimut , Enger Shirin A. , Schirrmacher Ralf
Published: October 2023

Background

Reduced expression or impaired signalling of tropomyosin receptor kinases (Trk receptors) are found in a vast spectrum of CNS disorders. [18F]TRACK is the first PET radioligand for TrkB/C with proven in vivo brain penetration and on-target specific signal. Here we report dosimetry data for [18F]TRACK in healthy humans. 6 healthy participants (age 22–61 y, 3 female) were scanned on a General Electric Discovery PET/CT 690 scanner. [18F]TRACK was synthesized with high molar activities (Am = 250 ± 75 GBq/µmol), and a dynamic series of 12 whole-body scans were acquired after injection of 129 to 147 MBq of the tracer. Images were reconstructed with standard corrections using the manufacturer’s OSEM algorithm. Tracer concentration time-activity curves (TACs) were obtained using CT-derived volumes-of-interest. Organ-specific doses and the total effective dose were estimated using the Committee on Medical Internal Radiation Dose equation for adults and tabulated Source tissue values (S values).

Results

Average organ absorbed dose was highest for liver and gall bladder with 6.1E−2 (± 1.06E−2) mGy/MBq and 4.6 (± 1.18E−2) mGy/MBq, respectively. Total detriment weighted effective dose EDW was 1.63E−2 ± 1.68E−3 mSv/MBq. Organ-specific TACs indicated predominantly hepatic tracer elimination.

Conclusion

Total and organ-specific effective doses for [18F]TRACK are low and the dosimetry profile is similar to other 18F-labelled radio tracers currently used in clinical settings.
An arachnoid cyst rupture complicated with subdural hygroma in a middle-aged woman: a case report and review of the literature
Authors: Sabooniha Fakhreddin , Baghershahi Ghasem
Published: October 2023

Background

Arachnoid cysts (ACs) account for about 1% of all intracranial mass lesions. The Sylvian fissure is the most common site of ACs which are usually asymptomatic. Traumatic rupture of arachnoid cysts complicated with subdural hygroma is a relatively rare entity in adults especially in females. There is no consensus on their management and each case could add to previous experiences leading to more uniform therapeutic measurements. This case encompasses a combination of watchful strategy, limited surgery and ultimately successful cyst fenestration which highlights a good outcome without complications by adopting a stepwise procedure.

Case presentation

Here, the case of a 51-year-old Persian woman being presented with a 2-month history of a localized headache which had begun 4 days after a minor head trauma. Early brain computed tomography (CT) obtained in another center at 4th day of post-injury which misinterpreted as an old infarct. Repeated CT in our center revealed a large AC of Sylvian fissure complicated with subdural hygroma. Initially a conservative management pursued but due to worsening of the symptoms, a burr-hole craniotomy performed for hygroma evacuation that subsequently followed by cyst fenestration about 1-month later.

Conclusion

Previous awareness about radiographic characteristics of ACs as well as employing appropriate imaging modality are necessary for correct and timely diagnosis of symptomatic patients after minor head trauma because incidentally found ACs might be the underpinning causes of symptoms. Also, following a multistage therapeutic process along with the involvement of patients in decision-making are of paramount importance.
Endovascular coil-embolization of an unruptured, true UAA during early pregnancy- a case report
Authors: Jannusch Kai , Steuwe Andrea , Schimmöller Lars , Dietzel Frederic , Wilms Lena M. , Weiss Daniel , Ziayee Farid , Fehm Tanja Natascha , Schlimgen Charlotte , Poth Vanessa , Ziegler Reinhold Thomas , Minko Peter
Published: October 2023

Background

True uterine artery aneurysms, especially during pregnancy, are a rare entity and not well understood. Clinical symptoms are unspecific pelvic pain and pressure. Diagnosis can be confirmed by transvaginal color-coded-sonography and/or magnetic resonance imaging. Because of potential risk of rupture, immediate interdisciplinary discussion and treatment planning in the best interests of both mother and child is crucial.

Case presentation

We present a 31-year-old pregnant woman with increasing pelvic pain and pressure. Diagnosis of an unruptured uterine artery aneurysm was confirmed by color-coded-sonography and magnetic resonance angiography. After interdisciplinary consultation, successful endovascular super-selective coil-embolization was performed by using X-ray fluoroscopy. Thus, fetal radiation dose during treatment with 4.33 mGy (VirtualDoseTM) was as low as possible with no immediate harm to the fetus.

Conclusions

Unruptured true uterine artery aneurysms can be successfully treated by endovascular super-selective coil-embolization during early pregnancy with no immediate harm to the fetus.
Embolization of pseudoaneurysms in the ureteral branch of the renal artery
Authors: Saiga Atsushi , Aramaki Takeshi , Sato Rui , Asahara Kazuhisa , Goto Hironori
Published: October 2023

Background

Although transcatheter arterial embolization for pseudoaneurysms is already well-established, ureteral artery pseudoaneurysm embolization is extremely rare. The present case shows a successful transcatheter arterial embolization for pseudoaneurysms in the ureteral branch of the renal artery due to ureteral invasion from gastric cancer.

Case presentation

A 57-year-old female presented with gross hematuria after treatments for poorly differentiated gastric adenocarcinoma. A contrast-enhanced computed tomography revealed pseudoaneurysms around the right ureter with a massive hematoma in the right ureter and bladder. The diagnosis was ureteral branch pseudoaneurysms resulting from possible retroperitoneal invasion due to pelvic lymph node metastasis of gastric cancer. Transcatheter arterial embolization was performed using gelatin particles, successfully controlling her hematuria without complications.

Conclusions

Ureteral branch artery embolization, although extremely rare, may be an effective and safe treatment option.
Financial burden in the form of medical and non-medical out-of-pocket expenses on the family of children admitted to a pediatric intensive care unit in India
Authors: Jagtap Varun Ravindra , Save Sushma , Unki Praveen
Published: October 2023

Background

Pediatric intensive care unit (PICU) admissions can have significant repercussions on families, including financial burdens and psychological distress. Not only do they face the overwhelming concern for their child’s health and well-being, but they are also confronted with a range of practical and financial difficulties. Coping strategies play a vital role in mitigating the negative impact of PICU admissions on families. Various coping mechanisms, such as seeking social support, engaging in problem-solving, and utilizing emotional regulation techniques, can help families navigate the challenges they face. The objectives of the study are to understand the array of financial implications in the form of out-of-pocket expenses (OOPE) and to quantify with a better understanding of the composition of out-of-pocket expenses in the form of medical and non-medical expenses. It also aimed to determine the loss of productive hours in a family and to understand the burden of OOPE in relation to the income of the family.

Methods

This prospective observational study was conducted in the pediatric intensive care unit (PICU) of a tertiary care hospital over a period of 6 months after obtaining permission from the institutional ethics committee. Data pertaining to financial burden was collected with the help of Structured questionnaires which included the following categories travel, meals, accommodation, and incidental expenses were considered as non-medical expenses while all medicine costs and investigations were considered as medical expenses. The quantitative data were presented as the means ± SD as median with 25th and 75th percentiles (interquartile range) and were analyzed using ANOVA (for more than two groups) and independent t test (for two groups).

Results

More than half of the children (39(55.71%)) were not enrolled under any government scheme. The mean value of total medical and non-medical costs was 2525 ± 4035.28 and 2234.29 ± 846.84 Indian rupees. The mean value of total out-of-pocket expenses incurred per day (Indian rupees) on day 1, day 2, day 3, day 4, and day 5 were 1304 ± 587.2, 1208.86 ± 3773.84, 814.57 ± 565.03, 807.71 ± 522.76, and 699.86 ± 807.02 respectively.

Conclusion

Families of children admitted to the pediatric intensive care unit incurred catastrophic health expenditure with the cost of medicine contributing a major share. The lowest income brackets had much higher, more than twice the financial burden compared to the higher income group. Almost all families experienced a high loss of productivity in the form of a number of days lost due to the PICU admission of a child. Enrolment in government schemes helped to reduce OOPEs though better coverage of these schemes is needed.
The role of beta-blocker drugs in critically ill patients: a SIAARTI expert consensus statement
Authors: Guarracino Fabio , Cortegiani Andrea , Antonelli Massimo , Behr Astrid , Biancofiore Giandomenico , Del Gaudio Alfredo , Forfori Francesco , Galdieri Nicola , Grasselli Giacomo , Paternoster Gianluca , Rocco Monica , Romagnoli Stefano , Sardo Salvatore , Treskatsch Sascha , Tripodi Vincenzo Francesco , Tritapepe Luigi
Published: October 2023

Background

The role of β-blockers in the critically ill has been studied, and data on the protective effects of these drugs on critically ill patients have been repeatedly reported in the literature over the last two decades. However, consensus and guidelines by scientific societies on the use of β-blockers in critically ill patients are still lacking.

The purpose of this document is to support the clinical decision-making process regarding the use of β-blockers in critically ill patients. The recipients of this document are physicians, nurses, healthcare personnel, and other professionals involved in the patient’s care process.

Methods

The Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) selected a panel of experts and asked them to define key aspects underlying the use of β-blockers in critically ill adult patients. The methodology followed by the experts during this process was in line with principles of modified Delphi and RAND-UCLA methods. The experts developed statements and supportive rationales in the form of informative text. The overall list of statements was subjected to blind votes for consensus.

Results

The literature search suggests that adrenergic stress and increased heart rate in critically ill patients are associated with organ dysfunction and increased mortality. Heart rate control thus seems to be critical in the management of the critically ill patient, requiring careful clinical evaluation aimed at both the differential diagnosis to treat secondary tachycardia and the treatment of rhythm disturbance. In addition, the use of β-blockers for the treatment of persistent tachycardia may be considered in patients with septic shock once hypovolemia has been ruled out. Intravenous application should be the preferred route of administration.

Conclusion

β-blockers protective effects in critically ill patients have been repeatedly reported in the literature. Their use in the acute treatment of increased heart rate requires understanding of the pathophysiology and careful differential diagnosis, as all causes of tachycardia should be ruled out and addressed first.
Mapuche Anticolonial Politics and Chile's Social Uprising
Authors: Aedo Angel , Bernasconi Oriana , Martínez Damián Omar , Olivari Alicia , Pairican Fernando , Porma Juan
Published: October 2023

This essay examines milestones in the life history of one subject, Mauricio Lepin, and his involvement in the Chilean social uprising. By exploring the encounter of his trajectory with the uprising, the essay reveals under-explored dimensions of the anticolonial character of this critical event in Chile's history of the present. Lepin's case shows the entanglement of a long history of dispossession and resistance of the Mapuche people with a biographical story of social marginalization, political exclusion, and economic precariousness, shared with large majorities of Mapuche and non-Mapuche youth. It concludes by analyzing how, through the uprising, Lepin appears before himself as an actor among a multitude in struggle by putting into action the plural right to appear and the self-determination of a sovereign people.
Shadow Labor in Care Services: Why Do South Korean Women Care Workers Work Such Long Hours and Get Paid So Little?
Authors: Lee Joohee
Published: October 2023

Korea is a country with extremely long working hours and severe gender inequality in the labor market. Based on twenty-nine in-depth interviews with Korean women care workers, this study investigates key mechanisms that reproduce unpaid and unrecognized shadow labor in paid care services. Accordingly, it argues that the presumption that it is mostly Korean men who suffer from working long hours is incorrect. Women workers work long hours, and they often do so without compensation for overtime. They also engage in labor that is not included in their original job description. The Korean labor market supplies an unlimited number of women for cheap labor in the care service sector, meaning the government can depend heavily on private organizations and businesses to meet increasing care needs among the population. Because women care workers could not specify an employer who is responsible for their wages and working conditions, they could not see themselves as employees with basic labor rights. Instead, they take the familiar roles of dutiful daughters and caring mothers, consenting to the very situation that makes them susceptible to severe wage penalties and unrecognized and unappreciated long working hours.
Education, Employment, Family Formation Behaviors, and the Gender Health Gap: A Cross-National Comparison of Korea, the United States, and Finland
Authors: Woo Hyeyoung , Wilkinson Lindsey , Yoon Soo-Yeon
Published: October 2023

Despite improvements in the social status of women in recent decades, women still tend to report lower levels of health compared to men. This study examines the role of individual factors (i.e., education, employment, and family formation behaviors) and aggregate factors (i.e., gender context, work cultures, and work-family policy) in the association between gender and health using the cases of Korea, the United States, and Finland. The study’s results indicate that women experience lower levels of health than men in Korea and the United States, especially among younger adults, even after accounting for education, employment, and family status. In Finland, however, women do not have lower levels of health than men. Moreover, among older individuals, Finnish women exhibit a health advantage relative to Finnish men. The findings indicate that traditional gender role expectations, long hours at work, and inadequate work-family balance largely account for gender disparities in health in Korea and the United States. Gender egalitarianism at work, reduced work hours, and more family friendly work policies should help reduce such disparities.
The lymphatic system favours survival of a unique T. brucei population
Authors: Machado Henrique , Temudo António , Niz Mariana De
Published: October 2023

Trypanosoma brucei colonise and multiply in the blood vasculature, as well as in various organs of the host's body. Lymph nodes have been previously shown to harbour large numbers of parasites, and the lymphatic system has been proposed as a key site that allows T. brucei distribution through, and colonization of the mammalian body. However, visualization of host-pathogen interactions in the lymphatic system has never captured dynamic events with high spatial and temporal resolution throughout infection. In our work, we used a mixture of tools including intravital microscopy and ex vivo imaging to study T. brucei distribution in 20 sets of lymph nodes. We demonstrate that lymph node colonization by T. brucei is different across lymph node sets, with the most heavily colonised being the draining lymph nodes of main tissue reservoirs: the gonadal white adipose tissue and pancreas. Moreover, we show that the lymphatic vasculature is a pivotal site for parasite dispersal, and altering this colonization by blocking LYVE-1 is detrimental for parasite survival. Additionally, parasites within the lymphatic vasculature have unique morphological and behavioural characteristics, different to those found in the blood, demonstrating that across both types of vasculature, these environments are physically separated. Finally, we demonstrate that the lymph nodes and the lymphatic vasculature undergo significant alterations during T. brucei infection, resulting in oedema throughout the host's body.
Quantitative assessment of condylar bone resorption using fused CBCT images: differentiating and diagnosing three distinct groups based on volume and thickness decrease
Authors: Feng Ji-ling , Ma Ruo-han , Sun Li-li , Zhao Jun-ru , Zhao Yan-ping , Li Gang
Published: October 2023

Objectives

To investigate the accuracy of fused CBCT images in diagnosing three distinct groups of bone changes characterized by volume and thickness decrease in patients with temporomandibular joint osteoarthrosis (TMJ OA) during follow-up.

Methods

In this retrospective study, 109 patients (176 TMJs) with TMJ OA were included. Two consecutive CBCT images for the same patient were registered and fused. Then, three image sets were established: without fusion, fused 2D image, and fused 3D image. Three residents randomly and independently evaluated whether there was condylar resorption with the three image sets respectively. The samples diagnosed as condylar resorption by the expert panel were divided into three subgroups according to the volume and thickness decrease calculated after segmentation. The inter- and intraobserver agreement, receiver operating characteristic (ROC), and area under the curve (AUC) evaluated the diagnostic capability for different subgroups.

Results

For the volume decrease more than 50 mm3 and thickness decrease more than 1 mm groups, the AUC values for fused image sets were higher than those without fusion (p < 0.01). For the volume decrease within 50 mm3 and thickness decrease within 1 mm groups, the AUC values for fused 2D image sets were higher than the image sets without fusion (p < 0.05), but there was no significant difference between the fused 3D image sets and the image sets without fusion (p = 0.48 for volume decrease, p = 0.37 for thickness decrease).

Conclusions

The fused images can improve the diagnostic accuracy and repeatability for the samples with at least 50 mm3 volume decrease or 1 mm thickness decrease compared with the image groups without fusion.
A Method for Predicting Termite Damage in Wooden Cultural Properties Using a Machine Learning Model
Authors: Kim Young Hee , Kim Hyungyoug , Park Ji Hee , Kim Soo Ji , Jo Chang Wook , Lee Jeong Min
Published: October 2023

In this study, a machine learning model was established using termite damage and meteorological data on wooden cultural properties, and the prediction performance was evaluated. The data were divided into termite damage data, the location of wooden cultural properties, and meteorological data. Three observatories were searched based on the location of the wooden cultural properties, and meteorological data for about 8 years from 2010 to 2018 were combined to make a total of 491 data sets. As a result, it was confirmed that the value of small evaporation as a meteorological factor that directly affects termite damage is the time series independent variable that best explains the model, and showed an accuracy of 72.8% when the Linear SVM algorithm model was used. The value of small evaporation is the synoptic meteorological data of the Korea Meteorological Administration, and it is collected only at specific stations, not meteorological factors observed at all stations. Therefore, It is difficult to obtain enough data to make a predictive model. Since machine learning models can improve accuracy when the number of data is sufficient, prediction performance can be improved if more termite damage data and the value of small evaporation are obtained.
Case Report: Case report: An unusual presentation of granulomatosis with polyangiitis
Authors: Bannour Ichrak , Ben Brahim Maroi , Arfa Sondes , Amor Soumaya ben , Ben Mabrouk Asma , Berrich Olfa , Hammemi Sonia
Published: October 2023

Aim: We are reporting a case of an unusual presentation of granulomatosis with polyangiitis (GPA) with liver involvement. Case presentation: A 45-year-old male patient presented with erythematous plaques on the face and bilateral nasal obstruction. On physical examination, the patient had a ring-shaped squamous plaque on the face. The laboratory findings revealed an accelerated erythrocyte sedimentation rate at 100 mm/h, an elevated C-reactive protein at 66 mg/L, hyper gamma globulinemia 16 g/L and an elevated alkaline phosphatase (twice the upper normal limit). The craniofacial and thoracoabdominal computed tomography (CT) -scans showed ethmoid and maxillary sinusitis, low facial bone density, multiple mediastinal and hilar lymphadenopathy, diffuse small pulmonary nodules, and hepatomegaly. A cutaneous lesion biopsy, the nasal mucosa, and the liver showed a chronic inflammatory granulomatosis process with necrosis. Serum anti-neutrophil cytoplasmic antibody (ANCA) against PR3 was positive. The clinical, biological, radiological, and histological findings substantiated the diagnosis of GPA. The patient received systemic steroids combined with cyclophosphamide pulses on days 1, 14 and 28 and then he was lost to follow-up. Two-years later, he presented with a cardiac failure and skin ulcer in the right lower limb. A nasal endoscopic exam showed nasal septum cartilage perforation with resorption of the middle and inferior nasal concha. Two weeks later, he developed a diffuse alveolar hemorrhage and was therefore transferred to the intensive care unit but died of respiratory failure 3 days later. Conclusion: Clinicians should be aware of GPA atypical clinical manifestations.