bluuebunny/crossref_metadata_2025 huggingface dataset:
Reducing the burden of travel and environmental impact through decentralization of cancer care
Authors: Fattore Giovanni , Bobini Michela , Meda Francesca , Pongiglione Benedetta , Baldino Luca , Gandolfi Stefano , Confalonieri Licia , Proietto Manuela , Vecchia Stefano , Cavanna Luigi
Published: February 2024

Life expectancy, quality of life and satisfaction of oncologic patients highly depend on access to adequate specialized services, that consider their conditions in a holistic way. The present study aims to evaluate the introduction of oncology services in an outpatient setting in a mountain village in Northern Italy. The initiative is evaluated using the three pillars of sustainability (social, economic and environmental) as dimensions that are often overlooked by healthcare policy makers. Using micro data on 18,625 interventions, we estimate the number of kilometers saved by patients (reduction of “travel burden” as indicator of social sustainability), the additional travel costs for the NHS (indicator of economic sustainability) and the implied reduction of CO2 emissions (indicator of environmental sustainability). Over the period July 2016–2021, the decentralized health center delivered 2,292 interventions saving 218,566 km for a corresponding value of €131,140. The additional costs for the NHS was €26,152. The reduction of CO2 emissions was 32.37 Tons (€5,989). Overall, the socio-economic benefit of reducing travel of care for the patients residing in this remote valley was €110,976. This study adds original understanding of the benefits of decentralizing oncologic care and shows its operational feasibility conditions. Given the modest number of similar projects, it provides evidence to policy makers and, especially, managers who are faced with the challenge to implement the decentralization of specialized services.
State of the Regional Integration Within South Asian Association for Regional Organisation (SAARC): Assessment of India’s Leadership
Authors: Aryal Saroj Kumar , Bharti Simant Shankar
Published: February 2024

South Asia is one of the least integrated regions in terms of trade and people-to-people contact. With the goal of promoting regionalism, the South Asian Association for Regional Cooperation (SAARC) was founded in 1985 and now has eight South Asian countries as a member (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka). India alone controls more than 80% of all variables, including economy, size, and population. Thus, the entire regional integration of South Asia has been and will continue to be dependent on India’s intentions regarding SAARC. As a result of several bilateral disagreements between the organisation’s member states, the SAARC has been dubbed a dysfunctional, talk-shop, and dead organisation. Having said that, this article aims to investigate the role of India as a regional leader as well as its intention and approach towards South Asian integration. Similarly, this document also assesses the effect of India’s leadership on the regional integration of South Asia. This article is based on the qualitative method of research and thus uses discourse analysis as the main methodology. As primary sources, discourse analyses in international relations often examine official speeches, declarations, legislative debates, diplomatic documents, interviews, newspapers, and editorials. Other scholarly works, novels, and conceptual histories can be analysed in addition to these.
Training Concerns of Micro-influencers on Advertising and Marketing
Authors: Fernández-Gómez Erika , Feijoo Beatriz , Morante Bonet Miriam
Published: February 2024

Influencers have emerged as influential figures un bridging the gap between brands and consumers, establishing this practice as a viable profession in advertising. Among the diverse spectrum of influencers, micro-influencers, characterized by their follower count of less than 100,000, excel in fostering engagement due to their perceived authenticity and credibility. This study surveyed 290 micro-influencers regarding their educational needs and aspirations. The findings reveal that, despite possessing university degrees, micro-influencers often lack specialized training in digital content creation. Many express a strong desire to receive formal education at the university level to enhance their professionalism, with degrees in marketing or advertising being deemed particularly relevant. However, they encounter significant obstacles, primarily related to financial constraints and time availability. Consequently, universities face the imperative challenge of contributing to the professionalization of micro-influencers, a role that has traditionally been assumed by the industry.
Internal consistency reliability of the Revised Illness Perceptions Questionnaire: A systematic review and reliability generalization meta-analysis
Authors: Rivera Eleanor , Levoy Kristin , Park Chang , Villalobos Azucena , Martin Paige , Jung Kim Min , Hirschman Karen B
Published: February 2024

The Revised Illness Perception Questionnaire (IPQ-R) assesses patients’ perspectives of their illnesses. Original psychometric testing occurred in limited populations. The purpose of this reliability generalization meta-analysis was to: (1) estimate internal consistency reliability of each IPQ-R subscale, and (2) test moderators of these estimates. Web of Science was searched in July 2022 for articles citing the original IPQ-R paper that reported IPQ-R reliability data. Cronbach’s alphas (⍺) were pooled for each IPQ-R subscale using inverse variance weighting and DerSimonian and Laird estimation. Sixty-six studies met criteria. Overall pooled ⍺ estimates were acceptable: 0.71–0.87. Treatment control reliability was reduced among cardiac (⍺ = 0.68), diabetes/kidney disease (⍺ = 0.63), and mixed/other (⍺ = 0.66) samples; cyclical reliability was reduced in cancer (⍺ = 0.65) samples. Age, gender, and race were also significant moderators. Subscale reliability varied based on sample characteristics. Adapting IPQ-R subscales to account for sample variation could improve measurement of illness perception constructs.
Examining sense of purpose and conscientiousness as unique correlates of health: A bifactor examination
Authors: Hill Patrick L , Olaru Gabriel , Allemand Mathias
Published: February 2024

Conscientiousness and sense of purpose consistently predict health, wellbeing, and health behavior. However, it remains an open question whether they are unique or overlapping predictors of health and wellbeing. The current study considered this question using the MOSAiCH study, a nationally representative sample of 2305 Swiss adults ( M: 52.33 years old; SD = 17.36). Participants reported on sense of purpose and conscientiousness, in addition to multiple health, wellbeing, and health behavior indicators (e.g. dietary practices, activity engagement, health conditions, psychological concerns, and doctor visits). Results found conscientiousness and sense of purpose were moderately associated with multiple health, wellbeing, and health behavior indicators. Bifactor modeling was employed to test the incremental validity of conscientiousness and sense of purpose, when accounting for their shared variance. The specific factor for purpose predicted outcomes even when accounting for conscientiousness. However, conscientiousness had little incremental validity over the general factor.
Does language shape the way we think? A review of the foreign language effect across domains
Authors: Purpuri Silvia , Vasta Nicola , Filippi Roberto , Wei Li , Mulatti Claudio
Published: February 2024

Purpose and research question:

This review investigates the influence of the foreign language effect (FLE) on moral decision-making, risk aversion, and causality perception. Recent research indicates that bilinguals employ different decision-making strategies according to the language in use (first vs. second language).

Methodology:

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, we conducted a comprehensive literature review. Our analysis focused on empirical studies, yielding 28 articles that met our inclusion criteria.

Findings and conclusions:

Our findings reveal that participants, when operating in a foreign language context, are more inclined to accept harm for improved outcomes, exhibit reduced risk aversion, and display moderated causal perceptions, particularly in emotionally charged contexts. The variability in study conclusions can be attributed to factors such as age, personality, language proficiency, and linguistic characteristics.

Significance:

Our results support previous findings in the FLE, highlight limitations, and provide suggestions for future research.
The quality, suitability, and readability of web-based resources on endometriosis-associated dyspareunia: A systematic review
Authors: Abdulai Abdul-Fatawu , Howard A.Fuchsia , Parmar Gurkiran , Noga Heather , Abdul- Ghafoor Abdul Aziz , Lisonek Michelle , Yong Paul J
Published: February 2024

People commonly and increasingly rely on the internet to search for health information, including those related to endometriosis-associated dyspareunia. Yet the content of such websites may be of variable accuracy and quality. This review aims to evaluate the quality, readability, and suitability of web-based resources on endometriosis-associated dyspareunia for patients. We searched 3 databases – Google, Bing, and Yahoo – to identify websites related to endometriosis-associated dyspareunia. Two independent reviewers screened the search results against inclusion and exclusion criteria. Another set of two reviewers evaluated the selected websites using validated measurement instruments. Out of 450 websites, 21 met the inclusion criteria and were evaluated. More than half of the websites had information on content updates, reported on authorship, or disclosed sponsorship information. The mean quality and suitability scores were 47.5 (SD = 13.3) and 65.2 (SD = 13.6) respectively, thus suggesting generally adequate quality and suitability levels. However, the mean readability scores exceeded the recommended level for health-related websites. The poor readability of the websites might limit accessibility for a significant proportion of patients with low educational levels. The findings of this review have implications for designing high-quality, readable and up-to-date web interventions for people who rely on web platforms as an alternative or complementary source of health information on dyspareunia.
Insisting on not being addressed in that way: Ideology, subjection and agency in the context of spatial planning
Authors: Schröder Sabrina , Leibenath Markus
Published: February 2024

As planning systems in many countries have faced growing pressure over recent years, this has turned the spotlight on ethical aspects of planning, in particular the roles and identities of planners. Here the notions of ideology and subjection have served as important theoretical resources. However, these lines of thought have rarely been integrated, meaning that most studies on ideology have remained at a macro level of analysis. In response to this lacuna, the present paper uses Althusser’s concept of ideology and Butler’s concept of recognition to examine how planners perceive the scope and limits of their actions. From an ideology- and subjection-theoretical perspective, we analyse excerpts from narrative interviews conducted as part of a research project on the subjection of regional planners in Germany. Specifically, we focus on calls for public participation, using these as a basis to discuss planners’ scope of action and to identify three forms of “insisting on not being addressed in that way” (Judith Butler) at the micro level. They illustrate that interpellation and subjection are not linear, straightforward phenomena, but offer many possibilities for misrecognition or subtle forms of counter-action that could be explored more fully in future empirical research.
Characterization and depth detection of internal delamination defects in CFRP based on line laser scanning infrared thermography
Authors: Zhou Guangyu , Zhang Zhijie , Yin Wuliang , Chen Haoze , Wang Luxiang , Wang Dong , Ma Huidong
Published: February 2024

In this article, the shape characterization and depth detection of delamination defects in carbon fiber reinforced polymer (CFRP) sandwich are achieved by detecting delamination defects through line laser infrared thermography. In terms of defect shape characterization, the temperature matrix difference imaging method is proposed to characterize the shape of internal defects, and the defect shape distortion is corrected by the principal component analysis algorithm to optimize the effect of defect shape characterization. In terms of defect depth detection, this study constructs a dataset of cooling curves for defects of different depths and builds an encoder–decoder convolutional neural network structure based on the attention mechanism, which is centered on a streamlined encoder–decoder structure as well as a highly integrated attention gate, which is capable of accelerating the extraction of features and reducing the number of iterations of the algorithm. The results demonstrate that we achieved an average classification accuracy of 88.9% for defects with a depth gradient difference of 0.2 mm, attaining the highest classification accuracy of 95% for a single defect. Furthermore, our approach outperformed several classical classifiers by achieving superior accuracy with fewer iterations. The experimental results demonstrate that the line laser scanning inspection method is effective in the task of detecting internal defects in CFRP materials.
Relationship between dust allergen sensitization and cardiac autonomic function in patients with chronic obstructive pulmonary disease
Authors: Zeng Meie , Ye Shuifen , Huang Wanling , Deng Weiwei , Zou Simin , Huang Chunmei , Qiu Hanzhong
Published: February 2024

Objective

Cardiac autonomic function predicts cardiovascular disease risk. The aim of this study was to investigate the relationship between sensitization to dust allergens and cardiac autonomic dysfunction in patients with chronic obstructive pulmonary disease (COPD), and to provide new ideas for the prevention of cardiovascular complications in these patients.

Methods

Immunoassays for sensitization to cats/dogs, cockroaches and dust mites were performed in 840 patients with COPD. Indicators of heart rate variability in these patients were used to assess cardiac autonomic function, including standard deviation of normal-to-normal intervals (SDNN), root-mean square of successive differences between normal-to-normal intervals (RMSSD), low-frequency power (LF), high-frequency power (HF), and LF/HF ratios, which were obtained based on ambulatory electrocardiographic monitoring data. The relationship between sensitization to these dust allergens and heart rate variability was explored using multivariate logistic regression.

Findings

The multivariate analyses showed that sensitization to total allergens was associated with reduced levels of SDNN, RMSSD, LF and HF and with increased levels of the LF/HF ratio in the patients with COPD ( p < .05).

Conclusion

Dust allergen sensitization may be associated with cardiac autonomic dysfunction in patients with COPD. Whether desensitization can prevent cardiovascular complications in these patients should be further explored.
Basal thumb arthritis surgery: complications and its management
Authors: Herren Daniel B.
Published: February 2024

The management of complications after surgery for basal thumb arthritis is sometimes challenging, and there are no clear recommendations on how to evaluate and manage patients with residual symptoms. The aim of the present article was to review the most common complications after surgery for basal thumb arthritis, with an emphasis on resection arthroplasty, joint replacement and joint fusion. In addition, possible management strategies for the different types of complications will be highlighted.
Readmission Rates Among Acute Reperfusion Treatment Modalities for Patients With Ischemic Stroke
Authors: Arevalo C Yurany A. , Nanavati Hely D. , Lin Chen
Published: February 2024

Background and purpose

Understanding various aspects associated with readmission after acute ischemic stroke (AIS) is an important priority. Our study aims to examine whether 60-day readmission rates differed among patients with AIS who were treated with different acute reperfusion treatment modalities along with associated clinical factors.

Methods

This is a retrospective analysis of a continuous cohort of patient with AIS, who received either intravenous recombinant tissue plasminogen activator (IV rtPA), endovascular treatment (EVT) or both, and were discharged alive. Patients readmitted within 60 days were identified as the readmission group. Multivariable logistic regression was used to identify all-cause readmission post-stroke between treatment groups.

Results

The final cohort comprised of 358 patients with AIS receiving IV rtPA only (N = 160), EVT only (N = 106), or both (N = 92). Fifty-six patients were readmitted to the hospital within 60-day follow-up period. The adjusted logistic regression model indicated that compared to patients who received IV tPA only, patients receiving both IV rtPA and EVT had significantly lower odds (OR = .27; 95% CI = .10, .75)) of getting readmitted within 60-day post-discharge from stroke admission.

Conclusion

In this sample of AIS hospitalizations, treatment-type was positively associated with 60-day readmission. Future studies are necessary to understand whether treatment-related adverse events, and readmission are avoidable.
Empowered and engaged: Group exercise for adolescent depression – perspectives from adolescents, parents and healthcare professionals
Authors: Mortazavi Rebecca , Andersson Rebecca , Jarbin Håkan , Larsson Ingrid
Published: February 2024

Objectives:

Depression is increasing and is a leading cause of disease burden among adolescents. Available evidence-based treatments with medication or psychotherapy have modest effects. Aerobic exercise is a hopeful alternative as an augmenter or a stand-alone treatment. Qualitative studies have shown that participants in group exercise for adolescent depression experienced improved mood and a sense of achievement, commitment and empowerment. This study aimed to explore not only adolescents’ but also parents’ and healthcare professionals’ experiences of a group exercise intervention for adolescents with depression.

Methods:

Nine adolescents who had participated in a group aerobic exercise intervention for 12 weeks, eight parents and two healthcare professionals were interviewed. We used a latent qualitative content analysis with an inductive approach that resulted in nine sub-categories, three categories and an overarching theme.

Results:

The experiences of a group exercise intervention for adolescents with depression were expressed in the overarching theme ‘Group exercise for adolescent depression promotes empowerment and engagement in everyday life’, based on three categories: exercise alleviates depressive symptoms, exercise contributes to balance in life and exercise promotes self-esteem. However, there was variation in our results, in that not all participants experienced improvements from exercising. Adolescents described more varied experiences, while parents and healthcare professionals mainly expressed positive views.

Conclusions:

Our findings suggest that group exercise for adolescent depression promotes empowerment and engagement in everyday life, according to adolescents, and more clearly so according to parents and healthcare professionals.
Biofilms and Biodeterioration: The Case of an Ancient Indian Monument
Authors: Sachdeva Saloni , Srivastava Priyansh , Alam Nawaz , Sarethy Indira P.
Published: February 2024

Historical buildings are substantially built with sedimentary rocks, especially limestone, and form an important component of a country’s cultural heritage. The monuments are exposed to external environmental forces (humidity and temperature) that facilitate the proliferation of microorganisms and biofilms in an ecological succession. Feroz Shah Kotla is an ancient monument in Delhi, India, dating back to 1354 ad, and constructed of limestone, and with a discoloured façade now. The main objective of the present study was to characterise the biofilm present in areas of monuments exposed to sun and shaded areas, as influenced by two seasons—winter and monsoon (rainy), in terms of moisture, chlorophyll, protein and exopolysaccharide (EPS) as a function of carbohydrate concentration. The moisture, protein and EPS contents were higher in samples obtained from sun-exposed areas of rainy season samples and least in shaded areas of winter samples, while the chlorophyll content was highest in sun-exposed winter samples. The ICP-MS analysis showed that Ca concentration was highest (15,967.92 µg−1). Scanned electron microscope images show the presence of coccoid, bacillus and filamentous forms of microorganisms, and sparser in the dry season. The results of the present study provide significant clues that the deterioration of such ancient monuments is correlated to the establishment and continued presence of biofilms which eventually weaken and corrode the surface; appropriate conservation actions can be congruent in targeting biofilms successfully.
West Asia and North Africa: A Sustainability Analysis
Authors: Agarwal Manmohan
Published: February 2024

The concept of sustainability can be analyzed from different viewpoints, including sustaining a high rate without which other goals of a “good life,” particularly the Sustainable Development Goals (SDGs), are not achievable. Alternatively, the need for reduction in greenhouse gas (GHG) emissions is employed to assess sustainability. This essay discusses economic progress in West Asia and North Africa (WANA) relative to other developing regions, its success in achieving the Millennium Development Goals (MDGs), and progress toward achieving the SDGs before discussing the region’s emissions of GHGs and CO2. The WANA region has performed relatively poorly economically and its performance has deteriorated since 2008, and the oil countries perform worse than nonoil ones. Low investment rates and worsening external balance bedevil its economic prospects. Prospects for the region achieving the SDGs are much worse than other regions and have become bleaker since COVID-19. The region is a relatively high emitter of GHGs.
Impaired T cells and “memory-like” NK-cell reconstitution is linked to late-onset HCMV reactivation after letermovir cessation
Authors: Lauruschkat Chris David , Muchsin Ihsan , Rein Alice Felicitas , Erhard Florian , Grathwohl Denise , Dölken Lars , Köchel Carolin , Nehmer Anne , Falk Christine Susanne , Grigoleit Götz Ulrich , Einsele Hermann , Wurster Sebastian , Kraus Sabrina
Published: February 2024

Allogeneic hematopoietic stem cell transplantation (alloSCT) is the only cure for many hematologic malignancies. However, alloSCT recipients are susceptible to opportunistic pathogens, such as human cytomegalovirus (HCMV). Letermovir prophylaxis has revolutionized HCMV management, but the challenge of late HCMV reactivations has emerged. Immunological surrogates of clinically significant HCMV infection (csCMVi) after discontinuation of letermovir remain to be defined. Therefore, we studied natural killer (NK)-cell reconstitution along with the global and HCMV pp65-specific T-cell repertoire of 24 alloSCT recipients at 7 time points before (day +90) and after (days +120-270) cessation of letermovir prophylaxis. Patients who experienced csCMVi had lower counts of IFN-γ+ HCMV–specific CD4+ and CD8+ T cells than HCMV controllers. Furthermore, patients with csCMVi displayed late impairment of NK-cell reconstitution, especially suppression of “memory-like” CD159c+CD56dim NK-cell counts that preceded csCMVi events in most patients. Moreover, several surrogates of immune reconstitution were associated with the severity of HCMV manifestation, with patients suffering from HCMV end-organ disease and/or refractory HCMV infection harboring least HCMV–specific T cells and “memory-like” NK cells. Altogether, our findings establish an association of delayed or insufficient proliferation of both HCMV–specific T cells and “memory-like” NK cells with csCMVi and the severity of HCMV manifestations after discontinuation of letermovir prophylaxis.
Identification and analysis of key circRNAs in the mouse embryonic ovary provides insight into primordial follicle development
Authors: Wang Xiangyan , Zhang Yan , Yu Jianjie , Ma Yabo , Xu Yaxiu , Shi Jiaqi , Qi Zhipeng , Liu Xinfeng
Published: February 2024

Background

CircRNAs are a class of noncoding RNAs with tissue- and development-specific expression characteristics. In many mammals, primordial follicle development begins in the embryonic stage. However, the study of circRNAs in primordial follicle development in mice has not been reported.

Results

In this study, ovaries were collected from mouse foetuses at 15.5 days post coitus (dpc) and 17.5 dpc, which are two key stages of primordial follicle development. A total of 4785 circRNAs were obtained by using RNA-seq. Of these, 83 differentially expressed circRNAs were identified. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses showed that these differential circRNAs were mainly involved in the regulation of reproductive development. Through qRT-PCR, back-splice sequence detection and enzyme digestion protection experiments, we found that circ-009346, circ-014674, circ-017054 and circ-008296 were indeed circular. Furthermore, circ-009346, circ-014674 and circ-017054 were identified as three key circRNAs by analysing their expression in the ovaries of mice at different developmental stages. The circRNA-miRNA-mRNA interaction network was constructed and validated for target miRNA and mRNA using qRT-PCR. The interacting genes circ-009346, circ-014674, and circ-017054 were subjected to KEGG enrichment analysis. We found that circ-014674 may participate in the assembly and reserve of primordial follicles through oestrogen and the Janus kinase (JAK) signal transducer and activator of transcription (STAT) signalling pathway (JAK-SATA). Circ-009346 and circ-017054 may have similar functions and are involved in the activation and growth of primordial follicles through the mitogen-activated protein kinase (MAPK) and phosphoinositide 3-kinase (PI3K) signalling pathways.

Conclusions

Based on our findings, three circRNAs associated with primordial follicle development were identified, and their potential mechanisms of regulating primordial follicle development were revealed. These findings will help us better understand the molecular mechanism of circRNAs in primordial follicles and provide important references and targets for the development of primordial follicles.
Genetic parameter changes and age−age correlations in Pinus koraiensis growth over 40-year progeny testing
Authors: Lee Kyungmi , Oh Changyoung , Kim In Sik
Published: February 2024

Background

Early selection in tree breeding could be achieved by addressing the longevity of tree improvement activities. Genetic parameter changes and age–age correlations are essential for determining the optimal timing of early selection. Practical tracking of genetic parameters of Pinus koraiensis, a major timber species with economic and ecological value, has become feasible as its progeny testing has entered the mid-term age in Korea. However, research on the age−age correlation of P. koraiensis as progeny trials approach rotation age is limited. This study aimed to investigate genetic parameter trends and age−age correlations in P. koraiensis progeny. P. koraiensis progeny were assessed at two sites using a linear mixed-effects model with two-dimensional spatial autoregressive structure. Height, diameter, and volume growth were measured in 11 assessments over 40 years.

Results

Genetic parameters, such as height and diameter, showed different patterns of change. The heritability ranged for the three growth traits in 0.083–0.710, 0.288–0.781, and 0.299–0.755 across the sites and age. Height heritability and its coefficient of variance decreased, whereas the diameter and volume estimates remained relatively constant. Correlations with Age 40 for phenotypic, genetic, and rank of breeding values ranged between 0.16 and 0.92, 0.594 and 0.988, and 0.412 and 0.965, respectively. These correlations generally increased as the age approached Age 40, with particularly high levels observed at Age 26 and Age 30.

Conclusion

The observed genetic trends in P. koraiensis progeny testing offer valuable insights for early and precise selection. Notably, selecting superior genotypes at Ages 26–30 is supported by discernible genetic gains and robust correlations. Future research should integrate unbalanced data for selecting mother trees or families and conduct a comprehensive economic analysis of early selection to validate its practical benefits.
Exploration of neuron heterogeneity in human heart failure with dilated cardiomyopathy through single-cell RNA sequencing analysis
Authors: Cui Yu-Hui , Wu Chun-Rong , Xu Dan , Tang Jian-Guo
Published: February 2024

Objective

We aimed to explore the heterogeneity of neurons in heart failure with dilated cardiomyopathy (DCM).

Methods

Single-cell RNA sequencing (scRNA-seq) data of patients with DCM and chronic heart failure and healthy samples from GSE183852 dataset were downloaded from NCBI Gene Expression Omnibus, in which neuron data were extracted for investigation. Cell clustering analysis, differential expression analysis, trajectory analysis, and cell communication analysis were performed, and highly expressed genes in neurons from patients were used to construct a protein-protein interaction (PPI) network and validated by GSE120895 dataset.

Results

Neurons were divided into six subclusters involved in various biological processes and each subcluster owned its specific cell communication pathways. Neurons were differentiated into two branches along the pseudotime, one of which was differentiated into mature neurons, whereas another tended to be involved in the immune and inflammation response. Genes exhibited branch-specific differential expression patterns. FLNA, ITGA6, ITGA1, and MDK interacted more with other gene-product proteins in the PPI network. The differential expression of FLNA between DCM and control was validated.

Conclusion

Neurons have significant heterogeneity in heart failure with DCM, and may be involved in the immune and inflammation response to heart failure.
Patients risk for mortality at 90 days after proximal femur fracture – a retrospective study in a tertiary care hospital
Authors: Postler Anne , Posten Charlotte , Schubert Melanie , Beyer Franziska , Lützner Jörg , Vicent Oliver , Kleber Christian , Goronzy Jens , Kamin Konrad
Published: February 2024

Background

Despite improving the management of proximal femur fractures (PFF) with legal requirements of timing the surgery within 24 h, mortality rates in these patients remain still high. The objective of our study was to analyze potential cofactors which might influence the mortality rate within 90 days after surgery in PFF to avoid adverse events, loss of quality of life and high rates of mortality.

Methods

In this retrospective, single-center study all patients with PFF aged 65 years and older were included. We recorded gender, age, type of fracture, surgery and anesthesia, time, comorbidities and medication as well as complications and mortality rate at 90 days. Separate logistic regression models were used to assess which parameters were associated with patients’ mortality. The mortality rate was neither associated with timing, time and type of surgery nor time and type of anesthesia, but with higher age (OR 1.08 per year; 95% CI 1.034–1.128), lower BMI (OR 0.915 per kg/m2; 95% CI 0.857–0.978), higher CCI (OR 1.170 per point; 95% CI 1.018–1.345), dementia (OR 2.805; 95% CI 1.616–4.869), non-surgical complications (OR 2.276; 95% CI 1.269–4.083) and if mobilization was impossible (OR 10.493; 95% CI 3.612–30.479).

Results

We analyzed a total of 734 patients (age ≥ 65 years) who had a PFF in 2019 and 2020 and received surgery. 129 patients (17.6%) died until 90 days at an median age of 89.7 years (range 65–101 years).

Conclusion

The proportion of patients who died until 90 days after surgery is still high. It is less extend influenced by surgical and anaesthesiologic factors than by patient-related factors like age or lower BMI. Physicians should be aware of the importance of avoiding adverse events and the importance of patients’ mobilization to reduce mortality and improve patients’ outcome.
Explainable deep-neural-network supported scheme for tuberculosis detection from chest radiographs
Authors: Maheswari B. Uma , Sam Dahlia , Mittal Nitin , Sharma Abhishek , Kaur Sandeep , Askar S. S. , Abouhawwash Mohamed
Published: February 2024

Chest radiographs are examined in typical clinical settings by competent physicians for tuberculosis diagnosis. However, this procedure is time consuming and subjective. Due to the growing usage of machine learning techniques in applied sciences, researchers have begun applying comparable concepts to medical diagnostics, such as tuberculosis screening. In the period of extremely deep neural nets which comprised of hundreds of convolution layers for feature extraction, we create a shallow-CNN for screening of TB condition from Chest X-rays so that the model is able to offer appropriate interpretation for right diagnosis. The suggested model consists of four convolution-maxpooling layers with various hyperparameters that were optimized for optimal performance using a Bayesian optimization technique. The model was reported with a peak classification accuracy, F1-score, sensitivity and specificity of 0.95. In addition, the receiver operating characteristic (ROC) curve for the proposed shallow-CNN showed a peak area under the curve value of 0.976. Moreover, we have employed class activation maps (CAM) and Local Interpretable Model-agnostic Explanations (LIME), explainer systems for assessing the transparency and explainability of the model in comparison to a state-of-the-art pre-trained neural net such as the DenseNet.
Effectiveness of CT radiomic features combined with clinical factors in predicting prognosis in patients with limited-stage small cell lung cancer
Authors: Wu Jiehan , Zhou Yuntao , Xu Chang , Yang Chengwen , Liu Bingxin , Zhao Lujun , Song Jiawei , Wang Wei , Yang Yining , Liu Ningbo
Published: February 2024

Background

The prognosis of SCLC is poor and difficult to predict. The aim of this study was to explore whether a model based on radiomics and clinical features could predict the prognosis of patients with limited-stage small cell lung cancer (LS-SCLC).

Methods

Simulated positioning CT images and clinical features were retrospectively collected from 200 patients with histological diagnosis of LS-SCLC admitted between 2013 and 2021, which were randomly divided into the training (n = 140) and testing (n = 60) groups. Radiomics features were extracted from simulated positioning CT images, and the t-test and the least absolute shrinkage and selection operator (LASSO) were used to screen radiomics features. We then constructed radiomic score (RadScore) based on the filtered radiomics features. Clinical factors were analyzed using the Kaplan–Meier method. The Cox proportional hazards model was used for further analyses of possible prognostic features and clinical factors to build three models including a radiomic model, a clinical model, and a combined model including clinical factors and RadScore. When a model has prognostic predictive value (AUC > 0.7) in both train and test groups, a nomogram will be created. The performance of three models was evaluated using area under the receiver operating characteristic curve (AUC) and Kaplan–Meier analysis.

Results

A total of 1037 features were extracted from simulated positioning CT images which were contrast enhanced CT of the chest. The combined model showed the best prediction, with very poor AUC for the radiomic model and the clinical model. The combined model of OS included 4 clinical features and RadScore, with AUCs of 0.71 and 0.70 in the training and test groups. The combined model of PFS included 4 clinical features and RadScore, with AUCs of 0.72 and 0.71 in the training and test groups. T stages, ProGRP and smoke status were the independent variables for OS in the combined model, whereas T stages, ProGRP and prophylactic cranial irradiation (PCI) were the independent factors for PFS. There was a statistically significant difference between the low- and high-risk groups in the combined model of OS (training group, p < 0.0001; testing group, p = 0.0269) and PFS (training group, p < 0.0001; testing group, p < 0.0001).

Conclusion

Combined models involved RadScore and clinical factors can predict prognosis in LS-SCLC and show better performance than individual radiomics and clinical models.
A real-world cohort study of first-line afatinib in patients with EGFR-mutant advanced non-small cell lung cancer in Vietnam
Authors: Pham Cam Phuong , Nguyen Thi Thai Hoa , Do Anh Tu , Nguyen Tuan Khoi , Hoang Thi Anh Thu , Le Tuan Anh , Vuong Dinh Thy Hao , Nguyen Dac Nhan Tam , Dang Van Khiem , Nguyen Thi Oanh , Pham Van Luan , Nguyen Minh Hai , Vo Thi Huyen Trang , Do Hung Kien , Vu Ha Thanh , Nguyen Thi Thuy Hang , Pham Van Thai , Trinh Le Huy , Nguyen Khac Dung , Nguyen Hoang Gia , Truong Cong Minh , Pham Tran Minh Chau , Nguyen Thi Bich Phuong
Published: February 2024

Background

This study aimed to evaluate the efficacy and side effects of first-line afatinib treatment in a real-world setting in Vietnam.

Methods

This retrospective study was conducted across nine hospitals in Vietnam. Advanced epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC) patients who received afatinib as first-line therapy between April 2018 and June 2022 were included, and patient medical records were reviewed. Key outcomes were overall response rate (ORR), time-to-treatment failure (TTF), and tolerability.

Results

A total of 343 patients on first-line afatinib were eligible for the study. EGFR exon 19 deletion (Del19) alone was detected in 46.9% of patients, L858R mutation alone in 26.3%, and other uncommon EGFR mutations, including compound mutations, in 26.8%. Patients with brain metastases at baseline were 25.4%. Patients who received 40 mg, 30 mg, and 20 mg as starting doses of afatinib were 58.6%, 39.9%, and 1.5%, respectively. The ORR was 78.1% in the overall population, 82.6% in the Del19 mutation subgroup, 73.3% in the L858R mutation subgroup, and 75.0% in the uncommon mutation subgroup (p > 0.05). The univariate and multivariate analyses indicate that the ORR increased when the starting dose was 40 mg compared to starting doses below 40 mg (83.9% vs. 74.3%, p = 0.034). The median TTF (mTTF) was 16.7 months (CI 95%: 14.8–18.5) in all patients, with a median follow-up time of 26.2 months. The mTTF was longer in patients in the common EGFR mutation subgroup (Del19/L858R) than in those in the uncommon mutation subgroup (17.5 vs. 13.8 months, p = 0.045) and in those without versus with brain metastases at baseline (17.5 vs. 15.1 months, p = 0.049). There were no significant differences in the mTTF between subgroups based on the starting dose of 40 mg and < 40 mg (16.7 vs. 16.9 months, p > 0.05). The most common treatment-related adverse events (any grade/grade ≥ 3) were diarrhea (55.4%/3.5%), rash (51.9%/3.2%), paronychia (35.3%/5.0%), and stomatitis (22.2%/1.2%).

Conclusions

Afatinib demonstrated clinical effectiveness and good tolerability in Vietnamese EGFR-mutant NSCLC patients. In our real-world setting, administering a starting dose below 40 mg might result in a reduction in ORR; however, it might not have a significant impact on TTF.
A new technique to prevent conjunctival prolapse in Asian patients for correcting severe blepharoptosis
Authors: Xi Wenwen , He Ziqing , Yang Feng
Published: February 2024

Background

In Asian patients with severe ptosis,the use of conjoint fascia sheath (CFS) suspension or levator aponeurosis fascia complex shortening surgery can correct the ptosis. During these surgery, a significant amount of levator aponeurosis fascia shortening is performed, which often leads to serious complications such as conjunctival prolapse.This study compares two surgical approaches for correcting severe blepharoptosis:Conjoint fascial sheath (CFS) + levator aponeurosis and muller’s muscle complex (LM complex) suspension and conjoint fascial sheath (CFS) + LM complex+conjunctival suspension.The postoperative efficacy and the incidence of complications such as conjunctival prolapse are investigated for both procedures.

Methods

This study retrospectively analyzed 70 patients (77eyes) with severe blepharoptosis from January 2019 to December 2021. The patients were divided into the experimental group (34 cases, 38 eyes) and the control group (36 cases, 39 eyes). The experimental group was treated with CFS+LM complex + conjunctival suspension, and the control group was treated with CFS+LM complex suspension.The curative effect of blepharoptosis, the incidence of complications such as conjunctival prolapse and patient satisfaction were compared between the two different surgical methods.

Results

There was no significant difference in the correction effective rate between the experimental group (84.21%) and the control group (82.05%) (P > 0.05). There was no significant difference in the total incidence of complications between the experimental group (23.68%) and the control group (38.46%) (P > 0.05), but in the complication of conjunctival prolapse, the incidence of conjunctival prolapse in the experimental group was significantly lower than that in the control group. The difference was statistically significant (P < 0.05). In the survey of patient satisfaction rate, the satisfaction rate of the experimental group was significantly higher than that of the control group,which was statistically significant (P < 0.05).

Conclusions

Compared to CFS+LM complex suspension surgery, the CFS+LM complex + conjunctival suspension has a definite effect in preventing postoperative conjunctival prolapse .The procedure has a high feasibility, good corrective effect, and improves patient satisfaction after surgery.
A systematic review of inherited retinal dystrophies in Pakistan: updates from 1999 to April 2023
Authors: Munir Asad , Afsar Salma , Rehman Atta Ur
Published: February 2024

Background

Inherited retinal degenerations (IRDs) are a group of rare genetic conditions affecting retina of the eye that range in prevalence from 1 in 2000 to 1 in 4000 people globally. This review is based on a retrospective analysis of research articles reporting IRDs associated genetic findings in Pakistani families between 1999 and April 2023.

Methods

Articles were retrieved through survey of online sources, notably, PubMed, Google Scholar, and Web of Science. Following a stringent selection criterion, a total of 126 research articles and conference abstracts were considered. All reported variants were cross-checked and validated for their correct genomic nomenclature using different online resources/databases, and their pathogenicity scores were explained as per ACMG guidelines.

Results

A total of 277 unique sequence variants in 87 distinct genes, previously known to cause IRDs, were uncovered. In around 70% cases, parents of the index patient were consanguineously married, and approximately 88.81% of the detected variants were found in a homozygous state. Overall, more than 95% of the IRDs cases were recessively inherited. Missense variants were predominant (41.88%), followed by Indels/frameshift (26.35%), nonsense (19.13%), splice site (12.27%) and synonymous change (0.36%). Non-syndromic IRDs were significantly higher than syndromic IRDs (77.32% vs. 22.68%). Retinitis pigmentosa (RP) was the most frequently observed IRD followed by Leber’s congenital amaurosis (LCA). Altogether, mutations in PDE6A gene was the leading cause of IRDs in Pakistani families followed by mutations in TULP1 gene.

Conclusion

In summary, Pakistani families are notable in expressing recessively inherited monogenic disorders including IRDs likely due to the highest prevalence of consanguinity in the country that leads to expression of rare pathogenic variants in homozygous state.
Assessing pattern of the Pediatric Multisystem Inflammatory Syndrome (PMIS) in children during the COVID-19 pandemic: experience from the emergency department of tertiary care center of a low-middle-income country
Authors: Akhtar Saleem , Anis Iqra , Kumar Nirdosh Ashok , Ihsan Muhammad Tayyab , Raheem Ahmed , Bano Surraiya
Published: February 2024

Background

Pediatric Multisystem Inflammatory Syndrome (PMIS) is a hyperinflammatory condition affecting multiple organs in children, often resembling incomplete Kawasaki Disease during later phases of COVID-19 infection. Data on PMIS in low-middle-income countries, particularly in emergency department settings, is limited.

Objectives

This prospective observational study at Aga Khan University Hospital, Karachi, aimed to determine the frequency, clinical presentation patterns, and laboratory parameters of children with PMIS visiting the emergency department during the COVID-19 pandemic. Secondary objectives included assessing factors associated with in-hospital mortality.

Methods

From March 2020 to September 2021, patients meeting World Health Organization PMIS criteria were enrolled. COVID-19 testing included PCR and antibody testing. Data was collected through a questionnaire and analyzed statistically.

Results

Among 56 PMIS patients (85.7% male, mean age 7.67 ± 4.8 years), respiratory symptoms (70%), neurological symptoms (57%), and gastrointestinal symptoms (54%) were common presentations. Signs included delayed capillary refill time (93%), low-volume pulses (89%), and hypotension (68%). COVID-19 antibodies were positive in the majority (78.6%) while PCR was positive in 18%. Risk factors for mortality included prolonged emergency department stay, and high Ferritin and Lactate Dehydrogenase levels.

Conclusion

PMIS affects children of all ages. Respiratory and gastrointestinal symptoms are the most frequent presentations. Elevated inflammatory markers, including LDH, Ferritin, D-dimer, and Pro-BNP, correlate with higher mortality risk.