bluuebunny/crossref_metadata_2025 huggingface dataset:
Parenting Preterm Children: Emotional Availability At Preschool Age
Authors: Dietzel Jacqueline , Röer Jan Philipp , Vetterlein Sarah , Schölmerich Axel , Schneider Dominik T. , Gawehn Nina
Published: May 2023

Prematurity is a particular challenge for parents that severely affects the interaction and relationship dynamics between children and their caregivers. Previous studies mostly focused on the infancy of preterms but did not examine the development process. This study highlights whether preterm children and their main caregivers still differ in their emotional availability (EA) at preschool age. Caregiver-child interactions during the transition period of school entry were measured with the Emotional Availability Scales (EAS). N = 25 preterm (25–33 weeks of gestation) and n = 23 term children at an age of 5 years and their main caregivers were observed while playing a construction game that was eliciting either a low or moderate stress level. Caregivers of preterm children showed higher intrusiveness scores compared to caregivers of term dyads. Thus, it seems that parents of preterm children behave intrusively independently of their children's cognitive performance.
Visual Signs at Sociable Place Entrances: User Perceptions and Preferences
Authors: Ulusoy Noyan , Onur Zeynep
Published: May 2023

This study aims to determine which signs are cognitively sufficient to convince the viewer to enter a social place, through the integration of semiotics and design. Photographs of 6 social places were obtained through personal photographs. A semiotic model of entrances was created and qualitative data were analyzed. An online survey was used to find out the perceived effectiveness of signs influencing customer decisions. A total of 595 respondents from all over the world responded to the questionnaire. Chi-square analysis was used for statistical analysis for differences between countries and age groups. Results of this study showed that specific colors, lights, transparency, right symbols, large scaled forms and gold lettering on black background raise the visibility of social place entrances and convince customers to enter the place and explore further. According to color preferences of countries, differing from previous literature; black or gray tones followed by red was preferred in Turkey and Cyprus. Red was the most preferred color in the The U.S.A., Middle East and Far East. In order to convince the customers to enter sociable places; this study has pointed out the importance of right signs to be used at sociable place entrances considering the different cultural connotations.
What Is the Power of Identity? Examining the Moderating Role of Racial-Identity Latent Profiles on the Relationship Between Race-Related Stress and Trauma Symptoms Among Black American Women
Authors: Sheikh Ifrah S. , Lanni Daniel , Mekawi Yara , Powers Abigail , Michopoulos Vasiliki , Carter Sierra
Published: May 2023

In the current study, we investigated the emergence of racial-identity latent profiles and the potential for racial-identity profiles to moderate the relationship between race-related stress and trauma symptoms in nontreatment-seeking, trauma-exposed, Black American women ( N = 222). Racial-identity profiles emerged from latent profile analyses and supported a three-class solution: undifferentiated, detached, and nationalist. Analysis of variance revealed that the nationalist profile group experienced significantly higher race-related stress compared with the detached and undifferentiated profiles. Moderation analyses revealed racial-identity profile type predicted both total posttraumatic stress disorder (PTSD) symptoms and each PTSD symptom cluster; specifically, the nationalist profile type buffered the effects of race-related stress on PTSD symptoms. This study illustrates how stress from racial discrimination influences PTSD symptoms and the ways racial identity may mitigate this relationship, which has the capacity to inform the adaptation of PTSD treatments for minoritized groups.
Grassroots Initiatives for Ecological Transition in China
Authors: Sit Tsui , Chi Lau Kin , Zhiyou Huang , Shaoxiong Liang
Published: May 2023

In light of ecological disasters in China and social alienation among the Chinese people, this article argues that ecology must take precedence over economy, agriculture over industry and finance, and life over money and profit. The article focuses on the New Rural Reconstruction Movement and the Loving Home Village campaigns and identifies several grassroots initiatives in search for pathways to social and ecological transition. It presents in detail the trajectories of Little Donkey Farm, Liang Shuming Rural Reconstruction Center, Yun Jianli, and Yang Zhengxi, which are examples of how to mobilize both urban and rural communities to participate in social and ecolo- gical transformation.
After the Long Walk Home…the Gendered Rural Safety Net
Authors: Nathan Dev , Rahul S.  , Kelkar Govind
Published: May 2023

In the absence of adequate social security for migrant workers, the recession forced the mass exodus of millions of circular migrants supported by their rural households of largely left-behind women. Our article looks at what happened after that. How did the returned migrants manage to survive and retain their capacity to work till they were required back in urban employment? This article argues that gendered rural households functioned as safety nets in the severe recession in the Indian economy which highlights the weakness in the state policy and lack of resources in the wake of the COVID-19 pandemic. They were safety nets not only for workers directly working in food value chains but also for reverse migrants. Overall, the recession did not just result in a temporary loss of income but also increased inequality and strengthened the oligopoly structure of the Indian economy.
Takotsubo Syndrome and Complete Heart Block: A Diagnostic and Management Conundrum
Authors: Olson Erik , Manna Zachary , Tavokolian Kameron , Desai Dhaval , Kapoor Mahim
Published: May 2023

There is increasing evidence that Takotsubo cardiomyopathy behaves more like a highly variable and dangerous syndrome than an isolated cardiomyopathy. In this case report, we describe a case of Takotsubo cardiomyopathy complicated by complete heart block. We discuss the potential mechanisms for its etiology and examine the need for pacemaker placement.
Loneliness and Mental Health in Response to Early and Late COVID-19 Outbreak: A Cross-Sectional Study of Czech Adults Aged 50 and Over
Authors: Vaculíková Jitka , Hanková Magdalena
Published: May 2023

The unpredictable spread of the COVID-19 pandemic, national lockdowns, and public health measures implemented in the Czech Republic had a negative effect on older adults’ mental health and loneliness. The 2,631 older adults in 2020 and 2,083 older adults in 2021 used in this study formed a nationally representative sample of the Survey of Health, Ageing and Retirement in Europe (SHARE). Almost every third older adult experienced feelings of loneliness in both stages of the COVID-19 outbreak. Loneliness increased in 2021 in those individuals who reported their physical health as poor, who felt nervous, sad or depressed, and who had ever left their home since the outbreak. According to age-related drivers of loneliness, feelings of loneliness were prevalent (40% vs. 45%) among younger retirees in both waves. In both data sets, declared feelings of sadness or depression were the strongest sustainable predictor of loneliness (2020 and 2021 models, OR = 3.69; 95% CI [2.90, 4.69] and OR = 2.55; [1.97, 3.30]). Being a woman and feeling nervous equated with a higher likelihood of feeling lonely compared to counterparts. Policy makers should therefore aim to carefully improve psychosocial and health-related consequences faced by this vulnerable population during the pandemic and beyond.
Reconciling Development Infrastructure and Heritage Protection, Through Heritage Impact Assessments: A Case Study of the UNESCO World Heritage Site of the Omo Valley of Ethiopia
Authors: Tesfamichael Tekie F.
Published: May 2023

Development infrastructure and heritage protection are equally important to many societies and countries in the world. Therefore, it is vital to reconcile both needs of development infrastructure and heritage protection through methods of heritage impact assessment (HIA) conducted using International Council on Monuments and Sites (ICOMOS) guidelines. The UNESCO World Heritage Site of the Omo valley of Ethiopia is home to various palaeontological, archaeological and paleoanthropological records and, hence, has huge significance to the world as well as to Ethiopia. A road construction designed to pass through the Shungura Formation in the UNESCO World Heritage Site of the Omo valley of Ethiopia poses a serious problem to the heritage site, and an HIA was conducted to investigate thoroughly the impacts of the road construction on the heritage site. The ICOMOS guideline is a useful tool to carry out HIA, and it is used as a guiding method to conduct the HIA. In order to assess the impacts, data from the key attributes of the heritages were collected; these data are faunal fossils, archaeological records such as stone tools and geological exposures used to date fossils. These are the features that make the heritage site significant, and concentrations of these data from 4 m by 4 m gridded areas are assessed through ICOMOS guidelines, and high concentrations of faunal fossils and archaeological records are found in the areas where the road construction was designed to pass. The impacts of the road construction on the key attributes of the heritage vary from adverse effects (A1 and A4) to severe adverse effects (A2 and A3). Therefore, the road construction design Alt-00 adversely affects the heritage-bearing Shungura Formation which hosts the key attributes of the heritages in the Omo valley of Ethiopia. Following the results of this HIA, an alternative road construction design Alt-03 was suggested, and the new road construction design is adopted by the Ethiopian Road Authority. This particular study from the Omo valley of Ethiopia has played a significant role in saving the heritage sites and has also important implications in balancing the needs of heritage protection and development infrastructure to other parts of the country and elsewhere in the world, and it is a good contribution to future research related to heritages and impacts of development infrastructures.
Optimising collective accuracy among rational individuals in sequential decision-making with competition
Authors: Mann Richard P
Published: May 2023

Theoretical results underpinning the wisdom of the crowd, such as the Condorcet Jury Theorem, point to substantial accuracy gains through aggregation of decisions or opinions, but the foundations of this theorem are routinely undermined in circumstances where individuals are able to adapt their own choices based after observing what other agents have chosen. In sequential decision-making, rational agents use the choices of others as a source of information about the correct decision, creating powerful correlations between different agents’ choices that violate the assumptions of independence on which the Condorcet Jury Theorem depends. In this paper, I show how such correlations emerge when agents are rewarded solely based on their individual accuracy, and the impact of this on collective accuracy. I then demonstrate how a simple competitive reward scheme, where agents’ rewards are greater if they correctly choose options that few have already chosen, can induce rational agents to make independent choices, returning the group to optimal levels of collective accuracy. I further show that this reward scheme is robust, offering improvements to collective accuracy across wide range of competition strengths, suggesting that such schemes could be effectively implemented in real-world contexts to improve collective wisdom.
Inpatient Rehabilitation After Acute Severe Stroke: Predictive Value of the National Institutes of Health Stroke Scale Among Other Potential Predictors for Discharge Destination
Authors: Tarvonen-Schröder Sinikka , Niemi Tuuli , Koivisto Mari
Published: May 2023

Background:

Research focusing on predictors for discharge destination after rehabilitation of inpatients recovering from severe stroke is scarce. The predictive value of rehabilitation admission NIHSS score among other potential predictors available on admission to rehabilitation has not been studied.

Aim:

The aim of this retrospective interventional study was to determine the predictive accuracy of 24 hours and rehabilitation admission NIHSS scores among other potential socio-demographic, clinical and functional predictors for discharge destination routinely collected on admission to rehabilitation.

Material and Methods:

On a university hospital specialized inpatient rehabilitation ward 156 consecutive rehabilitants with 24 hours NIHSS score ⩾15 were recruited. On admission to rehabilitation, routinely collected variables potentially associated with discharge destination (community vs institution) were analyzed using logistic regression.

Results:

70 (44.9%) of rehabilitants were discharged to community, and 86 (55.1%) were discharged to institutional care. Those discharged home were younger and more often still working, had less often dysphagia/tube feeding or DNR decision in the acute phase, shorter time from stroke onset to rehabilitation admission, less severe impairment (NIHSS score, paresis, neglect) and disability (FIM score, ambulatory ability) on admission, and faster and more significant functional improvement during the in-stay than those institutionalized.

Conclusion:

The most influential independent predictors for community discharge on admission to rehabilitation were lower admission NIHSS score, ambulatory ability and younger age, NIHSS being the most powerful. The odds of being discharged to community decreased with 16.1% for every 1 point increase in NIHSS. The 3-factor model explained 65.7% of community discharge and 81.9% of institutional discharge, the overall predictive accuracy being 74.7%. The corresponding figures for admission NIHSS alone were 58.6%, 70.9% and 65.4%.
A national seismic risk model for Canada: Methodology and scientific basis
Authors: Hobbs Tiegan E , Journeay J Murray , Rao Anirudh S , Kolaj Michal , Martins Luis , LeSueur Philip , Simionato Michele , Silva Vitor , Pagani Marco , Johnson Kendra , Rotheram Drew , Chow William
Published: May 2023

Canada is exposed to rare but potentially destructive earthquakes that threaten densely settled metropolitan centers in many parts of the country. To assess the impacts and consequences of future natural-hazard events and help advance policy goals and objectives of the Sendai Framework for Disaster Risk Reduction, Natural Resources Canada, through a collaborative partnership with the Global Earthquake Model Foundation, produced a national seismic risk model. Developing this model has required the creation of a national exposure inventory, Canadian-specific fragility and vulnerability curves, and significant simplification of the Canadian Seismic Hazard Model which forms the basis for the design seismic hazard values of the National Building Code of Canada. Using the Global Earthquake Model Foundation’s OpenQuake Engine, probabilistic stochastic risk modeling is completed under baseline and simulated retrofit conditions to assess seismic risk at the neighborhood level for all settled areas in Canada. Output risk metrics include the expected immediate physical impacts of earthquake events such as building damage, casualties, and direct economic losses. This article documents the technical details of the modeling approach including a description of novel data sets in use, a summary of the extensive sensitivity testing undertaken, and characterization of quality control implemented in the absence of usable validating earthquake loss data. The results from this model, such as loss exceedance curves and annual average losses, provide an open, accessible and quantitative base of evidence for decision-making at local, regional, and national levels. As a large country with a complex seismic hazard model and dispersed populations, this Canadian study is unique. However, the challenges faced and solutions offered are likely to be of interest to other nations pursuing similar programs.
ASCE/SEI 41 assessment of reinforced concrete buildings: Benchmarking nonlinear dynamic procedures with empirical damage observations
Authors: Cook Dustin , Sen Andrew , Liel Abbie , Basnet Tarbin , Creagh Ariel , Koodiani Hamid Khodadadi , Berkowitz Russell , Ghannoum Wassim , Hortacsu Ayse , Kim Insung , Lehman Dawn , Lowes Laura , Matamoros Adolfo , Naeim Farzad , Sattar Siamak , Smith Rob
Published: May 2023

ASCE/SEI 41 is the consensus US standard for the seismic evaluation and retrofit of existing buildings. Although the performance-based engineering standard is based on decades of research and has been significantly vetted by ASCE and other committees, it is unclear how well the evaluations capture the seismic response of real building systems. This article examines six, primarily nonductile, reinforced concrete buildings, including four damaged in earthquakes and two experimental structures tested and damaged on shake tables, to compare the measured response and observed damage to simulated outcomes produced following ASCE/SEI 41 nonlinear dynamic procedure. The results show that the simulations are generally able to capture the story mechanism and peak transient story drift demands at the critical story (predicted values are typically within ±20% of the measured values). However, drifts at non-critical stories and floor accelerations at all stories show greater error relative to the measured responses. At the component level, the simulations, in most cases, correctly identify the location(s) of the critical component(s) and the failure mode (e.g. flexure vs shear). However, the extent of the damage is overestimated in some cases. These results form the basis for recommendations for column, beam, and wall modeling procedures that can be used to improve ASCE/SEI 41.
Targeting and sensitizing MDR cancer by an MMP2 and pH dual-responsive ZnO-based nanomedicine
Authors: Zhou Qing , Zhang Li , Li Yujiao , Wang Jiao , He Xiaolu , Zhang Jieyu , Qiao Youbei , Wu Hong , Zhu Lin
Published: May 2023

Zinc oxide nanoparticles (ZnO NPs) have been known as a therapeutic agent and drug delivery system for treating various diseases, including infectious diseases and cancer. However, due to the low biocompatibility, short in vivo half-life, and potential toxicity, the previous studies on ZnO NPs were mainly focused on their in vitro applications. The effective and safe ZnO NP-based systems which can be used for in vivo drug delivery have been rarely reported. In this study, we developed a novel dual-responsive hybrid ZnO NP (ZnO/DPPG/PEG-pp-PE) consisting of the ZnO NPs, phospholipid (DPPG), and enzyme-sensitive amphiphilic polymer (PEG-pp-PE), which could respond to both tumoral matrix metalloproteinase 2 (MMP2) and intracellular acidic pH, for tumor-targeted drug delivery and multidrug resistant (MDR) cancer treatment. The dual-responsive ZnO/DPPG/PEG-pp-PE could easily load the model drug, doxorubicin (DOX), and showed excellent physicochemical properties, stability, and MMP2 and pH dual sensitivity. The ZnO/DPPG/PEG-pp-PE/DOX showed the MMP2-dependent cellular uptake, enhanced cell penetration, and improved anticancer activity in the MDR cancer cells and their spheroids. In the MDR tumor-bearing mice, the ZnO/DPPG/PEG-pp-PE/DOX improved the biocompatibility, tumor targetability, and anticancer activity of DOX and ZnO without significant toxicity compared to the free DOX, ZnO/DOX, and nonsensitive ZnO NPs. The data suggested that the dual-sensitive ZnO-based nanomedicine could be a promising delivery system for targeted drug delivery and therapy against the MDR cancer.
ADAMTS9-AS1 inhibits tumor growth and drug resistance in clear cell renal cell carcinoma via recruiting HuR to enhance ADAMTS9 mRNA stability
Authors: Zhao Enyang , Geng Bo , Tao Ran , You Bosen , Liu Yunli , Hou Wenbin , Wang Wanhui , Wang Changlin , Li Xuedong
Published: May 2023

The lack of efficacious treatments for clear cell renal cell carcinoma (ccRCC) has led to a poor 5-year survival rate. Here, we found that the expression of ADAM metallopeptidase with thrombospondin type 1 motif 9 (ADAMTS9) antisense RNA 1 (ADAMTS9-AS1) is commonly decreased in ccRCC tissues. Decreased ADAMTS9-AS1 is associated with advanced stages and poor prognosis in ccRCC patients. Additionally, we found that promoter hypermethylation contributes to the suppression of ADAMTS9-AS1 expression in ccRCC that contained relatively low levels of ADAMTS9-AS1. Further functional studies demonstrated that ADAMTS9-AS1 inhibits cell growth and drug resistance through enhancing mRNA stability of ADAMTS9 in ccRCC. Mechanistically, ADAMTS9-AS1 directly bound to Human Antigen R (HuR). Then, the ADAMTS9-AS1-HuR complex was guided to the ADAMTS9 3’UTR through specific RNA–RNA interaction. Moreover, ADAMTS9-AS1 expression is positively correlated with ADAMTS9 expression in ccRCC tissues. In summary, our data not only highlight the important role of ADAMTS9-AS1 in ccRCC progression, but also reveal new regulatory mechanisms of ADAMTS9, which provides important insights into novel treatment strategies targeting ADAMTS9-AS1-HuR- ADAMTS9 axis in ccRCC.
Composition of mucus- and digesta-associated bacteria in growing pigs with and without diarrhea differed according to the presence of colonic inflammation
Authors: Panah Farhad M. , Lauridsen Charlotte , Højberg Ole , Jensen Henrik Elvang , Nielsen Tina Skau
Published: May 2023

Background

In the pig production, diarrhea can occur during different growth stages including the period 4–16 weeks post weaning, during which a diarrheal outbreak also termed as colitis-complex diarrhea (CCD) can occur and it is distinct from post-weaning diarrhea (1–2 weeks post weaning). We hypothesized that CCD in growing pigs is associated with changes in colonic microbiota composition and fermentation patterns, and the aim of the present observational study was to identify changes in digesta-associated bacteria (DAB) and mucus-associated bacteria (MAB) in the colon of growing pigs with and without diarrhea. A total number of 30 pigs (8, 11, and 12 weeks of age) were selected; 20 showed clinical signs of diarrhea and 10 appeared healthy. Based on histopathological examination of colonic tissues, 21 pigs were selected for further studies and classified as follows: without diarrhea, no colon inflammation (NoDiar; n = 5), with diarrhea, without colonic inflammation (DiarNoInfl; n = 4), and with diarrhea, with colonic inflammation (DiarInfl; n = 12). Composition (based on 16S rRNA gene amplicon sequencing) and fermentation pattern (short-chain fatty acids; SCFA profile) of the DAB and MAB communities were characterized.

Results

The DAB showed higher alpha diversity compared to MAB in all pigs, and both DAB and MAB showed lowest alpha diversity in the DiarNoInfl group. Beta diversity was significantly different between DAB and MAB as well as between diarrheal groups in both DAB and MAB. Compared to NoDiar, DiarInfl showed increased abundance of various taxa, incl. certain pathogens, in both digesta and mucus, as well as decreased digesta butyrate concentration. However, DiarNoInfl showed reduced abundance of different genera (mainly Firmicutes) compared to NoDiar, but still lower butyrate concentration.

Conclusion

Diversity and composition of MAB and DAB changed in diarrheal groups depending on presence/absence of colonic inflammation. We also suggest that DiarNoInfl group was at the earlier stage of diarrhea compared with DiarInfl, with a link to dysbiosis of colonic bacterial composition as well as reduced butyrate concentration, which plays a pivotal role in gut health. This could have led to diarrhea with inflammation due to a dysbiosis, associated with an increase in e.g., Escherichia-Shigella (Proteobacteria), Helicobacter (Campylobacterota), and Bifidobacterium (Actinobacteriota), which may tolerate or utilize oxygen and cause epithelial hypoxia and inflammation. The increased consumption of oxygen in epithelial mucosal layer by infiltrated neutrophils may also have added up to this hypoxia. Overall, the results confirmed that changes in DAB and MAB were associated with CCD and reduced butyrate concentration in digesta. Moreover, DAB might suffice for future community-based studies of CCD.
Comparison of accuracy between augmented reality/mixed reality techniques and conventional techniques for epidural anesthesia using a practice phantom model kit
Authors: Hayasaka Tatsuya , Kawano Kazuharu , Onodera Yu , Suzuki Hiroto , Nakane Masaki , Kanoto Masafumi , Kawamae Kaneyuki
Published: May 2023

Background

This study used an epidural anesthesia practice kit (model) to evaluate the accuracy of epidural anesthesia using standard techniques (blind) and augmented/mixed reality technology and whether visualization using augmented/mixed reality technology would facilitate epidural anesthesia.

Methods

This study was conducted at the Yamagata University Hospital (Yamagata, Japan) between February and June 2022. Thirty medical students with no experience in epidural anesthesia were randomly divided into augmented reality (-), augmented reality (+), and semi-augmented reality groups, with 10 students in each group. Epidural anesthesia was performed using the paramedian approach with an epidural anesthesia practice kit. The augmented reality (-) group performed epidural anesthesia without HoloLens2Ⓡ and the augmented reality (+) group with HoloLens2Ⓡ. The semi-augmented reality group performed epidural anesthesia without HoloLens2Ⓡ after 30 s of image construction of the spine using HoloLens2Ⓡ. The epidural space puncture point distance between the ideal insertion needle and participant’s insertion needle was compared.

Results

Four medical students in the augmented reality (-), zero in the augmented reality (+), and one in the semi-augmented reality groups failed to insert the needle into the epidural space. The epidural space puncture point distance for the augmented reality (-), augmented reality (+), and semi-augmented reality groups were 8.7 (5.7–14.3) mm, 3.5 (1.8–8.0) mm (P = 0.017), and 4.9 (3.2–5.9) mm (P = 0.027), respectively; a significant difference was observed between the two groups.

Conclusions

Augmented/mixed reality technology has the potential to contribute significantly to the improvement of epidural anesthesia techniques.
Difficult airway management and low Bispectral Index (BIS) in a patient with left Bochdalek congenital diaphragmatic hernia (CDH)
Authors: Dahaba Ashraf A.
Published: May 2023

Background

Bochdalek congenital diaphragmatic hernia (CDH) is a developmental defect in the posterolateral diaphragm, allowing herniation of abdominal contents into the thorax causing mechanical compression of the developing lung parenchyma and lung hypoplasia. We describe a case of an adult patient with a Bochdalek hernia who underwent minimally invasive right thoracotomy Perceval bioprosthetic aortic valve replacement (AVR) requiring one-lung ventilation (OLV) on the side of the hernia. This is a complex and challenging case that brings up numerous thought-provoking anesthetic implications. To the best of our knowledge, a Pubmed search did not reveal any publication to date of difficult airway management in an adult patient with CDH.

Case presentation

The first major problem encountered was patient’s crus habitus anatomical condition (exceedingly ventrally displaced trachea) Mallampati Class IV and Cormack-Lehane grade IV extremely difficult endotracheal intubation. Neither glottis nor epiglottis was visible on laryngoscopy; resulting in failed placement of the double-lumen endobronchial tube (DLT) following numerous attempts. The DLT was eventually placed via GlideScope videolaryngoscopy. Whereas the endobroncheal right lung block for left OLV was successfully placed using fiberopticscopy. The crus habitus encroached on OLV tidal volume by the cranially displaced ascending colon and left kidney. Anesthesia was maintained with remifentanil /sevoflurane; adjusted to maintain bispectral index (BIS) at 40–60. Digitally recorded BIS was 38–62 except when BIS precipitously declined to 14–38 (SR, suppression ratio < 10) for 25 min after termination of the cardiopulmonary bypass.

Conclusions

We report a case essentially dealing with an anatomically distorted difficult airway in a patient with left Bochdalek CDH undergoing a complex AVR. We describe anesthetic difficulties and unforeseen issues encountered; such as an extremely difficult DLT placement.
Postoperative effect of sufentanil preemptive analgesia combined with psychological intervention on breast cancer patients
Authors: Tan Hong , Wang Chengqiang , Jiang Yihong , Shi Quan , Liang Wei , Li Di
Published: May 2023

Objectives

To explore the postoperative effects of sufentanil preemptive analgesia combined with psychological intervention on breast cancer patients undergoing radical surgery.

Methods

112 female breast cancer patients aged 18–80 years old who underwent radical surgery by the same surgeon were randomly divided into 4 groups, and there were 28 patients in each group. Patients in group A were given 10 µg sufentanil preemptive analgesia combined with perioperative psychological support therapy (PPST), group B had only 10 µg sufentanil preemptive analgesia, group C had only PPST, and group D were under general anesthesia with conventional intubation. Visual analogue scoring (VAS) was used for analgesic evaluation at 2, 12 and 24 h after surgery and compared among the four groups by ANOVA method.

Results

The awakening time of patients in group A or B was significantly shorter than that in group C or D, and the awakening time in group C was significantly shorter than that in group D. Moreover, patients in group A had the shortest extubation time, while the group D had the longest extubation time. The VAS scores at different time points showed significant difference, and the VAS scores at 12 and 24 h were significantly lower than those at 2 h (P < 0.05). The VAS scores and the changing trend of VAS scores were varied among the four groups (P < 0.05). In addition, we also found that patients in group A had the longest time to use the first pain medication after surgery, while patients in group D had the shortest time. But the adverse reactions among the four groups showed no difference.

Conclusions

Sufentanil preemptive analgesia combined with psychological intervention can effectively relieve the postoperative pain of breast cancer patients.
Diagnostic performance of the normal range of gastrin calculated using strict criteria based on a combination of serum markers and pathological evaluation for detecting gastritis: a retrospective study
Authors: Nagasaki Naoko , Takigawa Hidehiko , Ito Masanori , Boda Tomoyuki , Kotachi Takahiro , Hayashi Ryohei , Yuge Ryo , Urabe Yuji , Oka Shiro , Tanaka Shinji
Published: May 2023

Background

The ABC method, which combines the pepsinogen method and anti-Helicobacter pylori antibody titers, has been used for risk screening for gastric cancer in Japan. However, it has been reported that there are cases of gastritis and carcinogenesis risk even in group A, which is considered to be a low-risk group based on the ABC method. Currently, in group A, endoscopic examination is needed to strictly discriminate “patients without gastritis” (defined as true A patients) from those “with gastritis.” A simple and minimally invasive diagnostic criterion for gastritis using serological markers is desirable. In this study, we aimed to identify the normal serum gastrin concentrations in normal stomach cases based on pathological diagnosis and investigate the usefulness of serum gastrin concentrations in diagnosing gastritis.

Methods

Patients who underwent endoscopy and blood tests at Hiroshima University Hospital were enrolled in the study and categorized into the “pathologically-evaluated group” and “endoscopically-evaluated group,” according to the evaluation method of atrophic gastritis. Initially, we measured serum gastrin concentrations in the normal stomach cases in the pathologically-evaluated group and calculated the normal range of serum gastrin concentrations. We used the upper limit of this normal range of serum gastrin concentrations and performed a validation study to determine its usefulness as a diagnostic marker for distinguishing between cases of gastritis and true A in the endoscopically-evaluated group.

Results

The 95th percentile of serum gastrin concentrations in pathologically-evaluated normal stomach cases was 34.12–126.03 pg/mL. Using the upper limit of this normal range of serum gastrin concentrations, the sensitivity, specificity, positive predictive value, and negative predictive value for gastritis were 52.8%, 92.6%, 97.0%, and 31.0%, respectively. Additionally, the receiver operating characteristic (ROC) curve for the endoscopically-evaluated group showed an area under the ROC curve of 0.80.

Conclusion

The gastrin cut-off value of 126 pg/mL has a good positive predictive value (97.0%) for detecting gastritis positing its use as a marker for cases requiring endoscopy. However, the identification of patients with gastritis having normal serum gastrin concentrations due to insufficient sensitivity remains a challenge for the future.
A case of herpes simplex virus induced peripheral neuropathy and encephalitis with positive GM3 and CASPR2 antibody
Authors: Lu Hongji , Liao Yingdi , Zhang Changlin , Wen Wanxin , Du Yaming , Zhao Min , Wang Lixin
Published: May 2023

Background

We reported on a case involving an older patient with HSV-1 encephalitis who simultaneously experienced the onset of peripheral nerve symptoms associated with the presence of anti-GM3 immunoglobulin G (IgG).

Case presentation

A 77-year-old male was admitted to hospital with high fever, weakness of both lower limbs, and an unstable gait. A CSF test revealed a strikingly increased protein level (1,002 mg/L, normative values: 150-450 mg/L) and MRI revealed hyper-signal lesions in the right temporal lobe, right hippocampus, right insula, and right cingulate gyrus. The CSF was positive for HSV PCR (HSV-1,17870). In addition, the serum samples were positive for CASPR2 antibodies (antibody titer: 1/10) and anti-GM3 immunoglobulin G (IgG) (+). The patient was diagnosed with HSV-1-induced peripheral nerve symptoms that were associated with encephalitis and the presence of anti-GM3 IgG and anti-CASPR2 antibodies. The patient had received included intravenous immunoglobulin, intravenous acyclovir, and corticosteroids therapy. At the one-year follow-up examination, he had regained the necessary skills associated with daily life.

Conclusions

Herpes simplex virus infection often induces encephalitis, and reaction to the virus may trigger an autoimmune response. Early diagnosis and treatment can avoid the progression of the disease to include autoimmune encephalitis.
Reflective, pragmatic, and reactive decision-making by maternity service providers during the SARS-CoV-2 pandemic health system shock: a qualitative, grounded theory analysis
Authors: Silverio Sergio A. , De Backer Kaat , Brown Jeremy M. , Easter Abigail , Khazaezadeh Nina , Rajasingam Daghni , Sandall Jane , Magee Laura A.
Published: May 2023

Background

Pregnant and postpartum women were identified as having particular vulnerability to severe symptomatology of SARS-CoV-2 infection, so maternity services significantly reconfigured their care provision. We examined the experiences and perceptions of maternity care staff who provided care during the pandemic in South London, United Kingdom – a region of high ethnic diversity with varied levels of social complexity.

Methods

We conducted a qualitative interview study, as part of a service evaluation between August and November 2020, using in-depth, semi-structured interviews with a range of staff (N = 29) working in maternity services. Data were analysed using Grounded Theory analysis appropriate to cross-disciplinary health research.

Analysis & findings

Maternity healthcare professionals provided their views, experiences, and perceptions of delivering care during the pandemic. Analysis rendered three emergent themes regarding decision-making during reconfigured maternity service provision, organised into pathways: 1) ‘Reflective decision-making’; 2) ‘Pragmatic decision-making’; and 3) ‘Reactive decision-making’. Whilst pragmatic decision-making was found to disrupt care, reactive-decision-making was perceived to devalue the care offered and provided. Alternatively, reflective decision-making, despite the difficult working conditions of the pandemic, was seen to benefit services, with regards to care of high-quality, sustainability of staff, and innovation within the service.

Conclusions

Decision-making within maternity care was found to take three forms – where at best changes to services could be innovative, at worst they could cause devaluation in care being delivered, and more often than not, these changes were disruptive. With regard to positive changes, healthcare providers identified staff empowerment, flexible working patterns (both for themselves and collectively as teams), personalised care delivery, and change-making in general, as key areas to capitalise on current and ongoing innovations borne out of the pandemic. Key learnings included a focus on care-related, meaningful listening and engagement of staff at all levels, in order to drive forward high-quality care and avoid care disruption and devaluation.
Irrational prescription and its costs in neonatal surfactant therapy: public and private hospitals of Iran in 2018
Authors: Izadi Reyhane , Habibolahi Abbas , Jahanmehr Nader , Khodakarim Soheila
Published: May 2023

Background

Irrational prescription and its subsequent costs are a major challenge worldwide. Health systems must provide appropriate conditions for the implementation of national and international strategies to prevent irrational prescription. The aim of the present study was to determine the irrational surfactant prescription among neonates with respiratory distress and the resulting direct medical costs for private and public hospitals in Iran.

Methods

This was a cross-sectional descriptive study performed retrospectively using data belonged to 846 patients. Initially, the data were extracted from the patients’ medical records and the information system of the Ministry of Health. The obtained data were then compared with the surfactant prescription guideline. Afterward, each neonatal surfactant prescription was evaluated based on the three filters listed in the guideline (including right drug, right dose, and right time). Finally, chi-square and ANOVA tests were used to investigate the inter-variable relationships.

Results

The results showed that 37.47% of the prescriptions were irrational and the average costs of each irrational prescription was calculated as 274.37 dollars. It was estimated that irrational prescriptions account for about 53% of the total surfactant prescription cost. Among the selected provinces, Tehran and Ahvaz had the worst and the best performance, respectively. As well, public hospitals outperformed private hospitals in terms of the in drug selection, but they underperformed them in terms of the right dose determination.

Conclusion

The results of the present study are considered as a warning to insurance organizations, in order to reduce unnecessary costs caused by these irrational prescriptions by developing new service purchase protocols. Our suggestion is the use of educational interventions to reduce irrational prescriptions due to drug selection as well as using computer alert approaches to reduce irrational prescriptions caused by wrong dose administration.
The effect of posterior cruciate ligament tibial avulsion fracture on functional outcomes in knees with concomitant ipsilateral lower limb fractures: a matched-cohort analysis
Authors: Xiong Hua-zhang , Yang Hong-jie , Du Lian-rong , Liu Xiu-qi , Sun Lv , Jin Ying , Dong Li-ming
Published: May 2023

Background

At present, the optimal treatment for posterior cruciate ligament tibial avulsion fracture (PCLTAF) combined with concomitant ipsilateral lower limb fractures remains unclear. The present study aimed to assess the preliminary outcomes of treatment for PCLTAF with concomitant ipsilateral lower limb fractures by open reduction and internal fixation (ORIF).

Materials and Methods

The medical records of patients who sustained PCLTAF with concomitant ipsilateral lower limb fractures between March 2015 and February 2019 and underwent treatment at a single institution were retrospectively reviewed. Imaging examinations performed at the time of injury were applied to identify concomitant ipsilateral lower limb fractures. We used 1:2 matching between patients with PCLTAF combined with concomitant ipsilateral lower limb fractures (combined group; n = 11) and those with isolated PCLTAF (isolated group; n = 22). Outcome data were collected, including the range of motion (ROM) and visual analogue scale (VAS), Tegner, Lysholm, and International Knee Documentation Committee (IKDC) scores. At the final follow-up, the clinical outcomes were compared between the combined and isolated groups and between patients who underwent early-stage surgery and those who underwent delayed treatment for PCLTAF.

Results

Thirty-three patients (26 males, 7 females) were included in this study, with eleven patients having PCLTAF and concomitant ipsilateral lower limb fractures and a follow-up of 3.1 to 7.4 years (average, 4.8 years). Compared to patients in the isolated group, patients in the combined group demonstrated significantly worse Lysholm scores (85.7 ± 5.8 vs. 91.5 ± 3.9, p = 0.040), Tegner scores (4.4 ± 0.9 vs. 5.4 ± 0.8, p = 0.006), and IKDC scores (83.6 ± 9.3 vs. 90.5 ± 3.0, p = 0.008). Inferior outcomes were found in patients with delayed treatment.

Conclusions

Inferior results were found in patients with concomitant ipsilateral lower limb fractures, while better outcomes were obtained in patients with PCLTAF through early-stage ORIF using the posteromedial approach. The present findings may help determine the prognoses of patients with PCLTAF combined with concomitant ipsilateral lower limb fractures treated through early-stage ORIF.
Which non-infection related risk factors are associated with impaired proximal femur fracture healing in patients under the age of 70 years?
Authors: Halvachizadeh Sascha , Martin David Paul , Pfeifer Roman , Jukema Gerrolt Nico , Gueorguiev Boyko , Pape Hans-Christoph , Berk Till
Published: May 2023

Background/purpose

Impaired healing is a feared complication with devastating outcomes for each patient. Most studies focus on geriatric fracture fixation and assess well known risk factors such as infections. However, risk factors, others than infections, and impaired healing of proximal femur fractures in non-geriatric adults are marginally assessed. Therefore, this study aimed to identify non-infection related risk factors for impaired fracture healing of proximal femur fractures in non-geriatric trauma patients.

Methods

This study included non-geriatric patients (aged 69 years and younger) who were treated between 2013 and 2020 at one academic Level 1 trauma center due to a proximal femur fracture (PFF). Patients were stratified according to AO/OTA classification. Delayed union was defined as failed callus formation on 3 out of 4 cortices after 3 to 6 months. Nonunion was defined as lack of callus-formation after 6 months, material breakage, or requirement of revision surgery. Patient follow up was 12 months.

Results

This study included 150 patients. Delayed union was observed in 32 (21.3%) patients and nonunion with subsequent revision surgery occurred in 14 (9.3%). With an increasing fracture classification (31 A1 up to 31 A3 type fractures), there was a significantly higher rate of delayed union. Additionally, open reduction and internal fixation (ORIF) (OR 6.17, (95% CI 1.54 to 24.70, p ≤ 0.01)) and diabetes mellitus type II (DM) (OR 5.74, (95% CI 1.39 to 23.72, p = 0.016)), were independent risk factors for delayed union. The rate of nonunion was independent of fracture morphology, patient’s characteristics or comorbidities.

Conclusion

Increasing fracture complexity, ORIF and diabetes were found to be associated with delayed union of intertrochanteric femur fractures in non-geriatric patients. However, these factors were not associated with the development of nonunion.
Knowledge, attitude, and uptake of human papillomavirus vaccine among adolescent schoolgirls in Ethiopia: a systematic review and meta-analysis
Authors: Addisu Dagne , Gebeyehu Natnael Atnafu , Belachew Yismaw Yimam
Published: May 2023

Background

Cervical cancer is an international public health issue. Nearly all cases of cervical cancer are caused by the human papillomavirus. The HPV vaccine prevents more than 75% of cervical cancer. The extent to which adolescent girls' knowledge and uptake of the HPV vaccine have to be investigated in order to build effective promotion strategies and increase the uptake of the vaccine. The evidence that is currently available in this area is controversial and inconclusive. Hence, this study has estimated the pooled proportion of good knowledge, positive attitude, and uptake of the HPV vaccine and its associated factors among adolescent schoolgirls in Ethiopia.

Methods

PubMed, Google Scholar, AJOL, ScienceDirect, and DOAJ were used to search relevant studies. A total of 10 studies were included. The data were extracted by two reviewers using Microsoft Excel and exported to STATA Version 17 for analysis. A random effects model was applied during the analysis. Heterogeneity and publication bias across the studies were evaluated using I2 statistics and Egger’s test, respectively. The PROSPERO registration number for the review is CRD42023414030.

Result

A total of eight studies comprising 3936 study participants for knowledge and attitude and five studies with 2,481 study participants for uptake of HPV were used to estimate the pooled proportions of good knowledge, a positive attitude, and uptake of the HPV vaccine, respectively. The pooled proportions of good knowledge, positive attitude, and uptake of the HPV vaccine were 55.12%, 45.34%, and 42.05%, respectively. Being an urban resident (OR = 4.17, 95% CI = 1.81, 9.58), having good knowledge (OR = 6.70, 95% CI = 3.43, 13.07), and a positive attitude (OR = 2.04, 95% CI = 1.51, 2.74), were significantly associated with the uptake of the vaccine.

Conclusion

The pooled proportions of good knowledge, a positive attitude, and uptake of the HPV vaccine were low in Ethiopia. Being an urban resident and having good knowledge and a positive attitude towards the HPV vaccine were significantly associated with the uptake of the HPV vaccine. We recommend increasing adolescent knowledge, positive attitudes, and uptake of HPV vaccination through school-based seminars, health education, and community mobilization.