bluuebunny/crossref_metadata_2025 huggingface dataset:
Walking on a Balance Beam as a New Measure of Dynamic Balance to Predict Falls in Older Adults and Patients with Neurological Conditions
Authors: Hortobágyi Tibor , Vetrovsky Tomas , Uematsu Azusa , Sanders Lianne , da Silva Costa Andréia Abud , Batistela Rosangela Alice , Moraes Renato , Granacher Urs , Szabó-Kóra Szilvia , Csutorás Bence , Széphelyi Klaudia , Tollár József
Published: May 2024

Background

Beam walking is a new test to estimate dynamic balance. We characterized dynamic balance measured by the distance walked on beams of different widths in five age groups of healthy adults (20, 30, 40, 50, 60 years) and individuals with neurological conditions (i.e., Parkinson, multiple sclerosis, stroke, age: 66.9 years) and determined if beam walking distance predicted prospective falls over 12 months.

Methods

Individuals with (n = 97) and without neurological conditions (n = 99, healthy adults, age 20–60) participated in this prospective longitudinal study. Falls analyses over 12 months were conducted. The summed distance walked under single (walking only) and dual-task conditions (walking and serial subtraction by 7 between 300 to 900) on three beams (4, 8, and 12-cm wide) was used in the analyses. Additional functional tests comprised grip strength and the Short Physical Performance Battery.

Results

Beam walking distance was unaffected on the 12-cm-wide beam in the healthy adult groups. The distance walked on the 8-cm-wide beam decreased by 0.34 m in the 20-year-old group. This reduction was ~ 3 × greater, 1.1 m, in the 60-year-old group. In patients, beam walking distances decreased sharply by 0.8 m on the 8 versus 12 cm beam and by additional 1.6 m on the 4 versus 8 cm beam. Beam walking distance under single and dual-task conditions was linearly but weakly associated with age (R2 = 0.21 for single task, R2 = 0.27 for dual-task). Age, disease, and beam width affected distance walked on the beam. Beam walking distance predicted future falls in the combined population of healthy adults and patients with neurological conditions. Based on receiver operating characteristic curve analyses using data from the entire study population, walking ~ 8.0 of the 12 m maximum on low-lying beams predicted future fallers with reasonable accuracy.

Conclusion

Balance beam walking is a new but worthwhile measure of dynamic balance to predict falls in the combined population of healthy adults and patients with neurological conditions. Future studies are needed to evaluate the predictive capability of beam walking separately in more homogenous populations.

Clinical Trial Registration Number NCT03532984.
Contraction of Respiratory Viral Infection During air Travel: An Under-Recognized Health Risk for Athletes
Authors: Ruuskanen Olli , Dollner Henrik , Luoto Raakel , Valtonen Maarit , Heinonen Olli J. , Waris Matti
Published: May 2024

Air travel has an important role in the spread of viral acute respiratory infections (ARIs). Aircraft offer an ideal setting for the transmission of ARI because of a closed environment, crowded conditions, and close-contact setting. Numerous studies have shown that influenza and COVID-19 spread readily in an aircraft with one virus-positive symptomatic or asymptomatic index case. The numbers of secondary cases differ markedly in different studies most probably because of the wide variation of the infectiousness of the infector as well as the susceptibility of the infectees. The primary risk factor is sitting within two rows of an infectious passenger. Elite athletes travel frequently and are thus prone to contracting an ARI during travel. It is anecdotally known in the sport and exercise medicine community that athletes often contract ARI during air travel. The degree to which athletes are infected in an aircraft by respiratory viruses is unclear. Two recent studies suggest that 8% of Team Finland members traveling to major winter sports events contracted the common cold most probably during air travel. Further prospective clinical studies with viral diagnostics are needed to understand the transmission dynamics and to develop effective and socially acceptable preventive measures during air travel.
A telemonitoring intervention design for patients with poorly controlled type 2 diabetes: protocol for a feasibility study
Authors: Laursen Sisse H. , Giese Iben Engelbrecht , Udsen Flemming W. , Hejlesen Ole K. , Barington Pernille F. , Ohrt Morten , Vestergaard Peter , Hangaard Stine
Published: May 2024

Background

Maintaining optimal glycemic control in type 2 diabetes (T2D) is difficult. Telemedicine has the potential to support people with poorly regulated T2D in the achievement of glycemic control, especially if the telemedicine solution includes a telemonitoring component. However, the ideal telemonitoring design for people with T2D remains unclear. Therefore, the aim of this feasibility study is to evaluate the feasibility of two telemonitoring designs for people with non-insulin-dependent T2D with a goal of identifying the optimal telemonitoring intervention for a planned future large-scale randomized controlled trial.

Method

This 3-month randomized feasibility study will be conducted in four municipalities in North Denmark starting in January 2024. There will be 15 participants from each municipality. Two different telemonitoring intervention designs will be tested. One intervention will include self-monitoring of blood glucose (SMBG) combined with sleep and mental health monitoring. The second intervention will include an identical setup but with the addition of blood pressure and activity monitoring. Two municipalities will be allocated to one intervention design, whereas the other two municipalities will be allocated to the second intervention design. Qualitative interviews with participants and clinicians will be conducted to gain insight into their experiences with and acceptance of the intervention designs and trial procedures (e.g., blood sampling and questionnaires). In addition, sources of differences in direct intervention costs between the two alternative interventions will be investigated.

Discussion

Telemonitoring has the potential to support people with diabetes in achieving glycemic control, but the existing evidence is inconsistent, and thus, the optimal design of interventions remains unclear. The results of this feasibility study are expected to produce relevant information about telemonitoring designs for people with T2D and help guide the design of future studies. A well-tested telemonitoring design is essential to ensure the quality of telemedicine initiatives, with goals of user acceptance and improved patient outcomes.

Trial registration

ClinicalTrials.gov, ID: NCT06134934. Registered November 1, 2023. The feasibility trial has been approved (N-20230026) by the North Denmark Region Committee on Health Research Ethics (June 5, 2023).
Cavernoma in a young adult: a case report
Authors: Ali Hina , Zaki Samar , Bari Ehsan , Khowaja Sara
Published: May 2024

Cavernomas or cavernous malformations of the central nervous system are acquired or hereditary vascular anomalies. Although they are present in 0.1–0.5% in the general population, they are usually asymptomatic and undetected until symptoms occur. We report a case of a healthy young adult, who presented with acute onset of dizziness, and intermittent episodes of loss of consciousness. MRI brain was suggestive of right insular cortex and right basal ganglia cavernoma. The patient later on developed seizures in the form of automatisms (continuous lip smacking). Surgical removal of the cavernoma was planned as in this case it was present in an eloquent area causing seizures. Seizure producing brain mapping and intraoperative electrocorticography was also performed which is rare in the region and offered by only few centres. The surgical resection of cavernoma was successfully performed, and patient reported improvement in symptoms during subsequent follow-ups.
Recent advances of collagen composite biomaterials for biomedical engineering: antibacterial functionalization and 3D-printed architecturalization
Authors: Zheng Lu , Tseomashko Natalya , Voronova Anastasiia , Vasil’kov Alexander , Hu Xiaoqing , Wang Xiaoying
Published: May 2024

Collagen possesses high biocompatibility with all tissue and cell types in the body, enabling the creation of multifunctional composite materials for medical applications. In biomedical engineering, naturally-sourced collagen is often combined with diverse organic and inorganic bioactive components to eliminate defects and disorders in fields including orthopedics, dermatology, and more. At the same time, medical-related infection issues and the precise treatment needs of patients require collagen composite biomaterials to have antibacterial properties and customized structures. This paper reviews the antibacterial functionalization of collagen composite biomaterials in recent years, including the combination with inorganic or organic antibacterial agents, which is beneficial for preventing and controlling biological contamination in medical applications. Then, the existing problems and future development directions for the architecturalization of collagen composite materials with 3D printing were discussed, providing guidance for personalized customization of multifunctional materials to meet the specific needs of patients in the future.

Graphical Abstract
Artificial intelligence as a negative predictive tool for breast cancer postoperative recurrence
Authors: Mansour Sahar , Azzam Heba , El-Assaly Hany
Published: May 2024

Background

Mammography alone is an ineffective method for breast cancer surveillance and diagnosing cancer recurrence. The aim was to evaluate the ability of artificial intelligence (AI) to read digital mammograms as an additive tool to exclude recurrence in the operative bed of known breast cancer patients following the different surgical procedures.

Methods

We used a retrospective cohort study of post-surgery mammograms (n = 577). Imaging was performed within 6 months after the surgery or more. The AI solution used to read mammograms (AI-MMG) provided a targeted heat map of the operative bed, which was supported by a decision likelihood score percentage of cancer recurrence. The reference for suspicious or malignant-looking abnormalities (n = 62, 12.3%) was diagnosed by biopsy. A clear operative bed and benign-looking changes (n = 442) were confirmed by ultrasound characterization patterns and one year of intermittent follow-up.

Results

The AI scoring percentage for a clear operative bed ranged between 0 and 26%, with a mean of 15% ± 5.4%. Operative bed benign changes ranged from 10 to 88%, with a mean of 48.2% ± 21.2%, while malignancy recurrence ranged from 65 to 99%, with an average of 87.7% ± 10.5%. The “ROC: Receiver Operating Characteristic” curve for AI to predict cancer in the surgical bed on mammograms was 0.906. The optimum cutoff value to distinguish between benign postoperative alterations and malignancy recurrence was 56.5% (95%, CI 0.824–1.060, p value < 0.001).

Excellent agreement between AI-MMG and pathology or ultrasound results was observed, and Kappa was 0.894, p value < 0.001.

Conclusions

The use of artificial intelligence has enhanced the diagnostic performance of the postoperative mammograms to rule out recurrent malignancies in breast cancer surveillance.
Can early post-operative MRI describe a predictor model for the likelihood of early breast cancer recurrence after conservative surgery?
Authors: Elboghdady Aya Ahmed , Shawky Sarah Ahmed , Mohsen Mohamed , Zaky Mona Mahmoud
Published: May 2024

Background

Breast-conserving surgery is becoming more commonly used in breast cancer treatment. However, after surgery, the breast may undergo rapid changes that can sometimes hide signs of tumor recurrence. Breast MRI is highly sensitive and specific in detecting any residual or recurrent tumors after breast-conserving therapy, making it an effective tool in the management of breast cancer. We aimed to assess the detectability of DCE-MRI in breast cancer female patients following breast conservative surgery (after a minimum of 1–4 months post-operative) to confirm complete tumor removal and differentiate between post-procedural complications and metachronous cancer in the ipsilateral or contralateral breast.

Methods

This retrospective study was conducted from March 2017 to December 2023 on 269 patients. All cases had undergone breast conservative surgery and were suspected of either recurrence or post-operative complications by clinical examination and/or sono-mammography. DCE-MRI was performed at 1.5T. The findings were correlated with the histopathological results in all cases.

Results

Patients’ mean age was 50.7 years with 389 suspected breast lesions, post-surgical traumatic fat necrosis was the most common benign finding (75.8%), and most common histological type in malignant cases was invasive mammary carcinoma (15.2%). Sensitivity and specificity of MRI BI-RADS to differentiate benign from malignant lesions were 100%. The best ADC cutoff value to differentiate between benign and malignant lesions was 1.25 × 10−3 mm2/s. The model of predictors of likelihood of malignant lesion nature had sensitivity 77%, specificity 77.8%, PPV 90% and NPV 96.7%.

Conclusions

MRI proved crucial in assessing patients after BCS. DWI can be included in patients with negative sono-mammographic examination for initial lesions detection without the need of contrast media, yet DCE MRI is mandatory in case of lesion characterization to delineate its nature, thus it cannot be replaced by DWI alone.
Do no harm: the impact of implementing cancer prevention strategies on other preventive health measures
Authors: Emmons Karen M. , Pelton-Cairns Leslie , Gundersen Daniel A. , Cruz Jennifer L. , Mascioli Lynette , Kruse Gina R. ,   For the ISCCCE Partnership
Published: May 2024

Background

Translational efforts to increase uptake of evidence-based practices typically look at those outcomes in isolation of their impact on other aspects of care delivery. If we are in fact to “do no harm”, we must consider the possible negative impact of improving use of one practice on other quality measures. Alternatively, a focus on one practice could lead to spread of effective strategies to other practices, which would be highly beneficial. We studied the impact of a colorectal cancer (CRC) screening initiative on delivery of other preventive care measures.

Methods

We used an interrupted time series design with implementation year as the interruption point. The initiative was conducted between 2015 and 2020, with three staggered cohorts. Main outcomes were quality measures for colorectal cancer screening, cervical cancer screening, hypertension management, diabetes management, weight screening and follow-up, tobacco use screening and cessation treatment, and depression screening and follow-up.

Results

The initiative was associated with an increase in CRC screening (OR = 1.67, p ≤ 0.01; average marginal effect = 12.2% points), and did not reduce performance on other quality measures in the year of CRC program implementation or a change in their respective secular trends.

Conclusions

The initiative led to a clinically meaningful increase in CRC screening and was not associated with reductions in delivery of six other preventive services. Quality improvement (QI) initiatives typically approach implementation with an eye towards reducing unintended impact and leveraging existing staff and resources. Implementation research studies may benefit from considering how QI initiatives factor in the local context in implementation efforts.
Upper limb muscle strength and exercise endurance as predictors of successful extubation in mechanically ventilated patients
Authors: de Beer-Brandon Caroline R. , van Rooijen Agatha J. , Becker Piet J. , Paruk Fathima
Published: May 2024

Background

Failed extubation increases the intensive care unit (ICU) length of stay, hospital length of stay, and financial costs and it reduces the patient’s functional ability. Avoiding failed extubation is of utmost importance, therefore predictors for successful extubation are paramount.

Objective

To determine if successful extubation in mechanically ventilated patients can be predicted by physiotherapists using upper limb muscle strength and exercise endurance.

Methods

Fifty-seven patients from the medical and trauma ICUs of a large academic hospital were eligible for testing. Muscle strength was evaluated using the Oxford grading scale, Medical Research Council score (MRC score), handgrip dynamometer, and maximum inspiratory pressure (MIP). Exercise endurance was tested while the patient was actively riding the MOTOmed® letto2 cycle ergometer for six minutes with the upper limbs.

Results

Exercise endurance (time the patient rode actively) (P = 0.005), MRC-score (P = 0.007), and number of days ventilated (P = 0.005) were associated with successful extubation. The handgrip strength (P = 0.061), MIP (P = 0.095), and muscle strength of the sternocleidomastoid (P = 0.053) and trapezius muscles (P = 0.075) were marginally associated with successful extubation. Due to multicollinearity when developing the prediction equation, the final multivariable logistic regression prediction model included only exercise endurance and the number of days ventilated. The newly developed prediction equation conferred a sensitivity of 81.82% and a specificity of 77.14% to predict successful extubation.

Conclusion

Successful extubation of mechanically ventilated patients can be predicted by physiotherapists using the newly developed prediction equation consisting of exercise endurance and number of days ventilated.
Launching an International Community of Practice in Hematology/Oncology Medical Education
Authors: Walsh Katherine , Manochakian Rami , Schwartz Jennifer , Brondfield Sam
Published: May 2024

A community of practice (CoP) is a group of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly. While the field of hematology/oncology has historically prioritized clinical care and biomedical research, medical education has received increasing attention within hematology/oncology in recent years. In 2018, ASCO launched the Education Scholars Program to train hematology/oncology clinicians in the science of teaching and learning. However, the number of hematology/oncology educators nationally and internationally far exceeds the capacity of the Education Scholars Program to train them. In addition, hematology/oncology educators often lack sufficient mentorship and guidance at their own institutions to pursue their chosen career path effectively. To ensure high-quality clinical care and research for generations to come, attention must be paid to improving support for hematology/oncology educators. Therefore, supported by ASCO, we developed an international medical education (Med Ed) CoP for hematology/oncology educators with the purpose of providing them with support, community, mentorship, resources, and scholarly opportunities in medical education. In this article, we describe the development of the Med Ed CoP using a three-stage framework (Establish-Grow-Sustain) including successes, challenges, and reflections. By supporting the needs of hematology/oncology educators, the Med Ed CoP will serve as a home for all who contribute to the field of hematology/oncology.
Phase I and Randomized Phase II Study of Ruxolitinib With Frontline Neoadjuvant Therapy in Advanced Ovarian Cancer: An NRG Oncology Group Study
Authors: Landen Charles N. , Buckanovich Ronald J. , Sill Michael W. , Mannel Robert S. , Walker Joan L. , DiSilvestro Paul A. , Mathews Cara A. , Mutch David G. , Hernandez Marcia L. , Martin Lainie P. , Bishop Erin , Gill Sarah E. , Gordinier Mary E. , Burger Robert A. , Aghajanian Carol , Liu Joyce F. , Moore Kathleen N. , Bookman Michael A.
Published: May 2024

PURPOSE

The interleukin-6/Janus kinase (JAK)/signal transducers and activators of transcription 3 axis is a reported driver of chemotherapy resistance. We hypothesized that adding the JAK1/2 inhibitor ruxolitinib to standard chemotherapy would be tolerable and improve progression-free survival (PFS) in patients with ovarian cancer in the upfront setting.

MATERIALS AND METHODS

Patients with ovarian/fallopian tube/primary peritoneal carcinoma recommended for neoadjuvant chemotherapy were eligible. In phase I, treatment was initiated with dose-dense paclitaxel (P) 70 mg/m2 once daily on days 1, 8, and 15; carboplatin AUC 5 intravenously day 1; and ruxolitinib 15 mg orally (PO) twice a day, every 21 days (dose level 1). Interval debulking surgery (IDS) was required after cycle 3. Patients then received three additional cycles of chemotherapy/ruxolitinib, followed by maintenance ruxolitinib. In the randomized phase II, patients were randomly assigned to paclitaxel/carboplatin with or without ruxolitinib at 15 mg PO twice a day for three cycles, IDS, followed by another three cycles of chemotherapy/ruxolitinib, without further maintenance ruxolitinib. The primary phase II end point was PFS.

RESULTS

Seventeen patients were enrolled in phase I. The maximum tolerated dose and recommended phase II dose were established to be dose level 1. One hundred thirty patients were enrolled in phase II with a median follow-up of 24 months. The regimen was well tolerated, with a trend toward higher grade 3 to 4 anemia (64% v 27%), grade 3 to 4 neutropenia (53% v 37%), and thromboembolic events (12.6% v 2.4%) in the experimental arm. In the randomized phase II, the median PFS in the reference arm was 11.6 versus 14.6 in the experimental, hazard ratio (HR) for PFS was 0.702 (log-rank P = .059). The overall survival HR was 0.785 ( P = .24).

CONCLUSION

Ruxolitinib 15 mg PO twice a day was well tolerated with acceptable toxicity in combination with paclitaxel/carboplatin chemotherapy. The primary end point of prolongation of PFS was achieved in the experimental arm, warranting further investigation.
Phase I/II Study of a Vascular Endothelial Growth Factor Receptor Vaccine in Patients With NF2-Related Schwannomatosis
Authors: Tamura Ryota , Yamanobe Yoshiharu , Fujioka Masato , Morimoto Yukina , Fukumura Mariko , Nakaya Masato , Oishi Yumiko , Sato Mizuto , Ueda Ryo , Fujiwara Hirokazu , Hikichi Tetsuro , Noji Shinobu , Oishi Naoki , Ozawa Hiroyuki , Ogawa Kaoru , Kawakami Yutaka , Ohira Takayuki , Yoshida Kazunari , Toda Masahiro
Published: May 2024

PURPOSE

The humanized antivascular endothelial growth factor (VEGF) antibody bevacizumab (Bev) is efficacious for the treatment of NF2-related schwannomatosis (NF2), previously known as neurofibromatosis type 2. This study evaluated the safety and efficacy of a VEGF receptor (VEGFR) vaccine containing VEGFR1 and VEGFR2 peptides in patients with NF2 with progressive schwannomas (jRCTs031180184).

MATERIALS AND METHODS

VEGFR1 and VEGFR2 peptides were injected subcutaneously into infra-axillary and inguinal regions, once a week for 4 weeks and then once a month for 4 months. The primary end point was safety. Secondary end points included tolerability, hearing response, imaging response, and immunologic response.

RESULTS

Sixteen patients with NF2 with progressive schwannomas completed treatment and were assessed. No severe vaccine-related adverse events occurred. Among the 13 patients with assessable hearing, word recognition score improved in five patients at 6 months and two at 12 months. Progression of average hearing level of pure tone was 0.168 dB/mo during the year of treatment period, whereas long-term progression was 0.364 dB/mo. Among all 16 patients, a partial response was observed in more than one schwannoma in four (including one in which Bev had not been effective), minor response in 5, and stable disease in 4. Both VEGFR1-specific and VEGFR2-specific cytotoxic T lymphocytes (CTLs) were induced in 11 patients. Two years after vaccination, a radiologic response was achieved in nine of 20 assessable schwannomas.

CONCLUSION

This study demonstrated the safety and preliminary efficacy of VEGFR peptide vaccination in patients with NF2. Memory-induced CTLs after VEGFR vaccination may persistently suppress tumor progression.
Multi-Institutional Study of Referral Patterns for Gynecologic Oncology Consultation
Authors: DeMari Joseph A. , Madeka Isheeta , Evans Joni K. , Bailey Courtney , Bartucci Kristen , Bottsford-Miller Justin , Bradford Leslie , Burnett Brian , Kelly Rebeca , Rowland Michelle , Wallbillich John J. , Shalowitz David I.
Published: May 2024

PURPOSE

Evaluation by a gynecologic oncologist (GO) is associated with improved clinical outcomes for patients with gynecologic cancers, yet little is known about health care factors that influence patients' referrals to GO.

METHODS

Medical records of 50 consecutive new patients seen in GO clinics at each of six referral centers across the United States were reviewed. Patient and disease characteristics were collected along with referral indication, evaluation and referral dates, diagnostic procedures, provider specialties, and zone improvement plan (ZIP) code of up to three referring providers per patient. The primary outcome was interval between first evaluation and referral. Univariate associations were evaluated with Chi-square and Wilcoxon rank-sum tests and multivariable associations with negative binomial regression models. Secondary outcome was prolonged time to GO referral, defined as greater than the 75th percentile. Logistic regression was used for multivariable modeling.

RESULTS

Three hundred patient records were analyzed. The median time from first health care encounter to referral was 15 days (IQR, 5-43). The mean distance from residence to GO was 39.8 miles (standard deviation, 53.8). Seventy-one percent of GO referrals were initiated by obstetrician-gynecologists, 9% by family physicians, and 6% internists. Presentation-to-referral interval was 76% shorter for patients evaluated by an emergency medicine clinician (exp(Beta), 0.24; 95% CI, 0.11 to 0.53; P < .001). Public insurance was associated with 1.47 times longer time to referral compared with private insurance (exp(Beta), 1.47; 95% CI, 1.05 to 2.04; P = .001). Residents of nonmetropolitan ZIP codes were less likely to have prolonged time to referral (odds ratio [OR], 0.288; P = .017). Distance from residence to GO (per 10 miles) increased the likelihood of prolonged time to referral (OR, 1.10; P = .010).

CONCLUSION

Interventions are needed to improve recognition and referral of patients for gynecologic oncology evaluation. Community outreach and engagement with obstetrician-gynecologists should be prioritized to improve times to referral.
The p-type modulation of
by Ca and Cd doping
Authors: Cui Huiqin , Zheng Shijiao , Zhang Zhiyi , Chen Bo , Zhang Yongjia , Li Jie , Wang Juanfen , Xue Lin , Zhang Longlong
Published: May 2024

Two-dimensional (2D) Bi2O2Se has been widely used as optoelectronic detector due to its excellent carrier mobility and environmental stability. However, the synthesis of the p-type Bi2O2Se remains challenging which hinders its further applications. In this paper, we have investigated the electronic properties of the native point defects and the Ca/Cd-doping effects on Bi2O2Se using first-principles calculations. The results indicate that Se vacancy (V
Se
) and O vacancy (V
O
) are shallow donors, which lead to the n-type Bi2O2Se semiconductor. Ca substituting Bi (Ca
Bi
) and Cd substituting Bi (Cd
Bi
) are acceptors and can compensate the n-type behavior of shallow donors. The compensation effect of Cd
Bi
is weaker than that of Ca
Bi
due to its higher formation energies. Additionally, the calculation results of the Fermi level, defect and carrier concentrations indicate that Ca
Bi
shifts the Fermi level towards the valence band maximum (VBM), however, it is not sufficient to convert Bi2O2Se into the p-type.
Timing of a First Romantic Union Among Sexual Minority Young Adults
Authors: Mernitz Sara , Hsu Jaime , Pollitt Amanda
Published: May 2024

Cohabitation and marriage are critical milestones during the transition to adulthood; however, there is limited research on the timing of young adults’ first same-sex unions. There is some evidence that same-sex unions may be delayed, particularly for men. Further, formation of both same- and different-sex dating relationships, common among sexual minority young adults, may also extend to cohabitation and marriage. We used the National Longitudinal Study of Adolescent to Adult Health to predict the timing of a first romantic union, defined as a cohabitation or marriage, among sexual minority young adults. We then distinguished between women and men and the timing of a different-sex versus a same-sex union. Compared with heterosexual young adults, lesbian and gay young adults entered a union at later ages (driven by men), whereas bisexual young adults entered a union at younger ages (driven by women). Lesbian and gay young adults who entered a first union with a same-sex partner did so at later ages than those who entered a first union with a different-sex partner. Results suggest that patterns of sexual minority dating relationship formation might extend to unions.
Passion Relic Devotion, an Implanted Relic, and a Prostheticized Body: Rethinking Matter and Agency in “A Grete Myracle of a Knyghte Good Callyd Syr Roger Wallysborow”
Authors: Calkin Siobhain Bly
Published: May 2024

This article analyzes an English miracle narrative in which a portion of the Holy Cross is implanted within a knight's body in the Holy Land and is translated to Cornwall. The text raises important questions about what implantation means for the relic and human matters so conjoined and their respective agencies. Drawing on ideas about prostheticized bodies developed in disability studies can help scholars better understand the ontological questions raised by the melding of human and nonhuman matters, the profound vulnerability this entails for the devout human subject, and the ways in which this fusion of relic and human matter is socially transformative for the broader community. The article thus outlines some of the complex negotiations of matter and agency that could be imagined as part of the affective world of late medieval and early modern Passion relic veneration.
Outcomes of transarterial chemoembolization in patients with unresectable hepatocellular carcinoma: A tertiary center experience
Authors: Tahir Misbah , Khalid Mustafa  , Ali Muhammad , Khalid Danial
Published: May 2024

Objective: To assess the overall survival in patients with intermediate stage hepatocellular carcinoma following transarterial chemoembolization.
Methods: It is a retrospective descriptive study carried out in the Department of Radiology of Liaquat National Hospital Karachi, Pakistan. Seventy-two patients were enrolled from July 2014 to December 2021 and had chemoembolization therapy. Patients were followed till their demise. Mean and Median survivals were calculated.
Results: A total of 72 patients had a median survival of 15 months with 95% confidence interval (11 months was lower bound and 18 months was upper bound), 19 months was the mean survival time with 95% confidence interval (14.7 months was lower limit and 22.6 months the upper limit). The factors which had a significant impact on the median survival time were Child-Pugh classification, average size of tumor and embolization pattern.
Conclusion: Transarterial chemoembolization (TACE) increases the median survival time effectively and safely in patients with hepatocellular carcinoma. However complete resolution of disease is not possible with TACE, with most patient eventually succumbing to the disease. The overall survival for TACE in this study correlates well with other studies. Child Pugh Class, tumor size and embolization pattern have significant effect on survival of patients.
doi: https://doi.org/10.12669/pjms.40.6.7593
How to cite this: Tahir M, Mustafa K, Ali M, Khalid D. Outcomes of transarterial chemoembolization in patients with unresectable hepatocellular carcinoma: A tertiary center experience. Pak J Med Sci. 2024;40(6):1196-1200. doi: https://doi.org/10.12669/pjms.40.6.7593
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Hepatitis-B immune status and vaccination in Family Medicine Practice: A retrospective study
Authors: GOKTAS OLGUN
Published: May 2024

Objective: To examine the relationship between Hepatitis B vaccination status and demographic and hepatitis B markers of individuals receiving healthcare services.
Methods: The study designed in a retrospective structure using quantitative research methods was conducted with a total of 1837 individuals including medical school students and other healthcare professionals (975 female, 862 male) aged 19-77 who were registered to the Family Health Center between March 1, 2023, and March 31, 2023. In the study, sociodemographic characteristics, infancy and adult full-dose hepatitis-B vaccines, and marker laboratory measurements of these individuals who were registered to the Family Health Center were examined. SPSS 25.00 program was used for statistical analysis and the level of significance was determined as 0.05.
Results: In general, the rate of three doses of vaccination in infancy was 55.1%. Vaccine doses administered to individuals were one with 15.1%, two with 22.9%, and three with 62.1%. In the study, it was determined that anti-HBs levels before and after vaccination differed significantly according to vaccine doses (p=0.01). It was determined that the anti-HBs levels of the three doses vaccine group were 100 and above (p=0.01).
Conclusion: Although the Universal Hepatitis-B Vaccination Program was followed in our study, it was determined that antibody levels in healthcare workers decreased or ended over time, and hepatitis-B antibody levels increased significantly with each dose of vaccine administered. For this reason, it is of great importance to determine regular antibody levels and develop standard vaccination programs, especially in healthcare workers.
doi: https://doi.org/10.12669/pjms.40.6.8371
How to cite this: Goktas O. Hepatitis-B immune status and vaccination in Family Medicine Practice: A retrospective study. Pak J Med Sci. 2024;40(6):1163-1167. doi: https://doi.org/10.12669/pjms.40.6.8371
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Clear Cell Renal Cell Carcinoma with Neovascularization and Ureteral Extension in a 63-Year-Old Female Unravelled by Pelvicalyceal Penetration
Authors: Zafar Nauman , Nusrat Nadeem , Bajwa Sarmad Imtiaz , Imtiaz Saira
Published: May 2024

Approximately 3% to 4% of all newly diagnosed cancers are kidney tumours, which can develop from either the renal parenchymal tissue or the renal pelvis. Kidney cancer is one of the 13 most prevalent kinds of malignancy worldwide. 85% of all malignant kidney neoplasms are renal cell carcinomas (RCC). We present a rare instance of an RCC that had a thrombus in the ureter and had directly extended into the renal pelvicalyceal system.
A thorough diagnostic workup was required because the patient had a number of symptoms, including flank pain, hematuria, and weight loss. Imaging tests identified a renal parenchymal-derived infiltrative tumour with remarkable pelvicalyceal penetration. Neovascularization was found within the tumour as a result of additional search. The discovery of ureteral extension, a peculiar characteristic, raised questions regarding both local and distant metastases. R.E.N.A.L nephrometry score was 11 with high complexity. Multidisciplinary management of the intricate clinical problem was employed. After removing the tumour mass, the ureteral involvement was treated with surgical resection, adjuvant therapy, and CT monitoring over the three-month high-risk follow-up period. With surgery, targeted treatment was employed to stop the cancer from growing.
Conclusion: The importance of identifying unusual RCC presentations and employing a comprehensive diagnostic and treatment strategy is emphasised by this study. The complex interaction of ureteral extension, neovascularization, and pelvicalyceal penetration highlights the aggressiveness of advanced RCC. Since we are not aware of any literature documented instances including this combination, there are few studies explaining pelvicalyceal system invasion that defies commonly recognised diagnostic and treatment paradigms for renal cell carcinoma.
doi: https://doi.org/10.12669/pjms.40.6.8715
How to cite this: Zafar N, Nadeem Bin Nusrat, Bajwa SI, Imtiaz S. Clear Cell Renal Cell Carcinoma with Neovascularization and Ureteral Extension in a 63-Year-Old Female Unravelled by Pelvicalyceal Penetration. Pak J Med Sci. 2024;40(6):1300-1302.  doi: https://doi.org/10.12669/pjms.40.6.8715
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
An unusual presentation of fungal brain abscess in immunocompetent host
Authors: Bhatti Sajid Islam , German Sidra , Waqar Tajammul , Naqvi Rubina
Published: May 2024

Focal area of necrosis, with a surrounding membrane within the brain parenchyma, usually resulting from an infectious process or rarely from a traumatic process known as brain abscess. We report a case of young female, who presented with multiple abscess in left frontal and right occipital region of brain, she was otherwise immunocompetent, lacking any known risk factor for opportunistic infection. And this fungal abscess manifest with unusual presentation of bilateral lower limb weakness along with seizures and fever. This infection leads to acute kidney injury (AKI), necessitating kidney replacement therapy (RRT) in term of intermittent hemodialysis (IHD). After drainage of abscess and antifungal therapy, she responded well, her acute kidney injury resolved and she showed clinical and radiological improvement.
doi: https://doi.org/10.12669/pjms.40.6.8877
How to cite this: Bhatti SI, German S, Waqar T, Naqvi R. An unusual presentation of fungal brain abscess in immunocompetent host. Pak J Med Sci. 2024;40(6):1306-1309. doi: https://doi.org/10.12669/pjms.40.6.8877
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Efficacy of uniportal versus multiportal video-assisted thoracoscopic lobectomy for non-small cell lung cancer: A retrospective analysis
Authors: Zheng Xing , Wang Wenmin , Li Xiang , He Pengyixiang , Wu Xu
Published: May 2024

Objective: To compare the uniportal and multiportal video-assisted thoracoscopic surgery (VATS) in patients with non-small-cell lung cancer (NSCLC).
Methods: Medical records of 128 patients with NSCLC who underwent surgical treatment in the First School of Clinical Medicine, Southern Medical University from August 2020 to February 2022 were retrospectively analyzed. There were 60 patients who underwent uniportal VATS (UVATS group) and 68 patients underwent multiportal VATS (MVATS group). The relevant indexes, complications, postoperative pain levels and quality of life, recurrence, metastases and survival between the two groups were compared.
Results: UVATS was associated with longer operation time and higher intraoperative blood loss compared to MVATS (P<0.05). The postoperative drainage volume, and the visual analogue scale (VAS) scores at 24 and 72 hours were lower in the UVATS group compared to the MVATS group, while the chest tube retention time and hospitalization time were shorter than those in the MVATS group (P<0.05). The quality of life at six months after surgery in the UVATS group was significantly higher than that in the MVATS group (P<0.05).
Conclusions: UVATS and MVATS have similar outcomes in patients with NSCLC. Although UVATS surgery takes longer and is associated with more interoperative bleeding, it can reduce postoperative pain, shorten postoperative recovery time, and help further improve the quality of life of patients after surgery.
doi: https://doi.org/10.12669/pjms.40.6.9313
How to cite this: Zheng X, Wang W, Li X, He P, Wu X. Efficacy of uniportal versus multiportal video-assisted thoracoscopic lobectomy for non-small cell lung cancer: A retrospective analysis. Pak J Med Sci. 2024;40(6):1135-1139. doi: https://doi.org/10.12669/pjms.40.6.9313
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Enlightenment, modernity and democracy:
Authors: Pearce Colin
Published: May 2024

This essay seeks to demonstrate a certain overlap between the political thought of Leo Strauss (1899-1973) and H. L. Mencken (1888-1956). The argument fully recognizes that Strauss is a political philosopher inclined to the classics and natural right, and Mencken is a journalist inclined to the moderns and the power of scientific progress, they nevertheless occupy the same terrain in respect of certain opinions on the purely political plane. Allowing a great distance between the two men philosophically speaking, we can still see them come together in arguing that a regime which looks up to certain individuals of ability, talents, character, intellect and virtue has to be the standard by which the discipline of political science makes its judgments concerning the phenomena of political life.
The Machiavellian reality of Leo Strauss
Authors: Vavouras Elias
Published: May 2024

What is it makes Machiavelli such a decisive thinker, worthy of the Straussian interpretation? For Strauss, Machiavellian theoretical achievement is that he succeeds in misleading us, in leading us through his intelligent propaganda away from philosophy or political science in the literal sense of the word. He uses his interpretation of Machiavellian thought as a means of esoteric expression of his own positions. While he states that thoughts are expressed on Machiavelli, in fact Strauss' thoughts are expressed with Machiavelli as his "speaker-mouthpiece", with the aim of returning to the point where the Machiavellian rupture began, in classical natural right. As much as we agree or disagree with the Straussian interpretation, we cannot ignore the driving force it activates in the debate over the shaping of Machiavellian reality. After all, the Strauss’s analysis itself in the Machiavellian text aims at overcoming structural problems of the political thought and of the human condition in general.
Variational problems in submanifold geometry
Authors: Φουρτζής Ιωάννης
Published: May 2024

Στην παρούσα διατριβή, το πρώτο κεφάλαιο αναφέρει έννοιες από την Γεωμετρία Υποπολυπτυγμάτων. Εισαγάγουμε τις έννοιες των αρμονικών και ελαχιστικών απεικονίσεων και ανακαλούμε ολικά αποτελέσματα που χρησιμοποιούνται στις αποδείξεις. Το δεύτερο κεφάλαιο αφιερώνεται στην περιγραφή της μοναδιαίας εφαπτόμενης δέσμης ενός πολυπτύγματος Riemann. Επιπλέον, βρίσκουμε τις εξισώσεις Euler-Lagrange για το συναρτησοειδές ενέργειας και όγκου για μοναδιαία διανυσματικά πεδία. Στο τρίτο κεφάλαιο περιέχεται ο ορισμός της δεύτερης θεμελιώδους μορφής μιας φύλλωσης από μέγιστους κύκλους της τριδιάστατης σφαίρας και αποδεικνύονται οι εξισώσεις Riccati και Codazzi. Επιπλέον, παρέχουμε μια εναλλακτική προσέγγιση στην κατασκευή των Gluck και Warner. Ως εκ τούτου, λόγω της προσέγγισης μας δίνουμε απλοποιημένες αποδείξεις σε έναν αριθμό από ήδη γνωστά αποτελέσματα. Στο τέταρτο και πέμπτο κεφάλαιο περιέχονται οι αποδείξεις των αποτελεσμάτων μας για την αρμονική και ελαχιστική περίπτωση, αντίστοιχα. Συγκεκριμένα, δείχνουμε ότι οι συσχετισμένες απεικονίσεις Gauss με τέτοιες φυλλώσεις είναι αρμονικές ή αντίστοιχα ελαχιστικές αν και μόνο αν το μοναδιαίο διανυσματικό πεδίο που παράγει την φύλλωση από μέγιστους κύκλους είναι αρμονικό ή αντίστοιχα ελαχιστικό μοναδιαίο διανυσματικό πεδίο. Τα αποτελέσματα αυτά είναι ανάλογα ενός κλασικού Θεωρήματος των Ruh και Vilms που αφορά την αρμονικότητα μιας απεικόνισης Gauss ενός ελαχιστικού υποπολυπτύγματος του ευκλείδειου χώρου. Επιπλέον, αποδεικνύεται ότι αν έχουμε αρμονικό ή ελαχιστικό μοναδιαίο διανυσματικό πεδίο ολικά ορισμένο στην τριδιάστατη σφαίρα και οι ολοκληρωτικές του καμπύλες είναι μέγιστοι κύκλοι τότε αυτό είναι διανυσματικό πεδίο Hopf.
Microencapsulated phase change materials for thermal energy storage in buildings
Authors: Παρούτογλου Ευδοξία
Published: May 2024

Τα συστήματα αποθήκευσης θερμικής ενέργειας παίζουν σημαντικό ρόλο στην εξοικονόμηση ενέργειας και στη βελτίωση του κλίματος των εσωτερικών χώρων. Η αποθήκευση θερμικής ενέργειας λανθάνουσας θερμότητας με χρήση υλικών αλλαγής φάσης σε εφαρμογές θέρμανσης, εξαερισμού και κλιματισμού κτιρίων επιτρέπει την αποθήκευση σημαντικής ποσότητας ενέργειας σε σχετικά μικρό όγκο και την απορροφά/απελευθερώνει σε μικρό εύρος θερμοκρασίας. Ο κύριος στόχος της παρούσας μελέτης ήταν η ανάπτυξη και ο θερμικός χαρακτηρισμός μικροενθυλακωμένων υλικών αλλαγής φάσης σε κτιριακές εφαρμογές. Τα μικροενθυλακωμένα υλικά αλλαγής φάσης αποθηκεύουν σημαντική ενέργεια και αποφεύγεται η διαρροή ή ο διαχωρισμός φάσεων σε σύγκριση με τα υλικά αλλαγής φάσης σε αρχική μορφή. Στην παρούσα διατριβή, επτά υλικά αλλαγής φάσης που ανήκουν στις κατηγορίες των οργανικών παραφινών, των οργανικών μη παραφινών και των ανόργανων αλάτων χαρακτηρίστηκαν θερμικά. Επιπλέον, αυτή η μελέτη παρουσιάζει την ανάπτυξη υλικών αλλαγής φάσης, πολυμερών υλικών αλλαγής φάσης και μητρών ηλεκτροϊνοποιημένων ινών από υλικά αλλαγής φάσης. Όλες οι παραλλαγές των γαλακτωμάτων υλικών αλλαγής φάσης, των πολυμερών και των ηλεκτροϊνοποιημένων ινών χαρακτηρίστηκαν θερμικά και μορφολογικά. Η οργανική παραφίνη του εμπορίου RT18™ με θερμοκρασία τήξης 18°C σε αρχική μορφή, μορφή γαλακτώματος και ηλεκτροϊνοποιημένων ινών βρέθηκε κατάλληλη για εφαρμογή σε συστήματα αποθήκευσης θερμικής ενέργειας λανθάνουσας θερμότητας σε εφαρμογές κτιρίων. Η οργανική παραφίνη RT18™ εμφάνισε λανθάνουσες θερμότητες τήξης/στερεοποίησης 137-139 kJ/kg. Οι ηλεκτροϊνοποιημένες ίνες με πυρήνα υλικού αλλαγής φάσης από οργανική παραφίνη RT18™ και κέλυφος PCL παρουσίασαν λανθάνουσα θερμότητα στερεοποίησης τήξης 102,1/82,21 kJ/kg. Επιπλέον, μετά τη διεξαγωγή πειραματικών μελετών στα υλικά αλλαγής φάσης έγινε αριθμητική ανάλυση. Τα συστήματα αποθήκευσης θερμικής ενέργειας λανθάνουσας θερμότητας διαφορετικών γεωμετριών μελετήθηκαν χρησιμοποιώντας το λογισμικό Comsol Multiphysics6.0 FEM. Μελετήθηκε η επίδραση των εσωτερικών και εξωτερικών πτερυγίων σε έναν διπλό σωλήνα που ενθυλακώνει το υλικό αλλαγής φάσης στον δακτυλιοειδή χώρο. Επιπρόσθετα, αναλύθηκε ένα σύστημα αποθήκευσης θερμικής ενέργειας λανθάνουσας θερμότητας μεμονωμένου σωλήνα που χρησιμοποιεί μήτρα ηλεκτροϊνώσεως ινών με πυρήνα υλικών αλλαγής φάσης σε άμεση επαφή με νερό. Οι διαδικασίες αλλαγής φάσης επιταχύνθηκαν με αύξηση του μήκους των πτερυγίων.