bluuebunny/crossref_metadata_2025 huggingface dataset:
Right-to-left-shunts in patients scheduled for neurosurgical intervention in semi-sitting position – a literature review based on two case scenarios
Authors: Nikolic Marina , Eisner C. , Neumann J. O. , Haux D. , Krieg S. M. , Wielpütz M. O. , Weigand M. A. , Tochtermann U. , Fischer Dania
Published: October 2024

Background

Neurosurgery performed in the semi-sitting position provides advantages for certain procedures. However, this approach is associated with potential complications, particularly venous air embolism. Due to typically negative venous pressure at the wound site, air can be drawn into the veins. This risk is especially high in patients presenting with an intra- or extracardiac right-to-left-shunt. Transoesophageal echocardiography can be used to detect a patent foramen ovale or other possible pulmonary-systemic shunt before placing the patient in the sitting position.

Case presentation

In this report, we present two young patients undergoing scheduled microsurgical vestibular schwannoma removal in a semi-sitting position who were diagnosed with congenital heart defects during routine perioperative assessment to detect possible intracardiac right-to-left shunts, using pre- and intraoperative transesophageal echocardiography (TEE) and additionally conducting an agitated saline bubble study under Valsalva manoeuvre. Patient A was diagnosed with a persistent left superior vena cava and Patient B with an unroofed coronary sinus (UCS). These findings confronted the anesthesiological and surgical teams with difficult individual decisions regarding further perioperative management.

Conclusions

Perioperative transesophageal echocardiography is a diagnostic tool to both detect intraoperative position-related air embolisms and to rule out intracardiac right-to-left shunts, e.g. a patent foramen ovale, in order to decide for or against a (semi-)sitting position. Depending on the surgical circumstances a semi-sitting positioning of patients presenting with an intracardiac right-to-left-shunt, e.g. a PFO, can be feasible in individual cases if there is an implemented therapeutic algorithm to immediately terminate significant venous air entry. However, since certain other intra- or extracardiac right-to-left-shunts, such as here presented PLSVC or UCS, are rare, there is no definitive way of estimating the amount of entered air through detected shunts or anomalous vessels. Therefore, it is recommended to avoid a (semi-)sitting position in favour of a lateral or prone position for a patient undergoing intracranial surgery, once the perioperative TEE shows air bubbles in the left atrium or ventricle whose origins cannot be defined solely through TEE for certain in order to ensure patient safety by minimizing the risk of intraoperative paradoxical air embolisms.
The patient’s perspectives of safe and routine proactive deprescribing in primary care for older people living with polypharmacy: a qualitative study
Authors: Okeowo D. A. , Fylan B. , Zaidi S. T. R. , Alldred D. P.
Published: October 2024

Background

The process of identifying and discontinuing medicines in instances in which harms outweigh benefits (deprescribing) can mitigate the negative consequences of problematic polypharmacy. This process should be conducted with a focus on the patient and involve collaborative decision-making. Evidence is needed regarding patients’ views on how deprescribing should be safely and routinely implemented in English primary care to improve its application. This study aimed to identify optimal methods of introducing and actioning deprescribing from the patient’s perspective.

Methods

Participants in England aged 65 and above who were taking five or more medicines and residing in their own homes were recruited through social media and service user groups. An interview guide was created from deprescribing literature and input from patients and the public, guided by the Normalisation Process Theory (NPT). The interviews were held online using Microsoft Teams® or via phone, recorded, and then transcribed. The data was analysed using the Framework analysis.

Results

Twenty patients (mean age of 74.5, SD = 6.93), with 75% being female, were enrolled in the study. Three main themes emerged: (1) ‘Why deprescribe now?’ emphasised the significance of explaining the reasons behind deprescribing; (2) ‘Monitoring and follow-up’ underscored the necessity of safety measures during deprescribing and patients’ willingness to self-monitor post-intervention; (3) ‘Roles and relationships’ explored patient perceptions of various healthcare professionals involved in deprescribing and the essential interpersonal skills for fostering therapeutic relationships.

Conclusion

Optimal methods of introducing deprescribing included communicating a convincing rationale for stopping medicines and preparing patients for deprescribing conversations. Patients required support from a range of healthcare professionals with whom they had an existing therapeutic relationship. Whilst patients were motivated to self-monitor unwanted/unexpected effects post-deprescribing, timely support was required. The nature of such bolstered collective action and cognitive participation within NPT enhances the normalisation potential of deprescribing. These findings highlight the significance of considering the content and process of deprescribing consultations to enhance normalisation and tackle problematic polypharmacy. This provides a deeper understanding of patients’ needs for implementing safe and routine deprescribing in primary care, which should be considered when designing medication review and deprescribing services.
New-generation tetracyclines for severe macrolide-resistant Mycoplasma pneumoniae pneumonia in children: a retrospective analysis
Authors: Song Xiaoxiao , Zhou Ning , Lu Shuanglong , Gu Changjuan , Qiao Xiaohong
Published: October 2024

Background

Macrolide-resistant Mycoplasma pneumoniae (MRMP) strains are increasingly prevalent, leading to a rise in severe Mycoplasma pneumoniae pneumonia incidence annually, which poses a significant threat to children’s health. This study aimed to compare the effectiveness and safety of oral minocycline and doxycycline for the treatment of severe MRMP pneumonia in children.

Methods

This retrospective analysis included children treated for severe MRMP pneumonia at the Pediatric Department of Tongji Hospital, Shanghai, China, between September 2023 and January 2024 using minocycline and doxycycline. The patients were divided into four groups according to treatment: oral doxycycline alone (DOX group), oral minocycline alone (MIN group), oral doxycycline with intravenous glucocorticoids (DOXG group), and oral minocycline with intravenous glucocorticoids (MING group). Student’s t-test, Mann–Whitney U test, and χ2 or Fisher’s exact tests were used for group comparisons.

Results

A total of 165 patients were included in this study: 84 received minocycline, and 81 received doxycycline. The DOX group had higher fever resolution rates within 24, 48, and 72 h compared to the MIN group (63.2% vs. 31.8%, 79.0% vs. 63.6%, and 100% vs. 90.9%, respectively; all p < 0.05). The DOXG group showed higher fever resolution rates within 24 and 48 h than the MING group (92.3% vs. 83.4%, 100% vs. 92.7%, all p > 0.05). There were no statistically significant differences in time to imaging improvement, cough improvement, and disappearance of wet rales between groups, regardless of glucocorticoid combination. The longer the duration of fever prior to tetracycline therapy, the greater the likelihood of hypoxemia (p = 0.039) and a greater than two-fold elevation in the D-dimer level (p = 0.004).Univariate binary logistic regression model analysis revealed that CRP and erythrocyte sedimentation rate at disease onset were associated with defervescence within 24 h after treatment with tetracyclines alone (p = 0.020, p = 0.027), with erythrocyte sedimentation rate also influencing defervescence within 48 h (p = 0.022).

Conclusion

Doxycycline treatment resulted in a higher rate of defervescence than minocycline. Prompt treatment reduced the probability of pleural effusion, hypoxemia, pulmonary atelectasis, and D-dimer levels > 2 times the reference value.
Non-surgical treatment of lateral malleolar fractures is safe: long-term follow-up of a comprehensive treatment algorithm
Authors: Börjesson Erik , Johannesson Karolina , Ekelund Jan , Rydberg Emilia Möller
Published: October 2024

Introduction

A study at Sahlgrenska University Hospital (SU) found significant variation in the treatment of ankle fractures, leading to the development of a structured treatment algorithm (TA). The TA aimed to standardise treatment and reduce the number of unnecessary surgical procedures. A follow-up study concluded that the number of surgeries had significantly decreased since the TA was introduced. However, the long-term effects of the TA and the reduced number of surgical procedures remain unclear. The aim of the study was to analyse the long-term effects of a structured TA for ankle fractures, focusing on complications and reoperation rates.

Method

The present study is a long-term follow-up of the same two cohorts of patients with lateral malleolar fractures of type AO/OTA44-B1, as studied in the previous studies on the TA for ankle fractures at SU. The current study compares a group of AO/OTA 44B1 fractures treated before introducing the TA, the pre-TA cohort (n = 410), with a group treated after introducing the TA, the post-TA cohort (n = 333). Both cohorts were followed for at least four years, and the outcomes were reoperation or complication. Reoperation was defined as any surgical procedure performed ≥ 30 days after the injury.

Results

The results highlight a statistically significant reduction in the reoperation rate for lateral malleolar ankle fractures from 7.1 to 2.4% (p = 0.006) after introducing a TA that reduced the number of primary surgical procedures. Hardware-related issues were identified as the dominant cause of reoperation in both cohorts. Three major reoperations were observed in the pre-TA cohort compared to none in the post-TA cohort. The present study revealed no increase in the frequency of reoperations (late surgeries) due to non-union.

Conclusion

The non-surgical treatment of stable ankle fractures does not lead to an increase in reoperations caused by non-union. A TA that reduces the need for primary surgical procedures for lateral malleolar fractures of type AO/OTA44-B1 has resulted in a significant decrease in reoperation rates and no increase in failure rates. This long-term follow-up demonstrates that a non-surgical approach to isolated lateral malleolar fractures is safe.
Evaluation of electrophotobiomodulation as a recent tool in the armamentarium of treatment of fingertip injuries
Authors: Elmelegy Nader Gomaa , Sadaka Mohamed Saad
Published: October 2024

Background

Traditional reconstructive options of fingertip injuries are technically difficult, usually need donor site skin grafting, leave visible scars, and need a protracted period of finger immobilization resulting in joint stiffness. Electro-photobiomodulation (EPBM), is the process of combining intense pulsed light and radiofrequency to modify tissues to help the body heal itself, lower inflammation, and promote wound healing.

Patients and methods

This study included 60 patients presented with fingertip injuries. Patients were randomly divided into two groups. Group 1 includes patients who were treated by EPBM. Group 2 includes patients who were treated by cross finger flap (CFF). Six months after complete healing, evaluation was performed for aesthetic and functional outcome and patient satisfaction.

Results

Compared to group 2 patients, group 1 patients had statistically significant better sensory outcome, better total active motion of affected digits, grip strength, patient satisfaction, healing time, and plastic surgeon general aesthetic evaluation and also, they had statistically significant less adverse events and cold intolerance with absent donor site pain and deformity.

Conclusion

EPBM is safe and effective treatment of fingertip injuries which shortens the healing time, produces the best aesthetic and functional result while avoiding donor site morbidity of the traditional reconstructive options.
Investigation of association between clinically significant prostate cancer, obesity and platelet to-lymphocyte ratio and neutrophil -to-lymphocyte ratio
Authors: Dahan Johanna , Pinthus Jehonathan , Delouya Guila , Taussky Daniel , Duceppe Emmanuelle , de Jesus Amanda , Leong Darryl
Published: October 2024

Introduction

Several blood markers of inflammation are elevated in prostate cancer (PCa) and have prognostic value. Little is known about the relationship between these markers, PCa, and other factors associated with chronic inflammation, such as smoking and obesity. We analyzed the interaction between neutrophil and platelet counts indexed to lymphocyte count (NLR and PLR, resp.) and clinically significant PCa (csPCa), accounting for the potential confounding factors of systemic inflammation.

Methods

NLR and PLR were evaluated in a multicenter prospective study in 443 patients. CsPCa was defined as a Gleason ≥ 4 + 3. Differences between patients with csPCa and non-csPCA were evaluated using the chi-square test, analysis of variance or the Kruskal-Wallis test. Multivariable logistic regression analysis adjusted for smoking, hypertension, diabetes, and cardiovascular disease, and in separate models, either body mass index or waist-to-hip ratio was used to characterize the relationship between inflammation and csPCa.

Results

None of the factors such as plateletcrit, NLR, and PLR were significantly different between patients with csPCa or non-significant PCa. After adjustment, there was no association between PLR, NLR, plateletcrit or platelet count and csPCa. In an exploratory analysis, there was no association between markers of inflammation and PSA levels > 10 ng/mL. When testing different NLR cutoffs to predict csPCa in ROC analysis, none reached a clinically meaningful value.

Conclusion

In contrast to previous studies, we found no significant association between easily available blood markers of inflammation and indices of PCa aggressiveness. Further research is required to determine whether inflammation promotes PCa. (ClinicalTrials.gov: NCT03127631. Date of registration: April 25, 2017.
Market concentration of the Brazilian hospital medical supplementary health system
Authors: Westarb Cruz June Alisson , Gomide Arivelton Loeschke , Tuon Felipe Francisco , Quadros Weymer Alex Sandro , da Costa Manuel Janice Alexandra
Published: October 2024

Background

The Brazilian supplementary health market has undergone transformations in recent years due to constant mergers and acquisitions of by large corporations, contributing to the increase in market concentration, especially in the poorest and least developed regions of the country. Thus, given the care it provides and its economic relevance, understanding the fundamentals of these movements, the likely consequences and trends for the health market are relevant, important, and strategic.

Objective

To understand the general and specific context of Brazilian supplementary health, its scenarios, and trends, with emphasis on the analysis of market concentration and recent mergers and acquisitions.

Methodology

The research is applied, descriptive and exploratory and uses secondary data from various sources, submitted to quantitative data analysis methods. The data are organized into three groups: historical and regulatory documents; industry data; and market.

Results

The results show the growing concentration of the market promoted by large publicly traded corporations, the growing relevance of tech startups on the healthcare landscape, the predominant use of the relative valuation model, with implicit multiples for asset pricing and the prevalence of corporate health plans.

Conclusion

The growing concentration of the system projects a market with fewer options and less competitiveness, since the growth of large operators is evident, in addition to the relevant increase in the number of complaints from users of the system, which signals the growing gap between the expectations of users and the levels of quality care offered. The study also highlights the predominance of corporate health plans, revealing the direct relationship between access to supplementary health services and employability rates. The analysis of M&A operations, in addition to the increase in market concentration, reveals the prevalence of the use of the relative valuation model and implicit multiples for the pricing of traded assets. This denotes the future expectation of wealth generation, at least equivalent to the historical series of the sector, on the part of investors, whose frustration may signal the decreasing attractiveness of resources and M&A operations in the sector in the coming years.
‘The doctor doesn’t understand Xhosa and the service user doesn’t understand English’ - exploring the role of security guards acting as informal interpreters in psychiatric care in South Africa
Authors: Hanft-Robert Saskia , Shongwe Lindokuhle , Cossie Qhama , Sithole Philasande , Roos Tessa , Mösko Mike , Swartz Leslie
Published: October 2024

Introduction

Assigning qualified interpreters is considered one of the most effective approaches to facilitate communication in language-discordant encounters in mental healthcare. However, particularly in settings with fewer resources, they are not always available and informal practices are often used.

Objective

This study aimed to investigate informal interpreting practices in mental healthcare in South Africa, focusing on security guards (SGs) serving as interpreters.

Methods

Guided interviews were conducted with SGs (n = 12) and mental healthcare providers (MHCPs) (n = 18) at a psychiatric hospital in South Africa. The interviews were audio recorded, transcribed verbatim and analyzed using a thematic analysis approach.

Results

Despite recognizing that SGs serving as interpreters is not an ideal solution to overcome language barriers and could potentially jeopardize the quality of treatment and its outcomes, MHCPs reported relying heavily on them due to the underrepresentation of South Africa’s linguistic diversity among them. Given the lack of formal interpreting services, the perceived racial, linguistic and socioeconomic similarities between SGs and some service users, as well as their immediate accessibility, were described as beneficial to providing a minimal level of care (e.g. obtaining information about service users’ backgrounds, getting an understanding of their symptoms, psychoeducation, explaining treatment options). Drawbacks reported are SGs being pulled away from their actual duties, experiencing emotional distress, juggling multiple sometimes conflicting roles, and the risk of incorrect interpretation, which could compromise ethical standards of care. Additionally, the complexity of power became apparent: While SGs hold little institutional power within the mental healthcare system, they become powerful figures when serving as interpreters.

Conclusion

It can be assumed that MHCPs will resort to informal interpreting practices as long as effective alternatives are lacking. In doing so, risks such as reduced quality of care are accepted, and the consequences and effects on those serving as interpreters are neglected, which raises concerns from an ethical point of view.
Antibacterial and wound healing potential of biosynthesized zinc oxide nanoparticles against carbapenem-resistant Acinetobacter baumannii: an in vitro and in vivo study
Authors: Selim Mohamed I. , Sonbol Fatma I. , El‑Banna Tarek E. , Negm Walaa A. , Elekhnawy Engy
Published: October 2024

Carbapenem-resistant Acinetobacter baumannii denotes a significant menace to public health, and it mandates an urgent development of new effective medications. Here, we aimed to estimate the efficiency of the zinc oxide nanoparticles (ZnO NP) biosynthesized from Arthrospira maxima (Spirulina) both in vitro and in vivo. Carbapenem-resistant A. baumannii isolates were collected, identified, tested for their antibiotic susceptibility, and then subjected to PCR to detect carbapenemase-producing genes. The most predominant carbapenemase resistance gene was blaKPC. The biosynthesized ZnO NP were characterized using UV, FTIR, XRD, SEM, and TEM. The prepared ZnO NP was then tested against A. baumannii isolates to determine the minimum inhibitory concentration (MIC), which ranged from 250 to 1000 μg/ml. Burn wound was persuaded in twenty rats and inoculated with carbapenem-resistant A. baumannii isolate. Rats were allocated into four groups: a negative control group, a positive control group treated with topical 0.9% saline, a test treatment group that received topical ZnO NP, and a standard treatment group. All groups received treatment for 15 consecutive days and then euthanized. Skin samples were harvested and then subjected to histopathological and immunochemical investigations. ZnO NP revealed a comparable antibacterial activity to colistin as it revealed a lower level of fibrosis, mature surface epithelization with keratinization, and restoration of the normal skin architecture. In addition, it significantly decreased the immunoreactivity of the studied inflammatory markers. Thus, ZnO NP synthesized by A. maxima could be considered a promising, safe, and biocompatible alternative to traditional antibiotics in the therapy of carbapenem-resistant A. baumannii infections.
A growth-coupling strategy for improving the stability of terpenoid bioproduction in Escherichia coli
Authors: Tan Jing Chong , Hu Qitiao , Scrutton Nigel S.
Published: October 2024

Background

Achieving cost-competitiveness remains challenging for industrial biomanufacturing. With whole-cell biocatalysis, inefficiency presents when individual cells vary in their production levels. The problem exacerbates when the basis for such production heterogeneity is heritable. Here, evolution selects for the low- and non-producers, as they have lowered/abolished the cost of bioproduction to fitness. With the scale of population expansion required for industrial bioproduction, the asymmetrical enrichment can be severe enough to compromise the performance, and hence commercial viability of the bioprocess. Clearly, addressing production heterogeneity is crucial, especially in improving the stability of bioproduction across the cell generations. In this respect, we designed a growth-coupling strategy for terpenoid bioproduction in Escherichia coli. By knocking out the native 1-deoxy-D-xylulose 5-phosphate reductoisomerase (dxr) gene and introducing the heterologous mevalonate pathway, we created a chassis that relies solely on the latter for synthesis of all terpenoids. We hypothesise that the need to sustain the biosynthesis of endogenous life-sustaining terpenoids will impose a minimum level of productivity, which concomitantly improves the bioproduction of our target terpenoid.

Results

Following the confirmation of lethality of a dxr knockout, we challenged the strains with a continuous plasmid-based bioproduction of linalool. The Δdxr strain achieved an improved productivity profile in the first three days post-inoculation when compared to the parental strain. Productivity of the Δdxr strain remained observable near the end of 12 days, and after a disruption in nutrient and oxygen supply in a separate run. Unlike the parental strain, the Δdxr strain did not evolve the same deleterious mutations in the mevalonate pathway, nor a viable subgroup that had lost its resistance to the antibiotic selection pressure (a plausible plasmid loss event). We believe that this divergence in the evolution trajectories is indicative of a successful growth-coupling.

Conclusion

We have demonstrated a proof of concept of a growth-coupling strategy that improves the performance, and stability of terpenoid bioproduction across cell generations. The strategy is relatively broad in scope, and easy to implement in the background as a ‘fail-safe’ against a fall in productivity below the imposed minimum. We thus believe this work will find widespread utility in our collective effort towards industrial bioproduction.
Timing of food pieces introduction and neurodevelopment: findings from a nationwide birth cohort
Authors: Somaraki Maria , de Lauzon-Guillain Blandine , Camier Aurore , Bernard Jonathan Y. , Tafflet Muriel , Dufourg Marie-Noëlle , Charles Marie-Aline , Chabanet Claire , Tournier Carole , Nicklaus Sophie
Published: October 2024

Background

While complementary feeding can be challenging, little emphasis has been placed on the introduction to food texture/pieces, especially in terms of neurodevelopmental outcomes. This study aims to determine the association between the timing of introduction to food pieces during infancy and neurodevelopment in early childhood. We hypothesized that late introduction to food texture/pieces relates to unfavorable neurodevelopmental outcomes.

Methods

Families (n = 18329) were recruited from the general population during the nationwide ELFE (Étude Longitudinale Française depuis l’Enfance) birth cohort in France, and 8511 were selected for a complete case analysis. Age at introduction to food pieces was determined based on repeated assessments during the first year. A range of neurodevelopmental outcomes among children were assessed using validated instruments, i.e. composite scores at 1 and 3.5 years, and a score for language acquisition at 2 years. Risk for developmental delay at 3.5 years was defined based on a developmental quotient (DQ) below 90 according to the child’s chronological age and the respective composite score at this age. We used linear regression modelling to evaluate associations between age at introduction to food pieces and the standardised neurodevelopmental scores, while logistic regression models were used in the analyses according to the risk for developmental delay.

Results

Our findings highlight consistent associations between late introduction to food pieces (i.e., after 10 months, compared to early (before 8 months)) and lower estimates of standardised neurodevelopmental scores at ages 1, 2 and 3.5 years (-0.35 [-0.40; -0.30], -0.15 [-0.20; -0.10] and − 0.18 [-0.23; -0.13], respectively). Infants introduced to pieces late were also more likely to be at risk for developmental delay according to DQ < 90 (OR [95%CI] = 1.62 [1.36; 1.94]).

Conclusions

This study shows that late introduction to food pieces (> 10 months) is related to lower neurodevelopmental scores. Given the challenges that complementary feeding may pose, concerted efforts are required to enhance our understanding of the sensory aspects of early diets and to ultimately provide guidance.
Repetitive peripheral magnetic stimulation alone or in combination with repetitive transcranial magnetic stimulation in poststroke rehabilitation: a systematic review and meta-analysis
Authors: Wang Yong , Fong Kenneth N. K. , Sui Youxin , Bai Zhongfei , Zhang Jack Jiaqi
Published: October 2024

Objective

This study aimed to comprehensively review the effects of repetitive peripheral magnetic stimulation (rPMS) alone or in combination with repetitive transcranial magnetic stimulation (rTMS) on improving upper limb motor functions and activities of daily living (ADL) in patients with stroke, and to explore possible efficacy-related modulators.

Methods

A literature search from 1st January 2004 to 1st June 2024 was performed to identified studies that investigated the effects of rPMS on upper limb motor functions and ADL in poststroke patients.

Results

Seventeen studies were included. Compared with the control, both rPMS alone or rPMS in combination with rTMS significantly improved upper limb motor function (rPMS: Hedge’s g = 0.703, p = 0.015; rPMS + rTMS: Hedge’s g = 0.892, p < 0.001) and ADL (rPMS: Hedge’s g = 0.923, p = 0.013; rPMS + rTMS: Hedge’s g = 0.923, p < 0.001). However, rPMS combined with rTMS was not superior to rTMS alone on improving poststroke upper limb motor function and ADL (Hedge’s g = 0.273, p = 0.123). Meta-regression revealed that the total pulses (p = 0.003) and the number of pulses per session of rPMS (p < 0.001) correlated with the effect sizes of ADL.

Conclusions

Using rPMS alone or in combination with rTMS appears to effectively improve upper extremity functional recovery and activity independence in patients after stroke. However, a simple combination of these two interventions may not produce additive benefits than the use of rTMS alone. Optimization of rPMS protocols, such as applying appropriate dosage, may lead to a more favourable recovery outcome in poststroke rehabilitation.
PrescDRL: deep reinforcement learning for herbal prescription planning in treatment of chronic diseases
Authors: Yang Kuo , Yu Zecong , Su Xin , Zhang Fengjin , He Xiong , Wang Ning , Zheng Qiguang , Yu Feidie , Wen Tiancai , Zhou Xuezhong
Published: October 2024

Treatment planning for chronic diseases is a critical task in medical artificial intelligence, particularly in traditional Chinese medicine (TCM). However, generating optimized sequential treatment strategies for patients with chronic diseases in different clinical encounters remains a challenging issue that requires further exploration. In this study, we proposed a TCM herbal prescription planning framework based on deep reinforcement learning for chronic disease treatment (PrescDRL). PrescDRL is a sequential herbal prescription optimization model that focuses on long-term effectiveness rather than achieving maximum reward at every step, thereby ensuring better patient outcomes. We constructed a high-quality benchmark dataset for sequential diagnosis and treatment of diabetes and evaluated PrescDRL against this benchmark. Our results showed that PrescDRL achieved a higher curative effect, with the single-step reward improving by 117% and 153% compared to doctors. Furthermore, PrescDRL outperformed the benchmark in prescription prediction, with precision improving by 40.5% and recall improving by 63%. Overall, our study demonstrates the potential of using artificial intelligence to improve clinical intelligent diagnosis and treatment in TCM.
Evaluation of global and regional myocardial work by echocardiography in patients with Fabry disease
Authors: Wang Han , Yang Ying , Liu Lin , Zhao Yawen , Li Yang , Zhang Wei , Ma Wei
Published: October 2024

Background

This study aimed to quantitatively evaluate the left ventricular global and regional myocardial work of patients in Fabry disease (FD) by echocardiographic pressure–strain loop (PSL) analysis.

Results

The study included 48 patients with FD and 48 healthy controls matched for age and sex. According to the presence/absence of left ventricular hypertrophy (LVH), the patients with FD were divided into an LVH + group and an LVH– group. Left ventricular blood pressure was estimated noninvasively according to echocardiographic valvular events and systolic pressure in the brachial artery. Left ventricular myocardial work parameters were acquired by echocardiographic pressure–strain loop analysis.

The FD groups had a significantly lower global longitudinal strain (GLS), global work index, global work efficiency (GWE), global constructive work and higher global waste work than the control group (P < .05). Regional analysis showed that all segmental myocardial waste work increased and myocardial work efficiency decreased in the LVH + group than in the LVH– group (P < .05). Segmental longitudinal strain, myocardial work index, and myocardial constructive work were markedly lower in the basal and middle segments (P < .05) and preserved in the apical segments. Multivariate analysis revealed that GWE and GLS were significant related to LVH.

Conclusions

Myocardial work analysis can be used to assess global and regional myocardial work in patients with FD. In this study, GLS and GWE were reduced in patients with FD and associated with the presence of LVH. Basal and middle myocardial work decreased in relation to the LVH, while apical myocardial work remained, which added value to explore the distribution of myocardial impairment.
A comprehensive lifestyle index and its associations with DNA methylation and type 2 diabetes among Ghanaian adults: the rodam study
Authors: Abidha C. A. , Meeks K. A. C. , Chilunga F. P. , Venema A. , Schindlmayr R. , Hayfron-Benjamin C. , Klipstein-Grobusch Kerstin , Mockenhaupt Frank P. , Agyemang C. , Henneman P. , Danquah I.
Published: October 2024

Background

A series of modifiable lifestyle factors, such as diet quality, physical activity, alcohol intake, and smoking, may drive the rising burden of type 2 diabetes (T2DM) among sub-Saharan Africans globally. It is unclear whether epigenetic changes play a mediatory role in the associations between these lifestyle factors and T2DM. We assessed the associations between a comprehensive lifestyle index, DNA methylation and T2DM among Ghanaian adults.

Methods

We used whole-blood Illumina 450 k DNA methylation data from 713 Ghanaians from the Research on Obesity and Diabetes among African Migrants (RODAM) study. We constructed a comprehensive lifestyle index based on established cut-offs for diet quality, physical activity, alcohol intake, and smoking status. In the T2DM-free discovery cohort (n = 457), linear models were fitted to identify differentially methylated positions (DMPs) and differentially methylated regions (DMRs) associated with the lifestyle index after adjustment for age, sex, body mass index (BMI), and technical covariates. Associations between the identified DMPs and the primary outcome (T2DM), as well as secondary outcomes (fasting blood glucose (FBG) and HbA1c), were determined via logistic and linear regression models, respectively.

Results

In the present study population (mean age: 52 ± 10 years; male: 42.6%), the comprehensive lifestyle index showed a significant association with one DMP annotated to an intergenic region on chromosome 7 (false discovery rate (FDR) = 0.024). Others were annotated to ADCY7, SMARCE1, AHRR, LOXL2, and PTBP1 genes. One DMR was identified and annotated to the GFPT2 gene (familywise error rate (FWER) from bumphunter bootstrap = 0.036). None of the DMPs showed significant associations with T2DM; directions of effect were positive for the DMP in the AHRR and inverse for all the other DMPs. Higher methylation of the ADCY7 DMP was associated with higher FBG (p = 0.024); LOXL2 DMP was associated with lower FBG (p = 0.023) and HbA1c (p = 0.049); and PTBP1 DMP was associated with lower HbA1c (p = 0.002).

Conclusions

In this explorative epigenome-wide association study among Ghanaians, we identified one DMP and DMR associated with a comprehensive lifestyle index not previously associated with individual lifestyle factors. Based on our findings, we infer that lifestyle factors in combination, affect DNA methylation, thereby influencing the risk of T2DM among Ghanaian adults living in different contexts.
Octonion quadratic-phase Fourier transform: inequalities, uncertainty principles, and examples
Authors: Kumar Manish , Bhawna
Published: October 2024

In this article, we define the octonion quadratic-phase Fourier transform (OQPFT) and derive its inversion formula, including its fundamental properties such as linearity, parity, modulation, and shifting. We also establish its relationship with the quaternion quadratic-phase Fourier transform (QQPFT). Further, we derive the Parseval formula and the Riemann–Lebesgue lemma using this transform. Furthermore, we formulate two important inequalities (sharp Pitt’s and sharp Hausdorff–Young’s inequalities) and three main uncertainty principles (logarithmic, Donoho–Stark’s, and Heisenberg’s uncertainty principles) for the OQPFT. To complete our investigation, we construct three elementary examples of signal theory with graphical interpretations to illustrate the use of OQPFT and discuss their particular cases.
Preparation of α-zein loaded with baicalincomposites: A study on their in vitro simulated digestive behavior and molecular dynamics simulation
Authors: Zhou RunCheng , Liang QiLin , Lei Han , Liang Tianci , Chen Simin , Chen Xin
Published: October 2024

In order to improve the bioavailability of baicalin, this article prepared for α-zein loaded with baicalin composites (α-zein@BA) by pH driven method and they were characterized using scanning electron microscopy, infrared spectroscopy, and measurement of particle size distribution in water solution phase techniques. The digestive behavior and antioxidant activity of composites before and after simulating gastrointestinal fluid in vitro were studied as well. At the same time, molecular dynamics simulation techniques were used to reveal the molecular mechanism behind the formation of the composite between the two. The results indicated that the composites of α-zein@BA were observed to be approximately spherical under a scanning electron microscope, and their particle size was mainly distributed in the range of 94.55-145.10 μm in aqueous solution, whose encapsulation efficiency of baicalin was (86.61 ± 0.71) %. Infrared spectroscopy analysis indicated that α-zein and baicalin mainly formed complexes through hydrogen bonding, electrostatic and hydrophobic interactions. The measurement results of baicalin residue in simulated digestion of gastric and intestinal fluids in vitro are as follows: α-zein@BA > Baicalin, while both significantly increased in the gastric digestion stage (P < 0.05) and significantly decreased in the intestinal digestion stage (P < 0.05). Molecular dynamics simulation studies have shown that baicalin has a promoting effect on protein structural stability, and protein 158SER and GLN196 were mainly formed hydrogen bonds with it, while hydrophobic interactions were mainly manifested between non-polar amino acids such as PHE201 and PRO200. This study indicates that α-zein and baicalin can form stable composites, improving the bioavailability of baicalin.
Comprehensive atlas of mitochondrial distribution and dynamics during oocyte maturation in mouse models
Authors: Hao Xia , Zhao Jian , Rodriguez-Wallberg Kenny A.
Published: October 2024

Background

Oocytes, the largest cells in mammals, harbor numerous mitochondria within their cytoplasm. These highly dynamic organelles are crucial for providing energy resources and serving as central regulators during oogenesis. Mitochondrial dynamics ensure proper energy distribution for various cellular processes involved in oocyte maturation. Previous studies have used alterations in mitochondrial distribution as a biomarker to assess the oocyte health. However, there are discrepancies between studies regarding mitochondrial distribution profiles in healthy oocytes. Consequently, a comprehensive mitochondrial distribution profile in oocytes during maturation has not been fully characterized. Additionally, there is a lack of objective, quantitative methods to evaluate alterations in mitochondrial distribution profiles in oocytes.

Methods

This study aims to provide an in-depth overview of mitochondrial distribution profiles in mouse oocytes at different maturation stages: germinal vesicle (GV) stage, metaphase I (MI), and mature metaphase II (MII). Freshly collected mouse GV, MI and MII oocytes were stained with MitoTracker Red. Confocal microscopy was used to obtain images of mitochondrial distribution profiles in these oocytes. Using the Imaris software, we reconstructed three-dimensional (3D) surface renderings of each oocyte and quantitatively illustrated the mitochondrial distribution profiles.

Results

At the GV stage, mitochondria in oocytes were evenly distributed throughout the ooplasm. As oocytes progressed to MI and MII stages, mitochondria aggregated and formed clusters, the mean size of mitochondrial clusters and the proportions of clustered mitochondria increased along with the maturation of oocytes.

Conclusions

Our findings reveal that mitochondria in mouse oocytes are highly dynamic, undergoing significant reorganizations during oocyte maturation. We for the first time provided comprehensive mitochondrial distribution profiles in mouse oocytes at the GV, MI and MII stages. These mitochondrial distribution profiles were further quantitatively evaluated. Our methods provide an objective and standardized approach for evaluating alterations in mitochondrial dynamics, which can be used as biomarkers to monitor oocyte conditions during maturation.
Academic psychiatry is everyone's business
Authors: Critchley Hugo D. , Tracy Derek K. , Malhi Gin S. , Alexander Laith , Baldwin David S. , Cavanagh Jonathan , Chamberlain Samuel R. , Cipriani Andrea , Farooq Saeed , Hassiotis Angela , Howes Oliver , Jauhar Sameer , Lawrie Stephen M. , Lagunes-Cordoba Emmeline , Lingford-Hughes Anne , MacCabe James H. , Memon Ismail , Mulholland Ciaran , Sami Musa , Sayal Kapil , Shankar Rohit , Sinclair Lindsey , Sparasci Oliver , Staufenberg Ekkehart F. A. , Stirland Lucy E. , Stokes Paul R. A. , Jones Charlotte Wilson , Woodruff Peter W. R. , Young Allan H.
Published: October 2024

This editorial considers the value and nature of academic psychiatry by asking what defines the specialty and psychiatrists as academics. We frame academic psychiatry as a way of thinking that benefits clinical services and discuss how to inspire the next generation of academics.
Analytics of Raciality / Analítica de Racialidade
Authors: da Silva Denise Ferreira
Published: October 2024

This chapter challenges the centrality of the logic of exclusion—the view that race is politically and socially significant only when race identification is explicitly or implicitly used to justify discrimination—in the understanding of race injustice. It explores the political-symbolic processes that have produced the mechanisms of racial power, of which police brutality is a most dramatic example. To elaborate this critique of the logic of exclusion, the chapter discusses the newspaper account of an episode of police terror in a favela of Rio de Janeiro, Brazil. Chacina de Vigário Geral reveals this form of race injustice produced in an analytic of raciality. To grasp the power-effects raciality manifested in police brutality demands an approach that goes beyond the view of race as a mechanism of exclusion.
De-hygienization Clusivities / Clusividades de De-higienização
Authors: Blanchette Thaddeus Gregory , Simões Soraya , Murray Laura Rebecca , Brêtas Thayane , Silva Ana Paula da
Published: October 2024

This chapter looks at attempts to remake Rio to be like Global North cities during the period 1889–2020. It highlights local elites’ plans to whiten, Europeanize, and (later) Americanize a city that has remained obdurately nonwhite. Adopting the perspectives of major Carioca urbanists, the chapter unpacks the imported North American concept of gentrification in Carioca contexts, suggesting that the emic category of hygienization might better conceptualize the constant desire of the city’s elites to create a Paris of the tropics in the face of chronic undercapitalization and political resistance by varied sectors of the urban masses. The authors take the red-light district of the Mangue/Vila Mimosa as the empirical object of analysis. The Mangue still survives in today’s Vila Mimosa and is presently facing political and economic threats to its existence brought about by a new wave of land speculation and authoritarian municipal politics in the São Cristovão neighborhood.
Posterior Reduction and Temporary Fixation Through Intermuscular Approach for Odontoid Fracture
Authors: Xu Zhenji , Wu Ji , Wang Haibin , Chen Changhong , Zhang Bangke , Lu Xuhua , Ni Bin , Chen Fei , Guo Qunfeng
Published: October 2024

BACKGROUND AND OBJECTIVE:

Posterior reduction and temporary fixation (PRTF) through open approach can effectively avoid the loss of C1-C2 motion caused by posterior atlantoaxial fusion in the treatment of odontoid fracture. PRTF through intermuscular approach can preserve the integrity of the paravertebral muscle. However, its contribution to the preservation of C1-C2 rotation remains unassessed in the context of fresh odontoid fractures.

METHODS:

The data of 31 patients with odontoid fractures who underwent PRTF through intermuscular approach were retrospectively reviewed. Operation time, intraoperative blood loss, the time of ambulation and surgery-related complications were recorded. After fracture healing, the instrumentation was removed. The Japanese Orthopedic Association score, Visual Analog Scale score for neck pain, and patient satisfaction were recorded. The range of motion in rotation of C1-C2 was calculated 1 month after removing the instrumentation.

RESULTS:

Fracture healing was observed in all patients, and the instrumentation was removed. After removing the instrumentation, the range of motion of C1-C2 in rotation was returned to 35.6° ± 4.8°. Patient satisfaction was improved (P < .05). There was no significant difference in Japanese Orthopedic Association scores and Visual Analog Scale score for neck pain between 2 values before and after removing the instrumentation (P > .05). No osteoarthritis was observed at the C1-C2 lateral mass joints. There were no perioperative complications.

CONCLUSION:

PRTF through intermuscular approach can be used as a salvage treatment of an odontoid fracture with an intact transverse ligament in cases of failure of, or contraindication to, anterior screw fixation. This minimally invasive technique can effectively preserve the rotational function of the atlantoaxial complex.
Material Analysis and Conservation Treatment of Wooden Artifacts Excavated at the Ssangbuk-ri 280-10 Site in Buyeo, Korea
Authors: Kang Min Ji , Song Hee Soo , Kim Soo Chul
Published: October 2024

Numerous Baekje historical sites are located in Ssangbuk-ri, Buyeo, where a diverse array of wooden artifacts, including lacquerware, was excavated in a waterlogged condition. Consequently, comprehensive analysis and conservation treatments were undertaken. The study encompassed four wooden artifacts and one lacquerware. Species identification was conducted for all five artifacts, and the coating residue on the surface of one lacquerware was discerned using FT-IR. The results revealed that the Y-shaped and Drill-shaped wooden artifacts were crafted from Hard pine, the Square container with a handle from Juglans spp., the Arrow-shaped wooden object from Pyrus spp., and the Lacquerware from Castanea spp.. Additionally, the surface coating of the lacquerware was confirmed to be lacquer. Conservation treatments involved PEG(Polyethylene glycol) impregnation and freeze-drying methods, ensuring the stable storage and display of these artifacts.
Case Study and Literature Review on 3D Data Acquisition Technology for Small Artifacts
Authors: Moon Sol Mi , Rhee Bo A
Published: October 2024

This study typification artifacts and data acquisition technologies and derived implications through a survey of domestic and oversea cases related to 3D data acquisition technology for small artifacts equal to or less than 15 cm. In terms of the type of relics, ceramics and earthenware(44.8%) and metals(27.6%) occupied the top ranks, while the proportion of wood and stone was relatively very low. In terms of technology, X-ray CT(61.2%), 3D scanning(15.5%), and photogrammetry(11.7%) showed high utilization rates. In order to ensure the sustainability and utilization of cultural heritage at a macro level, it is necessary to establish an accurate analysis of relics and a preservation strategy that complements the limitations of 3D data acquisition technology through the convergence of various technologies to increase the effectiveness of data acquisition, and to determine the external shape of the relics. An in-depth approach to future convergence technology is required to acquire high-precision 3D data, including information as well as internal structure and manufacturing techniques.