bluuebunny/crossref_metadata_2025 huggingface dataset:
Particle Image Velocimetry Measurement of Velocity Fields Surrounding Cloud Cavitation Induced by Submerged Water-Jet
Authors: Ushioku Takahiro , Yoshimura Hiroaki
Published: November 2024

It is well known that cloud cavitation shows growth and collapse behavior in an extremely short period of time, and how the velocity fields appear associated with the unsteady behavior of the cloud has not been well understood. In this paper, we experimentally investigate the velocity fields surrounding the cloud induced by a pulsed submerged water-jet injection. To do this, we employ the fluorescent Particle Image Velocimetry (PIV) method, by which particle images are recorded by a high-speed camera with 300,000 frames per second, and the two-dimensional velocity and vorticity fields in the unsteady behavior of the cloud, namely, the inception, growth, collapse and rebound are measured. In particular, we illustrate that flows of twin vortices appear near the cloud and move along its boundary associated with its growth and shrink behaviors. Then they collide with each other, disappear just before the collapse of the cloud, and finally reappear in the high vorticity regions just after the cloud collapse. These facts suggest that the unsteady behaviors of the cloud induce the motion of the twin vortices. Further, we shall make some comparisons between the observations in experiments and those obtained by our previous numerical study.
Identification of two transcription factors that work coordinately to regulate early development in
Entamoeba
Authors: Lozano-Amado Daniela , Singh Upinder
Published: November 2024

The protozoan parasite
Entamoeba
has a life cycle that switches between infective cysts and invasive trophozoites. Encystation, a crucial process in parasite biology, is controlled by different mechanisms including transcriptional control. We identified two nuclear proteins in
Entamoeba invadens
, EIN_066100 and EIN_085620, that regulate parasite development by binding to a DNA motif (TCACTTTC) in the promoter regions of genes upregulated in the first 8 h of stage conversion. Overexpression of EIN_066100, a homolog of MAK16 protein, resulted in reduced amoebic proliferation without affecting encystation efficiency. Overexpression of EIN_085620, a protein with an RNA-recognition motif (RRM), led to increased encystation efficiency. Glutathione S-transferase (GST) pull down assays revealed that EIN_066100 interacts with EIN_085620 both
in vivo
and
in vitro,
and this interaction is mediated by the EIN_085620 RRM domain. By evaluating truncated proteins with deletions at either the N-terminal or C-terminal regions of EIN_066100, we elucidated the importance of its N-terminal region in proper protein localization, proliferation, encystation, and interaction with EIN_085620. Taken together, these results indicate a coordinated role of EIN_066100 and EIN_085620 in regulating
Entamoeba
development. This work sheds light on the molecular mechanisms in the earliest stages of
Entamoeba
encystation.

IMPORTANCE

An important biological process in the biology of
Entamoeba
is stage conversion, which plays a crucial role in disease propagation, facilitating parasite survival outside the host and spreading to new hosts. Multiple mechanisms contribute to controlling the expression of amebic stage-specific genes such as epigenetic and transcriptional control. Identification of early transcriptional control regulators is crucial to understanding the initiation of the encystation cascade. We identified two nuclear proteins, EIN_066100 and EIN_085620, involved in the proliferation and developmental regulation of
E. invadens
. These proteins work by direct binding to each other and mediating encystation efficiency. Study of new regulators involved in
Entamoeba
development represents an important advance in a critical aspect of parasite biology.
Vanishing bile duct syndrome: a sequela of temozolomide and levetiracetam-induced cholestatic liver injury
Authors: Martens Lindsey , Babalola Olawale , Aslam Awais , Ashraf Rabiah
Published: November 2024

Temozolomide (TMZ)–levetiracetam (LEV) combination therapy in glioblastoma management is gradually becoming a mainstay treatment given its superior effect compared with TMZ monotherapy. While there have been previous cases of hepatotoxicity, there are no prior reports of vanishing bile duct syndrome (VBDS) associated with TMZ-LEV combination use. This case report details a male in his 50s who had recently completed TMZ and LEV for right frontal lobe glioblastoma. He presented 3 days later with painless jaundice, dark urine and pale stools. Laboratory evaluation was remarkable for marked hyperbilirubinemia and transaminitis. Extensive work up for hepatic and extra-hepatic causes of jaundice was of no yield, thus necessitating a liver biopsy. Liver pathology showed a non-specific histomorphology pattern suggesting drug-induced liver injury and cholestasis with severe ductopenia. VBDS due to TMZ and LEV was diagnosed. The patient followed with the gastroenterology clinic over 6 months for persistently elevated liver function tests before suffering a fatal cardiac arrest.
A solitary enchondroma in the radial shaft
Authors: Annappa Rajendra , Kamath Surendra Umesh , Patil Rakshith , Mohan Saraswathi Ram
Published: November 2024

Solitary enchondromas are usually seen in the tubular bones of the hands and feet. Their occurrence in the radius is extremely rare. Here, we report a male patient in his 30s with a history of pain in the right forearm for the past 7 months and swelling for the past 4 months. He was radiologically diagnosed with enchondroma of the radial shaft. He underwent an open biopsy and curettage of the lesion. The histopathological evaluation further confirmed the diagnosis. Following the surgical management, he was symptomatically better on follow-up visits. Enchondromas of the radius are rare in occurrence. A high index of suspicion and clinical evaluation is necessary to diagnose and manage such lesions.
Delayed identification of Bardet-Biedl syndrome
Authors: Kanitkar Shubhangi , Ande Sai Priya , Shivnitwar Sachin K , Edara Manaswini
Published: November 2024

Bardet-Biedl syndrome is a central obesity syndrome with a hereditary link affecting non-motile cilia that can be diagnosed clinically. Central obesity and polydactyly are important phenotypic features of this syndrome. Most cases are identified in early childhood. The report discusses the retrospective diagnosis of Bardet-Biedl syndrome in a heart failure patient. On examination, the patient revealed central obesity, polydactyly, retinitis pigmentosa and an atrial septal defect. The involvement of multiple systems with phenotypic traits resulted in a syndromic association. The woman was treated conservatively for her symptoms with diuretics. Past hospital visits by the patient overlooked the diagnosis of Bardet-Biedl syndrome. This syndrome is diagnosed using the criteria established by Beales and colleagues. Although specific management strategies for treating the syndrome have yet to be proposed, diagnosis aids in genetic counselling for affected couples, metabolic syndrome management, blindness rehabilitation and early detection of organ damage, allowing for adequate follow-up.
Primary squamous cell carcinoma of the prostate
Authors: Mak Gerald , Chew Kenneth , Wood Dale , Thompson James
Published: November 2024

Primary squamous cell carcinoma of the prostate is a rare entity, with limited documented cases in the medical literature. Herein, we present a case of primary prostatic squamous cell carcinoma in a male in his 60s, detailing the clinical presentation, diagnostic workup, histopathological findings and treatment. Our case highlights the diagnostic and therapeutic challenges associated with this uncommon malignancy.
Peritoneal tuberculosis: the diagnostic challenge must not preclude treatment
Authors: Correia Isabel Marques , Costa Regina , Madeira Joana Inês Martins , Fonseca Isabel
Published: November 2024

Peritoneal tuberculosis (TB) is a rare extrapulmonary infection caused byMycobacterium tuberculosis. It is mainly found in countries with a high burden of TB, so travelling from an endemic area should raise suspicion. Although it is a well-recognised disease, it remains a challenge due to its difficult clinical and microbiological diagnosis. This can lead to a delay, both in diagnosis and treatment with serious prognostic implications. We describe the case of a woman in her mid-50s who presented with fever, abdominal pain, vomiting, breathlessness, anorexia and weight loss. On physical examination, she had decreased breath sounds at the right lung and clinical ascites. Blood tests revealed elevated inflammatory markers and anaemia. Imaging showed ascites, enhanced peritoneal thickening, densification of the mesenteric fat and right pleural effusion. After paracentesis, diagnostic thoracotomy and laparoscopy were undertaken. Based on a presumptive diagnosis, treatment was started.M. tuberculosiswas lastly isolated in ascitic fluid culture after 6 weeks. The patient completed a 6-month course of anti-TB drugs with a favourable outcome.
Characteristics of urinary stone composition among patients with urolithiasis: a retrospective study in China
Authors: Wang Bin , Zheng Xujuan , Xiong Juan , Sun Zhongyi
Published: November 2024

Objective

To present the most recent data on urinary calculi characteristics in the southern region of China and explore the effects of sociodemographic, clinical and laboratory characteristics on stone composition to fill the research gap.

Setting

A retrospective observational study was performed in Shenzhen between December 2019 and August 2022.

Participants

A total of 858 calculi samples from patients with urolithiasis were analysed via infrared spectroscopy.

Methods

The stone was classified by the European Association of Urology guidelines and the Mayo Clinic stone classification practices. Multivariate logistic regression models were conducted to evaluate the association between different characteristics and urinary stone composition.

Results

We found that the majority of these patients with urolithiasis were under 60. Almost half of the stone samples (49.4%) were single constitute, and calcium oxalate stone accounted for the highest proportion (80.0%), followed by infection stone (10.0%) and uric acid stone (4.9%). Of these, 78.0% were collected from males, with a male-to-female ratio of 3.54:1; the majority (95.0%) of calculi localisation was in the upper urinary tract. Multivariate analysis found that age, gender, history of urolithiasis, kidney disease, anatomical location and urinary pH influenced urinary stone composition.

Conclusions

The effective prevention of urolithiasis is the key to this working-age population. These findings may supply significant evidence for understanding the underlying aetiology of urolithiasis and offer clues for effectively preventing and treating urinary calculi.
Factors associated with HPV vaccine acceptance and hesitancy in Africa: a systematic review protocol
Authors: Mavundza Edison Johannes , Jaca Anelisa , Cooper Sara , Ndwandwe Duduzile Edith , Wiysonge Charles Shey
Published: November 2024

Introduction

Human papillomavirus (HPV) infection is the most prevalent sexually transmitted infection worldwide. HPV vaccination is an important tool to prevent and control HPV infection and its complications. Despite carrying the severe burden of disease, HPV vaccine coverage in Africa remains low. The aim of the current review is to evaluate the factors associated with HPV vaccination acceptance among adolescent men and women, young men and women, parents/caregivers, men who have sex with men, healthcare workers and programme managers in Africa.

Methods and analysis

We will include peer-reviewed quantitative studies. We will search PubMed, Scopus, PsycInfo, Web of Science and Cochrane Central Register of Controlled Trials, with no language restriction, to identify eligible studies. Two review authors will independently screen the titles and abstracts of the search output in Covidence to select potentially eligible studies. The same two reviewers will independently screen the full-text of all identified potentially eligible articles to identify studies meeting inclusion criteria. Two review authors will independently extract data from eligible studies using a predefined data extraction form. Two review authors will independently assess the risk of bias in each included study, using the Effective Public Health Practice Project ‘Quality Assessment Tool for Quantitative Studies’. We will assess the quality of evidence using the method for Grading of Recommendations Assessment, Development and Evaluation.

Ethics and dissemination

Ethical approval is not required for this study because we will use already published data. The results of this review will be disseminated through peer-reviewed publication and conference presentation.

PROSPERO registration number

CRD42023475810.
Study protocol: the ‘Endoscope CRC’ cohort, a prospective biobank study on the development and evaluation of diagnostic and prognostic biomarker profiles for colorectal cancer and premalignant lesions
Authors: Cheng Hao Ran , van Vorstenbosch Robert , Jonkers Daisy , Masclee Adrian , Schoon Erik , van Schooten Frederik J , Smolinska Agnieszka , Mujagic Zlatan
Published: November 2024

Introduction

Early detection of colorectal cancer (CRC) and clinically relevant (advanced) adenomas leads to a significant reduction of CRC-related mortality and morbidity. However, the faecal immunochemical test (FIT) suffers from a high number of false-positive results and is insensitive to detecting advanced adenomas, resulting in false-negative results for these premalignant lesions. Therefore, more accurate, non-invasive screening tools are needed for the detection and prognostication of colorectal neoplasia. Previous research on volatile organic compounds (VOCs) analysis in breath and faeces has shown to be promising potential biomarkers for this purpose. Several VOC-sampling methods, including breath sampling, have improved significantly over the recent years resulting in an increased reliability of measurements. Therefore, we aim to identify relevant VOC profiles in exhaled breath and faeces for the diagnosis of colorectal neoplasia while taking into account relevant confounding factors. Follow-up data will be used to identify relevant VOC profiles in exhaled breath and faeces for the prognostication of colorectal neoplasia. Finally, a biobank will be set up for future research questions on this topic.

Methods and analysis

Subjects with positive FIT within the Dutch national CRC cancer screening programme are included. Subjects are asked to fill in questionnaires and exhaled breath, faeces and blood are sampled prior to colonoscopy. All subjects are asked to fill in follow-up questionnaires at years 1 and 5 of the study. In case of surveillance colonoscopies, subjects are asked to provide exhaled breath, faeces and blood prior to the colonoscopy again. Breath sampling is performed using the ReCIVA breath sampler. VOCs in breath and faeces are analysed using gas-chromatography-mass spectrometry (GC-MS). Raw GC-MS data is preprocessed and analysed using machine learning techniques.

Ethics and dissemination

The study is approved by the medical ethics committee at the Maastricht University Medical Center (NL74844.068.20) in November 2021 and started inclusion in January 2022.
Efficacy and safety of electroacupuncture for metabolic dysfunction-associated fatty liver disease: a study protocol for a multicentre, randomised, sham acupuncture-controlled, patient-blinded clinical trial
Authors: Zhao Jingjie , Zhao Xinyu , Wang Qianyi , Ren Hao , Cao DI , Hu Xiangdong , Yang Lei , Chen Wei , Yang Jing-Wen , You Hong
Published: November 2024

Background

Metabolic dysfunction-associated fatty liver disease (MAFLD) is the most common chronic liver disease in the world and carries an increased risk of liver-related events, but no approved medicine. Electroacupuncture has been used to treat non-alcoholic fatty liver disease, but its effect was uncertain because of the poor quality of prior studies. We designed this trial to evaluate the efficacy and safety of electroacupuncture for MAFLD.

Methods/design

This is a multicentre, randomised, sham acupuncture-controlled, patient-blinded clinical trial. Participants will take part in a total of 20 weeks of study, containing three phases: a 4‐week run-in period, 12‐week treatment (36 sessions of acupuncture) and 4‐week follow‐up. A total of 144 eligible patients diagnosed with MAFLD will be randomly allocated to the electroacupuncture or sham acupuncture groups. The primary outcome is the percentage of relative liver fat reduction on the MRI proton density fat fraction from baseline to 12 weeks. Secondary outcomes include magnetic resonance elastography, liver and metabolic biomarkers, anthropometry parameters, blinding assessment, credibility and expectancy, and adverse events. All patients who receive randomisation will be included in the intent-to-treat analysis.

Discussion

The finding of this trial will provide evidence of the efficacy and safety of electroacupuncture for the treatment of MAFLD. The results of this study will be published in peer-reviewed journals.

Trial registration number

www.chictr.org.cn, ChiCTR2200060353. It was registered on 29 May 2022.
Determinants of underweight among returnee lactating mothers in Gedeb District, Southern Ethiopia: a case–control study
Authors: Estifanos Mahlet Birhane , Erku Abera Negesse , Ewune Temesgen Muche , Amare Hiwot Hailu , Zenebe Wagaye Alemu , Zerfu Taddese Alemu
Published: November 2024

Objective

This study aimed to assess the determinants of underweight among returnees lactating mothers in governmental health facilities of Gedeo zone, Southern Ethiopia.

Design

Case–control study.

Setting

Gedeb District governmental health facilities.

Participants

A total of 264 returnees lactating mothers (88 cases and 176 controls) were randomly selected from four health institutions of Gedeb District.

Outcome measures

Underweight was measured by anthropometric measurement weight/height2. An institutional-based unmatched case–control study was conducted from 11 July 2022 to 20 September 2022. The study involved 264 returnee lactating mothers, with 88 classified as cases (body mass index, BMI<18.5 kg/m²) and 176 as controls (BMI 18.5–24.9 kg/m²). Participants were selected through simple random sampling from public health institutions. Data were collected on sociodemographic, reproductive and nutritional factors using structured questionnaires and anthropometric measurements. Bivariate and multivariable logistic regression analyses were performed to identify significant determinants of maternal underweight.

Result

The study identified several key determinants of underweight. Returnee lactating mothers with a short birth interval (<24 months) were significantly more likely to be underweight (adjusted OR (AOR) 4.04, 95% CI 1.68 to 9.74). Unplanned pregnancies (AOR 7.60, 95% CI 3.14 to 18.41), home deliveries (AOR 5.81, 95% CI 2.09 to 16.14) and meals frequency <3 per day (AOR 2.51, 95% CI 1.12 to 5.63) were also strongly associated with increased risk of underweight. Inadequate dietary diversity (AOR 3.92, 95% CI 1.52 to 10.15) and food insecurity (AOR 4.72, 95% CI 1.77 to 12.61) further contributed to the risk. Poor socioeconomic status was associated with a higher likelihood of being underweight (AOR 4.38, 95% CI 1.49 to 12.82).

Conclusion

The study highlights significant factors contributing to maternal underweight among returnee lactating mothers. Addressing short birth intervals, unplanned pregnancies, dietary diversity and food insecurity is crucial. Policy-makers should focus on targeted interventions to improve maternal health, with special emphasis on returnee lactating mothers. Enhanced healthcare access, nutritional support and socioeconomic development are essential for mitigating underweight and improving overall health outcomes.
Correcting near vision impairment and women’s empowerment: a before-after mixed-methods study among older Zanzibari craftswomen
Authors: Omar Fatma , Othman Omar Juma , Yong Ai Chee , McConnell Emma , Mulewa Damaris , Graham Christine , Shah Kajal , Martins Michelle Fernandes , Farmer Adrianna , Graham Ronnie , Mashayo Eden , Chan Ving Fai
Published: November 2024

Objective

To understand if presbyopia correction could empower older craftswomen entrepreneurs living in Zanzibar.

Design

Mixed-method, before-after intervention study.

Setting

Unguja and Pemba islands, Zanzibar.

Participants

209 craftswomen (weaving, tailoring and sewing, pottery and producing oil and making soaps) 40 years and older with correctable presbyopia, with no other ocular morbidities.

Intervention

Eye health assessment and near vision spectacle correction for 6 months.

Primary and secondary outcomes

Change in economic, social, psychological and political empowerment (4-point Likert scale responses) before and after correction. Odds ratios were calculated to determine the likelihood of upward movement on the Likert scale. Five focus group interviews were conducted to explore the craftswomen’s daily experiences concerning vision correction and empowerment, and subsequently, narrative analysis was conducted.

Results

Of the 209 craftswomen who completed the baseline survey from 4 to 21 April 2022, 157 (75.1%) were successfully followed up from 6 to 27 October 2022. Craftswomen reported significantly greater economic, social, psychological and political empowerment in 14 out of 18 statements (77.8%) (p<0.05). Qualitative responses showed that after correction, craftswomen reported having greater autonomy in running the business and improved income, better decision-making power for their business and children, greater independence and confidence and greater participation in problem-solving for the community and appointing leaders. We did not observe a significant change in the following: ability to make decisions for their family, understanding their capabilities, ability to be elected as a leader and ability to advise government leaders.

Conclusion

The correlation between presbyopia correction and empowerment among older Zanzibari craftswomen is mostly positive. Some aspects of empowerment require further investigation with an extended timeframe.
Knowledge, attitudes and practices regarding medication splitting and crushing among the general public in Jordan: a cross-sectional study
Authors: Jaradat Abdolelah , Alomari Esra'a Ali , Bayan Mohammad Fouad , Naser Abdallah Y
Published: November 2024

Background

Splitting or crushing medications are used for dosage administration when a certain dose is not easily accessible. Understanding the splitting or crushing of medications is essential to guarantee safe medication administration since inappropriate handling might impact therapeutic efficacy, safety and patient outcomes.

Objectives

This study intends to examine the practices, attitudes and knowledge of the Jordanian population regarding the splitting/crushing of medications.

Study design and setting

This is a cross-sectional survey study conducted in Jordan between November 2022 and March 2023. The questionnaire tool was adapted from previous literature, and binary logistic regression analysis was used, to identify the predictors of participants’ knowledge concerning medication splitting/crushing.

Participants

A total of 1259 participants from the general public were involved, without restrictions on gender or age.

Results

Around 22.2% of participants confirmed that tablet splitting/crushing is a useful way to reduce medication costs. 67.0% reported that they are not sure whether tablets are suitable for splitting/crushing/crushing. 75.8% reported that they refer to package leaflet information to check whether tablets are suitable for splitting/crushing. 84.8% correctly believed that scored tablets can be split, while unscored tablets cannot. 72.0% identified correctly that not all types of tablets and capsules can be split/crushed or dissolved. The mean knowledge score of study participants was 2.7 (SD: 1.5) out of 6, which is equal to 45% of the maximum attainable score and reflects a weak level of knowledge about tablet crushing. Those who hold a bachelor’s degree and have an income level of JD500–JD1000 (which is equal to US$715–US$1428) were more likely to have knowledge about tablet crushing. Around 39.2% of the participants reported that they had split or crushed tablets to reach their desired dose, of which the vast majority (82.9%) were using scored tablets.

Conclusion

Understanding of tablet-splitting and crushing techniques ought to be enhanced while encouraging prescribing practices that stress safety and well-informed decision-making. Patients should actively seek reliable sources of information, have an awareness of which tablets can be safely divided and actively engage with healthcare experts to receive appropriate guidance.
Clinical impact of customised positive airway pressure (PAP) therapy interfaces versus usual care in the treatment of patients with sleep-disordered breathing (3DPiPPIn): a randomised controlled trial protocol
Authors: Mansell Stephanie K , Mandal Swapna , Ridout Deborah , Olsen Oliver , Gowing Francesca , Kilbride Cherry , Hilton Stephen T , Main Eleanor , Schievano Silvia
Published: November 2024

Introduction

Sleep-disordered breathing affects 1.6 million people in the UK. The recognised treatment is positive airway pressure (PAP) therapy, delivered via a generic conventional interface (mask). PAP therapy improves morbidity, mortality and quality of life, but treatment effectiveness depends on interface fit and tolerance. Interface side effects include pressure ulcers, skin reactions and interface leak. Three-dimensional (3D) printing is an innovative technology that can produce customised interfaces.

Aims

The primary aim is to assess the impact of customised versus conventional interfaces on residual Apnoea Hypopnea Index at 6 months.

Methods and analysis

This is a randomised control trial via block randomisation, minimised by age >65 and ethnicity, using a computerised random number generator. Patients with sleep-disordered breathing under the care of the Royal Free London NHS Foundation Trust will be recruited. Patients new to therapy will be randomised to customised interface or conventional interface for 6 months. A sample size of 160 is required for 80% power with a significance of 5%, accounting for a 20% dropout rate. Descriptive statistics will report demographics. The primary and secondary outcomes will be compared using linear regression adjusted for baseline score.

Ethics and dissemination

This protocol has been approved by the Hampshire B Research Ethics Committee (REC reference: 22/SC/0405). Results will be disseminated to healthcare professionals and patients through conferences, open-access journals, newsletters, a study webpage, infographics, animations, social media and healthcare awards.

ISRCTN registration number

74082423.
Effect of acupuncture on quality of life in atrial fibrillation: study protocol for a randomised controlled trial
Authors: Li Meng-Tong , Shi Guang-Xia , Wang Yu , Wu Bang-Qi , Zhang Zhao-Hui , Zhao Qing-Yan , Wang Xian , Li Xue-Bin , Guo Wei-Hua , He Li , Zhang Hao-Lin , Wang Lin , Wang Xue-Wen , Tu Jian-Feng , Wang Hai-Ying , Yan Shi-Yan , Lin Ying , Li He-Wen , Liu Cun-Zhi , Wang Li-Qiong
Published: November 2024

Introduction

Atrial fibrillation (AF) is the prevalent cardiac arrhythmia and can significantly impair the quality of life (QoL). Although catheter ablation (CA) is an established treatment for AF,post-procedural complications or perceived inadequate control of AF may diminish the QoL for some patients, potentially even to levels lower than pre-procedure. Preliminary findings from our previous pilot trial indicate that acupuncture may positively influence QoL in AF patients post-CA. This study aims to increase the sample size to evaluate the efficacy of acupuncture as an adjunctive treatment to conventional medical therapy in improving QoL of patients with AF after CA.

Methods and design

This multicentre randomised clinical trial will be conducted in China. A total of 146 eligible patients will be randomly assigned in a 1:1 ratio to either the acupuncture group or the sham acupuncture group. All patients will receive standard postablation care and undergo 18 sessions of acupuncture/sham acupuncture within 12 weeks following CA, followed by a 9-month follow-up period. The primary outcome is the change in the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) summary score from baseline to months 6 after CA. Secondary outcomes include the changes in the AFEQT subscale scores at months 6, the AFEQT summary and subscale score at months 3 and 12, AF burden, AF recurrence, heart rate variability, number of cardioversions, repeat CA procedures, European Heart Rhythm Association score, number of arrhythmia-related hospitalisations, average heart rate, use of Six-Dimensional Health State Short Form to assess health status, costs incurred by disease treatment, Credibility/Expectancy Questionnaire and blinded assessments. Adverse events will also be meticulously recorded throughout the trial.

Ethics and dissemination

Ethics approval has been granted by the Ethics Committee of Beijing University of Traditional Chinese Medicine (approval no: 2020BZYLL0802) and seven other subcentres. The findings of the study results will be disseminated through presentations at scientific conferences or publications in peer-reviewed journals.

Trial registration number

ChiCTR2100049323.
Exploring what influences the uptake of cancer rehabilitation services: a realist informed mixed-methods study
Authors: Csontos Judit Katalin , Roche Dominic , Watts Tessa
Published: November 2024

Objectives

To investigate how uptake of cancer rehabilitation services is affected by information provision and whether it is influenced by people’s perception and attitudes towards rehabilitation interventions and therapies.

Design

This study followed a realist informed mixed-methods design. Descriptive secondary analysis of a cancer rehabilitation database containing information about number of people attending services, their diagnosis and sex and semi-structured interviews with people affected by cancer (PABC) and healthcare professionals (HCPs) were conducted.

Setting

Cancer rehabilitation services located in two cancer centres in South Wales, UK.

Participants

PABC who received care from any of the included cancer rehabilitation services. HCPs providing cancer rehabilitation at any of the included services.

Interventions

Exercise-based cancer rehabilitation, fatigue management, acupuncture and allied health professional support were provided as cancer rehabilitation.

Results

Twenty HCPs and 15 PABC were recruited for semi-structured interviews across the two services. The number of database records used for the secondary analysis ranged from 212 to 347 between 2014 and 2017. Based on descriptive analysis of these records and thematic analysis of HCPs’ interviews, uptake of cancer rehabilitation services often fluctuated. This could be attributed to PABC reporting issues with information provision on available services. Based on PABC’s accounts, they learnt about cancer rehabilitation in various ways, often by chance via word of mouth. Information provision was influenced by several issues including lack of consensus on what cancer rehabilitation means, the wider multidisciplinary team’s (MDT) perception and knowledge on cancer rehabilitation, the prevailing medical model in healthcare and the lack of routine provision of services. The perception and attitude of PABC did not seem to inhibit uptake and information provision.

Conclusions

To modify these inhibiting issues, the education of the wider MDT regarding the aim, modalities and importance of cancer rehabilitation is crucial.
Effect of different durations of preoperative computerised cognitive training on postoperative delirium in older patients undergoing cardiac surgery: a study protocol for a prospective, randomised controlled trial
Authors: Qiu Xinyuan , Wang Lili , Wen Xinge , Meng Qingling , Qi Junwei , Li Chuang , Yin Hua , Ling Fei , Yuhan Qiao , Zhang Wen , Zhang Yueying
Published: November 2024

Introduction

Postoperative delirium (POD) is a common neurological complication after surgery among older patients, characterised by acute disturbances in consciousness, attention and cognition, usually occurring within 24–72 hours after surgery. POD has a significant impact on the prognosis of older patients undergoing major cardiovascular surgery, including increased length of hospital stay, hospital costs and readmission rates, with an incidence rate as high as 26%–52%. Computerised cognitive training (CCT) refers to difficulty-adaptive training in cognitive domains such as attention, memory and logical reasoning, using systematically designed tasks. Existing studies have shown that CCT has reduced the risk of delirium in non-cardiac surgery patients with at least minimal compliance. The purpose of this study is to investigate the effects of preoperative CCT on the incidence of POD in older patients undergoing elective cardiac surgery, to clarify the dose–effect relationship between different training time of preoperative CCT and POD and to explore the minimum effective time target that can significantly lower the incidence of POD.

Methods and analysis

This is a prospective, single-blind, randomised controlled trial that aims to enrol 261 older patients scheduled for elective cardiac surgery at the Affiliated Hospital of Xuzhou Medical University. The patients will be randomised into three groups: group C will be the routine care group (no CCT prior to surgery); group L will be the low-dose time group (with a total of 5 hours of CCT prior to surgery) and group H will be the high-dose time group (with a total of 10 hours of CCT prior to surgery). The primary outcome is the incidence of delirium within 7 days after surgery. Secondary outcomes include postoperative mild neurocognitive disorder (NCD) and postoperative major NCD (30 days up to 1 year), time of onset and duration and severity of delirium, and all-cause mortality within 1 year after surgery. The results of this study are of significant importance for establishing effective, patient-centred and low-risk prevention strategies for POD/postoperative NCD.

Ethics and dissemination

This study protocol has been approved by the Ethics Committee of the Affiliated Hospital of Xuzhou Medical University (Ethics Number: XYFY2023-KL149-01). All participants will provide written informed consent, and the results of the study will be published in international peer-reviewed academic journals and presented at academic conferences.

Trial registration number

ChiCTR2300072806.
Descriptive qualitative study of breathlessness and its management of Turkish individuals with self-reported heart failure
Authors: Seckin Muzeyyen , Petrie Mark C , Stewart Simon , Johnston Bridget Margaret
Published: November 2024

Aims

To explore the experiences of individuals with heart failure, with a specific focus on elucidating the full spectrum of symptoms experienced and their subjective descriptions of breathlessness and self-management strategies regarding socio-cultural-behavioural context.

Design

Qualitative descriptive study underpinned by critical realism and situation-specific theory of heart failure self-care.

Setting

Participants from various settings (hospitals and community) in Southeastern Türkiye.

Participants

Adults reporting heart failure and breathlessness.

Methods

Semi-structured interviews were carried out with 20 individuals (11 women and 9 men). Data were audio-recorded and transcribed. Participants were asked to describe their symptoms, experiences with breathlessness, self-management strategies and health needs from their perspectives. The interview data were analysed using reflexive thematic analysis.

Results

There were a range (31 physical and 7 psycho-social behavioural) of symptoms experienced by participants. This included fatigue, difficulty sleeping, pain (not including chest pain) and fear about death and dying. Based on reflexive thematic analysis of semi-structured interviews, six main themes were identified. First two themes (knowledge and misconception, and experience of breathlessness) were related to breathlessness experience and knowledge. The third theme (culture and religious consideration) highlighted the importance of cultural and religious perspectives in breathlessness regarding Turkish socio-cultural-behavioural context. Themes four (breathlessness self-management/physical) and five (breathlessness self-management/psychological) were identified as self-management strategies for breathlessness. The need for improved health behaviours (improved health behaviours) was also identified.

Conclusion

Breathlessness and self-management strategies are affected by individual perspectives in relation to their socio-cultural-behavioural context. Understanding individuals’ unique breathlessness experiences regarding their socio-cultural-behavioural context assists in the identification of possible individualised-care strategies to improve their life and care quality in heart failure. We recommend creating a person-centred symptom assessment strategy with reference to culture or transculture guided by nurses. This will help to understand individuals’ unique symptom profiles and tailor responses to their needs.
Primary prevention of cardiovascular diseases among women in a South Asian population: a descriptive study of modifiable risk factors
Authors: Rauf Rubina , Khan Muhammad Nauman , Sial Jawaid Akbar , Qamar Nadeem , Saghir Tahir , Kazmi Khawar Abbas
Published: November 2024

Objective

The aim of this study was the assessment of modifiable risk factors of cardiovascular diseases (CVD) among women versus men at a newly developed preventive cardiology clinic of a large tertiary care cardiac centre in Pakistan.

Design

Observational study.

Setting

Tertiary care cardiac hospital in Karachi, Pakistan.

Participants

Data for this study were obtained retrospectively from a prospectively collected ongoing registry. We have included all female and male individuals who have presented or were referred to our clinic for primary prevention. All the participants had no history of ischaemic heart disease.

Outcome measure

In this study, we evaluated the CVD risk factors, estimated risk of CVD, and glycaemic and cholesterol control at baseline and at subsequent follow-ups for high-risk patients.

Results

A total of 535 patients, 314 females, were included with a mean age of 48.3±12.5 years. At baseline, 57.9% (128) of men versus 73.2% (230) of women (p<0.001) were known cases of hypertension (HTN); 18.1% (40) vs 26.8% (84) (p=0.019) were diabetic; 40.5% (89) vs 9.2% (29) (p<0.001) were tobacco users; 26.0% (56) vs 3.2% (10) (p<0.001) were smokers; and 26.9% (57) vs 50.5% (153) had BMI ≥30 kg/m2, respectively.

Baseline atherosclerotic cardiovascular disease (ASCVD) risk score was available for 348 (65%), 61.5% (136) of men versus 67.5% (212) of women. The median ASCVD risk score was 6.8% (2.8%–16.1%) vs 2.25% (1%–5.1%) (p<0.001 for men and women, respectively). The ASCVD risk score was ≥20% (high risk) for 22.1% (30) vs 1.9% (4), while the ASCVD risk score was <5% (low risk) for 40.4% (55) vs 74.1% (157) of men and women, respectively.

A repeat ASCVD assessment at a median follow-up of 49.5 (7.0–231) days was available for 259 (48.4%) patients, 26.2% (58) of men vs 64% (201) of women, respectively. The median follow-up ASCVD score was 6.55% (2.8%–15.4%) vs 2.1% (0.9%–4.8%) (p<0.001 with ≥20% (high risk) in 19% (11) vs 2% (4) and <5% (low risk) in 34.5% (20) vs 77.1% (155) of men and women, respectively).

Conclusion(s)

There is a high prevalence of modifiable risk factors for atherosclerotic CVD such as HTN, diabetes and obesity in women as compared with men, but interestingly, ASCVD risk score at the baseline as well as at the follow-up is high in men versus women. Some other non-modifiable risk factors like age, gender and blood lipid profile may also contribute to this difference between the high prevalence of risk factors and low ASCVD risk score in women. With appropriate follow-up and proper counselling, the looming CVD can be better prevented in this population. A dedicated preventive cardiology clinic for the identification of high-risk women and systematic follow-up is needed to predict their actual CVD risk.

Trial registration

NCT06503341.
Exploring whether home-based neuromodulation can boost the analgesic effects of exercise in people with knee osteoarthritis: protocol for a double-blinded, pilot randomised controlled trial
Authors: McNally Keeley R , Summers Simon , Stanton Tasha R , McAuley James , Chang Wei-Ju , Chowdhury Nahian , Cavaleri Rocco
Published: November 2024

Introduction

Knee osteoarthritis (OA) represents a leading cause of disability globally. Exercise has been demonstrated to improve pain and function in people with knee OA. However, when in pain, commencement of exercise is difficult, and clinical effects with such interventions are often modest. Recently, transcranial direct current stimulation (tDCS), a form of non-invasive brain stimulation, has been shown to bolster the pain-relieving effect of exercise in experimental settings. While promising, the utility of employing this approach beyond the research environment is yet to be elucidated. Therefore, this pilot study aims to investigate the feasibility, safety, adherence, tolerability and preliminary efficacy of tDCS and exercise in home-based settings to improve pain and function in people with knee OA.

Methods and analysis

This protocol is for a pilot randomised, double-blinded, sham-controlled trial. 24 individuals with idiopathic knee OA will be randomised to receive either active tDCS+exercise (Intervention) or sham tDCS+exercise (Control) at home. Participants will receive 20 min of tDCS 5 days per week for the first 2 weeks of this 8-week trial. Participants in both groups will complete a lower limb strengthening programme 3 days per week for the entire 8 weeks. Outcome measures of feasibility (acceptability, satisfaction, retention), safety, adherence and tolerability will be assessed throughout the trial period, with clinical outcomes of pain and function assessed before and following the intervention. Feasibility, safety, adherence and tolerability outcomes will be explored descriptively using frequencies and percentages. To examine preliminary efficacy, within-group and between-group changes in pain and functional measures will be analysed.

Ethics and dissemination

This protocol obtained ethical approval from the Queensland University of Technology Human Research Ethics Committee (HREA 2024-8302-20200). All participants will provide written informed consent. The findings of the study will be disseminated via journal publications and international conference proceedings.

Trial registration number

ACTRN12624000397516p.
Qualitative exploration of the barriers and facilitators to community pharmacy PrEP delivery for UK pharmacists and underserved community members using the COM-B model of behaviour change
Authors: Harrison China , Family Hannah , Kesten Joanna , Denford Sarah , Scott Jennifer , Sabin Caroline , Copping Joanna , Harryman Lindsey , Cochrane Sarah , Saunders John , Hamilton-Shaw Ross , Horwood Jeremy
Published: November 2024

Objectives

Expanding delivery of oral pre-exposure prophylaxis (PrEP) to community pharmacies could improve access, aligning well with the UK government’s goals to eliminate new HIV acquisitions by 2030. Using the Capability, Opportunity, Motivation, Behaviour (COM-B) model for behaviour change, the aim of this research was to explore the barriers and facilitators of community pharmacy PrEP delivery, for pharmacists and community members.

Methods

Community members at elevated risk of acquiring HIV and community pharmacists were recruited to participate in semi-structured interviews. Interviews were recorded, transcribed, and thematically analysed within the framework of the COM-B model.

Results

17 interviews with pharmacists (pharmacy owners n=7; employed pharmacists n=6; locums n=4) and 24 with community members (black African women n=6; other women n=2; young adults aged 18–25 years n=6; transgender people n=6; female sex workers n=4) were carried out. Capability barriers included suboptimal awareness and knowledge of PrEP, pharmacy facilities and pharmacist roles in delivering public health services. Opportunity barriers included a lack of staff capacity, privacy and pharmacy screening and monitoring facilities. Motivational barriers included a concern that increased access could increase sexually transmitted infections and involve a financial cost. Capability facilitators included awareness raising, HIV and PrEP training and education. Opportunity facilitators included PrEP appointments and the accessibility of pharmacies. Motivational facilitators included a preference for pharmacy delivery over other models (eg, sexual health, General Practitioner (GP)), and a belief that it would be discrete and less stigmatising.

Conclusion

Pharmacy PrEP delivery is acceptable but for it to be feasible, results point to the need for the development of a behaviour change intervention focusing on education, training and awareness raising, targeting pharmacists and community members to stimulate patient activation and de-stigmatise HIV. This intervention would need to be facilitated by system and environmental changes (eg, commissioning service).
Novel insights into RNA polymerase II transcription regulation: transcription factors, phase separation, and their roles in cardiovascular diseases
Authors: Liu Mengmeng , Li Yingrui , Yuan Xin , Rong Shunkang , Du Jianlin
Published: November 2024

Transcription factors (TFs) are specialized proteins that bind DNA in a sequence-specific manner and modulate RNA polymerase II (Pol II) in multiple steps of the transcription process. Phase separation is a spontaneous or driven process that can form membrane-less organelles called condensates. By creating different liquid phases at active transcription sites, the formation of transcription condensates can reduce the water content of the condensate and lower the dielectric constant in biological systems, which in turn alters the structure and function of proteins and nucleic acids in the condensate. In RNA Pol II transcription, phase separation formation shortens the time at which TFs bind to target DNA sites and promotes transcriptional bursting. RNA Pol II transcription is engaged in developing several diseases, such as cardiovascular disease, by regulating different TFs and mediating the occurrence of phase separation. This review aims to summarize the advances in the molecular mechanisms of RNA Pol II transcriptional regulation, in particular the effect of TFs and phase separation. The role of RNA Pol II transcriptional regulation in cardiovascular disease will be elucidated, providing potential therapeutic targets for the management and treatment of cardiovascular disease.