bluuebunny/crossref_metadata_2025 huggingface dataset:
circMTO1/miR‐30c‐5p/SOCS3 axis alleviates oral submucous fibrosis through inhibiting fibroblast–myofibroblast transition
Authors: Bin Xin , Cheng Jing‐Yi , Deng Zhi‐Yuan , Li Bo , Xu Xing‐Huan‐Yu , Liu Ou‐Sheng , Tang Zhangui
Published: May 2024

Background

circRNAs have been shown to participate in diverse diseases; however, their role in oral submucous fibrosis (OSF), a potentially malignant disorder, remains obscure. Our preliminary experiments detected the expression of circRNA mitochondrial translation optimization 1 homologue (circMTO1) in OSF tissues (n = 20) and normal mucosa tissues (n = 20) collected from Hunan Xiangya Stomatological Hospital, and a significant decrease of circMTO1 expression was showed in OSF tissues. Therefore, we further explored circMTO1 expression in OSF.

Methods

Target molecule expression was detected using RT‐qPCR and western blotting. The migration and invasion of buccal mucosal fibroblasts (BMFs) were assessed using wound healing and Transwell assays. The interaction between miR‐30c‐5p, circMTO1, and SOCS3 was evaluated using dual luciferase, RNA immunoprecipitation (RIP), and RNA pull‐down assays. The colocalisation of circMTO1 and miR‐30c‐5p was observed using fluorescence in situ hybridisation (FISH).

Results

circMTO1 and SOCS3 expression decreased, whereas miR‐30c‐5p expression increased in patients with OSF and arecoline‐stimulated BMFs. Overexpression of circMTO1 effectively restrained the fibroblast–myofibroblast transition (FMT), as evidenced by the increase in expression of Coll I, α‐SMA, Vimentin, and the weakened migration and invasion functions in BMFs. Mechanistic studies have shown that circMTO1 suppresses FMT by enhancing SOCS3 expression by sponging miR‐30c‐5p and subsequently inactivating the FAK/PI3K/AKT pathway. FMT induced by SOCS3 silencing was reversed by the FAK inhibitor TAE226 or the PI3K inhibitor LY294002.

Conclusion

circMTO1/miR‐30c‐5p/SOCS3 axis regulates FMT in arecoline‐treated BMFs via the FAK/PI3K/AKT pathway. Expanding the sample size and in vivo validation could further elucidate their potential as therapeutic targets for OSF.
Standard tests of haemostasis do not predict elevated thromboelastographic maximum amplitude, an index of hypercoagulability, in sick dogs
Authors: Clarkin‐Breslin R. C. , Chalifoux N. V. , Buriko Y.
Published: May 2024

Objectives

To compare standard tests of haemostasis in hypercoagulable and normocoagulable sick dogs as identified by thromboelastography.

Materials and Methods

We compared prothrombin time, activated partial thromboplastin time, D‐dimers, packed red blood cell volume and platelet counts in client‐owned sick dogs with hypercoagulable (n = 36) and normocoagulable (n = 35) states as identified by thromboelastography maximum amplitude above or within the established reference interval, respectively.

Results

Seventy‐one dogs were included. Thirty‐six dogs were hypercoagulable and 35 were normocoagulable on thromboelastography. Using multivariable linear models, prothrombin time, activated partial thromboplastin time and D‐dimers were not associated with hypercoagulability. Platelet counts and packed red blood cell volume were significantly associated with hypercoagulability.

Clinical Significance

Prothrombin time, activated partial thromboplastin time and D‐dimers were not useful in the identification of hypercoagulability in dogs as defined by thromboelastography.
Prevalence of HCV infection in Europe in the DAA era: Review
Authors: D'Ambrosio Roberta , Anolli Maria P. , Pugliese Nicola , Masetti Chiara , Aghemo Alessio , Lampertico Pietro
Published: May 2024

In 2016, the Global Health Sector Strategy, ratified by the 69th World Health Assembly, set the ambitious goal of eliminating hepatitis C virus (HCV) and hepatitis B virus infections by 2030, emphasizing the importance of national screening programmes. Achieving this goal depends on each country's ability to identify and treat 80% of chronic hepatitis C cases, a critical threshold set by the World Health Organization. Traditionally, estimates of HCV prevalence have been based on interferon era studies that focused on high‐risk subgroups rather than the general population. In addition, the incomplete data available from national registries also limited the understanding of HCV prevalence. The 2016 report from the European Centre for Disease Prevention and Control highlighted that HCV rates varied across European counties, ranging from .1% to 5.9%. However, data were only available for 13 countries, making the overall picture less clear. Additionally, the epidemiological data may have underestimated the true burden of HCV due to lack of awareness among those with chronic infection. The main objective of this review is to provide a comprehensive summary of HCV epidemiology in Europe in the current era of direct‐acting antivirals (DAAs). The data included in the analysis range from the end of 2013 to December 2023 and have been categorised according to the United Nations Geoscheme. The resulting synthesis underscores the noteworthy impact of DAA treatment on the epidemiological situation.
The Egalitarian Objection to Coercion
Authors: Lovett Adam
Published: May 2024

I develop an egalitarian account of what's objectionable about coercion. The account is rooted in the idea that certain relationships, like those of master to slave or lord to peasant, are relationships of subordination or domination. These relationships are morally objectionable. Such relationships are in part constituted by asymmetries of power. A master subordinates a slave because the master has more power over the slave than vice versa. Coercion is objectionable, I argue, because it creates such asymmetries of power and so creates relationships of subordination. This account, moreover, illuminates what's wrong with blackmail, exploitation, withholding aid, and compulsion.
Multiplex‐genome‐editing based rapid directional improvement of complex traits in rice
Authors: Wei Yidong , Zhang Haomin , Fan Jiaxing , Cai Qiuhua , Zhang Zhixing , Wang Jinlan , Zhang Min , Yan Fengting , Jiang Jiahuan , Xie Hongguang , Luo Xi , Wei Linyan , Lin Yuelong , He Wei , Qu Mengyu , Zhang Xinxin , Zhu Yongsheng , Xie Huaan , Zhang Jianfu
Published: May 2024

Although thousands of genes have been identified or cloned in rice (Oryza sativa) in the last two decades, the majority of them have only been separately characterized in specific varieties or single‐gene modified backgrounds, thus limiting their practical application. We developed an optimized multiplex genome editing (MGE) toolbox that can efficiently assemble and stably express up to twelve sgRNA targets in a single plant expression vector. In this study, we established the MGE‐based Rapid Directional Improvement (MRDI) strategy for directional improvement of complex agronomic traits in one small‐scale rice transformation. This approach provides a rapid and practical procedure, encompassing sgRNA assembly, transgene‐free screening and the creation of promising germplasm, by combining the precision of gene editing with phenotype‐based field breeding. The MRDI strategy was used to generate the full diversity of twelve main agronomic genes in rice cultivar FXZ for the directional improvement of its growth duration and plant architecture. After applying the MRDI to FXZ, ideal plants with the desired traits of early heading date reduced plant height, and more effective panicles were generated without compromising yield, blast resistance and grain quality. Furthermore, the results of whole‐genome sequencing (WGS), including the analysis of structural variations (SVs) and single nucleotide variations (SNVs) in the MGE plants, confirmed the high specificity and low frequency of unwanted mutations associated with this strategy. The MRDI breeding strategy would be a robust approach for exploring and applying crucial agronomic genes, as well as for generating novel elite germplasm in the future.
Re‐evaluating the energy balance of the many routes of carbon flow through and from photorespiration
Authors: Walker Berkley , Schmiege Stephanie C. , Sharkey Thomas D.
Published: May 2024

Photorespiration is an essential process related to photosynthesis that is initiated following the oxygenation reaction catalyzed by rubisco, the initial enzyme of the Calvin–Benson–Bassham cycle. This reaction produces an inhibitory intermediate that is recycled back into the Calvin–Benson–Bassham cycle by photorespiration which requires the use of energy and the release of a portion of the carbon as CO2. The energy use and CO2 release of canonical photorespiration form a foundation for biochemical models used to describe and predict leaf carbon exchange and energy use (ATP and NAPDH). The ATP and NADPH demand of canonical photorespiration is thought to be different than that of the Calvin–Benson–Bassham cycle, requiring increased flexibility in the ratio of ATP and NADPH from the light reactions. Photorespiration requires many reactions across the chloroplasts, mitochondria and peroxisomes and involves many intermediates. Growing evidence indicates that these intermediates do not all stay in photorespiration as typically assumed and instead feed into other aspects of metabolism and leave as glycine, serine, and methylene‐THF. Here we discuss how alternative flux through and from canonical photorespiration alters the ATP and NADPH requirements of metabolism following rubisco oxygenation using additional derivations of biochemical models of leaf photosynthesis and energetics. Using these new derivations, we determine that the ATP and NADPH demands of photorespiration are highly sensitive to alternative flux in ways that fundamentally changes how photorespiration contributes to the ratio of total ATP and NADPH demand. Specifically, alternative flows of carbon through photorespiration could reduce ATP and NADPH demand ratio to values below what is produced from linear electron transport.
Mental health among centenarians living in Switzerland
Authors: Uittenhove Kim , Rohner Shauna L. , Falciola Justine , Gomes da Rocha Carla , Röcke Christina , Cavalli Stefano , Herrmann François , Jopp Daniela S. , von Gunten Armin
Published: May 2024

Background

Given the increasing number of people achieving exceptionally long lifespans, there is an urgent need for a better understanding of mental health in centenarians. This study aimed to understand the prevalence of mental health conditions—depressive symptoms, anxiety, sleep disturbances, disinhibition, and aberrant motor behaviour—among centenarians in Switzerland.

Methods

Data were collected from N = 169 participants via telephone interviews or paper questionnaires, either directly from centenarians or through proxy informants. Half the data were collected during a period when protective measures were imposed due to the COVID‐19 pandemic, and half were collected after the measures were lifted.

Results

Mental health conditions were prevalent in our sample, particularly depressive symptoms (44.51%) and anxiety (42.17%). Significant positive associations were found between depressive symptoms and anxiety, and between disinhibition and aberrant motor behaviour. Furthermore, we identified statistical predictors for the occurrence of mental health conditions. Notably, institutionalised living increased the odds of depressive symptomatology, while those with higher education levels or an absence of cognitive impairment experienced more sleep disturbances. Finally, cognitive impairment was linked to increased disinhibition and aberrant motor behaviour.

Conclusions

The high prevalence of mental health conditions underscores the need for proactive mental health care strategies in advanced old age. Moreover, it is vital to consider the interconnected nature of mental health conditions and to prioritise vulnerable groups, such as centenarians in institutional settings.
Pollinator planting establishment and bee visitation are influenced by seeding rate and post‐seeding management
Authors: Perkins Jacquelyn A. , Walters Jenna , Rowe Logan , Brokaw Julia , Gedlinske Lauren , Anderson Elisabeth , Wang Sichao , Isaacs Rufus
Published: May 2024

Perennial wildflower plantings are commonly used to support pollinators and other beneficial insects, but their establishment can be costly, and few studies have directly compared the effectiveness of different management strategies for wildflower establishment. To determine the relative importance of pre‐seeding weed control, seed density, and post‐seeding management on seed mix establishment, we developed a multifactorial field experiment in a grass‐dominated weed community. Pre‐seeding management treatments (mowing, herbicide, or soybean cover crops) did not affect the stem density of sown plants, or the percent of ground covered by sown plants. However, the percent of ground covered by weeds was significantly influenced by pre‐seeding treatments, with infrequent mowing resulting in significantly less weedy ground cover than the herbicide or soybean pre‐seeding treatments. Plots with a higher seeding rate had a significantly greater density of sown wildflower species and a higher percent cover of these species after 3 years. Plots that received no post‐seeding management had higher stem density, a greater percent ground cover of sown forbs, and higher species richness compared to those that were intensively managed (mow or mow + herbicide). The total number of bee visits (honey bees, bumble bees, and other wild bees) increased with higher forb species richness, higher ground cover of sown forbs, and higher sown species richness. Doubling the density of seeds resulted in a 24.3% increase in the number of wild bees observed. When establishing wildflower habitat for pollinators, investment in ground preparation and seeding density has the greatest impact on sown species establishment.
Learning Style Approaches in Christian Education
Authors: Ma Yan
Published: May 2024

Learning style theories suggest that individual learners may have different ways of learning and will probably learn better with their preferred learning methods. Educators in almost all fields are increasingly aware of the importance of adopting learning style approaches, which requires instructors to understand the diverse learning styles of students and adapt their teaching strategies to accommodate various learning styles. Given the existence of diverse learning styles, it is impossible to have any single correct way to learn or to teach. However, instructors can provide students with a beneficial and rewarding learning experience by accommodating various learning styles. As the research in the field of learning styles testifies, students will benefit from learning style approaches that are properly adopted. In various areas of Christian education, Christian instructors are also able to make use of learning style approaches to facilitate the learning process of their students.
The additive function of YIGE2 and YIGE1 in regulating maize ear length
Authors: Liu Yu , Li Huinan , Liu Jie , Wang Yuebin , Jiang Chenglin , Zhou Ziqi , Zhuo Lin , Li Wenqiang , Fernie Alisdair R. , Jackson David , Yan Jianbing , Luo Yun
Published: May 2024

Ear length (EL) is a key trait that greatly contributes to yield in maize. Although dozens of EL quantitative trait loci have been mapped, very few causal genes have been cloned, and the molecular mechanisms remain largely unknown. Our previous study showed that YIGE1 is involved in sugar and auxin pathways to regulate ear inflorescence meristem (IM) development and thus affects EL in maize. Here, we reveal that YIGE2, the paralog of YIGE1, regulates maize ear development and EL through auxin pathway. Knockout of YIGE2 causes a significant decrease of auxin level, IM length, floret number, EL, and grain yield. yige1 yige2 double mutants had even shorter IM and ears implying that these two genes redundantly regulate IM development and EL. The genes controlling auxin levels are differential expressed in yige1 yige2 double mutants, leading to lower auxin level. These results elucidated the critical role of YIGE2 and the redundancy between YIGE2 and YIGE1 in maize ear development, providing a new genetic resource for maize yield improvement.
Estimating waiting time for compatible blood: A Negative Binomial approach
Authors: Baskin Leland B.
Published: May 2024

Objectives

Screening blood units for compatibility constitutes a Bernoulli series. Estimating the number of units needed to be screened represents a classic waiting time problem that may be resolved using the Negative Binomial Distribution. The currently recommended method for estimating the number of units screened, n, to find a required number of compatible units, r, with a given probability, p, is n = r/p. This coincides with the mean of the Negative Binomial Distribution so that the actual number of units screened will often be underestimated by the current method.

Methods

The cumulative distribution function of the Negative Binomial Distribution provides the probability of success (compatibility), F(n;r,p), as a function of the number of trials performed (attempted crossmatches), n, the probability of success on each trial, p, and the number of successes (compatible units) required, r. Choosing a threshold cumulative probability sufficiently high, such as F ~ 0.9, for example, will provide confidence that the projected number of units screened will be underestimated less often (~10% of the time).

Results

With F ≥ 0.9, the estimated number of attempted crossmatches ranges from 1.3 to 2.3 times as many as the number calculated by the current method. As a rule of thumb approximately 1.6 times the current estimated number provides a similar estimate (n ~ 1.6∙r/p).

Conclusions

Waiting time underestimation will be reduced significantly by using the Negative Binomial Distribution solution and should be accompanied by improved customer satisfaction.
Vascularity evaluation of the equine tarsocrural and proximal intertarsal joint septum, and comparative analysis of two arthroscopic transection techniques
Authors: Labordère Alexandra L. , Ruzickova Pavlina , Kamus Louis J. , Beauchamp Guy , Malo Alexia , Richard Hélène , Laverty Sheila
Published: May 2024

Objective

To evaluate vascularity of the synovial membrane covered septum (SMS) separating the tarsocrural (TC) and proximal intertarsal (PIT) joints (Part 1) and compare two methods of transection, electrosurgical or Ferris Smith rongeur (FS rongeur) (Part 2).

Study design

Experimental study.

Sample population

Part 1, 10 SMS (n = 5 horses). Part 2, six horses (n = 12 tarsi).

Methods

In part 1, SMS harvested postmortem were each divided into eight regions of interest (ROIs), processed for histology, and immunostained with anti‐α‐actin antibody for blood vessel identification. Vascular density was calculated for each ROI. Data was compared within and between horses. In part 2, six horses underwent TC arthroscopy. Each limb was randomly assigned to undergo either electrosurgical or FS rongeur SMS transection. SMS transection and total operative time were recorded. Intraoperative hemorrhage was scored. Data was compared between both techniques.

Results

Significant interindividual variations in SMS vascular density were detected (p = .02), but there were no differences among ROIs. No differences in the transection time were detected between electrosurgery (4.83 ± 0.54 min) and FS rongeur (4.33 ± 0.67 min). No differences were found in intraoperative hemorrhage scores between techniques.

Conclusion

Vascularity within the SMS varies among horses but not within its regions. Electrosurgical or FS rongeur transection of the medial SMS during tarsocrural arthroscopy is a rapid technique and improves surgical access to the dorsal compartment of the PIT.
Design, Fabrication, and Testing of a Novel Thermally Actuated Tesla Valve: A Hybrid Microvalve
Authors: Lee Jonghyun , Bamido Alaba , Thyagarajan Ashok , Shettigar Nandan , Banerjee Debjyoti
Published: May 2024

A novel thermally actuated hybrid microvalve (similar to a Tesla valve configuration) was designed, fabricated, assembled, and tested using soft lithography-based approaches. The modified design integrates the “normally open and closed” hybrid configurations of Tesla valves with a thermo-pneumatic (or thermal-hydraulic) actuator microfabricated in situ that modulates the diodicity of the microvalve apparatus in the microfluidic chip. Diodicity (Di) is defined as the ratio of flowrate in the forward direction to that of the reverse direction (for a constant value of pressure drop that is imposed on a microvalve device). The results from the study successfully demonstrated the operation of an array of Tesla Valves that are normally open in forward direction and marginally closed in reverse direction at room temperature (i.e., with Di > 1, the flow resistance values were different when the inlet and outlet ports were swapped). When the microfluidic chip was heated (at steady-state conditions with a nominal temperature of ∼30 °C), the diodicity virtually vanished (i.e., Di ≈ 1) resulting in both reverse and forward directions being normally open (or having the same flow resistance irrespective of the flow direction).
Reducing Leak and Increasing Comfort of an N95 Filtering Facepiece Respirator for Aged-Care Workers Using a Customized, Soft, and Compliant Mask Frame
Authors: Chapman Darius , Strong Campbell , Dharmaprani Dhani , Kaur Prabhpreet , Tiver Kathryn , Ganesan Anand N.
Published: May 2024

This prospective cohort study examines the quantitative fit-factor and tolerability impact of a novel custom frame designed to fit beneath N95 filtering facepiece respirators (FFRs) in a healthcare setting. Conducted at a medium-sized metropolitan residential aged care facility (RACF) in South Australia, sixty participants underwent quantitative fit testing while wearing institutional-provided N95 FFRs. Utilizing three-dimensional (3D) face scanning with a proprietary iPhone app, personalized frames were created using flexible silicone foam with a rigid plastic interior “backbone” to ensure compliance and comfort. Following the fitting of custom frames, participants underwent repeat quantitative fit testing using the same style and size of N95 FFRs. Results indicate a remarkable improvement, with 81.5% of participants achieving a pass on quantitative fit testing when using their custom frame in conjunction with the N95 FFRs, compared to a baseline pass rate of only 21.7% (odds ratio (OR) 20.9, 95% confidence interval (CI): 8.26, 58.50, p < 0.001 via logistic regression). Additionally, participants reported a 2.4 times higher level of tolerability when wearing the custom frame with their N95 FFRs compared to using FFRs alone (p < 0.001). In conclusion, the study demonstrates that wearing a customized frame device under an N95 FFR significantly enhances the likelihood of achieving a pass on quantitative fitting and offers a substantially more tolerable experience for wearers. These findings highlight the potential of personalized frame devices to improve respiratory protection efficacy and wearer comfort in healthcare settings.
Challenges to the proof of violence, and social stigma for ethnic migrant women in the current Victims of Family Violence (VFV) visa policy in Aotearoa New Zealand
Authors: Ayallo Irene , Kelly Tyler
Published: May 2024

Introduction: Ethnic victim-survivors[1] from Middle Eastern, African, and Latin American (MELAA) communities are unlikely to apply for the VFV visas (Ayallo, 2019), which does not reflect the number of family violence experiences in these communities. Instead, this paper argues that it is a testament to specific cultural factors determining their engagement with this policy. While some of these have previously been reported, their cultural aspects are not adequately understood.
Approach: Data were drawn from a study exploring the cultural contexts within which ethnic migrant women engage with the VFV visa policy. The study used narrative inquiry and semi-structured interviews to explore 20 participants’ experiences with the VFV visa policy process. Participants included ten victim-survivors and ten supporting non-medical practitioners.
Findings: Analyses showed that victim-survivors face significant barriers in accessing this visa. Proving that violence occurred, hardship and inability to return to their country of origin due to social stigma are complex and challenging for ethnic migrant women. The cultural reasons discussed in this paper include that psychological abuse is dominant, violence occurs transnationally, and hardship and social stigma are understood collectively and socially.
Implications: Given the potential of this visa policy initiative to provide safety for victim-survivor, recommendations for change are proposed. A humanitarian and compassionate approach that arises from the experiences of the 20 participants and a critical examination of countries with comparable policy frameworks is proposed. Further research is recommended with relevant stakeholders to explore the practicality of implementing such a humanitarian application process in the Aotearoa context.
 
[1] The term is used here to refer to individuals who have experienced family violence and successfully or unsuccessfully engaged with the VFV visa policy. In this paper, the term is used interchangeably with woman/women as appropriate (reflecting that in this study, all victim-survivors were women).
Recognition of the role of our journal Aotearoa New Zealand Social Work
Authors: Beddoe Liz
Published: May 2024

Editorial
Preoperative and postoperative 3D reconstruction for surgical management of a post-cholecystectomy biliary stricture
Authors: Nola Valentina , Vicente Emilio , Quijano Yolanda , Caruso Riccardo
Published: May 2024

Cholecystectomy-related iatrogenic biliary injuries cause intricate postoperative complications that can significantly affect a patient’s life, often leading to chronic liver disease and biliary stenosis. These patients require a multidisciplinary approach with intervention from radiologists, endoscopists and surgeons experienced in hepatobiliary reconstruction. Symptoms vary from none to jaundice, pruritus and ascending cholangitis. The best strategy for the management of biliary stricture is based on optimal preoperative planning. Our patient presented 1 year after an iatrogenic lesion was induced during a cholecystectomy, and was managed with a complex common bile duct reconstruction through a Roux-en-Y hepaticojejunostomy. The three-dimensional (3D) model reconstruction of the biliary tract was pivotal in the planning of the patient’s surgery, providing additional preoperative and intraoperative assistance throughout the procedure. The 3D model’s description of detailed spatial relations between the bile duct and the vascular structure in the liver hilum enabled a correct surgical dissection and safe execution of the anastomosis.
Autosomal recessive limb girdle muscular dystrophy-type 5 (LGMDR-5)
Authors: Ashokkumar Hamritha , Bhatia Sakshi Upendra , Azhagar Nambi Santhi Vaanmathi , Kumar Radha
Published: May 2024

Limb-girdle muscular dystrophy (LGMD) comprises a heterogeneous group of rare genetic disorders characterised by progressive weakness and atrophy of the muscles, primarily affecting the pelvic and shoulder girdles. A developmentally normal, early adolescent male presented with complaints of difficulty in using all four limbs with a waddling gait, gradually progressive over the last 5 years. No significant family history was noted. We noticed thinning and atrophy of both upper and lower limbs, proximal more than distal, associated with wasting, hypotonia and decreased power in all four limbs. Gower’s sign was positive. The winging of the scapula was present. All deep tendon reflexes and superficial reflexes were present with flexor response in both plantars. The sensory system was normal. An initial diagnosis of muscular dystrophy was made and confirmed with clinical exome sequencing, which showed a pathogenic variant indicating a very rare type of autosomal recessive LGMD. This disease was previously named LGMD2C and has now been renamed under LGMDR5.
Scapula alata, a rare complication after minimally invasive repair of pectus excavatum
Authors: Laven Iris E W G , van Polen Elise J , Vissers Yvonne L J , de Loos Erik R
Published: May 2024

A male patient in his early 30s underwent minimally invasive repair of pectus excavatum. According to standard Nuss bar procedure, a 30-degree thoracoscope was introduced through a right midaxillary 10 mm trocar in the 4th intercostal space. Two bars and five stabilisers were placed in a retromuscular position. After discharge, the patient experienced right upper back pain requiring prolonged opioid usage for three months and right scapular winging limiting functional activities. After conservative treatment with physiotherapy for 11 months, the patient still suffered from residual scapula alata with pain and muscle weakness. On suspicion of long thoracic nerve neuropraxia related to the thoracoscope placement, an electromyogram was conducted 16 months following surgery, revealing mild polyphasic potentials of the serratus anterior muscle without abnormal muscle unit action potential. After extended conservative therapy for another year, physical examination 28 months after surgery showed almost complete resolution of scapular winging.
Comparing the effectiveness and cost-effectiveness of sulfonylureas and newer diabetes drugs as second-line therapy for patients with type 2 diabetes
Authors: Franchi Matteo , Pellegrini Giacomo , Avogaro Angelo , Buzzetti Giuliano , Candido Riccardo , Cavaliere Arturo , Consoli Agostino , Marzona Irene , Mennini Francesco Saverio , Palcic Stefano , Corrao Giovanni
Published: May 2024

Introduction

We aimed to compare the effectiveness and cost-effectiveness profiles of glucagon-like peptide-1 receptor agonist (GLP-1-RA), sodium-glucose cotransporter 2 inhibitor (SGLT2i), and dipeptidyl peptidase-4 inhibitor (DPP-4i) compared with sulfonylureas and glinides (SU).

Research design and methods

Population-based retrospective cohort study based on linked regional healthcare utilization databases. The cohort included all residents in Lombardy aged ≥40 years, treated with metformin in 2014, who started a second-line treatment between 2015 and 2018 with SU, GLP-1-RA, SGLT2i, or DPP-4i. For each cohort member who started SU, one patient who began other second-line treatments was randomly selected and matched for sex, age, Multisource Comorbidity Score, and previous duration of metformin treatment. Cohort members were followed up until December 31, 2022. The association between second-line treatment and clinical outcomes was assessed using Cox proportional hazards models. The incremental cost-effectiveness ratios (ICERs) were calculated and compared between newer diabetes drugs and SU.

Results

Overall, 22 867 patients with diabetes were included in the cohort, among which 10 577, 8125, 2893 and 1272 started a second-line treatment with SU, DPP-4i, SGLT2i and GLP-1-RA, respectively. Among these, 1208 patients for each group were included in the matched cohort. As compared with SU, those treated with DPP-4i, SGLT2i and GLP-1-RA were associated to a risk reduction for hospitalization for major adverse cardiovascular events (MACE) of 22% (95% CI 3% to 37%), 29% (95% CI 12% to 44%) and 41% (95% CI 26% to 53%), respectively. The ICER values indicated an average gain of €96.2 and €75.7 each month free from MACE for patients on DPP-4i and SGLT2i, respectively.

Conclusions

Newer diabetes drugs are more effective and cost-effective second-line options for the treatment of type 2 diabetes than SUs.
Associations between prior healthcare use, time to diagnosis, and clinical outcomes in inflammatory bowel disease: a nationally representative population-based cohort study
Authors: Jayasooriya Nishani , Saxena Sonia , Blackwell Jonathan , Bottle Alex , Creese Hanna , Petersen Irene , Pollok Richard C G
Published: May 2024

Background

Timely diagnosis and treatment of inflammatory bowel disease (IBD) may improve clinical outcomes.

Objective

Examine associations between time to diagnosis, patterns of prior healthcare use, and clinical outcomes in IBD.

Design

Using the Clinical Practice Research Datalink we identified incident cases of Crohn’s disease (CD) and ulcerative colitis (UC), diagnosed between January 2003 and May 2016, with a first primary care gastrointestinal consultation during the 3-year period prior to IBD diagnosis. We used multivariable Cox regression to examine the association of primary care consultation frequency (n=1, 2, >2), annual consultation intensity, hospitalisations for gastrointestinal symptoms, and time to diagnosis with a range of key clinical outcomes following diagnosis.

Results

We identified 2645 incident IBD cases (CD: 782; UC: 1863). For CD, >2 consultations were associated with intestinal surgery (adjusted HR (aHR)=2.22, 95% CI 1.45 to 3.39) and subsequent CD-related hospitalisation (aHR=1.80, 95% CI 1.29 to 2.50). For UC, >2 consultations were associated with corticosteroid dependency (aHR=1.76, 95% CI 1.28 to 2.41), immunomodulator use (aHR=1.68, 95% CI 1.24 to 2.26), UC-related hospitalisation (aHR=1.43, 95% CI 1.05 to 1.95) and colectomy (aHR=2.01, 95% CI 1.22 to 3.27). For CD, hospitalisation prior to diagnosis was associated with CD-related hospitalisation (aHR=1.30, 95% CI 1.01 to 1.68) and intestinal surgery (aHR=1.71, 95% CI 1.13 to 2.58); for UC, it was associated with immunomodulator use (aHR=1.42, 95% CI 1.11 to 1.81), UC-related hospitalisation (aHR=1.36, 95% CI 1.06 to 1.95) and colectomy (aHR=1.54, 95% CI 1.01 to 2.34). For CD, consultation intensity in the year before diagnosis was associated with CD-related hospitalisation (aHR=1.19, 95% CI 1.12 to 1.28) and intestinal surgery (aHR=1.13, 95% CI 1.03 to 1.23); for UC, it was associated with corticosteroid use (aHR=1.08, 95% CI 1.04 to 1.13), corticosteroid dependency (aHR=1.05, 95% CI 1.00 to 1.11), and UC-related hospitalisation (aHR=1.12, 95% CI 1.03 to 1.21). For CD, time to diagnosis was associated with risk of CD-related hospitalisation (aHR=1.03, 95% CI 1.01 to 1.68); for UC, it was associated with reduced risk of UC-related hospitalisation (aHR=0.83, 95% CI 0.70 to 0.98) and colectomy (aHR=0.59, 95% CI 0.43 to 0.80).

Conclusion

Electronic records contain valuable information about patterns of healthcare use that can be used to expedite timely diagnosis and identify aggressive forms of IBD.
Mapping patient education encounters in elective surgery: a cohort study and cross-sectional survey
Authors: Booker James , Penn Jack , Koh Chan Hee , Newall Nicola , Rowland David , Sinha Siddharth , Hanrahan John G , Williams Simon C , Sayal Parag , Marcus Hani J
Published: May 2024

Objective

Develop a process map of when patients learn about their proposed surgery and what resources patients use to educate themselves.

Design

A mixed methods design, combining semistructured stakeholder interviews, quantitative validation using electronic healthcare records (EHR) in a retrospective cohort and a cross-sectional patient survey.

Setting

A single surgical centre in the UK.

Participants

Fourteen members of the spinal multidisciplinary team were interviewed to develop the process map.

This process map was validated using the EHR of 50 patients undergoing elective spine surgery between January and June 2022. Postprocedure, feedback was gathered from 25 patient surveys to identify which resources they used to learn about their spinal procedure. Patients below the age of 18 or who received emergency surgery were excluded.

Interventions

Elective spine surgery and patient questionnaires given postoperatively either on the ward or in follow-up clinic.

Primary and secondary outcome measures

The primary outcome was the percentage of the study cohort that was present at encounters on the process map. Key timepoints were defined if >80% of patients were present. The secondary outcome was the percentage of the study cohort that used educational resources listed in the patient questionnaire.

Results

There were 342 encounters which occurred across the cohort, with 16 discrete event categories identified. The initial surgical clinic (88%), anaesthetic preoperative assessment (96%) and admission for surgery (100%) were identified as key timepoints. Surveys identified that patients most used verbal information from their surgeon (100%) followed by written information from their surgeon (52%) and the internet (40%) to learn about their surgery.

Conclusions

Process mapping is an effective method of illustrating the patient pathway. The initial surgical clinic, anaesthetic preoperative assessment and surgical admission are key timepoints where patients receive information. This has future implications for guiding patient education interventions to focus at key timepoints.
Healthcare-associated infections in long-term care facilities: a systematic review and meta-analysis of point prevalence studies
Authors: Bennett Noleen , Tanamas Stephanie K , James Rodney , Ierano Courtney , Malloy Michael J , Watson Eliza , Sluggett Janet K , Dunt David , Thursky Karin , Worth Leon J
Published: May 2024

Objectives

Residents of long-term care facilities (LTCFs) are especially vulnerable to acquiring healthcare-associated infections (HAIs). Our systematic review and meta-analysis estimated the burden of HAIs, identified the most frequent HAIs and explored the impact of facility-level and surveillance methodological differences on HAI burden in LTCFs, as determined by point prevalence studies (PPS).

Design

Systematic review and meta-analysis.

Data sources

Bibliographic databases MEDLINE (Ovid), Embase (Ovid) and CINAHL (EBSCOhost) were searched for potentially eligible English-language original research publications. References of short-listed full-text publications, the European Centre for Disease Control and Prevention website and an unpublished 2016–2022 Australian Aged Care PPS report were also checked.

Eligibility criteria

PPS monitoring HAIs, published and undertaken between January 1991 and June 2023 in LTCFs.

Data extraction and synthesis

Two reviewers independently screened for eligible PPS and if included, assessed risk of bias for each PPS using the Joanna Briggs Institute (JBI) critical appraisal tool for prevalence studies. Meta-analysis was performed using a generalised linear mixed model.

Results

31 publications (including 123 PPS from 33 countries encompassing 709 860 residents) were included. Nine PPS (7.3%) were allocated a JBI quality score greater than 80% while 30 PPS (24.4%) were allocated a score between 70% and 80%. The overall pooled HAI point prevalence was 3.5% (95% CI 3.1% to 4.0%); 3.9% (95% CI 3.2% to 4.7%) when higher bias-risk PPS (<70% quality score) were excluded. Of 120 PPS, the most frequently reported HAIs were urinary tract (UTIs; 38.9%), respiratory tract (RTIs; 33.6%) and skin or soft tissue (SSTIs; 23.7%) infections. HAI point prevalence varied by geographical region (p<0.001), study decade (p<0.001) and HAI surveillance definitions used (p<0.001). There was no difference across facility types (p=0.57) or season (p=0.46).

Conclusions

HAIs remain a global public health problem and threat to the safety of LTCF residents; effective infection prevention and control strategies to reduce HAIs in LTCFs are still required. Guidance specifically about the prevention and management of UTIs, RTIs and SSTIs should be prioritised.

PROSPERO registration number

CRD42023406844.
Quality of life among residents of informal urban settlements during the COVID-19 pandemic in Salvador, Brazil
Authors: Mogaji Hammed , Nery Nivison , Argibay Hernan D , Cruz Jaqueline S , Carneiro Ianei O , Lustosa Ricardo , Ko Albert I , Costa Federico , Begon Mike , Khalil Hussein
Published: May 2024

Background

Disadvantaged populations, especially those living in rural and informal settlements, constitute the most affected during the COVID-19 pandemic. However, there is limited information on the health-related quality of life (HRQOL) and indirect consequences of non-pharmaceutical interventions implemented during the pandemic.

Methods

We leveraged on an ongoing prospective open-cohort survey and performed a cross-sectional analysis of data collected between November 2021 and July 2022 among 793 residents above age 5 in a large slum community in the city of Salvador, Brazil. We describe the HRQOL of residents, explored participants’ perception about the pandemic, and the relationship between sociodemographic, economic and employment data on physical and mental health scores using both χ2statistics and separate mixed-effects regression models.

Results

Most participants were female (58.9%), aged 18–45 years (45%), with nearly half (49.7%) employed before pandemic, of whom 38.8% lost jobs during the pandemic. Food insecurity was 69.6%, and only 27.1% received government aid. Those retaining employment during the pandemic had better physical (β: 4.02, 95% CI 1.34 to 6.69, p<0.001) and mental (β: 3.08, 95% CI 0.60 to 5.56, p<0.001) health. Females had lower physical health scores than males (β: −2.44, 95% CI −3.94 to −0.94, p=0.002). Older participants had lower physical health scores (β: −9.11, 95% CI −12.14 to −6.07, p<0.001), but higher schooling improved physical health (p<0.001). Females and older adults faced more COVID-impacted challenges (p<0.001) related to health, education, family, social relationships, work, finances and employment.

Conclusion

We found lower HRQOL among adults, females, the unemployed and those with lower school attainment. In addition, women and individuals in older age groups reported experiencing COVID-impacted mental challenges more frequently than others. These findings highlight the need to prioritise creation of economic opportunities and expansion of existing assistance programmes for marginalised populations residing in these slums.
Identification of individual-level clinical factors associated with increased risk of death during heatwaves: a time-stratified case-crossover study using national primary care records in England
Authors: Thompson Ross , Kovats Sari , Hajat Shakoor , Macintyre Helen , O’Connell Emer
Published: May 2024

Background

Despite an increase in heat-related deaths occurring in England in recent years, one of the key recommended actions of identifying individuals at risk and deploying targeted interventions is not routinely undertaken. A major contributing factor to this is a lack of understanding of the individual-level risk factors that would support an evidence-based approach to targeted prevention.

Objective

To identify individual-level clinical risk factors for heat-related mortality in England by using primary care records and to estimate potential effect modification of a range of pre-existing conditions, clinical measurements and prescribed medications.

Methods

A time-stratified case-crossover analysis was undertaken of 37 individual-level clinical risk factors. Patient’s data were obtained from the Clinical Practice Research Datalink. Conditional logistic regression was used to characterise associations between temperature and the risk of death on hot days.

Results

Heat mortality risk was modified by a large range of pre-existing conditions, with cardiorespiratory, mental health and cognitive function conditions, diabetes and Parkinson’s, all increasing risk. The most striking increase was observed for depression with an OR of 1.25 (95% CI 1.09 to 1.44), the highest observed for pre-existing conditions. Individuals prescribed medications to treat heart failure and high blood pressure also have increased odds of death during heatwaves. There appears to be evidence of an increasing trend in ORs for diastolic blood pressure (DBP) categories, with ORs increasing from low DBP up to prehypertensive DBP group.

Conclusions

This is the first study to explore a comprehensive set of individual-level clinical risk factors and heat using primary care records in England. Results presented have important implications for patient medication management during heat events, incorporating heat-risk considerations into other health policies such as suicide prevention plans and highlighted potential differences between clinical vulnerability and patients at risk.
Increased risk of adverse gestational outcomes in pregnant women with primary Sjögren’s syndrome
Authors: Tan Zhen , Shao Meilin , Zhou Yingbo , Wang Li , Ma Yan , Xiang Nan , Yuan Xiang , Wang Bin , Xie Xiangliang , Zhou Mingtao , Wang Yumin , Li Sidong , Li Xiaomei
Published: May 2024

Objectives

This study aimed to identify risk factors contributing to diverse pregnancy outcomes in primary Sjögren’s syndrome (pSS) cases.

Methods

A retrospective analysis was conducted on pregnant individuals with pSS, who received outpatient or inpatient care across multiple hospitals in Anhui Province, China, from January 2015 to December 2022.

Results

This study included 164 pregnant women with pSS and 328 control subjects, with no statistically significant difference in average age between the two groups. Analysis of pregnancy outcomes revealed that, compared with the control group, pregnant women in the pSS group were more likely to experience miscarriages, both spontaneous (12.80% vs 1.52%, p<0.001) and therapeutic (6.10% vs 0.91%, p<0.05). The proportion of placental abnormalities detected during prenatal ultrasound in women from the pSS group was higher (14.63% vs 6.40%, p<0.05). In the analysis of pregnancy outcomes for live-born neonates, a higher incidence of congenital heart abnormalities was observed in the pSS group (27.34% vs 12.03%, p<0.05). While there were no significant differences between the pSS pregnancies in terms of both normal and adverse pregnancy outcomes, a comparison of fetal survival and fetal loss in pSS pregnancies revealed a greater use of prophylactic anticoagulant therapy in the fetal survival group. Notably, the application of low molecular weight heparin (LMWH) emerged as an independent protective factor for fetal survival.

Conclusions

Compared with non-autoimmune controls, pregnancy in women with pSS presents more challenges. Importantly, we observed that the use of LMWH as anticoagulant therapy is an independent protective measure for fetal survival.
Percolating lives: statistical mechanics in Naples
Authors: Esposito Salvatore , Amabile Alessandro
Published: May 2024

We reconstruct the intriguing case of the formation of the Naples group of Statistical Mechanics, which took more than two decades, from the first steps at the end of 1960 aimed at acquiring skills and knowledge abroad, until the formal establishment of the group at the beginning of the 1990 s. A number of important results were obtained seamlessly during this period by Antonio Coniglio and his large number of collaborators, but although favorable opportunities for the formation of the group emerged, starting from the beginning of the 1980 s, several factors (including a certain disinterest in supporting research in Italy) effectively delayed the formation of a group by about a decade. We here provide a fairly comprehensive picture of the relevance of the group of Neapolitan statistical physicists even before its formation, also reviewing the main contributions achieved by these people both during the process of formation of the group and in the first decade of its life.