bluuebunny/crossref_metadata_2025 huggingface dataset:
The Antelope and the Lioness
Authors: Michelakis Pantelis
Published: December 2023

The aim of this article is to show that readings of Riefenstahl as an artistic genius with full control over all aspects of her work have closed off more complex readings of the prologue of her film Olympia (1938). The author argues that we cannot begin to appreciate the density of this section of the film and its complex attitude toward ancient Greece without taking a closer look at the troubled collaboration between Leni Riefenstahl and Willy Zielke as two filmmakers with different visions, preoccupations, methods of work, and degrees of involvement in the making of the prologue. Attention is drawn to the hermeneutic difficulty of policing the boundaries between different types of aesthetics and different types of politics as they are played out in this section of Olympia. The article also teases out some of the difficulties around the question of how to situate the different themes and practices of the prologue within broader cinematic and extra cinematic histories of fascist aesthetics as they intersect with issues of classicism and modern subjectivity.
The Living Archive
Authors: Di Martino Giovanna
Published: December 2023

This article discusses the practices of documentation and archiving related to classical performance in the Italian Fascist regime, and their implications for the study of fascist art and culture more widely. The first part discusses a number of institutions as the sites of Italian Fascism’s archiving of classical performance. The second part, drawing on the work of Eric Ketelaar and Amalia G. Sabiescu, considers how Italian Fascism made use of the historically connoted ‘cultural tools’ of ancient Greek theatre as ‘living archives’. It discusses the aesthetic means that came to characterize all classical performances as living archives and considers the use of ancient Greek and Roman sites all over the peninsula and in colonized Libya as the archival sites of the classical performances. In the conclusion, it argues that the combination of performance and archives empowered these cultural tools to become the means for the reconstruction and transmission of Fascism’s newly crafted social memory and identity of the Italian nation.
Paramilitarism in Fascism and the Radical Right
Authors: Jackson Paul
Published: December 2023

The sixth annual convention of the International Association for Comparative Fascist Studies (COMFAS) took place from 6 to 8 October 2023 and this year was hosted by Central European University in Vienna. The event, organised by Antonio Costa Pinto alongside COMFAS Presidents Aristotle Kallis and Constantin Iordachi, fostered an important, constructive space to discuss research, both in formal panels and keynote sessions, as well as informally across the three days. The theme year was ‘Paramilitarism in Fascism and the Radical Right’, a field that allowed for a wide range of time periods and approaches to the topic to be explored.
Editorial Introduction
Authors: Ioannidou Eleftheria
Published: December 2023

This special issue examines the use of classical antiquity within artistic, cultural, and political events under fascist regimes in the interwar period. Fascist Italy and Nazi Germany promoted the production of ancient drama, alongside forms of theater modelled on Greek antiquity, organized grand-scale classical spectacles, and deployed ancient themes and classical-looking symbols and insignia at political gatherings and displays. The analyses presented in this special issue bring into dialogue the scholarship on theater and culture under fascist regimes with the growing literature on the reception of the classics to foreground the significance of performative practices in reconfiguring the classicizing mythologies of fascism. It is the hope of the guest editors that the findings presented here will contribute to the study of performances that strove to re-enact historical pasts beyond the scope of classical reception.
Performative Mo(nu)ments
Authors: Ioannidou Eleftheria
Published: December 2023

The forms of popular and mass theater developed in Fascist Italy and Nazi Germany reached back to classical antiquity to reinvent theater as a secular rite. At first glance, the use of the theatrical medium is at odds with the classicizing monumentality that characterized the cultural expression of fascist regimes. Theatrical performances are by their very nature ephemeral events; unlike monuments, they do not leave their mark on civic space, and can barely provide a testament to generations to come. Drawing on performance theory and cultural history, the author argues that these antiquity-inspired performances provided powerful sites of re-enacting the myth of national rebirth. Fascist regimes used open-air theaters and forms modelled on Greek theater, whilst also tapping into the notions of performance that had been developed within the traditions of the theatrical vanguard to offer the experience of a reborn past. These performances brought forth grandiose visions of classical antiquity through living bodies and helped to embed the imagined past into a mythicized present. The intertwining between the theatrical medium and classical reception allow us to demonstrate the significance of embodied practices in shaping fascism’s political radicalism.
A Sense of No Ending: Kalīla and Dimna between Fluidity and Completeness
Authors: Stephan Johannes
Published: December 2023

This article examines the question of endings in the Book of Kalīla and Dimna as one of the most prominent works of Arabic literature. Being a complex framing narrative, Kalīla and Dimna contains several dimensions of open-endedness which are fostered by the remarkable fluidity in the book’s transmission. I will argue that both the open-endedness and the fluidity hinge upon an ideal of completeness in both historical and thematic terms which can be observed in the two main parts of the book. In the first part, consisting of prefaces, different authors—such as Ibn al-Muqaffaʿ, the translator into Arabic, and the otherwise unknown ʿAlī b. al-Shāh al-Fārisī—continue a story of transmitting the book and adding prefaces, hinting at the book’s undefined nature, its continuous relevance and its expansive potential. Ibn al-Muqaffa’s ethics of reading, a cautioning against quick conclusions and a plea for attaining a complete understanding, is, I argue, applied in the second part, the chapters mostly containing animal fables. Here, I will present two examples, “The Ringdove” and “The Monkey and the Turtle.” While the latter of the two narratives practises mise en abyme, shedding new light on the main intrigue in order to complete the moral message of the chapter, “The Ringdove” advances the interconnectedness between individuals and narratives, thereby presenting a sense of no ending.
Textual Endings as Persuasive Educational Beginnings: An Inquiry into the Epistles of the Brethren of Purity
Authors: Günther Sebastian
Published: December 2023

The Brethren of Purity, a circle of high-ranking 9th and 10th-century scholars from the Iraqi port city of Basra, is renowned for having produced an immense literary corpus of encyclopedic erudition: the Rasāʾīl Ikhwān al-Ṣafāʾ. The wide range of religious and non-religious subjects of these Epistles, the questions as to the identity of their authors and intended addressees, as well as the specifics of the language and literary devices characterizing these treatises, have fascinated readers and researchers from medieval times to the present. Surprisingly, however, the Epistles have not yet been adequately studied from the perspective of their role in Islamic educational thought.

This article takes a step in that direction by looking into the pedagogical dimension of remarks the Brethren offer to conclude some of their treatises. It focuses primarily on the endings of their perhaps most programmatic texts, i.e., Epistle 7 (“On the Scientific Arts”), Epistle 8 (“On the Practical Crafts”) and Epistle 22 (“Animals versus Man”). The endings of a few individual chapters in these three works are also examined. Guiding this approach are questions such as: What differentiates each ending from the body of its respective text? What functions do they have beyond merely summarizing content? And are there indications that preceding literary and scientific traditions, Islamic or non-Islamic, may have influenced the form, language and style of these finales? Thus we hope to advance some insights into the Epistles’ role in the general development of classical Arabic writing, and their educational significance more specifically.
Closures: Endings in al-Qalqashandī’s Literary Encyclopaedia and Malmlūk Carpets
Authors: al-Jammal Lina
Published: December 2023

Recent studies indicate an intersection and an interaction between the literary works of a certain culture and its art works. In the Mamlūk era, literary encyclopaedias flourished, while carpet weaving thrived above other artisanal industries. Taking into consideration the enormity of both endeavors—which seem to have been part of the collective aesthetic taste at the time—this research enquires about a potential link between the framing of Mamlūk carpets and that of the literary encyclopaedia of that era. It also conducts a comparison between the artistic characteristics of carpet edges, being the visual ending of their patterns, and significant features of the closure of Ṣubḥ al-aʿshā fī ṣināʿat al-inshā by Aḥmad b. ʿAlī al-Qalqashandī (d. 821/1418), one of the most famous Mamlūk encyclopaedias, which demonstrates the level of literary maturity this type of work reached in the beginning of the 9th/15th century.
Contreversy of the Beginning and Ending of the Novel ʿAwdat al-ṭāʾir ilā l-baḥr by Ḥalīm Barakāt
Authors: Ghannūm ʿImād Bassām
Published: December 2023

This paper discusses the end of the novel ʿawdat al-ṭāʾir ila l-baḥr by Halīm Barakāt, published by Dār Al-Nahār in 1969. The title clarifies that the return takes place after the ending, and is therefore a temporal concept that follows the conclusion; the events of the novel take place within this closed circle. Since the ending is deemed a temporal concept, this paper aims to study the temporal techniques used by the author in his novel, which were employed to create the desired ending.
Modelling as Media Transformations
Authors: Ciula Arianna , Eide Øyvind , Marras Cristina , Sahle Patrick
Published: December 2023

Chapter 4, Modelling as media transformation, dwells on the tangible physical forms of models as material and mediated media products expressed and shared in human communication. The forms models take are discussed in terms of configurations of media modalities. This intermedia studies approach, whereby modelling is studied as a media transformation process, complements the semiotic perspective of chapter 3 by revisiting some of the previous examples and integrating them with a variety of heterogeneous models, from archaeology and theatre studies to numerical mathematics, and media transformation processes, including formalisations undertaken in DH research.
Preparation of Kudzu vine oral formulation and its application against doxorubicin-induced cardiotoxicity via alteration of gut microbiota
Authors: Wang Qingmei , Zhang Xuanguo
Published: December 2023

In this experimental protocol, we scrutinized the preventive effect of Kudzu vine extract on DOX-induced cardiac toxicity via alteration of gut microbiota. Sprague-Dawley (SD) was used in this protocol and the rats were divided into different groups and received the DOX (3 mg/kg)
for induction the cardiac remodeling and Kudzu vine extract (50, 100 and 200 mg/kg) administration was used for the estimation of cardioprotective potential for 5 weeks. Afterward, biochemical parameter, electrolyte, antioxidant, cytokines and inflammatory parameters were estimated.
Kudzu vine remarkably improved the body weight and declined the heart weight. Kudzu vine extract significantly (P <0.001) suppressed the level of CK-MB, LDH, CK, cTnT and BNP. Kudzu vine significantly (P <0.001) improved the level of Na+,
Ca2+, K+ and Cl− and decreased the level of urea, magnesium, total protein, albumin and globulin. Kudzu vine remarkably altered the lipid and antioxidant parameters. Additionally, Kudzu vine extract suppressed the level of TNF-α,
IL-1β, IL-6 and improved the level of TGF-β, IL-10. DOX-induced cardiac dysfunction exhibited the altered relative abundance of different bacteria and Kudzu vine remarkably restore the relative abundance of different bacteria. Therefore, Kudzu vine extract
has beneficial effects against DOX-induced cardiac toxicity via alteration of gut microbiota.
Metabonomics of brain tissue in migraine rat model induced by nitroglycerin or cortical spreading depression
Authors: Yang Jiansheng , Wu Di , Zeng Liling , Zhong Minzhi , Liang Tianshan , Jiang Honghong , Liu Qiang , Wu Yanhua , Li Hui
Published: December 2023

This study analyzes the differences in potential biomarkers of migraine models constructed by two commonly used modeling methods through metabolomics research. Migraine models were constructed by nitroglycerin (NTG) induction or mechanical stimulus-induced cortical spreading depression
(CSD) in rats. Multivariate analysis was used for metabolomic analysis. Compared with control group, NTG migraine group had 1 different metabolite up-regulated and 14 down-regulated. Compared with NTG migraine group, 13 differential metabolites in the CSD migraine model group were up-regulated
and 12 were down-regulated. Both nitroglycerin-induced and mechanical stimulation-induced CSD can construct migraine rat models, and the biomarkers of the two models are different.
Evaluation and continuous improvement of magnetic components material design skills in interdisciplinary switched-mode power supply
Authors: Kuang Yi , Zhang Zhiyong , Duan Bin
Published: December 2023

The design of switched-mode power supplies (SMPSs) is a material-electrical engineering interdisciplinary problem. The design of magnetic component materials can significantly affect SMPSs’ performances. In engineering education, the design and development of solutions is an important
skill for engineering students. However, the traditional engineering experiments curriculum is shown as validation and single-disciplinary experiments as well as one-sided assessment results. To foster open-ended exploration, enhance students’ material design skills, and improve skills
adaptation, students must tackle real engineering problems and develop practical design solutions. This paper proposes an exploratory factor analysis and knowledge graph-based method for evaluating and continuously improving magnetic components material design skills in the context of SMPS
design tasks. First, we used the multiple imputation method to address the missing data. Each imputed data was analyzed to extract factors through parallel analysis, ordinary least squares estimation, and target rotation. Then, we identified four sub-skills: efficiency design skill, passive
device design skill, power magnetic reduction design skill, and power economy design skill. The RMSEA for the four-factor model is 0.042, suggesting a good fit to the data. We established the relationships between these sub-skills and SMPS performance metrics. Furthermore, the average of the
factor scores from each of the imputed datasets and the SMPS design constraints were combined to obtain the cut-off scores to evaluate engineering students’ achievements in these sub-skills. Finally, we constructed an SMPS magnetic components material knowledge graph, which could recommend
specific experimental tasks, relevant knowledge areas, and SMPS performance metrics, providing personalized guidance to designers.
Clinical efficacy and short-term prognosis of butylphthalide sodium chloride injection combined with edaravone dextroborneol in acute stroke
Authors: Cao Guangyu , Zhou Jianju , Yu Guoqing , Fu Xiaohong , Xiong Bo
Published: December 2023

Stroke is one of the important causes of death of patients. Both butylphthalide sodium chloride injection (BSCI) and edaravone dextroborneol (ED) show a curative effect. We intend to assess their effect on acute stroke. Patients with acute ischemic stroke diagnosed by our hospital in
the past were included as research objects and different treatment methods were used to divide them into different groups. The research group was given combined treatment (BSCI and ED). The normal group chose one of the drugs as treatment. The curative effect was recorded. The neurological
deficit score, the commonly used clinical infection markers mainly include IL-6, CRP and TNF-α, and the Barthel index widely used in the field of rehabilitation and elderly patients, hemorheology index and the expression of NSE were evaluated. The changes before and after medical
level were compared with the adverse reaction group during the treatment. The analysis of Barthel index reflected that the effective rate was higher than normal group. Changes in neural functions were decreased than normal group (P <0.05) and the adverse reactions in the curing process
were lower in both groups, but there was no statistical difference (P >0.05). Our research shows that combined therapy can improve drug efficacy by reducing the expression of cytokines and it does not bring about an increase in toxic and side effects. Combination therapy improves
neurological function, reduces cytokine secretion, improves drug efficacy, and has a high drug safety.
Differential clinical impact of letermovir prophylaxis according to graft sources: a KSGCT multicenter retrospective analysis
Authors: Toya Takashi , Mizuno Kota , Sakurai Masatoshi , Kato Jun , Mori Takehiko , Doki Noriko , Masuda Shinichi , Aotsuka Nobuyuki , Tsukamoto Shokichi , Sakaida Emiko , Nakajima Yuki , Fujisawa Shin , Machida Shinichiro , Aoyama Yasuyuki , Yokoyama Hiroki , Shono Katsuhiro , Hatta Yoshihiro , Usuki Kensuke , Kataoka Keisuke , Kanda Yoshinobu
Published: December 2023

Clinically significant cytomegalovirus infection (csCMVi) is frequently observed after allogeneic hematopoietic stem cell transplantation (HSCT) and prophylaxis with letermovir is commonly adopted. However, the clinical benefit of letermovir prophylaxis according to graft sources has not been sufficiently elucidated. We retrospectively analyzed 2194 recipients of HSCT who were CMV-seropositive (236 with letermovir prophylaxis and 1958 without prophylaxis against CMV). csCMVi was significantly less frequent in patients with letermovir prophylaxis than in those without (23.7% vs 58.7% at 100 days after HSCT, P < .001) and the same trend was seen when recipients of bone marrow (BM), peripheral blood stem cell (PBSC), or cord blood (CB) transplantation were separately analyzed. In recipients of BM, nonrelapse mortality (NRM) was significantly lower in the letermovir group at 6 months after HSCT (5.0% vs 14.9%, P = .018), and the same trend was observed in recipients of PBSCs (14.7% vs 24.8%, P = .062); however, there was no statistical significance at 1 year (BM, 21.1% vs 30.4%, P = .67; PBSCs, 21.2% vs 30.4%, P = .096). In contrast, NRM was comparable between recipients of CB with and without letermovir prophylaxis throughout the clinical course (6 months, 23.6% vs 24.3%, P =.92; 1 year, 29.3% vs 31.0%, P = .77), which was confirmed by multivariate analyses. In conclusion, the impact of letermovir prophylaxis on NRM and csCMVi should be separately considered according to graft sources.
A novel and innovative cancer classification framework through a consecutive utilization of hybrid feature selection
Authors: Mahto Rajul , Ahmed Saboor Uddin , Rahman Rizwan ur , Aziz Rabia Musheer , Roy Priyanka , Mallik Saurav , Li Aimin , Shah Mohd Asif
Published: December 2023

Cancer prediction in the early stage is a topic of major interest in medicine since it allows accurate and efficient actions for successful medical treatments of cancer. Mostly cancer datasets contain various gene expression levels as features with less samples, so firstly there is a need to eliminate similar features to permit faster convergence rate of classification algorithms. These features (genes) enable us to identify cancer disease, choose the best prescription to prevent cancer and discover deviations amid different techniques. To resolve this problem, we proposed a hybrid novel technique CSSMO-based gene selection for cancer classification. First, we made alteration of the fitness of spider monkey optimization (SMO) with cuckoo search algorithm (CSA) algorithm viz., CSSMO for feature selection, which helps to combine the benefit of both metaheuristic algorithms to discover a subset of genes which helps to predict a cancer disease in early stage. Further, to enhance the accuracy of the CSSMO algorithm, we choose a cleaning process, minimum redundancy maximum relevance (mRMR) to lessen the gene expression of cancer datasets. Next, these subsets of genes are classified using deep learning (DL) to identify different groups or classes related to a particular cancer disease. Eight different benchmark microarray gene expression datasets of cancer have been utilized to analyze the performance of the proposed approach with different evaluation matrix such as recall, precision, F1-score, and confusion matrix. The proposed gene selection method with DL achieves much better classification accuracy than other existing DL and machine learning classification models with all large gene expression dataset of cancer.
Plastome phylogenomics and morphological traits analyses provide new insights into the phylogenetic position, species delimitation and speciation of Triplostegia (Caprifoliaceae)
Authors: Fu Qing-Li , Mo Zhi-Qiong , Xiang Xiao-Guo , Milne Richard I. , Jacquemyn Hans , Burgess Kevin S. , Sun Ya-Nan , Yan Hua , Qiu Li , Yang Bo-Yun , Tan Shao-Lin
Published: December 2023

Background

The genus Triplostegia contains two recognized species, T. glandulifera and T. grandiflora, but its phylogenetic position and species delimitation remain controversial. In this study, we assembled plastid genomes and nuclear ribosomal DNA (nrDNA) cistrons sampled from 22 wild Triplostegia individuals, each from a separate population, and examined these with 11 recently published Triplostegia plastomes. Morphological traits were measured from herbarium specimens and wild material, and ecological niche models were constructed.

Results

Triplostegia is a monophyletic genus within the subfamily Dipsacoideae comprising three monophyletic species, T. glandulifera, T. grandiflora, and an unrecognized species Triplostegia sp. A, which occupies much higher altitude than the other two. The new species had previously been misidentified as T. glandulifera, but differs in taproot, leaf, and other characters. Triplotegia is an old genus, with stem age 39.96 Ma, and within it T. glandulifera diverged 7.94 Ma. Triplostegia grandiflora and sp. A diverged 1.05 Ma, perhaps in response to Quaternary climate fluctuations. Niche overlap between Triplostegia species was positively correlated with their phylogenetic relatedness.

Conclusions

Our results provide new insights into the species delimitation of Triplostegia, and indicate that a taxonomic revision of Triplostegia is needed. We also identified that either rpoB-trnC or ycf1 could serve as a DNA barcode for Triplostegia.
New measure of functional tooth loss for successful Oral ageing: a cross-sectional study
Authors: Cheng Yiting , Cheng Li , Zhu Fangzhi , Xiang Yong , Duan Shaoying , Luo Jingjing , Lei Lei , Cai He , Hu Tao
Published: December 2023

Background

This cross-sectional study evaluated the impacts of functional tooth loss on oral health-related quality of life (OHRQoL) among elderly people compared with the impacts of several common indicators of oral health. Additionally, the cut-off of functional tooth loss needed for a better OHRQoL was investigated to establish a new measure for successful oral ageing.

Methods

Data from people aged 65–74 were extracted from the Fourth National Oral Health Survey in Sichuan, China. Functional tooth loss was defined as both natural tooth loss and nonfunctional teeth, such as third molars, residual roots, and removable dentures. The cut-offs of tooth loss were first identified as 12, based on the previous definition of functional dentition (≥20 natural teeth except the third molars), and 14, 16, or 18 for further investigation. OHRQoL was evaluated by the standardized Geriatric Oral Health Assessment Index (sGOHAI) score. Logistic regression was performed to estimate the impacts on OHRQoL. Additionally, subgroup analyses were conducted using the stratified chi-square test to explore the effect of functional tooth loss at each position.

Results

The mean GOHAI score of the 744 participants was 48.25 ± 7.62. Elderly people who had lost ≤12 functional teeth had greater odds of reporting a higher sGOHAI score than those who had lost more functional teeth (odds ratio (OR) 1.49, 95% confidence interval (CI) 1.05–2.11). No significant difference in the sGOHAI score was detected between people who had lost 13–16 functional teeth and those who had lost ≤12 functional teeth (0.61, 0.35–1.07). The loss of second premolars and first and second molars had great impacts on the sGOHAI score when ≤12 or ≤ 16 functional teeth had been lost.

Conclusions

Compared with natural tooth loss, functional dentition and occluding pairs, functional tooth loss can be a better indicator of OHRQoL in the elderly population. Sixteen remaining functional teeth seem to be sufficient to maintain good OHRQoL and successful oral ageing despite that number being previously acknowledged as ≥20 teeth.
CT target scanning in the diagnosis of solid pseudopapillary tumor of the pancreas
Authors: Wang Hai-tao , Wang Yu-tao , Yu Zhi-hai , Tu Can , Lu Bin , Yu Liang , Feng Di , Wang Tie-gong
Published: December 2023

Objective

To discuss the value of computed tomography (CT) iterative reconstruction technique combined with target scanning in the diagnosis of solid pseudopapillary tumor of the pancreas (SPTP).

Methods

The clinical information and CT examination data of 27 patients with SPTP were retrospectively analyzed, and the general condition and CT performance of the patients were observed. The CT image reconstruction algorithm of all patients used iterative reconstruction technique combined with the application of target scanning technique.

Results

A total of 27 patients were included in this study, including 6 males and 21 females, aged 14–72 years with a mean age of 39.6 ± 13.6 years. SPTP was more common in young and middle-aged females, with a low level of tumor markers, dominated by cystic-solid tumors. The combination of CT iterative reconstruction technology and targeted scanning revealed the following: the capsule of SPTP was clear and complete, where calcifications were visible, solid components were progressively enhanced, and rare pancreatic and bile duct dilation was seen. Tumors were cystic-solid in 18 of 27 patients with SPTP, of which the solid components showed isodensity or slightly low-density, with calcifications. The solid components and cyst walls were mildly enhanced during the arterial phase, and were progressively enhanced during the parenchymal phase, portal vein phase, and delayed phase, with their enhancement degree lower than that of normal pancreatic parenchyma, and pancreatic and bile duct dilation was rare. There were no statistical differences in tumor location, morphology, growth pattern, integrity of capsule, cystic or solid, calcifications, and enhancement features between the male group and the female group (P > 0.05).

Conclusion

The iterative reconstruction combined with target scanning clearly displayed the CT features of tumors, helping the diagnosis and clinical treatment of the disease.
BMC pregnancy and childbirth - ‘screening and management of food insecurity in pregnancy’
Authors: Agho Kingsley Emwinyore , van der Pligt Paige
Published: December 2023

Addressing food insecurity during pregnancy is a major public health problem that demands guided interventions and translational research in public health. In this Editorial, we provide the context and invite contributions for our BMC Pregnancy and Childbirth Collection on Screening and management of food insecurity in pregnancy.
Clinical features and prognosis of cardiac metastatic tumors
Authors: Lin Zhongqiao , Xiao Huazhen , Liu Jun , Chen Ling , Zhang Huishan , Huang Yufang , Chen Yu , Lin Jing
Published: December 2023

Background

This study aimed to explore the clinical features and prognosis of cardiac metastatic tumors. In addition, whether continuing antitumor therapy after the development of cardiac metastases can benefit patients and the response of cardiac metastases were investigated.

Methods

A retrospective analysis was conducted on patients with malignancies who were admitted to Fujian Cancer Hospital and Fujian Provincial Hospital from January 2007 to September 2022, and the follow-up period ended in March 2023. Clinical data were gathered, treatment efficacy was evaluated, and survival analysis was performed.

Results

After the patients developed cardiac metastasis, the overall 30-day, 3-month, 6-month, and 12-month survival rates were 85.00%, 59.00%, 51.00% and 38.00%, respectively. With continued treatment, the average survival time was 27.33 months (95% confidence interval [CI]: 16.88–37.79), which exceeded the 6.6 months (95% confidence interval [CI]: 0.03–13.69) observed for patients who withdrew from treatment (P < 0.001). The responses of cardiac metastases corresponded to the responses of the primary tumors. Patients with a cardiac response had a median survival time of 55.60 months, which exceeded the 13.40 months observed for those without a cardiac response. However, there was no significant difference (P = 0.375).

Conclusions

In conclusion, continuing antitumor therapy after the development of cardiac metastases can significantly prolong patient survival. Cardiac metastases and primary tumors respond consistently to antitumor treatment. The risk of death due to heart failure in cancer patients with cardiac metastases needs to be further investigated.
Factors associated with smoking intensity among adult smokers: findings from the longitudinal cohort of the Tehran lipid and glucose study
Authors: Abbasi-Dokht-Rafsanjani Marjan , Hosseinzadeh Samaneh , Bakhshi Enayatollah , Azizi Fereidoun , Khalili Davood
Published: December 2023

Background

Smoking is a significant public health problem, and there is a scarcity of documents regarding its severity, particularly in developing countries. This study aimed to determine factors related to the number of cigarettes consumed daily by adult smokers in Tehran.

Methods

This study was conducted within the framework of the longitudinal study of Tehran Lipid and Glucose Study (TLGS). The study included 786 adult smokers living during four consecutive follow-ups from 2005 to 2016. The intensity of smoking was measured by the number of cigarettes consumed daily by adult smokers. Data analysis was done longitudinally and based on the mixed effects zero-inflated discrete Weibull (ZIDW) regression model.

Results

The mean age of the individuals was 40.35 ± 12.68 years, and 643 (81.8%) of them were men. Also, 52.7% of individuals were daily smokers, 15.6% were occasional smokers, and 31.7% were non-smokers who became smokers during the study. Variables of age 1.005 (95%CI: 1.001–1.008), gender of male 1.196 (95%CI: 1.051–1.39), and marital status (divorced/widowed vs. single) 1.168 (95%CI: 1.015–1.39) were positively associated with smoking intensity. Education level (master and higher vs. illiterate) 0.675 (95%CI: 0.492–0.926)), employment status (student vs. unemployed) 0.683 (95%CI: 0.522–0.917), (housewife vs. unemployed) 0.742 (95%CI: 0.606–0.895), (Unemployed with income vs. unemployed) 0.804 (95%CI: 0.697, 0.923), implementation of smoking prohibition regulations (yes vs. no) 0.88 (95%CI: 0.843–0.932), and history of cardiovascular disease in male relatives (yes vs. no) 0.85 (95%CI: 0.771–0.951) were associated with lower smoking intensity.

Conclusion

We showed that demographic factors are associated with the intensity of smoking among adults and should be considered in policymakers’ intervention programs to reduce smoking and quit smoking.
Safety and efficacy of cryobiopsy for the diagnosis of lymphangioleiomyomatosis compared with forceps biopsy and surgical lung biopsy
Authors: Yao Yao , Chen Xiaobo , Chen Huanjie , Xiao Zhulin , Li Shiyue
Published: December 2023

Background

Transbronchial lung forceps biopsy (TBFB) is recommended before a surgical lung biopsy (SLB) when a definitive diagnosis of lymphangioleiomyomatosis (LAM) is required for patients without any additional confirmatory features. Transbronchial lung cryobiopsy (TBCB) has been suggested as replacement test in patients considered eligible to undergo SLB for the diagnosis of interstitial lung diseases. The efficacy and safety of TBCB were compared with that of TBFB and SLB in the diagnosis of LAM.

Methods

A retrospective analysis was conducted on 207 consecutive patients suspected with LAM in the First Affiliated Hospital of Guangzhou Medical University from 2005 to 2020.

Results

The difference in diagnostic rate of patients suspected with LAM between TBCB (20/30, 66.7%) and TBFB (70/106, 66.0%) groups was not significant (p = 0.949). One patient performed TBCB with negative pathological results could be diagnosed exclusively after SLB. LAM diagnosis was confirmed by surgical pathological findings in 3 TBFB-negative patients. More patients with minimal cystic profusion were diagnosed with LAM by TBCB (5/19, 26.3%) and SLB (11/39, 28.2%) than by TBFB (3/61, 4.9%) (TBCB vs TBFB: p = 0.04, SLB vs TBFB, p < 0.001). The difference between the severity of cystic lung disease in patients diagnosed with LAM through TBCB and SLB was not significant (p > 0.05). One pneumothorax, 8 mild bleeding and 1 moderate bleeding were observed in TBCB. One pneumothorax, 15 mild bleeding and 1 moderate bleeding occurred after TBFB.

Conclusion

Compared to TBFB, TBCB is safe and effective in diagnosing LAM at a higher diagnostic rate in patients with minimal cystic profusion.
Soluble receptor for advanced glycation end products (sRAGE) is associated with obesity rates: a systematic review and meta-analysis of cross-sectional study
Authors: Tayyib Nahla A , Ramaiah Pushpamala , Alshahrani Shadia Hamoud , Margiana Ria , Almalki Sami G. , Kareem A. K. , Zabibah Rahman S. , Shbeer Abdullah M. , Ali Saad Hayif Jasim , Mustafa Yasser Fakri
Published: December 2023

Background

Several studies have highlighted the possible positive effects of soluble receptor for advanced glycation end products (sRAGE) against obesity. However, due to their inconsistent results, this systematic review and meta-analysis aimed to quantitatively evaluate and critically review the results of studies evaluating the relationship between sRAGE with obesity among adult population.

Methods

In the systematic search, the eligibility criteria were as follows: studies conducted with a cross-sectional design, included apparently healthy adults, adults with obesity, or obesity-related disorders, aged over 18 years, and evaluated the association between general or central obesity indices with sRAGE.

Results

Our systematic search in electronic databases, including PubMed, Scopus, and Embase up to 26 October, 2023 yielded a total of 21,612 articles. After removing duplicates, screening the titles and abstracts, and reading the full texts, 13 manuscripts were included in the final meta-analysis. According to our results, those at the highest category of circulating sRAGE concentration with median values of 934.92 pg/ml of sRAGE, had 1.9 kg/m2 lower body mass index (BMI) (WMD: -1.927; CI: -2.868, -0.986; P < 0.001) compared with those at the lowest category of sRAGE concentration with median values of 481.88 pg/ml. Also, being at the highest sRAGE category with the median values of 1302.3 pg/ml sRAGE, was accompanied with near 6 cm lower waist circumference (WC) (WMD: -5.602; CI: -8.820, -2.383; P < 0.001 with 86.4% heterogeneity of I2) compared with those at the lowest category of sRAGE concentration with median values of 500.525 pg/ml. Individuals with obesity had significantly lower circulating sRAGE concentrations (WMD: -135.105; CI: -256.491, -13.72; P = 0.029; with 79.5% heterogeneity of I2). According to the subgrouping and meta-regression results, country and baseline BMI were possible heterogeneity sources. According to Begg’s and Egger’s tests and funnel plots results, there was no publication bias.

Conclusion

According to our results, higher circulating sRAGE concentrations was associated with lower BMI and WC among apparently healthy adults. Further randomized clinical trials are warranted for possible identification of causal associations.
The experience of dry mouth and screening for Sjogren’s syndrome by the dentist: patient-reported experiences
Authors: Rihab Boughanmi , Lina El Houari , Noémie Simon-Tillaux , Jean Saide , Marjolaine Gosset
Published: December 2023

Background

One of the main clinical features of Sjögren’s Syndrome is oral dryness, which is associated with an increased risk of oral diseases and a lower oral life quality. Dentists have a key role to play in the Sjögren’s Syndrome diagnosis and specific management. In parallel, many patients rely on patient associations, which offer opportunities for members to seek information about their disease and share their experiences. We aimed to evaluate patients experience with dry mouth and the importance of dentists in Sjögren’s Syndrome diagnosis and its management.

Methods

We carried out a cross-sectional survey in 2020 based on a questionnaire drafted in collaboration with clinicians specializing in Sjögren’s Syndrome and patient members of a patient association. The survey consisted of 27 questions divided into the six sections: the patient’s profile, their experience with dry mouth and treatments used to manage, characteristics of experienced oral-health problems, effects of dry mouth and its consequences on the quality of life, evaluation of the dentist role in the screening of Sjögren’s Syndrome, and its management by the dentist. Recruitment was carried out via the patient association’s newsletter, website, and social networks. Sjögren’s diagnosis was self-reported.

Results

One thousand four hundred fifty-eight patients fully responded to the survey. Most respondents were women over 50 and were mainly concerned with primary Sjögren’s Syndrome. Overall, 86.97% of respondents reported experiencing frequent or constant dry mouth and 69.01% declared having had oral problems (candidiasis, oral pain, loss or alteration of taste, bad breath, gastro-esophageal reflux). We found a positive correlation between the frequency of dry mouth and each of these disorders and between the frequency of dry mouth and alterations in life quality dimensions. Finally, 74.9% of patients did not report having dry mouth to their dentist prior to being diagnosed with Sjögren’s Syndrome and 58% had not been informed about the oral risks associated with it by their dentist and sought information themselves or from their physician.

Conclusions

We confirm the significant consequences of dry mouth on oral quality of life, as well as its association with oral health problems. Sjögren’s Syndrome screening by dentists should be increased, as well as prevention of the associated oral health risks.
Comparing characteristics and perspectives of U.S. anesthesiology fellows in training and anesthesiologists in their first year of practice
Authors: Toutkoushian Emily , Chen Dandan , Sun Huaping , Warner David O. , Macario Alex , Deiner Stacie G. , Keegan Mark T.
Published: December 2023

Background

The purpose of this study was to evaluate relationships between demographics, professional characteristics, and perceived challenges facing the specialty of anesthesiology among physicians who entered a fellowship and those who started independent practice immediately after finishing a U.S. anesthesiology residency.

Methods

Anesthesiologists in the year after their residency graduation were invited to take an online survey during the academic years of 2016–2017, 2017–2018, and 2018–2019, with questions about their personal characteristics, the nature of their professional lives, and their perceptions of the greatest challenge facing the profession of anesthesiology.

Results

A total of 884 fellows-in-training and 735 anesthesiologists starting independent practice right after the completion of their residency responded. Fellows were slightly younger (mean = 33.2 vs. 34.0 years old, p < 0.001), were more likely to have a spouse who works outside the home (63.9% vs. 57.0%, p = 0.002), had fewer children (mean = 0.69 vs. 0.88, p < 0.001), worked more hours per week (mean = 56.2 vs. 52.4, p < 0.001), and were less likely to report a personal and professional life balance (66.4% vs. 72.3% positive, p = 0.005) than direct-entry anesthesiologists. Fellows and direct-entry anesthesiologists identified similar challenges in three broad themes – workforce competition (80.3% and 71.8%), healthcare system changes (30.0% and 37.9%), and personal challenges (6.4% and 8.8%). Employment security issues posed by non-physician anesthesia providers and perceived lack of appreciation of anesthesiologists’ value were commonly cited. Relative weighting of challenge concerns varied between fellows and direct-entry physicians, as well as within these groups based on gender, fellowship subspecialty, location or size of practice, and frequency of supervisory roles.

Conclusions

Anesthesiology fellows and direct-entry anesthesiologists had largely similar demographics and perspectives on the challenges facing anesthesiology in the United States. Group differences found in some demographics and perspectives may reflect different motivations for choosing their professional paths and their diverse professional experiences.
Postgraduate medical trainees at a Ugandan university perceive their clinical learning environment positively but differentially despite challenging circumstances: a cross-sectional study
Authors: Alele Paul E. , Kiptoo Joshua , Hill-Besinque Kathleen
Published: December 2023

Purpose

The clinical learning environment is an essential component in health professions’ education. Data are scant on how postgraduate trainees in sub-Saharan Africa perceive their medical school learning environments, and how those perceptions contribute to their engagement during training, their emotional wellbeing, and career aspirations. This study examined perceptions of postgraduate medical trainees (residents) in a resource-limited setting, regarding their learning environment and explored perceptual contributions to their career engagement during training. The data reported contribute to understanding how clinical learning environments can be improved in low-resource settings in Uganda and elsewhere.

Methods

This study was done at the Faculty of Medicine of Mbarara University of Science and Technology in Uganda. We used a descriptive cross-sectional design involving sequential mixed methods. Quantitative data were collected using the Postgraduate Hospital Educational Environment Measure (PHEEM). Qualitative data were collected using focus group discussions.

Results

Ninety of the 113 eligible residents responded (79.6%). Of these, 62 (68.9%) were males, 51 (56.7%) were third-year trainees, and the majority (40%) of the residents were aged between 30 and 34 years. Overall PHEEM scored 98.22 ± 38.09; Role Autonomy scored 34.25 ± 13.69, Teaching scored 39.7 ± 13.81, and Social Support scored 24.27 ± 10.59. Gender differences occurred in the perceptions of teaching and social support. Cronbach’s alpha coefficient was 0.94 for the overall PHEEM. Five major themes were identified from the qualitative data (trainee support, supervision environment, engagement with overall learning environment, preparation for future practice, and challenges that impede training).

Conclusions

Overall, this study suggests that postgraduate trainees at the institution perceived the clinical learning environment positively amidst challenges of limited resources. Trainees’ insights provided data that propose improvements on a number of domains in the learning environment.
Empowering nurses: exploring self-managed organizations in Indian healthcare
Authors: Malik Elham , Shankar Shail
Published: December 2023

Background

Given India’s high patient load on the existing healthcare setup, as well as political, social, and organizational challenges, the nursing sector is facing various problems, therefore leading to substandard nursing experiences leading to poor patient care at the parallel healthcare setups, specifically homecare. This paper presents self-managed organizations (SMOs) characterized by a horizontal management structure as an effective alternative to existing hierarchical management structures overladen with bureaucracy. Therefore, we are exploring the strategies at self-managed homecare organizations that can make nursing a better and more productive experience.

Method

This study utilized Constructivist Grounded Theory (CGT), employing semi-structured interviews to explore nursing dynamics in horizontal organizational structures. It delved into crucial aspects like finances, organizational structure, value systems, information flow, and conflict resolution within SMOs. The methodology involved theoretical sampling, prioritizing expert self-management knowledge over mere representativeness. Seven nurses, twelve management members, and fifteen patients from self-managed homecare organizations contributed to the examination of nursing experiences. Constant comparative analysis of data led to the identification of the Qualitative Success Enablers (QSEs), revealing three themes: Insightfulness, Enhancing Nursing Experience through Job Enrichment, and Autonomy-Enabled Intrapreneurship.

Results

The findings indicate that the horizontal management structure represented by the studied organization in India has shown considerable success in times laden with uncertainties during the COVID-19 pandemic, especially during the delta wave, which revealed the frailty of existing healthcare infrastructure. The organization successfully maintained a better nursing experience and gained patient and employee satisfaction, as revealed by in-depth semi-structured interviews and constant comparative analysis.

Conclusion

In a world of unique challenges, we stand on the brink of significant transformations. SMOs are vital in India’s homecare sector for enhancing nursing experiences and overall organizational performance. Fostering a trust-based environment within SMOs is integral to delivering effective services. The autonomy to design nursing jobs, insightfulness, and innovativeness in the nursing job through suitable training activities, various job enrichment methods, and finding meaningfulness in a job through softer aspects of caregiving result in an enhanced nursing experience at SMOs. This groundbreaking approach can be extended to other homecare organizations in India, relieving the strain on the existing healthcare system.