bluuebunny/crossref_metadata_2025 huggingface dataset:
Stratified analysis of clinical pregnancy outcomes of sequential embryo transfer in frozen embryo transfer cycles based on different factors: a retrospective study
Authors: Li Jialing , Ji Jing , Guo Hua , Wang Feimiao , Fu Yunxing , Hu Rong
Published: November 2023

Objective

To explore the effect of sequential embryo transfer (ET) on the pregnancy outcome of frozen-thawed embryo transfer (FET) cycle and the indications of sequential transfer.

Methods

A total of 1440 FET cycles were enrolled in this retrospective study, of which 1080 patients received conventional ET and 360 patients received sequential ET. Further stratified analysis was performed according to the number of previous failed cycles, the number of embryos transferred and the stage of blastocyst (day 5 or 6, denoted D5 or D6) transferred. Comparison of pregnancy rates, implantation rate, miscarriage rate and multiple pregnancy rate among the groups of patients.

Results

The clinical pregnancy rate and implantation rate of the sequential ET group were higher than those of the conventional ET group (P < 0.01); however, there was no statistical difference in multiple pregnancy rate and miscarriage rate (P > 0.05). In sequential transfer, the number of transferred embryos (2 or 3) and the stage of transferred blastocysts (D5 or D6) had no effect on clinical pregnancy rate, implantation rate, multiple pregnancy rate and miscarriage rate (P > 0.05). In patients with three or more previous failure cycles, the sequential ET group showed higher clinical pregnancy rate and implantation rate (P > 0.05).

Conclusions

Compared with conventional ET in FET cycle, sequential ET strategy could significantly improve the clinical pregnancy rate and implantation rate. In sequential transfer, patients with three embryos transferred don’t have higher pregnancy rate and implantation rate. Besides, sequential transfer is more suitable for patients with repeated implantation failures (RIF), and increase the utilization rate of D6 blastocysts.
Utilization and determinants of adequate quality antenatal care services in India: evidence from the National Family Health Survey (NFHS-5) (2019-21)
Authors: Girotra Siaa , Malik Mansi , Roy Shubhanjali , Basu Saurav
Published: November 2023

Background

Pregnancy-related complications and insufficiencies in antenatal care services are leading causes of maternal and infant morbidity and mortality in low-resource settings. However, there has been an undue focus on achieving a minimum number of Antenatal Care (ANC) visits without adequate focus on the factors affecting ANC service utilization. This secondary data analysis from the fifth round of the National Family Health Survey (NFHS-5, 2019-21) was conducted to estimate the coverage of adequate quality ANC service and its determinants in India.

Methods

The study sample included 176,877 women aged 15–49 years who had experienced a pregnancy in the last 5 years. The primary outcome variable was the utilization of ANC services by women during their last pregnancy assessed by the frequency of ANC visits and the quality of ANC services. Quality of ANC service utilisation was categorised as adequate quality, inadequate quality and ≥ 4 ANC visits and, inadequate quality and < 4 ANC visits. We performed multinomial logistic regression and reported relative risk ratio (RRR) along with 95% confidence intervals. We adjusted for sampling weight, clustering, and stratification in the sampling design.

Results

The median (IQR) number of ANC visits attended by a woman during her previous pregnancy was 4 (IQR 3–7). A majority (59.25%) of the women reported availing of ≥ 4 antenatal care (ANC) visits during their previous pregnancy while 6.12% of women reported availing no ANC visits in their last pregnancy. Women aged ≥ 30 years were significantly less likely (aRRR 0.73 95% CI 0.66, 0.80) to receive ANC services of inadequate quality, and < 4 ANC visits. Additionally, any exposure to mass media (aRRR 0.69 95% CI 0.66, 0.73), and having health insurance (aRRR 0.71 95% CI 0.68, 0.75) decreased their risk of receiving inadequate quality ANC services and < 4 ANC visits. Women belonging to the richest wealth quintile (aRRR 0.52 95% CI 0.47,0.58) and those with an intended pregnancy (aRRR 0.62 95% CI 0.58 ,0.66) were at significantly lower risk of utilizing inadequate quality ANC services and < 4 ANC visits.

Conclusion

Although nearly 3 in 5 women in India utilized a minimum mandated ≥ 4 ANC visits during their last pregnancy, only one in five of those received adequate quality of ANC services indicating suboptimal content. However, only one in five women utilized the WHO-mandated ≥ 8 ANC visits for a positive pregnancy experience. Furthermore, 14.3% of the women received ANC services of inadequate quality despite attending ≥ 4 ANC visits in their previous pregnancy. Our study emphasized the importance of the quality of ANC services utilised irrespective of number of ANC visits availed. Efforts should be undertaken to enhance the utilization of antenatal care (ANC) services by implementing media initiatives that aim to raise awareness, particularly among women belonging to disadvantaged population groups.
Investigate the relationship between the microbiota awareness in first trimester and high risk pregnancy in Turkish women: cross-sectional study
Authors: Cömert Tuğba Küçükkasap , Karadeniz Sinan , Akpınar Funda
Published: November 2023

Background

It is suggested that pregnancy risks may be related to microbial dysbiosis, and it is known that knowledge on this subject is reflected in behaviors. The purpose of this study was to investigate whether microbiota awareness in the first trimester of pregnancy is associated with pregnancy-related risks.

Methods

Within the scope of the study, the microbiota awareness scale was administered to 426 individuals in the first trimester of pregnancy, and information on any diagnosis related to high-risk pregnancy, gestational age, birth weight, and birth height of the newborn was obtained from their file records.

Results

The mean total microbiota awareness score of individuals was 61.38 ± 11.00 (26.00–91.00). The microbiota awareness score (56.85 ± 11.65) was found to be lower in individuals diagnosed with high-risk pregnancy (p < 0.05) than in healthy subjects (63.64 ± 9.94). Moreover, in individuals with high-risk pregnancies, a positive correlation was found between the microbiota awareness score and newborn birth weight and height (p < 0.05).

Conclusion

The poor microbiota awareness level in pregnant women is associated with high-risk pregnancy and neonatal growth status.
Comparative efficacy of aflibercept and ranibizumab in the treatment of age-related macular degeneration with retinal pigment epithelial detachment: a systematic review and network meta-analysis
Authors: Sun Zuhua , Yang Yating , Lin Bing , Huang Ying , Zhou Rong , Yang Chun , Li Yingzi , Huang Shenghai , Liu Xiaoling
Published: November 2023

Objectives

To evaluate the efficacy of anti-vascular endothelial growth factor (VEGF) in treatment of age-related macular degeneration (AMD) with retinal pigment epithelial detachment (PED).

Methods

Systematic review identifying studies comparing intravitreal ranibizumab (IVR), intravitreal aflibercept (IVA) and intravitreal conbercept (IVC) published before Mar 2022.

Results

One randomized controlled trial and 6 observational studies were selected for meta-analysis (1,069 patients). The change of best corrected visual acuity (BCVA) in IVA 2.0 mg group was better than IVR 0.5 mg (average difference 0.07) and IVR 2.0 mg (average difference 0.10), the differences were statistically significant. The change of the height of PED in IVA 2.0 group was better than IVR 0.5 group (average difference 45.30), the difference was statistically significant. The proportion of patients without PED at last visit in IVA 2.0 group were better than those in IVR 2.0 group (hazard ratio 1.91), the difference was statistically significant. There was no significant difference compared with IVR 0.5 group (hazard ratio 1.45). IVA required fewer injections than IVR, with a mean difference of -1.58.

Conclusions

IVA appears to be superior to IVR in improvement of BCVA, height decrease of PED and regression of PED with less injections in nAMD with PED.
The prevalence of malnutrition among critically ill children: a systematic review and meta-analysis
Authors: Abera Eyob Girma , Sime Habtamu
Published: November 2023

Background

Critically ill children have a lower nutritional reserve, compounding the restricted food intake during intensive care unit (ICU) and hospital stays, and scarce data are available to point out the problem. Therefore, this review aimed to assess the pooled prevalence of malnutrition among critically ill children.

Methodology

This systematic review was conducted in accordance with the JBI methodology for systematic reviews of prevalence and incidence. Databases including, PubMed/MEDLINE, CINAHL/EBSCO, HINARI, Google Scholar, and gray literatures were used to find relevant articles. Eligible studies were critically appraised by two independent reviewers. Systematic review and meta-analysis was conducted using STATA 17 software. Funnel plot and at the 5% significance level, Egger’s test were used to check for publication bias.

Result

From a total of 15 studies with 4331 study participants, the pooled prevalence of malnutrition in critically ill children was 37.19% (95% CI; 35.89–38.49) with a significant statistical heterogeneity (I2 = 98.6, P = < 0.0001). High income countries reported the lower pooled prevalence of malnutrition among critically ill children (30.14%, 95% CI; 28.41, 31.88). No publication bias was reported and sensitivity analysis suggested that no significance difference was shown in the prevalence of malnutrition among critically ill children with the pooled prevalence.

Conclusion

The current systematic review and meta-analysis showed that more than one in three critically ill children was malnourished. Serious medical conditions in children that deserve admission to the intensive care unit could be a complication of malnutrition that may end up in deaths unless the undernutrition is addressed together with critical care intervention. Hence, specific strategies to prevent malnutrition among this neglected segment should be integrated with the existing healthcare systems and nutritional programs.
The smoking and vaping model, A user-friendly model for examining the country-specific impact of nicotine VAPING product use: application to Germany
Authors: Sánchez-Romero Luz María , Liber Alex C. , Li Yameng , Yuan Zhe , Tam Jamie , Travis Nargiz , Jeon Jihyoun , Issabakhsh Mona , Meza Rafael , Levy David T.
Published: November 2023

Background

Simulation models play an increasingly important role in tobacco control. Models examining the impact of nicotine vaping products (NVPs) and smoking tend to be highly specialized and inaccessible. We present the Smoking and Vaping Model (SAVM),a user-friendly cohort-based simulation model, adaptable to any country, that projects the public health impact of smokers switching to NVPs.

Methods

SAVM compares two scenarios. The No-NVP scenario projects smoking rates in the absence of NVPs using population projections, deaths rates, life expectancy, and smoking prevalence. The NVP scenario models vaping prevalence and its impact on smoking once NVPs became popular. NVP use impact is estimated as the difference in smoking- and vaping-attributable deaths (SVADs) and life-years lost (LYLs) between the No-NVP and NVP scenarios. We illustrate SAVM’s adaptation to the German adult ages 18+ population, the Germany-SAVM by adjusting the model using population, mortality, smoking and NVP use data.

Results

Assuming that the excess NVP mortality risk is 5% that of smoking, Germany-SAVM projected 4.7 million LYLs and almost 300,000 SVADs averted associated with NVP use from 2012 to 2060. Increasing the excess NVP mortality risk to 40% with other rates constant resulted in averted 2.8 million LYLs and 200,000 SVADs during the same period.

Conclusions

SAVM enables non-modelers, policymakers, and other stakeholders to analyze the potential population health effects of NVP use and public health interventions.
Determinants of adverse management outcomes of blunt abdominal trauma patients operated at a referral hospital in southern Ethiopia: a retrospective record review
Authors: Abraha Demoz , Gebreyes Essay , Wolka Eskinder , Dender Getahun , Sorsa Abebe , Muhumuza Joshua
Published: November 2023

Background

Abdominal trauma is one of the common reasons for emergency visits yet there is paucity of data about the subject in the horn of Africa. This study was aimed at determining the determinants of adverse management outcomes of blunt abdominal trauma among operated patients at Wolaita Sodo University Teaching and Referral Hospital, Ethiopia.

Methods

This was a three-year retrospective review conducted among 128 patient records selected using purposive sampling in which all records for the patients operated for a diagnosis of blunt abdominal trauma during the study period were included. A pretested checklist was used to extract the data relating to adverse outcomes and characteristics of the patients. A descriptive analysis followed by logistic regression was done.

Results

Of the 128 patients, adverse management outcomes related to blunt abdominal trauma occurred in 52%. Patients residing in rural areas (adjusted odds ratio 3.23, 95% confidence interval: 1.13–9.24) and those with tachycardia, (adjusted odds ratio = 3.25, 95% confidence interval: 1.19–8.83) or tachypnea (adjusted odds ratio 3.25, 95% confidence interval: 1.19–8.83) were more likely to have adverse management outcomes.

Conclusion

Adverse management outcomes are relatively high and associated with rural residence and deranged vital signs (tachycardia and tachypnea). Close monitoring targeting patients from rural residence and those presenting with tachycardia and tachypnea is recommended.
Silver diamine fluoride with sodium fluoride varnish versus silver diamine fluoride in arresting early childhood caries: a 6-months follow up of a randomized field trial
Authors: Abdellatif Enas B. , El Kashlan Mona K. , El Tantawi Maha
Published: November 2023

Background

Early childhood caries (ECC) is the most prevalent chronic health problem in young children, and it can be arrested using professionally applied fluoride such as Sodium fluoride (NaF) varnish and Silver Diamine Fluoride (SDF). This trial compared two interventions to arrest ECC lesions: 38% SDF combined with 5% NaF varnish versus 38% SDF and assessed whether the arrest rate was affected by baseline lesion severity measured by ICDAS.

Methods

Children aged ≤ 4 years from 4 nurseries in a rural area in Alexandria, Egypt joined the study in March 2022. They were included if they had at least one active carious lesion with ICDAS codes ≥ 3. They were randomized to receive either 38% SDF with 5% NaF varnish or 38% SDF alone. In both groups, the agents were applied at baseline and after 6 months on the caries lesions. NaF was additionally applied on all teeth in the oral cavity, and it was also applied after three months. The primary outcome was lesion arrest status after six months. Parents’ satisfaction with their children’s appearance was the secondary outcome. Pearson Chi-Square test was used for bivariate comparison and multi-level multiple logistic regression was used to assess the effect of the intervention on caries arrest controlling for confounders. The interaction between the intervention and baseline lesion severity (categorized into moderate and severe lesions) was assessed and the p value was calculated.

Results

The study included 1606 lesions in 220 children, median (IQR) age = 48(9) months. The percentages of arrested lesions after the application of SDF + NaF and SDF only were 77.7% and 73.2% (p = 0.035). In multivariable analysis, SDF + NaF had significantly greater caries arrest effect than SDF alone (AOR = 2.12, p = 0.03) with significant difference (p = 0.03) between moderate (AOR = 4.10, p = 0.005) and advanced (AOR = 1.92, p = 0.08) lesions. Most parents were satisfied with their children’s appearance with no significant difference between groups (SDF + NaF = 84.5%, SDF = 78.18%, p = 0.23).

Conclusion

SDF + NaF had a higher arrest rate than SDF alone and this difference was significant in moderate but not advanced lesions. The findings have implications for the non-invasive management of ECC.

Trial registration

This trial was registered in the clinicaltrials.gov registry (#NCT05642494).
Sensitivity and specificity of the ICDAS II system and bitewing radiographs for detecting occlusal caries using the Spectra™ caries detection system as the reference test in children
Authors: Caceda Jorge H. , Jiang Shuying , Calderon Victor , Villavicencio-Caparo Ebingen
Published: November 2023

Background

Most studies assessing the sensitivity and specificity of caries detection methods have been performed in vitro using the histological method as the gold standard showing inconsistent values. The aim of this study was to compare the sensitivity and specificity in detecting occlusal caries using the International Caries Detection and Assessment System (ICDAS II) with the radiographic method (RM), while using the Spectra™ Caries Detection System (SCDS) as the reference test.

Methods

One hundred sixty children, ages 7–12 years, participated in the study. Five zones in the occlusal surfaces of 859 primary and 632 first permanent molars were examined visually using ICDAS-II, the RM using bitewing radiographs and SCDS. The descriptive statistics of sensitivity and specificity were calculated and compared.

Results

For all molars combined and for primary molars only, the sensitivity of ICDAS II was higher for detecting total caries (p < 0.001), caries in enamel (p < 0.001), and caries in dentin (p = 0.016), but it was not different for detecting caries in the dentin of permanent first molars (p = 0.214), and primary second molars (p = 0.761). The specificity of RM was higher for detecting total caries, caries in enamel for all molars combined and for permanent first molars (p < 0.001). For caries in dentin, the specificity of ICDAS II was higher for all molars combined and for primary molars only (p < 0.001). For total caries in primary molars only, and caries in dentin of permanent first molars only, the specificity was not different (p = 0.156 and p = 0.181 respectively).

Conclusions

The sensitivity and specificity of ICDAS II and RM changes depending on whether the carious lesion compromises the enamel or dentin, and if the caries detection is performed in the primary molars or permanent first molars.
Does maxillary sinus proximity affect molar root resorption during distalization using Invisalign? a CBCT study
Authors: Elfouly Dina , El-Harouni Nadia M. , Ismail Hanan A. , El-Bialy Tarek , Ghoneima Ahmed
Published: November 2023

Background

This study aimed to assess the correlation between maxillary sinus proximity to root apices of maxillary molars and root resorption during molar distalization using clear aligner therapy (CAT).

Materials and methods

Thirty-eight cone beam computed tomography scans (CBCTs) obtained pre- (T0) and post-treatment (T1) from 19 adult patients (36.68 ± 13.50 years), who underwent maxillary molar distalization using Invisalign® aligners (Align Technology, Inc., San José, CA, USA) with a minimum of 2 mm distalization, were evaluated in this study At least 22 h of aligner wear per day was a main inclusion criterion. Sinus proximity and changes in root lengths were measured for 61 molars (183 roots). Spearman coefficient analysis was used for assessing correlation between sinus proximity and root resorption. The level of significance was set at p ≤ 0.05. The reproducibility of measurements was assessed by intraclass correlation coefficient (ICC).

Results

Spearman coefficient revealed no significant correlation between sinus proximity and molar root resorption for mesiobuccal, distobuccal or palatal roots (p = 0.558, p = 0.334, p = 0.931, respectively).

Conclusion

There was no correlation between maxillary sinus proximity to root apices of maxillary molars and root resorption.
Metabolomic and microbiome analysis of the protective effects of Puerarin against Salmonella Enteritidis Infection in chicks
Authors: Lu Yu , Ge Shihao , Zhang Haili , Lu Wen , Bao Xiangli , Pan Shiling , Pang Quanhai
Published: November 2023

Background

Salmonella Enteritidis is a zoonotic pathogen and poses a substantial risk to human health, as well as significant financial losses to the livestock and poultry industries. It is currently urgent to identify alternatives to antibiotic treatment.

Results

In this study, we explored the influence of Puerarin on the immunological response, intestinal flora, serum metabolome, and growth performance of chicks infected with Salmonella Enteritidis. Chicks were weighed at specific time points and the average daily gain (ADG) was calculated. Serum, intestinal, and cecal content samples were collected on days 10 and 17. The results showed that 100 mg/kg of Puerarin significantly suppressed inflammation and enhanced immune function. Metabolomic analysis showed significant differences in serum metabolites after Puerarin treatment and suggested that Puerarin may regulate abnormal amino acid and lipid metabolism after Salmonella Enteritidis infection through the autophagic and ABC transporter pathways. In addition, Puerarin suppressed Salmonella Enteritidis-induced intestinal flora dysbiosis through modulation of the microbial community structures (increased Lactobacillus, Faecalibacterium, and Subdoligranulum), as demonstrated by 16S rRNA analysis.

Conclusions

In conclusion, Puerarin can improve growth performance in chicks, suppress the inflammatory response in vivo, enhance immunity, and regulate lipid and amino acid metabolism and the intestinal flora.
Risk of cardiovascular events after an exacerbation of chronic obstructive pulmonary disease: results from the EXACOS-CV cohort study using the PHARMO Data Network in the Netherlands
Authors: Swart Karin M. A. , Baak Brenda N. , Lemmens Louise , Penning-van Beest Fernie J. A. , Bengtsson Camilla , Lobier Muriel , Hoti Fabian , Vojinovic Dina , van Burk Lindy , Rhodes Kirsty , Garbe Edeltraut , Herings Ron M. C. , Nordon Clementine , Simons Sami O.
Published: November 2023

Background

People living with chronic obstructive pulmonary disease (COPD) have an increased risk of experiencing cardiovascular (CV) events, particularly after an exacerbation. Such CV burden is not yet known for incident COPD patients. We examined the risk of severe CV events in incident COPD patients in periods following either moderate and/or severe exacerbations.

Methods

Persons aged ≥ 40 years with an incident COPD diagnosis from the PHARMO Data Network were included. Exposed time periods included 1–7, 8–14, 15–30, 31–180 and 181–365 days following an exacerbation. Moderate exacerbations were defined as those managed in outpatient settings; severe exacerbations as those requiring hospitalisation. The outcome was a composite of time to first severe CV event (acute coronary syndrome, heart failure decompensation, cerebral ischaemia, or arrhythmia) or death. Hazard ratios (HR) were estimated for association between each exposed period and outcome.

Results

8020 patients with newly diagnosed COPD were identified. 2234 patients (28%) had ≥ 1 exacerbation, 631 patients (8%) had a non-fatal CV event, and 461 patients (5%) died during a median follow-up of 36 months. The risk of experiencing the composite outcome was increased following a moderate/severe exacerbation as compared to time periods of stable disease [range of HR: from 15.3 (95% confidence interval 11.8–20.0) in days 1–7 to 1.3 (1.0–1.8) in days 181–365]. After a moderate exacerbation, the risk was increased over the first 180 days [HR 2.5 (1.3–4.8) in days 1–7 to 1.6 (1.3–2.1) in days 31–180]. After a severe exacerbation, the risk increased substantially and remained higher over the year following the exacerbation [HR 48.6 (36.9–64.0) in days 1–7 down to 1.6 (1.0–2.6) in days 181–365]. Increase in risk concerned all categories of severe CV events.

Conclusions

Among incident COPD patients, we observed a substantial risk increase of severe CV events or all-cause death following either a moderate or severe exacerbation of COPD. Increase in risk was highest in the initial period following an exacerbation. These findings highlight the significant cardiopulmonary burden among people living with COPD even with a new diagnosis.
Eleven metabolism‑related genes composed of Stard5 predict prognosis and contribute to EMT phenotype in HCC
Authors: Li Dongping , Lin Xiahui , Li Jiale , Liu Xinyi , Zhang Feng , Tang Wenqing , Zhang Si , Dong Ling , Xue Ruyi
Published: November 2023

Background

Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide, with a high mortality and poor survival rate. Abnormal tumor metabolism is considered a hallmark of HCC and is a potential therapeutic target. This study aimed to identify metabolism-related biomarkers to evaluate the prognosis of patients with HCC.

Method

The Cancer Genome Atlas (TCGA) database was used to explore differential metabolic pathways based on high and low epithelial-mesenchymal transition (EMT) groupings. Genes in differential metabolic pathways were obtained for HCC metabolism-related molecular subtype analysis. Differentially expressed genes (DEGs) from the three subtypes were subjected to Lasso Cox regression analysis to construct prognostic risk models. Stard5 expression in HCC patients was detected by western blot and immunohistochemistry (IHC), and the role of Stard5 in the metastasis of HCC was investigated by cytological experiments.

Results

Unsupervised clustering analysis based on metabolism-related genes revealed three subtypes in HCC with differential prognosis. A risk prognostic model was constructed based on 11 genes (STARD5, FTCD, SCN4A, ADH4, CFHR3, CYP2C9, CCL14, GADD45G, SOX11, SCIN, and SLC2A1) obtained by LASSO Cox regression analysis of the three subtypes of DEGs. We validated that the model had a good predictive power. In addition, we found that the high-risk group had a poor prognosis, higher proportion of Tregs, and responded poorly to chemotherapy. We also found that Stard5 expression was markedly decreased in HCC tissues, which was associated with poor prognosis and EMT. Knockdown of Stard5 contributed to the invasion and migration of HCC cells. Overexpression of Stard5 inhibited EMT in HCC cells.

Conclusion

We developed a new model based on 11 metabolism-related genes, which predicted the prognosis and response to chemotherapy or immunotherapy for HCC. Notably, we demonstrated for the first time that Stard5 acted as a tumor suppressor by inhibiting metastasis in HCC.
Evaluating local primary health care actions to address health inequities: analysis of Australia’s Primary Health Networks
Authors: Windle Alice , Javanparast Sara , Freeman Toby , Baum Fran
Published: November 2023

Background

Meso-level, regional primary health care organisations such as Australia’s Primary Health Networks (PHNs) are well placed to address health inequities through comprehensive primary health care approaches. This study aimed to examine the equity actions of PHNs and identify factors that hinder or enable the equity-orientation of PHNs’ activities.

Methods

Analysis of all 31 PHNs’ public planning documents. Case studies with a sample of five PHNs, drawing on 29 original interviews with key stakeholders, secondary analysis of 38 prior interviews, and analysis of 30 internal planning guidance documents. This study employed an existing framework to examine equity actions.

Results

PHNs displayed clear intentions and goals for health equity and collected considerable evidence of health inequities. However, their planned activities were largely restricted to individualistic clinical and behavioural approaches, with little to facilitate access to other health and social services, or act on the broader social determinants of health. PHNs’ equity-oriented planning was enabled by organisational values for equity, evidence of local health inequities, and engagement with local stakeholders. Equity-oriented planning was hindered by federal government constraints and lack of equity-oriented prompts in the planning process.

Conclusions

PHNs’ equity actions were limited. To optimise regional planning for health equity, primary health care organisations need autonomy and scope to act on the ‘upstream’ factors that contribute to local health issues. They also need sufficient time and resources for robust, systematic planning processes that incorporate mechanisms such as procedure guides and tools/templates, to capitalise on their local evidence to address health inequities. Organisations should engage meaningfully with local communities and service providers, to ensure approaches are equity sensitive and appropriately targeted.
School-based physical activity in relation to active travel – a cluster randomized controlled trial among adolescents enrolled in the school in motion study in Norway
Authors: Malnes Lena , Berntsen Sveinung , Kolle Elin , Ivarsson Andreas , Dyrstad Sindre M. , Resaland Geir K. , Solberg Runar , Haugen Tommy
Published: November 2023

Background

Active travel and school settings are considered ideal for promoting physical activity. However, previous research suggests limited effect of school-based interventions on overall physical activity levels among adolescents. The relationship between physical activity in different domains remains inconclusive. In this study, we examined the effects of adding two weekly hours of school-based physical activity on active travel rates.

Method

We analyzed data from 1370 pupils in the 9th-grade participating in the cluster RCT; the School In Motion (ScIM) project. Intervention schools (n = 19) implemented 120 min of class-scheduled physical activity and physical education, in addition to the normal 2 hours of weekly physical education in the control schools (n = 9), for 9 months. Active travel was defined as pupils who reported walking or cycling to school, while motorized travel was defined as pupils who commuted by bus or car, during the spring/summer half of the year (April–September), or autumn/winter (October–February). The participants were categorized based on their travel mode from pretest to posttest as; maintained active or motorized travel (“No change”), changing to active travel (motorized-active), or changing to motorized travel (active-motorized). Multilevel logistic regression was used to analyze the intervention effect on travel mode.

Results

During the intervention period, most participants maintained their travel habits. In total, 91% of pupils maintained their travel mode to school. Only 6% of pupils switched to motorized travel and 3% switched to active travel, with small variations according to season and trip direction. The intervention did not seem to influence the likelihood of changing travel mode. The odds ratios for changing travel habits in spring/summer season were from active to motorized travel 1.19 [95%CI: 0.53–2.15] and changing from motorized to active travel 1.18 [0.30–2.62], compared to the “No change” group. These findings were consistent to and from school, and for the autumn/winter season.

Conclusion

The extra school-based physical activity does not seem to affect rates of active travel among adolescents in the ScIM project.

Trial registration

Clinicaltrials.gov ID nr: NCT03817047. Registered 01/25/2019′ retrospectively registered’.
Classification of tumor types using XGBoost machine learning model: a vector space transformation of genomic alterations
Authors: Zelli Veronica , Manno Andrea , Compagnoni Chiara , Ibraheem Rasheed Oyewole , Zazzeroni Francesca , Alesse Edoardo , Rossi Fabrizio , Arbib Claudio , Tessitore Alessandra
Published: November 2023

Background

Machine learning (ML) represents a powerful tool to capture relationships between molecular alterations and cancer types and to extract biological information. Here, we developed a plain ML model aimed at distinguishing cancer types based on genetic lesions, providing an additional tool to improve cancer diagnosis, particularly for tumors of unknown origin.

Methods

TCGA data from 9,927 samples spanning 32 different cancer types were downloaded from cBioportal. A vector space model type data transformation technique was designed to build consistently homogeneous new datasets containing, as predictive features, calls for somatic point mutations and copy number variations at chromosome arm-level, thus allowing the use of the XGBoost classifier models. Considering the imbalance in the dataset, due to large difference in the number of cases for each tumor, two preprocessing strategies were considered: i) setting a percentage cut-off threshold to remove less represented cancer types, ii) dividing cancer types into different groups based on biological criteria and training a specific XGBoost model for each of them. The performance of all trained models was mainly assessed by the out-of-sample balanced accuracy (BACC) and the AUC scores.

Results

The XGBoost classifier achieved the best performance (BACC 77%; AUC 97%) on a dataset containing the 10 most represented tumor types. Moreover, dividing the 18 most represented cancers into three different groups (endocrine-related carcinomas, other carcinomas and other cancers),such analysis models achieved 78%, 71% and 86% BACC, respectively, with AUC scores greater than 96%. In addition, the model capable of linking each group to a specific cancer type reached 81% BACC and 94% AUC. Overall, the diagnostic potential of our model was comparable/higher with respect to others already described in literature and based on similar molecular data and ML approaches.

Conclusions

A boosted ML approach able to accurately discriminate different cancer types was developed. The methodology builds datasets simpler and more interpretable than the original data, while keeping enough information to accurately train standard ML models without resorting to sophisticated Deep Learning architectures. In combination with histopathological examinations, this approach could improve cancer diagnosis by using specific DNA alterations, processed by a replicable and easy-to-use automated technology. The study encourages new investigations which could further increase the classifier’s performance, for example by considering more features and dividing tumors into their main molecular subtypes.
Intrauterine growth restriction alters kidney metabolism at the end of nephrogenesis
Authors: Ho Sheng-Yuan , Yuliana Merryl Esther , Chou Hsiu-Chu , Chen Chung-Ming
Published: November 2023

Background

This study investigated the effect of uteroplacental insufficiency (UPI) on renal development by detecting metabolic alterations in the kidneys of rats with intrauterine growth restriction (IUGR).

Methods

On gestational day 17, pregnant Sprague Dawley rats were selected and allocated randomly to either the IUGR group or the control group. The IUGR group received a protocol involving the closure of bilateral uterine vessels, while the control group underwent a sham surgery. The rat pups were delivered on gestational day 22 by natural means. Pups were randomly recruited from both the control and IUGR groups on the seventh day after birth. The kidneys were surgically removed to conduct Western blot and metabolomic analyses.

Results

IUGR was produced by UPI, as evidenced by the significantly lower body weights of the pups with IUGR compared to the control pups on postnatal day 7. UPI significantly increased the levels of cleaved caspase-3 (p < 0.05) and BAX/Bcl-2 (p < 0.01) in the pups with IUGR. Ten metabolites exhibited statistically significant differences between the groups (q < 0.05). Metabolic pathway enrichment analysis demonstrated statistically significant variations between the groups in the metabolism related to fructose and mannose, amino and nucleotide sugars, and inositol phosphate.

Conclusions

UPI alters kidney metabolism in growth-restricted newborn rats and induces renal apoptosis. The results of our study have the potential to provide new insights into biomarkers and metabolic pathways that are involved in the kidney changes generated by IUGR.
The effect of paclitaxel- and fisetin-loaded PBM nanoparticles on apoptosis and reversal of drug resistance gene ABCG2 in ovarian cancer
Authors: McFadden Melayshia , Singh Santosh Kumar , Kinnel Briana , Varambally Sooryanarayana , Singh Rajesh
Published: November 2023

Background

High-grade serous ovarian cancer (OvCa) is the most common type of epithelial OvCa. It is usually diagnosed in advanced stages, leaving a woman’s chance of survival below 50%. Despite traditional chemotherapeutic therapies, there is often a high recurrence rate following initial treatments. Hence, a targeted drug delivery system is needed to attack the cancer cells and induce apoptosis, overcome acquired drug resistance, and protect normal cells from cytotoxicity. The present study shows that targeting folate receptor alpha (FRα) through planetary ball milling (PBM) nanoparticles (NPs) induces apoptosis in OvCa cells.

Results

Human tissue microarrays (TMAs) show overexpression of FRα in Stage IV OvCa tissues compared to matched normal tissues. They provide a focus for a targeted delivery system. We formulated PBM nanoparticles encapsulated with paclitaxel (PTX) or fisetin (Fis) and conjugated with folic acid (FA). The cytotoxic effect of these PBM NPs reduced the concentration of the toxic chemotherapy drug PTX by five-fold. The combined treatment of PTX-FA NPs and Fis-FA NPs inhibited cell proliferation and induced apoptosis more extensively than the individual drugs alone. Apoptosis of OvCa cells, determined by flow cytometry, showed an increase from 14.4 to 80.4% (OVCAR3 cells) and from 2.69 to 90.0% (CAOV3 cells) in the number of apoptotic cells. Also, expressions of the pro-apoptotic markers, BAK and active caspase-3, were increased after PTX-FA + Fis-FA PBM NP treatment. In addition to looking at targeted treatment effects on apoptosis, drug resistance was investigated. Drug resistance in OvCa cells was reversed by ABCG2, an ABC-transporter marker.

Conclusions

Our study shows that PTX-FA and Fis-FA PBM NPs directly target platinum-resistant OvCa cells, induce cytotoxic/apoptotic effects, and reverse multi-drug resistance (MDR). These findings allow us to create new clinical applications using PTX-FA and Fis-FA combination nanoparticles to treat drug-resistant cancers.
Painless nondiabetic lumbosacral radiculoplexus neuropathy with complete recovery: a case report
Authors: Tan Zhibin , Foong Wai Dic , Tan You-Jiang
Published: November 2023

Background

Lumbosacral radiculoplexus neuropathy, also known as amyotrophy, is an uncommon monophasic disorder characterized by inflammation of the lumbosacral nerve roots and plexuses. Lumbosacral radiculoplexus neuropathy is usually associated with diabetes mellitus, is typically painful at presentation, and often associated with long-term residual neurologic deficits. We report a case of painless, nondiabetic lumbosacral radiculoplexus neuropathy in a young Chinese woman, who made a full recovery after treatment with intravenous immunoglobulin, adding an atypical case to the scarce literature on lumbosacral radiculoplexus neuropathy.

Case presentation

A 35-year-old Chinese woman presented to our emergency department with 1-week history of painless left lower limb weakness and numbness. Examination revealed weakness confined to the left lower limb but spanning various nerves and myotomes, with abnormal sensation. Clinical localization to the lumbosacral plexus was supported by neurodiagnostic tests, and magnetic resonance imaging of the lumbosacral plexus showed that the nerve roots were also involved. After treatment with intravenous immunoglobulin for nondiabetic lumbosacral radiculoplexus neuropathy, the patient had a full recovery.

Conclusion

Our patient’s case highlights that lumbosacral radiculoplexus neuropathy, an already rare disorder, can occur in the absence of diabetes mellitus and pain, making it even harder to recognize. A systematic and meticulous clinical approach, supported by intelligent selection of adjunctive tests, is required for localization and diagnosis. With an accurate diagnosis, our case also demonstrates that appropriate and prompt treatment can lead to complete recovery, despite previous reports suggesting a high prevalence of long-term residual deficits after lumbosacral radiculoplexus neuropathy.
The effect of higher or lower mean arterial pressure on kidney function after cardiac arrest: a post hoc analysis of the COMACARE and NEUROPROTECT trials
Authors: Laurikkala Johanna , Ameloot Koen , Reinikainen Matti , Palmers Pieter-Jan , De Deyne Cathy , Bert Ferdinande , Dupont Matthias , Janssens Stefan , Dens Joseph , Hästbacka Johanna , Jakkula Pekka , Loisa Pekka , Birkelund Thomas , Wilkman Erika , Vaara Suvi T. , Skrifvars Markus B.
Published: November 2023

Background

We aimed to study the incidence of acute kidney injury (AKI) in out-of-hospital cardiac arrest (OHCA) patients treated according to low-normal or high-normal mean arterial pressure (MAP) targets.

Methods

A post hoc analysis of the COMACARE (NCT02698917) and Neuroprotect (NCT02541591) trials that randomized patients to lower or higher targets for the first 36 h of intensive care. Kidney function was defined using the Kidney Disease Improving Global Outcome (KDIGO) classification. We used Cox regression analysis to identify factors associated with AKI after OHCA.

Results

A total of 227 patients were included: 115 in the high-normal MAP group and 112 in the low-normal MAP group. Eighty-six (38%) patients developed AKI during the first five days; 40 in the high-normal MAP group and 46 in the low-normal MAP group (p = 0.51). The median creatinine and daily urine output were 85 μmol/l and 1730 mL/day in the high-normal MAP group and 87 μmol/l and 1560 mL/day in the low-normal MAP group. In a Cox regression model, independent AKI predictors were no bystander cardiopulmonary resuscitation (p < 0.01), non-shockable rhythm (p < 0.01), chronic hypertension (p = 0.03), and time to the return of spontaneous circulation (p < 0.01), whereas MAP target was not an independent predictor (p = 0.29).

Conclusion

Any AKI occurred in four out of ten OHCA patients. We found no difference in the incidence of AKI between the patients treated with lower and those treated with higher MAP after CA. Higher age, non-shockable initial rhythm, and longer time to ROSC were associated with shorter time to AKI.

Clinical trial registration: COMACARE (NCT02698917), NEUROPROTECT (NCT02541591).
Noise-induced transitions in an avian influenza model with the Allee effect
Authors: Guo Xiaoxia
Published: November 2023

This paper presents noise-induced transitions in a stochastic avian influenza model with Allee effect. In the deterministic case, one of three disease-free equilibria is always globally asymptotically stable in its attractive domain, and there is a unique endemic equilibrium when the basic reproduction number $R_{0}>1$

R
0

>
1
. In the stochastic case, a new dynamic phenomenon of noise-induced transition can be observed, that is, the stochastic trajectory can exit from the neighborhood of the epidemic equilibrium and pass into the vicinity of the trivial equilibrium. More precisely, in this paper, based on the stochastic sensitivity function technique, we construct the confidence ellipse and then estimate the critical value of the noise intensity leading to extinction. We also propose useful control strategies to prevent the noise-induced extinction.
Autologous non-invasively derived stem cells mitochondria transfer shows therapeutic advantages in human embryo quality rescue
Authors: Jiang Zhixin , Shi Cheng , Han Hongjing , Fu Min , Zhu Honglan , Han Tingting , Fei Jia , Huang Yining , Jin Zhiping , He Jianan , Wang Yanbin , Chen Xi , Shen Huan
Published: November 2023

Background

The decline in the quantity and quality of mitochondria are closely associated with infertility, particularly in advanced maternal age. Transferring autologous mitochondria into the oocytes of infertile females represents an innovative and viable strategy for treating infertility, with no concerns regarding ethical considerations. As the donor cells of mitochondria, stem cells have biological advantages but research and evidence in this area are quite scarce.

Methods

To screen out suitable human autologous ooplasmic mitochondrial donor cells, we performed comprehensive assessment of mitochondrial physiology, function and metabolic capacity on a varity of autologous adipose, marrow, and urine-derived mesenchymal stromal cells (ADSC, BMSC and USC) and ovarian germline granulosa cells (GC). Further, to explore the biosafety, effect and mechanism of stem cell-derived mitochondria transfer on human early embryo development, randomized in-vitro basic studies were performed in both of the young and aged oocytes from infertile females.

Results

Compared with other types of mesenchymal stromal cells, USC demonstrated a non-fused spherical mitochondrial morphology and low oxidative stress status which resembled the oocyte stage. Moreover, USC mitochondrial content, activity and function were all higher than other cell types and less affected by age, and it also exhibited a biphasic metabolic pattern similar to the pre-implantation stage of embryonic development. After the biosafety identification of the USC mitochondrial genome, early embryos after USC mitochondrial transfer showed improvements in mitochondrial content, activity, and cytoplasmic Ca2+ levels. Further, aging embryos also showed improvements in embryonic morphological indicators, euploidy rates, and oxidative stress status.

Conclusion

Autologous non-invasively derived USC mitochondria transfer may be an effective strategy to improve embryonic development and metabolism, especially in infertile females with advanced age or repeated pregnancy failure. It provides evidence and possibility for the autologous treatment of infertile females without invasive and ethical concerns.