bluuebunny/crossref_metadata_2025 huggingface dataset:
Evolution of Depressive Symptoms Among Depression Subtypes of Clinical and Functional Variables in Primary Care in Chile
Authors: Vitriol Verónica , Cancino Alfredo , Bustamante Catalina , Aylwin María de la Luz
Published: April 2024

Objective:

To compare the evolution of depressive symptoms among depressive subtypes based on clinical and functional variables in a sample of primary care in Chile.

Methods:

A longitudinal study was conducted in the Maule Region of Chile, focusing on 8 primary care from February 2014 to September 2015. Clinical and functional variables, including Mini International Neuro-psychiatric Interview, Outcome Questionnaire interpersonal and social sub-scales, were applied in a latent class analysis. This analysis categorized 210 patients into 3 subtypes: complex depression (N = 100), recurrent depression (n = 96), and unique depression (n = 14). Complex depression, exhibited a higher probability of suicide attempts, interpersonal and social dysfunction, and association with adverse childhood experiences according the Brief Physical and Sexual Abuse Questionnaire. Patients were monitored over 1 year with the Hamilton scale. The Kruskal-Wallis, non-parametric test, followed by paired Mann-Whitney test evaluated difference in the severity of depressive symptoms between the groups. Additionally, data on mental health interventions were collected.

Results:

Out of the 210 patients, 89% were women, with a median age of 50 (range 37-58), and 40.1% with only primary education. Sociodemographic characteristics not differ between groups. Significant differences in depressive symptom severity between the groups were found ( X2 90.06, P < .001, Kruskal-Wallis test, η2 = 0.084). Post hoc analyses indicated higher depressive symptoms in complex depression compared to recurrent ( Z = −9.501, P < .001) and unique ( Z = −2.877, P = .004) depression, with no significant difference between recurrent and unique depression ( Z = −1.58, P = .113). There were no differences in the number of medical and psychological controls between the groups. The patients with complex depression required greater modifications in the pharmacological prescriptions than those belonging to the other groups.

Conclusion

These results provide additional evidence of a complex depression subtype in primary care in Chile associated with adverse childhood experiences, that had worse resolution of depressive symptoms. Contrary to expectations, patients belonging to this group did not receive further medical and psychological interventions, probably due to a lack of specific clinical recommendations.
Spatial Pattern and Driving Mechanism of Urban Taxi Fares in China
Authors: Wenkang Dou , Jie Zhang
Published: April 2024

Taxi fare is related to the daily life of residents. Reasonable taxi fare not only meets the travel demand of residents but also improves the income of drivers and promotes employment. The spatial variation of taxi fares exists between different regions and cities. Previous studies on taxi fares have been conducted mostly in individual cities, and there has been no study on the spatial differentiation pattern of taxi fares on a national scale. Taking 336 cities across China as the research object, a multiple linear regression model of taxi fares was established by demonstrating the spatial variation pattern of taxi fares, the global differentiation index, spatial autocorrelation analysis, and kernel density analysis, etc. The significance of the study is to explore the law of spatial differentiation of taxi fares in China and to provide a stenographic record of taxi fare adjustment. The results show that: (1) the spatial variation of taxi fares across the country is significant, with the starting taxi fare range being between RMB 4 and RMB 14. (2) The global differentiation index of taxi fares is large, with two low-low clusters and three high-high clusters appearing spatially, and the results of the kernel density analysis surface a dispersion distribution centered on provincial capitals. (3) The divergence pattern of taxis nationwide is influenced by several factors. A multiple linear regression model is selected to establish a multiple linear regression model of urban disposable income per capita, regional GDP, urbanization rate, and urban population density, which shows that urban disposable income per capita has the greatest influence on taxi fares. The model shows that urban disposable income per capita has the greatest influence on taxi fares, and the fare of a 5 km taxi ride is 6.07. Taxi fares have a clear pattern of spatial differentiation in China and are most affected by urban disposable income per capita. Through this study, we can gain a deeper understanding of the variation in taxi fares across the country and provide data and theoretical support for the rationality of taxi fare adjustments.
Christianity, Democracy, and Suffering in Burma
Authors: Young Elijah
Published: April 2024

This article explores why and how Burmese Christians have intensely resisted the return of military tyranny, documents the disastrous ramifications of the deepening political crisis and rising violence for Christians, and presents how churches have cared for one another and helped each other to survive. In terms of number, size, and magnitude, this national catastrophe is historically unprecedented. With other Burmese, Christians have resisted the junta, primarily because, after enduring over half a century of viciousness under military rule, they cannot think of a future without democracy and freedom. This crisis also reveals that nonviolent resistance has failed and armed resistance becomes indispensable if the Burmese want a future without military tyranny. It is, however, not the Burmese that have changed, but the context in which they have found themselves.
Back to Jerusalem: The Chinese-Christian Road to Globalization and Self-fulfillment
Authors: Elazar Gideon
Published: April 2024

The Chinese Christian Back to Jerusalem (BTJ) movement has attracted significant attention in the past two decades. With an original goal of sending out 100,000 Chinese missionaries to destinations throughout Asia, the movement appears to express the vitality and dynamism of reform-era Chinese Christianity. In this article I examine the movement’s development and its close correspondence to Chinese state geopolitical ambitions to reshape twenty-first-century globalization through the One Belt One Road Initiative. I discuss the movement, development, and impact following the recent tightening of religious policy in China and the COVID-19 pandemic. While the BTJ may be seen as a Christian expression of the PRC’s self-confidence and nationalism it is also reflective of reform-era individuality, often including deep criticism of contemporary Chinese society.
A comparative study on the spatio-temporal patterns and drivers of net primary productivity in three basins across different climate gradients in China
Authors: Lai Xiaoming , Xu Ying , Yin Beini , Zhu Qing , Wang Guojie , Miao Lijuan
Published: April 2024

The comparative study on terrestrial net primary productivity in regions across climate gradients may help to better understand ecosystem response to climate change, yet is relatively understudied. Therefore, in this study, we compared the spatio-temporal patterns of net primary productivity during 2010-2019 and identify the different controls in three basins with typical climates in China: the Heihe River Basin with arid and semi-arid climate, Weihe River Basin with semi-arid and semi-humid climate, and Lower Yangtze River Basin with humid climate. Results indicated that the net primary productivity followed the order: Lower Yangtze River Basin (480.3 g C m−2 yr−1) > Weihe River Basin (346.7 g C m−2 yr−1) > Heihe River Basin (98.1 g C m−2 yr−1). The vegetation in the Heihe River Basin had severel hydrothermal limitation as the greatest importance of temperature and precipitation to the net primary productivity. In contrast, land cover type instead of climate became the most important variable on net primary productivity in the Weihe River Basin, and topography and land cover type were critical controls in the Lower Yangtze River Basin. In addition, the annual net primary productivity in all three areas exhibited an increasing trend during 2010-2019. However, the increase of net primary productivity in the Heihe River Basin was primarily driven by the increase of both temperature and precipitation due to the warming and humification in the northwestern of China. In contrast, the increase of temperature (especially spring warming) dominated the increase of net primary productivity in the Weihe River Basin and Lower Yangtze River Basin, due to the relatively sufficient precipitation. Furthermore, monthly net primary productivity exhibited a unimodal curve throughout the year. However, the increasing trend nearly stopped in June and July in the Lower Yangtze River Basin. This is possibly due to the light deficiency with abundant precipitation for plant photosynthesis in the natural ecosystem like forest and shrubland, and the rotation from wheat harvesting to rice planting in the cropland in these months.
OsCRLK2, a Receptor-Like Kinase Identified by QTL Analysis, is Involved in the Regulation of Rice Quality
Authors: Chen Ying , Shi Hanfeng , Yang Guili , Liang Xueyu , Lin Xiaolian , Tan Siping , Guo Tao , Wang Hui
Published: April 2024

The quality of rice (Oryza sativa L) is determined by a combination of appearance, flavor, aroma, texture, storage characteristics, and nutritional composition. Rice quality directly influences acceptance by consumers and commercial value. The genetic mechanism underlying rice quality is highly complex, and is influenced by genotype, environment, and chemical factors such as starch type, protein content, and amino acid composition. Minor variations in these chemical components may lead to substantial differences in rice quality. Among these components, starch is the most crucial and influential factor in determining rice quality. In this study, quantitative trait loci (QTLs) associated with eight physicochemical properties related to the rapid viscosity analysis (RVA) profile were identified using a high-density sequence map constructed using recombinant inbred lines (RILs). Fifty-nine QTLs were identified across three environments, among which qGT6.4 was a novel locus co-located across all three environments. By integrating RNA-seq data, we identified the differentially expressed candidate gene OsCRLK2 within the qGT6.4 interval. osclrk2 mutants exhibited decreased gelatinization temperature (GT), apparent amylose content (AAC) and viscosity, and increased chalkiness. Furthermore, osclrk2 mutants exhibited downregulated expression of the majority of starch biosynthesis-related genes compared to wild type (WT) plants. In summary, OsCRLK2, which encodes a receptor-like protein kinase, appears to consistently influence rice quality across different environments. This discovery provides a new genetic resource for use in the molecular breeding of rice cultivars with improved quality.
Mendelian randomization analysis of 34,497 German Holstein cows to infer causal associations between milk production and health traits
Authors: Schneider Helen , Haas Valentin , Krizanac Ana-Marija , Falker-Gieske Clemens , Heise Johannes , Tetens Jens , Thaller Georg , Bennewitz Jörn
Published: April 2024

Background

Claw diseases and mastitis represent the most important health issues in dairy cattle with a frequently mentioned connection to milk production. Although many studies have aimed at investigating this connection in more detail by estimating genetic correlations, they do not provide information about causality. An alternative is to carry out Mendelian randomization (MR) studies using genetic variants to investigate the effect of an exposure on an outcome trait mediated by genetic variants. No study has yet investigated the causal association of milk yield (MY) with health traits in dairy cattle. Hence, we performed a MR analysis of MY and seven health traits using imputed whole-genome sequence data from 34,497 German Holstein cows. We applied a method that uses summary statistics and removes horizontal pleiotropic variants (having an effect on both traits), which improves the power and unbiasedness of MR studies. In addition, genetic correlations between MY and each health trait were estimated to compare them with the estimates of causal effects that we expected.

Results

All genetic correlations between MY and each health trait were negative, ranging from − 0.303 (mastitis) to − 0.019 (digital dermatitis), which indicates a reduced health status as MY increases. The only non-significant correlation was between MY and digital dermatitis. In addition, each causal association was negative, ranging from − 0.131 (mastitis) to − 0.034 (laminitis), but the number of significant associations was reduced to five nominal and two experiment-wide significant results. The latter were between MY and mastitis and between MY and digital phlegmon. Horizontal pleiotropic variants were identified for mastitis, digital dermatitis and digital phlegmon. They were located within or nearby variants that were previously reported to have a horizontal pleiotropic effect, e.g., on milk production and somatic cell count.

Conclusions

Our results confirm the known negative genetic connection between health traits and MY in dairy cattle. In addition, they provide new information about causality, which for example points to the negative energy balance mediating the connection between these traits. This knowledge helps to better understand whether the negative genetic correlation is based on pleiotropy, linkage between causal variants for both trait complexes, or indeed on a causal association.
Mitogenomes do not substantially improve phylogenetic resolution in a young non-model adaptive radiation of freshwater gastropods
Authors: Stelbrink Björn , von Rintelen Thomas , Marwoto Ristiyanti M. , Salzburger Walter
Published: April 2024

Background

Species flocks in ancient lakes, and particularly those arising from adaptive radiation, make up the bulk of overall taxonomic and morphological diversity in these insular ecosystems. For these mostly young species assemblages, classical mitochondrial barcoding markers have so far been key to disentangle interspecific relationships. However, with the rise and further development of next-generation sequencing (NGS) methods and mapping tools, genome-wide data have become an increasingly important source of information even for non-model groups.

Results

Here, we provide, for the first time, a comprehensive mitogenome dataset of freshwater gastropods endemic to Sulawesi and thus of an ancient lake invertebrate species flock in general. We applied low-coverage whole-genome sequencing for a total of 78 individuals including 27 out of the 28 Tylomelania morphospecies from the Malili lake system as well as selected representatives from Lake Poso and adjacent catchments. Our aim was to assess whether mitogenomes considerably contribute to the phylogenetic resolution within this young species flock. Interestingly, we identified a high number of variable and parsimony-informative sites across the other ‘non-traditional’ mitochondrial loci. However, although the overall support was very high, the topology obtained was largely congruent with previously published single-locus phylogenies. Several clades remained unresolved and a large number of species was recovered polyphyletic, indicative of both rapid diversification and mitochondrial introgression.

Conclusions

This once again illustrates that, despite the higher number of characters available, mitogenomes behave like a single locus and thus can only make a limited contribution to resolving species boundaries, particularly when introgression events are involved.
RETRACTED ARTICLE: Accuracy of Genomic prediction for fleece traits in Inner Mongolia Cashmere goats
Authors: Yan Xiaochun , Li Jinquan , He Libing , Chen Oljibilig , Wang Na , Wang Shuai , Wang Xiuyan , Wang Zhiying , Su Rui
Published: April 2024

The fleece traits are important economic traits of goats. With the reduction of sequencing and genotyping cost and the improvement of related technologies, genomic selection for goats has become possible. The research collect pedigree, phenotype and genotype information of 2299 Inner Mongolia Cashmere goats (IMCGs) individuals. We estimate fixed effects, and compare the estimates of variance components, heritability and genomic predictive ability of fleece traits in IMCGs when using the pedigree based Best Linear Unbiased Prediction (ABLUP), Genomic BLUP (GBLUP) or single-step GBLUP (ssGBLUP). The fleece traits considered are cashmere production (CP), cashmere diameter (CD), cashmere length (CL) and fiber length (FL). It was found that year of production, sex, herd and individual ages had highly significant effects on the four fleece traits (P < 0.01). All of these factors should be considered when the genetic parameters of fleece traits in IMCGs are evaluated. The heritabilities of FL, CL, CP and CD with ABLUP, GBLUP and ssGBLUP methods were 0.26 ~ 0.31, 0.05 ~ 0.08, 0.15 ~ 0.20 and 0.22 ~ 0.28, respectively. Therefore, it can be inferred that the genetic progress of CL is relatively slow. The predictive ability of fleece traits in IMCGs with GBLUP (56.18% to 69.06%) and ssGBLUP methods (66.82% to 73.70%) was significantly higher than that of ABLUP (36.73% to 41.25%). For the ssGBLUP method is significantly (29% ~ 33%) higher than that with ABLUP, and which is slightly (4% ~ 14%) higher than that of GBLUP. The ssGBLUP will be as an superiors method for using genomic selection of fleece traits in Inner Mongolia Cashmere goats.
Effect of epidural dexmedetomidine in single-dose combined with ropivacaine for cesarean section
Authors: Liu Minghao , Chen Xuezi , Guo Dan
Published: April 2024

Background

Dexmedetomidine has arousal sedation and analgesic effects. We hypothesize that epidural dexmedetomidine in single-dose combined with ropivacaine improves the experience of parturient undergoing cesarean section under epidural anesthesia. This study is to investigate the effect of 0.5 µg/kg epidural dexmedetomidine combined with epidural anesthesia (EA) in parturients undergoing cesarean section.

Methods

A total of 92 parturients were randomly divided into Group R (receiveing epidural ropivacaine alone) Group RD (receiveing epidural ropivacaine with 0.5 µg/kg dexmedetomidine). The primary outcome and second outcome will be intraoperative NRS pain scores and Ramsay Sedation Scale.

Results

All 92 parturients were included in the analysis. The NRS were significantly lower in Group RD compared to Group R at all observation timepoint (P > 0.05). Higher Ramsay Sedation Scale was found in Group RD compared to Group R (P < 0.001). No parturient has experienced sedation score of 4 and above. No significant difference regarding the incidence of hypotension, bradycardia and nausea or vomiting, Apgar scores and the overall satisfaction with anesthesia was found between Group R and Group RD (P > 0.05).

Conclusion

Epidural dexmedetomidine of 0.5 µg/kg added slightly extra analgesic effect to ropivacaine in EA for cesarean section. The sedation of 0.5 µg/kg epidural dexmedetomidine did not cause mother-baby bonding deficit. Satisfaction with anesthesia wasn’t significantly improved by epidural dexmedetomidine of 0.5 µg/kg. No additional side effect allows larger dose of epidural dexmedetomidine attempt.

Trial registration

This study was registered at www.chictr.org.cn (ChiCTR2000038853).
Describing the content of trial recruitment interventions using the TIDieR reporting checklist: a systematic methodology review
Authors: Hudek Natasha , Carroll Kelly , Semchishen Seana , Vanderhout Shelley , Presseau Justin , Grimshaw Jeremy , Fergusson Dean A. , Gillies Katie , Graham Ian D. , Taljaard Monica , Brehaut Jamie C.
Published: April 2024

Background

Recruiting participants to clinical trials is an ongoing challenge, and relatively little is known about what recruitment strategies lead to better recruitment. Recruitment interventions can be considered complex interventions, often involving multiple components, targeting a variety of groups, and tailoring to different groups. We used the Template for Intervention Description and Replication (TIDieR) reporting checklist (which comprises 12 items recommended for reporting complex interventions) to guide the assessment of how recruitment interventions are described. We aimed to (1) examine to what extent we could identify information about each TIDieR item within recruitment intervention studies, and (2) observe additional detail for each item to describe useful variation among these studies.

Methods

We identified randomized, nested recruitment intervention studies providing recruitment or willingness to participate rates from two sources: a Cochrane review of trials evaluating strategies to improve recruitment to randomized trials, and the Online Resource for Research in Clinical triAls database. First, we assessed to what extent authors reported information about each TIDieR item. Second, we developed descriptive categorical variables for 7 TIDieR items and extracting relevant quotes for the other 5 items.

Results

We assessed 122 recruitment intervention studies. We were able to extract information relevant to most TIDieR items (e.g., brief rationale, materials, procedure) with the exception of a few items that were only rarely reported (e.g., tailoring, modifications, planned/actual fidelity). The descriptive variables provided a useful overview of study characteristics, with most studies using various forms of informational interventions (55%) delivered at a single time point (90%), often by a member of the research team (59%) in a clinical care setting (41%).

Conclusions

Our TIDieR-based variables provide a useful description of the core elements of complex trial recruitment interventions. Recruitment intervention studies report core elements of complex interventions variably; some process elements (e.g., mode of delivery, location) are almost always described, while others (e.g., duration, fidelity) are reported infrequently, with little indication of a reason for their absence. Future research should explore whether these TIDieR-based variables can form the basis of an approach to better reporting of elements of successful recruitment interventions.
Clinical outcomes of liver transplantation in human immunodeficiency virus/hepatitis B virus coinfected patients in China
Authors: Tang Jianxin , Weng Ruihui , Fang Taishi , Zhang Kangjun , Yan Xu , Jin Xin , Xie Linjie , Zhao Dong
Published: April 2024

Background

Highly active antiretroviral therapy (HAART) has been able to improve the immune system function and survival of human immunodeficiency virus (HIV) patients. However, Patients coinfected with HIV and hepatitis B virus (HBV) are more likely to develop end-stage liver disease (ESLD) than those infected with HBV alone. Consequently, liver transplantation is often required for these patients. This study evaluates the outcomes of orthotopic liver transplantation (OLT) of HIV-HBV coinfected patients in China.

Methods

We conducted a retrospective analysis on all HIV-HBV coinfected patients that underwent OLT from April 1, 2019 to December 31, 2021 and their outcomes were compared to all HBV monoinfected patients undergoing OLT during the same period. Patient outcomes were determined, including cumulative survival, viral load, CD4 T-cell count and postoperative complications.

Results

The median follow-up of HIV recipients was 36 months after OLT (interquartile range 12–39 months). Almost all patients had stable CD4 T-cell count (> 200 copies/ul), undetectable HBV DNA levels, and undetectable HIV RNA load during follow-up. The 1-, 2-, and 3-year posttransplant survival rates were 85.7% for the HIV group (unchanged from 1 to 3 years) versus 82.2%, 81.2%, and 78.8% for the non-HIV group. Cumulative survival among HIV-HBV coinfected recipients was not significantly different from the HBV monoinfected recipients (log-rank test P = 0.692). The percentage of deaths attributed to infection was comparable between the HIV and non-HIV groups (14.3% vs. 9.32%, P = 0.665). Post OLT, there was no significant difference in acute rejection, cytomegalovirus infection, bacteremia, pulmonary infection, acute kidney injury, de novo tumor and vascular and biliary complications.

Conclusions

Liver transplantation in patients with HIV-HBV coinfection yields excellent outcomes in terms of intermediate- or long-term survival rate and low incidence of postoperative complications in China. These findings suggest that OLT is safe and feasible for HIV-HBV coinfected patients with ESLD.

Trial registration

Chinese Clinical Trial Registry (ChiCTR2300067631), registered 11 January 2023.
Deep learning-based image annotation for leukocyte segmentation and classification of blood cell morphology
Authors: Anand Vatsala , Gupta Sheifali , Koundal Deepika , Alghamdi Wael Y. , Alsharbi Bayan M.
Published: April 2024

The research focuses on the segmentation and classification of leukocytes, a crucial task in medical image analysis for diagnosing various diseases. The leukocyte dataset comprises four classes of images such as monocytes, lymphocytes, eosinophils, and neutrophils. Leukocyte segmentation is achieved through image processing techniques, including background subtraction, noise removal, and contouring. To get isolated leukocytes, background mask creation, Erythrocytes mask creation, and Leukocytes mask creation are performed on the blood cell images. Isolated leukocytes are then subjected to data augmentation including brightness and contrast adjustment, flipping, and random shearing, to improve the generalizability of the CNN model. A deep Convolutional Neural Network (CNN) model is employed on augmented dataset for effective feature extraction and classification. The deep CNN model consists of four convolutional blocks having eleven convolutional layers, eight batch normalization layers, eight Rectified Linear Unit (ReLU) layers, and four dropout layers to capture increasingly complex patterns. For this research, a publicly available dataset from Kaggle consisting of a total of 12,444 images of four types of leukocytes was used to conduct the experiments. Results showcase the robustness of the proposed framework, achieving impressive performance metrics with an accuracy of 97.98% and precision of 97.97%. These outcomes affirm the efficacy of the devised segmentation and classification approach in accurately identifying and categorizing leukocytes. The combination of advanced CNN architecture and meticulous pre-processing steps establishes a foundation for future developments in the field of medical image analysis.
Clinical analysis of complete uterine rupture during pregnancy
Authors: Xie Jing , Lu Xuefang , Liu Miao
Published: April 2024

Background

Uterine rupture in pregnant women can lead to serious adverse outcomes. This study aimed to explore the clinical characteristics, treatment, and prognosis of patients with complete uterine rupture.

Methods

Data from 33 cases of surgically confirmed complete uterine rupture at Chenzhou No.1 People’s Hospital between January 2015 and December 2022 were analyzed retrospectively.

Results

In total, 31,555 pregnant women delivered in our hospital during the study period. Of these, approximately 1‰ (n = 33) had complete uterine rupture. The average gestational age at complete uterine rupture was 31+4 weeks (13+1–40+3 weeks), and the average bleeding volume was 1896.97 ml (200–6000 ml). Twenty-six patients (78.79%) had undergone more than two deliveries. Twenty-five women (75.76%) experienced uterine rupture after a cesarean section, two (6.06%) after fallopian tube surgery, one (3.03%) after laparoscopic cervical cerclage, and one (3.03%) after wedge resection of the uterine horn, and Fifteen women (45.45%) presented with uterine rupture at the original cesarean section incision scar. Thirteen patients (39.39%) were transferred to our hospital after their initial diagnosis. Seven patients (21.21%) had no obvious symptoms, and only four patients (12.12%) had typical persistent lower abdominal pain. There were 13 cases (39.39%, including eight cases ≥ 28 weeks old) of fetal death in utero and two cases (6.06%, both full term) of severe neonatal asphyxia. The rates of postpartum hemorrhage, blood transfusion, hysterectomy were 66.67%, 63.64%, and 21.21%. Maternal death occurred in one case (3.03%).

Conclusions

The site of the uterine rupture was random, and was often located at the weakest point of the uterus. There is no effective means for detecting or predicting the weakest point of the uterus. Rapid recognition is key to the treatment of uterine rupture.
Rational and design of prophylactic cranial irradiation (PCI) and brain MRI surveillance versus brain MRI surveillance alone in patients with limited-stage small cell lung cancer achieving complete remission (CR) of tumor after chemoradiotherapy: a multicenter prospective randomized study
Authors: Chen Mengyuan , Li Runhua , Kong Yue , Shi Lei , Wang Jing , Wang Yuezhen , Xu Yujin , Ji Yongling , Hu Xiao
Published: April 2024

Background

Prophylactic cranial irradiation (PCI) is part of standard care in limited-stage small cell lung cancer (SCLC) at present. As evidence from retrospective studies increases, the benefits of PCI for limited-stage SCLC are being challenged.

Methods

A multicenter, prospective, randomized controlled study was designed. The key inclusion criteria were: histologically or cytologically confirmed small cell carcinoma, age ≥ 18 years, KPS ≥ 80, limited-stage is defined as tumor confined to one side of the chest including ipsilateral hilar, bilateral mediastinum and supraclavicular lymph nodes, patients have received definitive thoracic radiotherapy (regardless of the dose-fractionation of radiotherapy used) and chemotherapy, evaluated as complete remission (CR) of tumor 4–6 weeks after the completion of chemo-radiotherapy. Eligible patients will be randomly assigned to two arms: (1) PCI and brain MRI surveillance arm, receiving PCI (2.5 Gy qd to a total dose of 25 Gy in two weeks) followed by brain MRI surveillance once every three months for two years; (2) brain MRI surveillance alone arm, undergoing brain MRI surveillance once every three months for two years. The primary objective is to compare the 2-year brain metastasis-free survival (BMFS) rates between the two arms. Secondary objectives include 2-year overall survival (OS) rates, intra-cranial failure patterns, 2-year progression-free survival rates and neurotoxicity. In case of brain metastasis (BM) detect during follow-up, stereotactic radiosurgery (SRS) will be recommended if patients meet the eligibility criteria.

Discussion

Based on our post-hoc analysis of a prospective study, we hypothesize that in limited-stage SCLC patients with CR after definitive chemoradiotherapy, and ruling out of BM by MRI, it would be feasible to use brain MRI surveillance and omit PCI in these patients. If BM is detected during follow-up, treatment with SRS or whole brain radiotherapy does not appear to have a detrimental effect on OS. Additionally, this approach may reduce potential neurotoxicity associated with PCI.
Pembrolizumab-based first-line treatment for PD-L1-positive, recurrent or metastatic head and neck squamous cell carcinoma: a retrospective analysis
Authors: Cirillo Alessio , Marinelli Daniele , Romeo Umberto , Messineo Daniela , De Felice Francesca , De Vincentiis Marco , Valentini Valentino , Mezi Silvia , Valentini Filippo , Vivona Luca , Chiavassa Antonella , Cerbelli Bruna , Santini Daniele , Bossi Paolo , Polimeni Antonella , Marchetti Paolo , Botticelli Andrea
Published: April 2024

Background

The KEYNOTE-048 trial showed that pembrolizumab-based first-line treatment for R/M HNSCC led to improved OS in the PD-L1 CPS ≥ 1 population when compared to the EXTREME regimen. However, the R/M HNSCC real-world population is generally frailer, often presenting with multiple comorbidities, worse performance status and older age than the population included in phase III clinical trials.

Methods

This is a retrospective, single-centre analysis of patients with R/M HNSCC treated with pembrolizumab-based first-line treatment.

Results

From February 2021 to March 2023, 92 patients were treated with pembrolizumab-based first-line treatment. Patients treated with pembrolizumab-based chemoimmunotherapy had better ECOG PS and younger age than those treated with pembrolizumab monotherapy. Median PFS and OS were 4 months and 8 months, respectively. PFS was similar among patients treated with pembrolizumab-based chemoimmunotherapy and pembrolizumab monotherapy, while patients treated with pembrolizumab monotherapy had worse OS (log-rank p =.001, HR 2.7). PFS and OS were improved in patients with PD-L1 CPS > = 20 (PFS: log-rank p =.005, HR 0.50; OS: log-rank p =.04, HR 0.57). Patients with higher ECOG PS scores had worse PFS and OS (PFS, log-rank p =.004; OS, log-rank p = 6e-04). In multivariable analysis, ECOG PS2 was associated with worse PFS and OS.

Conclusions

PFS in our real-world cohort was similar to the KEYNOTE-048 reference while OS was numerically inferior. A deeper understanding of clinical variables that might affect survival outcomes of patients with R/M HNSCC beyond ECOG PS and PD-L1 CPS is urgently needed.
Social vulnerability and cardiovascular risk factors in adolescents
Authors: de Farias Viviane Freire , Soares Larissa Almenara , Aranha Luciana Nicolau , Luiz Ronir Raggio , de Oliveira Gláucia Maria Moraes , Rosa Glorimar
Published: April 2024

Background

Social vulnerability can influence in the development of cardiovascular risk factors in adolescents (CRF). For this reason, the objective of our study was to evaluate the presence of CRF in adolescents, according to social vulnerability.

Methods

This is a cross-sectional study with 517 adolescents of both sexes, from 10 to 19 years of age, classified into 2 groups by social vulnerability, according to socioeconomic characteristics collected by means of questionnaires, where adolescents who did not have access to drinking water, sewage network, and adequate per capita income were classified as vulnerable. Anthropometric, biochemical, and blood pressure data were evaluated. Level of physical activity was assessed by an adapted questionnaire, and food intake was assessed by a 3-day food record. Independent T, Mann-Whitney, and χ2 tests were used, according to the scale of measurement of the variables, on the statistical program SPSS, version 25, at a significance level of 5%.

Results

Adolescents had median age of 14 (11 to 15) years; 58.4% were female; 32.4% were overweight, and 52.4% were physically inactive in leisure. Mean consumption of ultra-processed food was observed to account for 45.0% of calorie intake. Adolescents classified as vulnerable had lower weight, body mass index, waist circumference, hip circumference, and neck circumference when compared to non-vulnerable adolescents. Both groups had cholesterol concentrations above the normal level. Non-vulnerable adolescents had higher triglyceride concentrations, higher alcohol consumption, and lower fiber intake compared to vulnerable adolescents.

Conclusions

Adolescents with social vulnerability are less likely to have cardiovascular risk factors.
Trends in prevalence of hearing loss in adults in the USA 1999–2018: a cross-sectional study
Authors: Mo Fengxin , Zhu Shiheng , Jia Hanlu , Xia Yuan , Lang Li , Zheng Qiutong , Yuan Xiaojing , Wu Shan , Bai Yan , Yang Wenhan , Wang Liang , Chen Qingsong
Published: April 2024

Background

A better understanding of how the prevalence of hearing loss and its associated factors change over time could help in developing an appropriate program to prevent the development of hearing loss.

Methods

Population-representative cross-sectional data from the United States National Health and Nutrition Examination Survey (NHANES) were used to estimate the trends in the prevalence of hearing loss among adults in the USA over the period 1999–2018. A total of 15,498 adult participants aged 20 years or older had complete audiometric examination data. Logistic regression was employed to evaluate the trend in hearing loss; weighted Rao-Scott χ2 tests and univariate logistic regression analyses were used to examine the association between hearing loss and relevant factors.

Results

The overall hearing loss prevalence in 1999–2018 was 19.1% 19.1 (95% CI, 18.0–20.2%). The prevalence of hearing loss decreased in cycles (P for trend < 0.001). For participants aged 20–69 years, the prevalence decreased from 15.6% (95% CI, 12.9–18.4%) in 1999–2000 to 14.9% (95% CI, 13.2– 16.6%) in 2015–2016; for participants aged > 70 years the prevalence decreased from 79.9% (95% CI, 76.1–83.8%) in 2005–2006 to 64.5% (95% CI, 58.8–70.2%) in 2017–2018. Participants with hearing loss were likely to be older, male, non-Hispanic white, and to have not completed high school. Mild hearing loss was more prevalent among those aged 20–79 years; in those aged over 80 years the prevalence of moderate hearing loss exceeded that of mild loss. Among all otologically normal participants, hearing thresholds increased with age across the entire frequency range.

Conclusions

The prevalence of hearing loss in USA adults changed over the period 1999–2018. The trends observed provide valuable insight for making public health plans and allocating resources to hearing care. Further investigation is necessary to monitor hearing loss and its potential risk factors.
Incidence of sick leave and disability pension in adults with musculoskeletal pain and co-occurring long-term conditions: data from the Norwegian HUNT study and national registries
Authors: Marcuzzi Anna , Mork Paul Jarle , Aasdahl Lene , Skarpsno Eivind , Moe Karoline , Nilsen Tom Ivar Lund
Published: April 2024

Background

Musculoskeletal pain is one of the leading causes of work productivity loss. Long-term conditions (LTCs) commonly occur alongside musculoskeletal pain. However, the incidence of sick leave and disability pension according to LTC status in people with musculoskeletal pain has not been previously described.

Methods

Working-age participants (20–65 years) with persistent musculoskeletal pain who participated in the HUNT3 Study (1995–97) were included. Twenty-five LTCs were classified into 8 LTC groups according to the International Classification of Diseases version 11. Data on sickness and disability benefits were obtained from the National Insurance Database and linked to the HUNT3 data using participants’ personal identification number. Age-adjusted incidence rates (IRs) (per 10,000 person-years) and hazard ratios (HRs) of sick leave during 5-year follow-up and disability pension during ~ 25-year follow-up were estimated with 95% confidence intervals (CIs) and presented according to LTC status.

Results

Overall, 11,080 participants with musculoskeletal pain were included. Of those, 32% reported one LTC and 45% reported ≥ 2 LTCs. During the follow up period, 1,312 participants (12%) received disability pension due to musculoskeletal conditions. The IR of sick leave and disability pension due to musculoskeletal conditions increased with number of LTCs. Specifically, the IR of sick leave was 720 (95% CI 672 to 768) in participants without any LTCs and 968 (95% CI 927 to 1,009) if they had ≥ 2 LTCs. The IRs of disability pension were 87 (95% CI 75 to 98) and 167 (95% CI 154 to 179) among those with no LTCs and ≥ 2 LTCs, respectively. The incidence of sick leave and disability pension due to musculoskeletal conditions was largely similar across LTCs, although the incidence of disability pension was somewhat higher among people with sleep disorders (IR: 223, 95% CI 194 to 252).

Conclusions

Among people with persistent musculoskeletal pain, the incidence of prematurely leaving the work force due to musculoskeletal conditions was twice as high for those with multiple LTCs compared to those without any LTCs. This was largely irrespective of the type of LTC, indicating that the number of LTCs are an important feature when evaluating work participation among people with musculoskeletal pain.
Development of interprofessional education programmes in nursing care and oral healthcare for dental and nursing students
Authors: Haresaku Satoru , Naito Toru , Aoki Hisae , Miyoshi Maki , Monji Mayumi , Umezaki Yojiro , Miyazono Mami , Egashira Rui , Chishaki Akiko
Published: April 2024

Background

Interprofessional education (IPE) is essential for healthcare students to collaborate effectively in multidisciplinary teams. This study aimed to identify the effect of IPE programmes in nursing care and oral healthcare on dental and nursing students’ perceptions of interprofessional collaboration.

Methods

The study included 101 third-year dental and 98 fourth-year nursing students. The participants were divided into mixed-professional groups of four (2 dental and 2 nursing students). They participated in nursing care and oral healthcare training programmes that included student-on-student training and discussion groups. Questionnaires regarding perceptions of interprofessional collaboration were distributed to the participants before and after the programmes to compare the programmes before and after and between the dental and nursing students. The Wilcoxon signed-rank test and chi-square test were used to compare the data.

Results

Data from 79 dental students (42 males and 37 females) and 89 nursing students (4 males and 85 females) who completed both questionnaires were used for the comparisons. Perceptions of the differences between the approaches of different health professionals to nursing care, the roles of other professionals, and the need for multiprofessional collaboration improved significantly among both dental and nursing students after the programmes. Although the perception of their ability to communicate with unfamiliar or new people improved significantly only among the nursing students, other perceptions of their ability to communicate did not improve for either group. More dental students than nursing students chose nursing trainings as good programmes to participate in with other professional students, while more nursing students than dental students chose oral care trainings as good programmes. Many students commented that they learned about nursing and oral healthcare skills as well as the importance of teamwork and communication with other professionals. Seven students commented that they were more motivated to become dentists and nurses.

Conclusions

This study showed that IPE programmes for nursing care and oral healthcare might be effective at helping students understand other professionals and promoting multiprofessional collaboration. However, further studies are needed to develop IPE programmes to improve attitudes and abilities related to interprofessional communication skills.
A qualitative study to explore experiences of anti-racism teaching in medical residency programs across the United States and subsequent creation of the SPOC (Support - Pipeline - Outcomes - Community) Model to guide future curricula design
Authors: Gertz Alida M. , Smith Michele , Thomas Davon , Ti Angeline , Vamos Cheryl , Bohn Joe
Published: April 2024

Background

Racism contributes to health disparities and is a serious threat to public health. Teaching physicians about racism, how to address it in medical practice, and developing high quality and sustainable curricula are essential to combating racism.

Objective

This study aimed to (1) describe the experience of racism and anti-racism teaching in residency programs, and elicit recommendations from key informants, and (2) use these data and formative research to develop recommendations for other residencies creating, implementing, and evaluating anti-racism curricula in their own programs.

Methods

From May to July 2023, 20 faculty and residents were recruited via convenience sampling for key informant interviews conducted via Microsoft Teams. Interviews were audio recorded, transcribed, and coded. An initial list of themes was developed using theoretical frameworks, and then refined using a grounded-theory approach. A brief online optional anonymous demographic survey was sent to participants in August of 2023. 

Results

Eighty percent (20/25) of participants approached were interviewed. Seventy-five percent (15/20) answered a brief optional demographic survey. Seven themes emerged: (1) Racism in medicine is ubiquitous; (2) Anti-racism teaching in medicine varies widely; (3) Sustainability strategies should be multifaceted and include recruitment, resource allocation, and outcome measures; (4) Resources are widely available and accessible if one knows where to look; (5) Outcomes and metrics of success should include resident- faculty-, patient- community-, and system-focused outcomes; (6) Curricular strategies should be multilayered, longitudinal, and woven into the curriculum; and (7) Self-reflection and discomfort are necessary parts of the process. 

Conclusions

This study is one of the first to qualitatively examine perspectives of key stakeholders invested in anti-racism teaching for residents. The Support - Pipeline - Outcomes - Community (SPOC) Model, that was developed using information collected during this study, can be used in the future as a guide for others working to design and implement sustainable and high quality anti-racism curricula for residents.
Bridging the gap: understanding Belgian anesthesiologists’ proficiency and training demands in gastric point-of-care ultrasound, a case-based survey
Authors: Maseri Adrien , Delhez Quentin , Dincq Anne-Sophie , Lacrosse Dominique
Published: April 2024

Background

Pulmonary aspiration syndrome remains a significant complication of general anesthesia, particularly in unfasted patients. Gastric point-of-care ultrasound (POCUS) allows for both qualitative and quantitative assessment of gastric content, providing a safe and reliable method to assess gastric emptying and reduce the risk of aspiration during general anesthesia.

Methods

The survey was distributed to Belgian certified anesthesiologists and trainees between April 2020 and June 2021. Participants received a simulated clinical case of a patient at risk of gastric aspiration, created and approved by two certified anesthesiologists trained to perform gastric POCUS. The objectives of this study were to assess recognition of high-risk clinical situations for gastric aspiration, awareness of the gastric POCUS and its indications, and knowledge of the technical and practical conditions of the procedure among respondents trained in the technique. Furthermore, the study assessed the state of training in gastric POCUS, the desire for education, and the practical availability of ultrasound equipment. The survey used conditional branching to ensure unbiased responses to POCUS-related questions. It included multiple-choice questions, quantitative variables, and 5-point Likert scales. The margin of error was calculated using Daniel’s formula, corrected for a finite population.

Results

The survey was conducted among 323 anesthesiologists. Only 20.8% (27) recognized the risk of a full stomach based on the patient’s history. Anesthesiologists who recognized the indication for gastric POCUS and were trained in the procedure demonstrated good recall of the practical conditions for performing the procedure and interpreting the results. Only 13.08% (31) of all respondents had received training in gastric POCUS, while 72.57% (172) expressed interest in future training. Furthermore, 80.17% (190) of participants had access to adequate ultrasound equipment and 78.90% (187) supported teaching gastric POCUS to anesthesia trainees.

Conclusions

This survey offers insight into the epidemiology, clinical recognition, knowledge, and utilization of gastric POCUS among Belgian anesthesia professionals. The results emphasize the significance of proper equipment and training to ensure the safe and effective implementation of gastric POCUS in anesthesia practice. Additional efforts should focus on improving training and promoting the integration of gastric POCUS into daily clinical practice.