bluuebunny/crossref_metadata_2025 huggingface dataset:
Study on stiffness matching strategy of longitudinal sleeper and fastener to reduce tunnel wall vibration
Authors: He Kuang , He Yuanpeng , Yao Yuyang , Han Jian , Xiao Xinbiao , Chi Maoru
Published: February 2024

With the increase of the running time of the subway system, long-term use will lead to the reduction of damping, the change of the operating state of the wheels and the track, and the effect of vibration damping measures will gradually weaken. In order to maintain a low level of environmental vibration in vibration sensitive areas, the reconstruction of some existing lines with high level vibration is imminent. In order to solve this problem, this paper focuses on the reconstruction of the existing line of longitudinal sleeper track, which is commonly used in the middle and high level vibration reduction measure in the subway. Because of the high cost of reconstruction of the slab and its lower part, this paper tries to realize the reconstruction of the existing longitudinal sleeper track by changing the fastener system. In this paper, the environmental vibration prediction model of longitudinal sleeper track is established by using the theory of infinite long period structure and the 2.5-dimensional finite element and boundary element (2.5D FE-BE) environmental vibration prediction model. The validity of the numerical model is determined by comparing the field experiment with the numerical simulation. On the basis of the above, the stiffness matching of longitudinal sleeper and fastener is explored by using the verified numerical model. The reasons for the poor vibration reduction effect of the existing longitudinal sleeper matching floating rail fastener (low stiffness) are analyzed. And the matching strategy of the supporting stiffness for vibration reduction of longitudinal sleeper and fastener are summarized.
Closing medical encounters in China’s Mainland: Doctors’ fishing for patient-initiated terminal exchanges
Authors: Yang Zi , Cheng Fei
Published: February 2024

Drawing on conversation analysis, this paper explores how medical encounters are closed in China’s mainland. Based on a collection of 75 naturally occurring cases, we observe two dominant conversational practices oriented to closing Chinese medical encounters: a stand-alone ‘okay?’ as a generic preclosing initiation, and a gratitude-expressing action as the initiation of the closing sequence. Through a further examination of salient closing patterns in our data, we propose that Chinese doctors prefer fishing for patients’ initiation of the terminal exchange to closing the medical interaction by themselves. The ways of and reasons for eliciting a patient-initiated closure are also discussed. This study may provide a frame of reference for studying medical closures in other cultures and have implications for cross-cultural comparison.
Influence of applied stress on shape memory characteristics of Ni50Ti45Cu5 (at.%) alloy subjected to thermomechanical cycling
Authors: Ganesan Swaminathan , Vedamanickam Sampath , Huchappa Adarsh Sorekunte
Published: February 2024

Shape memory alloys have made rapid progress in many domains, primarily biomedical (endovascular stents, orthodontic archwires), and engineering (smart actuators, robotics, hydraulic couplings). The selection of a shape memory alloy for the indented application is based on its characteristic phase transformation temperatures. These characteristic temperatures are influenced by myriad parameters, such as composition, microstructure of the alloy, defect density, etc. When an shape memory alloy under an external load is subjected to cyclic operations to perform useful work, for example, actuators, these characteristic temperatures are modified. This study, therefore, aims to understand the influence of external loading on the shape memory characteristics of a Ni50Ti45Cu5 (at.%) alloy. A wire of 1.43 mm diameter and length of 100 mm was subjected to heating and cooling between its phase transformation temperatures in a cyclic manner under constant stress (of up to 60 MPa). The maximum recovery strain, actuation/retraction rate, and the stress influence coefficient were determined and compared with those of the other Ni-Ti and Cu-based shape memory alloys. The results show that raising the load level causes an increase in the transition temperatures, especially the Ms (martensite start temperature) rather than the other phase transformation temperatures (martensite finish (Mf), austenite start (As), austenite finish (Af)). It also significantly affects the recovery strain and the rate of retraction during forward transformation and the symmetry of operation.
An ethnography of mealtime care for people living with dementia in care homes
Authors: Faraday James , Abley Clare , Patterson Joanne M , Exley Catherine
Published: February 2024

Many people living with dementia have difficulties at mealtimes, which can result in serious complications for physical and mental health, leading to hospital admissions and even death. However, current training in mealtime care for staff working with this population has been found to be poorly reported, with variable effectiveness. It is essential that care home staff are able to provide good care at mealtimes. This study used ethnography to explore current practice in mealtime care for this population, identify good practice, and understand the factors influencing mealtime care. Approximately 28 h of mealtime observations were conducted in two UK care homes with diverse characteristics. Observations focused on interactions between care staff and residents living with dementia. Twenty-five semi-structured interviews were carried out with care home staff, family carers, and visiting health and social care professionals, to explore mealtime care from their perspectives. A constant comparative approach was taken, to probe emergent findings and explore topics in greater depth. Key thematic categories were identified, including: tensions in mealtime care; the symbolic nature of mealtime care; navigating tensions via a person-centred approach; contextual constraints on mealtime care; and teamwork in mealtime care. The findings indicated that a person-centred approach helps carers to find the right balance between apparently competing priorities, and teamwork is instrumental in overcoming contextual constraints. This evidence has contributed to development of a training intervention for care home staff. Future research should investigate the feasibility of mealtime care training in care homes.
Physician-led thoracic ultrasound-guided biopsy; a district general hospital perspective
Authors: Cafferkey M.J. , Martin G.A.
Published: February 2024

Background:

Physician-led thoracic ultrasound (TUS)-guided biopsies provide a prompt route to tissue diagnosis in pleural and peripheral lung malignancies. This retrospective study reviews the diagnostic performance and safety of this approach in a UK District General Hospital.

Methods:

Time to biopsy, diagnostic yield and complication rate were analysed in a cohort of 49 patients undergoing ultrasound-guided tissue sampling between September 2019 and December 2022.

Results:

Fifty-one TUS-guided biopsies were attempted. Mean time from decision to biopsy was 5 days. The overall diagnostic yield was 82%. Complication rate was low; 3 minor adverse effects were reported which led to no change in routine care.

Conclusion:

This single centre retrospective study shows that physician-led TUS-guided biopsy provides a safe and timely method of obtaining a tissue diagnosis in thoracic malignancy. It offers an alternative to computer tomography (CT)-guided or thoracoscopic biopsies and should be considered in selected patients where local procedural expertise exists.
STABILISE (Stent-Assisted Balloon-Induced Intimal Disruption and Relamination in Aortic Dissection Repair) Is Associated With Good Anatomical Results on the Distal Thoracoabdominal Aorta at 2 Years
Authors: Maurin Arnaud , Jacquier Alexis , Bartoli Axel , Barral Pierre-Antoine , Vecchini Fabien , Mancini Julien , Omnes Virgile , DeMasi Mariangela , Piquet Philippe , Gaudry Marine
Published: February 2024

Purpose:

The aim of this comparative study was to evaluate the increased aortic diameter of the distal aorta after implementing the STABILISE technique in complicated type B aortic dissection (AD).

Design:

This is a comparative monocentric retrospective study.

Materials and Methods:

All patients who underwent an STABILISE procedure for complicated AD between 2018 and 2020 were included and compared with a historic cohort treated with thoracic endovascular aortic repair (TEVAR) alone. Aortic diameters were measured at 6 different levels on the thoracic and abdominal aorta. The primary end point was an increased aortic diameter at 1 and 2 years. The exclusion criterion was the absence of a computed tomography (CT) scan at 1 or 2 years.

Results:

A total of 55 patients were included: 24 in the TEVAR group and 31 in the STABILISE group. At the level of the stent graft, there was a decrease in aortic diameters in both groups without significant differences. At the level of the distal aorta, there was an increase in aortic diameters in both groups without significant differences. There were significantly more patients in the TEVAR group with an unfavorable increase in aortic diameter >5 mm of the distal aorta at 2 years than in the STABILISE group: 8 (33%) vs 1 (3%) (p=0.01). For chronic ADs, a significantly greater increase in aortic diameters of the distal aorta was observed in the STABILISE group.

Conclusions:

The STABILISE technique is technically feasible and potentially leads to decreased longer re-intervention rates; indeed, more patients had an unfavorable increase in aortic diameter in the TEVAR group than in the STABILISE group at 2 years. The high rate of long-term distal aortic aneurysm progression and reintervention after TEVAR alone suggests that this option is not sufficient to definitively treat these complex patients.

Clinical Impact

This article reported the results of stent assisted balloon induced intimal disruption and relamination (STABILISE) with a follow-up at 2 years. This is the first comparative study between STABILISE, which has emerged as a new technique inducing aortic remodeling and therefore better long-term outcome, and the standard technique TEVAR alone. STABILISE technique is associated with good results on the distal aorta at 2 years with a rate of patient with unfavorable aortic diameter evolution greater in TEVAR group compared to STABILISE group and could improve the long-term results on the distal aorta by inducing extensive aortic remodeling.
TH17 cell: a double-edged sword in the development of inflammatory bowel disease
Authors: Wen Yue , Wang Han , Tian Dean , Wang Ge
Published: February 2024

Inflammatory bowel disease (IBD) is a chronic nonspecific inflammatory disease of the gastrointestinal tract, and its pathogenesis has not been fully understood. Extensive dysregulation of the intestinal mucosal immune system is critical in the development and progression of IBD. T helper (Th) 17 cells have the characteristics of plasticity. They can transdifferentiate into subpopulations with different functions in response to different factors in the surrounding environment, thus taking on different roles in regulating the intestinal immune responses. In this review, we will focus on the plasticity of Th17 cells as well as the function of Th17 cells and their related cytokines in IBD. We will summarize their pathogenic and protective roles in IBD under different conditions, respectively, hoping to further deepen the understanding of the pathological mechanisms underlying IBD and provide insights for future treatment.
Drug safety in older patients with alcohol use disorder: a retrospective cohort study
Authors: Schröder Sebastian , Westhoff Martin Schulze , Pfister Tabea , Seifert Johanna , Bleich Stefan , Koop Felix , Proskynitopoulos Phileas Johannes , Glahn Alexander , Heck Johannes
Published: February 2024

Background:

Older patients with alcohol use disorder are at particular risk of developing adverse drug reactions due to multimorbidity, polypharmacy, and altered organ function.

Objectives:

In this study, we investigated the frequency and characteristics of potentially serious alcohol–medication interactions, potentially inappropriate medications (PIMs) for older adults, and potential drug–drug interactions (pDDIs) in a population of older patients with alcohol use disorder over a 10-year period.

Design:

Retrospective monocentric cohort study.

Methods:

Prescribed medications were screened for potentially serious alcohol–medication interactions, PIMs, and pDDIs using the POSAMINO (POtentially Serious Alcohol–Medication INteractions in Older adults) criteria, the PRISCUS 2.0 list, the FORTA (Fit fOR The Aged) classification, and the drug interaction program AiD Klinik®.

Results:

We enrolled 114 patients aged ⩾65 years with alcohol use disorder, who were treated in an addiction unit of a university hospital in Germany. About 80.7% of the study population had at least one potentially serious alcohol–medication interaction. Potentially serious alcohol–medication interactions most commonly affected the cardiovascular (57.7%) and the central nervous system (32.3%). A total of 71.1% of the study population received at least one prescription of a FORTA C or D drug, compared with 42.1% who received at least one PIM prescription according to the PRISCUS 2.0 list. A total of 113 moderate and 72 severe pDDIs were identified in the study population.

Conclusion:

Older patients with alcohol use disorders are frequently exposed to potentially serious alcohol–medication interactions, PIMs, and pDDIs. Improvements in the quality of prescribing should primarily target the use of cardiovascular and psychotropic drugs.
A case report of QTc prolongation: Drug induced or myocarditis in Severe Acute Respiratory Syndrome Coronavirus 2
Authors: Gholipour Mahboobeh , Samidoost Pirooz , Moayerifar Mani , Ghasemzadeh Golshan
Published: February 2024

Remdesivir is a nucleotide prodrug of an adenosine analog. It binds to the viral Ribonucleic Acid (RNA)-dependent RNA polymerase and inhibits viral replication by terminating RNA transcription prematurely. Remdesivir has demonstrated in vitro and in vivo activity against Severe Acute Respiratory Syndrome Coronavirus 2; it also acts in vitro neutralization activity against the Omicron variant and its subvariants. We reported a 54-years-old woman admitted with Coronavirus disease 2019. Considering to require a high fraction of inspired oxygen therapy (⩾0.6) and based on lung high resolution computed tomography, Remdesivir therapy was ordered for 5 days. She experienced palpitations and dizziness 2 days after starting Remdesivir therapy. Her QTc interval was prolonged on the electrocardiogram without any significant electrolyte abnormalities or concomitant use of medications. Although the cardiac side effects of Remdesivir therapy have been well documented, in a few cases reported the association between Remdesivir therapy and QTc interval prolongation. Since, QTc interval prolongation has the potential risk of sudden cardiac death, the clinicians should be aware of mentioned association and check electrocardiogram daily, as well as other laboratory exams.
Health-promoting behaviours and psychological distress in breast cancer with endocrine therapy: Mediating roles of menopausal symptoms and social support
Authors: Li Xia , Wei Tingting , Zhang Yan , Ren Hailing , Liu Xinyu
Published: February 2024

Objective

To investigate the relationship between health-promotion behaviour and psychological distress and whether menopausal symptoms and social support mediate these relationships in patients with breast cancer receiving endocrine therapy.

Study design

This was a cross-sectional study involving convenience sampling that involved 226 patients with breast cancer.

Main outcome measures

Participants were investigated by self-reporting questionnaires that included demographic and clinical information, the Kessler psychological distress scale, the Health-Promoting Lifestyle Profile Ⅱ, the Menopause Rating Scale, and the Perceived Social Support Survey to measure psychological distress, health-promoting behaviour, menopausal symptoms, and social support, respectively. Mediation analyses were conducted with the bootstrapping method to test for mediating factors.

Results

In total, 78.7% patients reported that they were suffering from psychological distress. Their health-promoting behaviours were directly and negatively associated with psychological distress. In addition, health-promoting behaviour had a significant indirect effect on psychological distress through menopausal symptoms and social support. Mediating effects accounted for 34.8% and 27.6% of the total effect, respectively.

Conclusions

There was a high prevalence of psychological distress in patients with breast cancer receiving endocrine therapy. Menopausal symptoms and social support mediated the association between health-promoting behaviour and psychological distress. Health professionals should evaluate menopausal symptoms and health lifestyles, and provide professional interventions to increase health-promoting behaviours and manage unpleasant somatic symptoms for patients and their caregivers; these actions may improve their psychological distress.
Super SDKs: Tracking personal data and platform monopolies in the mobile
Authors: Pybus Jennifer , Coté Mark
Published: February 2024

In this article we address the question ‘what is tracking in the mobile ecosystem’ through a comprehensive overview of the Software Development Kit (SDK). Our research reveals a complex infrastructural role for these technical objects connecting end-user data with app developers, third parties and dominant advertising platforms like Google and Facebook. We present an innovative theoretical framework which we call a data monadology to foreground this interrelationship, predicated on an economic model that exchanges personal data for the infrastructural services used to build applications. Our main contribution is an SDK taxonomy, which renders them more transparent and observable. We categorise SDK services into three main categories: (i) Programmatic AdTech for monetisation; (ii) App Development, for building, maintaining and offering additional artificial intelligence features and (iii) App Extensions which more visibly embed third parties into apps like maps, wallets or other payment services. A major finding of our analysis is the special category of the Super SDK, reserved for platforms like Google and Facebook. Not only do they offer a vast array of services across all three categories, making them indispensable to developers, they are super conduits for personal data and the primary technical means for the expansion of platform monopolisation across the mobile ecosystem.
Contralateral Thoracotomy With Extracorporeal Circulation for Reoperative Resection of a Kommerell Diverticulum
Authors: Bartoli Carlo R. , Rajakumar Clement J. , Elmore James R. , Ziemer Gerhard
Published: February 2024

Reoperative vascular ring surgery is uncommon. Standard redo ipsilateral thoracotomy may present technical challenges and risks. We describe a patient with right aortic arch, aberrant left subclavian artery, and a Kommerell diverticulum in whom previous vascular ring division via left thoracotomy did not relieve dysphagia. Three years after the unsuccessful operation, left subclavian–carotid transposition via supraclavicular incision followed by resection of the Kommerell diverticulum via right thoracotomy with extracorporeal circulation relieved symptoms. Contralateral thoracotomy with extracorporeal circulation provides a safe, alternative approach to redo ipsilateral thoracotomy for resection of a symptomatic Kommerell diverticulum. We review the literature on the incidence, surgical indications, and operative approaches to manage symptoms from a Kommerell diverticulum.
Reliability of Vertebral Pelvic Angles in Assessment of Spinal Alignment
Authors: Nakarai Hiroyuki , Simon Chad Z. , Adida Samuel , Samuel Justin , Araghi Kasra , Kim Han Jo , Lovecchio Francis C.
Published: February 2024

Study Design

Reliability analysis.

Objectives

Vertebral pelvic angles (VPA) are gaining popularity given their ability to describe the shape of the spine. Understanding the reliability and minimal detectable change (MDC) is necessary to determine how these measurement tools should be used in the manual assessment of spine radiographs. Our aim is to assess intra- and interobserver intraclass correlation coefficients (ICC) and the MDC in the use of VPA for assessing alignment in adult spinal deformity (ASD).

Methods

Three independent examiners blindly measured T1, T4, T9, L1, and L4PA twice in ASD patients with a 4-week window after the initial measurements. Patients who had undergone hip or shoulder arthroplasty, fused or transitional vertebrae, or whose hip joints were not visible on radiographs were excluded. Power analysis calculated a minimum sample size of 19. Both intra- and interobserver ICC and MDC, which denotes the smallest detectable change in a true value with 95% confidence, were calculated.

Results

Out of the 193 patients, 39 were ultimately included in the study, and 390 measurements were performed by 3 raters. Intraobserver ICC values ranged from .90 to .99. The interobserver ICC was .97, .97, .96, .95, and .92, and the MDC was 5.3°, 5.1°, 4.8°, 4.9°, and 4.1° for T1, T4, T9, L1, and L4PA, respectively.

Conclusion

All VPAs showed excellent intra- and interobserver reliability, however, the MDC is relatively high compared to typical ranges for VPA values. Therefore, surgeons must be aware that substantial alignment changes may not be detected by a single VPA.
Concussion Rates in Youth Lacrosse Players and Comparison With Youth American Football
Authors: Macknofsky Brandon , Fomunung Clyde K. , Brown Shimron , Baran Jessica V. , Lavin Alessia C. , Sabesan Vani
Published: February 2024

Background:

There has been little focus on concussions in youth lacrosse players in the United States.

Purpose:

To provide a descriptive analysis of the epidemiology and incidence of concussions in youth lacrosse and compare the results with well-documented analyses of concussions in youth American football.

Study Design:

Descriptive epidemiology study.

Methods:

Data on concussions in pediatric patients playing lacrosse from 2006 to 2019 were collected using the National Electronic Injury Surveillance System (NEISS). Weighted calculations and combined participation data obtained from membership in USA Lacrosse were used to estimate injury incidence. A comparison dataset was created using the NEISS data on youth football-related concussions. The cause of concussion was categorized into player-to-player, player-to-stick, player-to-ball, or player-to-ground contact.

Results:

A total of 37,974 concussion injuries related to lacrosse were identified in players with a mean age of 14.5 ± 3.5 years; 70% of concussions occurred in boys. National participation in lacrosse increased from 2006 to 2011 by a mean of 10.3% annually, followed by a lower annual growth rate of 2.5% from 2012 to 2019. The overall incidence of concussion injuries increased over the study period ( r = 0.314), with the incidence rate in boys being greater than that of girls from 2009 to 2013. The most common cause of concussion was player-to-ground contact for boys and player-to-ball or player-to-stick contact for girls. The mean annual concussion incidences in youth lacrosse and youth football were 443 and 355 per 100,000 participants, respectively.

Conclusion:

Over the study period, 16% of lacrosse injuries were diagnosed as concussions, a higher mean annual incidence per 100,000 participants than that of youth football (443 vs 355). The cause of concussion was different based on sex, with higher rates of player-to-ball or player-to-stick contact in female players versus player-to-ground contact in male players.
European stroke organisation (ESO) guideline on cerebral small vessel disease, part 2, lacunar ischaemic stroke
Authors: Wardlaw Joanna M , Chabriat Hugues , de Leeuw Frank-Erik , Debette Stéphanie , Dichgans Martin , Doubal Fergus , Jokinen Hanna , Katsanos Aristeidis H , Ornello Raffaele , Pantoni Leonardo , Pasi Marco , Pavlovic Aleksandra M , Rudilosso Salvatore , Schmidt Reinhold , Staals Julie , Taylor-Rowan Martin , Hussain Salman , Lindgren Arne G
Published: February 2024

A quarter of ischaemic strokes are lacunar subtype, typically neurologically mild, usually resulting from intrinsic cerebral small vessel pathology, with risk factor profiles and outcome rates differing from other stroke subtypes. This European Stroke Organisation (ESO) guideline provides evidence-based recommendations to assist with clinical decisions about management of lacunar ischaemic stroke to prevent adverse clinical outcomes. The guideline was developed according to ESO standard operating procedures and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. We addressed acute treatment (including progressive lacunar stroke) and secondary prevention in lacunar ischaemic stroke, and prioritised the interventions of thrombolysis, antiplatelet drugs, blood pressure lowering, lipid lowering, lifestyle, and other interventions and their potential effects on the clinical outcomes recurrent stroke, dependency, major adverse cardiovascular events, death, cognitive decline, mobility, gait, or mood disorders. We systematically reviewed the literature, assessed the evidence and where feasible formulated evidence-based recommendations, and expert concensus statements. We found little direct evidence, mostly of low quality. We recommend that patients with suspected acute lacunar ischaemic stroke receive intravenous alteplase, antiplatelet drugs and avoid blood pressure lowering according to current acute ischaemic stroke guidelines. For secondary prevention, we recommend single antiplatelet treatment long-term, blood pressure control, and lipid lowering according to current guidelines. We recommend smoking cessation, regular exercise, other healthy lifestyle modifications, and avoid obesity for general health benefits. We cannot make any recommendation concerning progressive stroke or other drugs. Large randomised controlled trials with clinically important endpoints, including cognitive endpoints, are a priority for lacunar ischaemic stroke.
A content analysis of YouTube videos on palliative care: understanding the quality and availability of online resources
Authors: Almobarak Fhaied
Published: February 2024

Background:

Improvement in quality care is an important aspect of palliative care for individuals with serious illnesses. Palliative care is a multidisciplinary strategy that addresses the physical, emotional, social, and spiritual needs of patients and their families. As technology advances, digital media – especially YouTube – has come to serve as a virtual educational platform, offering resources for health-related information, including information about palliative care.

Objectives:

In this research, the main goal was to evaluate the quality and availability of online resources related to palliative care.

Design:

Two theoretical frameworks were used: the Health Communication Model and the Information Quality Framework. These frameworks offer a way to understand how YouTube videos contribute to palliative care information and assess the quality of that information.

Methods:

This study utilizes a quantitative analysis approach to assess the quality and accessibility of YouTube videos on palliative care. Specifically, a random sample of 300 YouTube videos addressing palliative care was examined. Descriptive statistics were used to analyze the data, including the frequency and distribution of the different types of content, sources, and quality indicators. Chi-square tests were done to compare the quality of information provided by different sources and types of content.

Results:

The results showed a variety of video types, with educational videos being the most common (40%), followed by personal stories (26.7%) and promotional videos (16.7%). We found that healthcare organizations (30%) and individual content creators (46.7%) were the sources for these videos.

Conclusion:

There were varying scores in terms of accuracy, completeness, and relevance when it came to quality assessment. While many videos received excellent ratings, some received poor ratings. Additionally, this analysis revealed that the majority of these videos were in English (83.3%), which poses a limitation for non-English speakers who may have difficulty understanding them.
From climate conflicts to environmental peacebuilding: Exploring local dimensions
Authors: Sändig Jan , Dalmer Natalia , Ide Tobias , Vogler Anselm
Published: February 2024

Environmental change and armed conflict are major challenges of the 21st century. Meanwhile, scholars and practitioners increasingly recognize the environment and natural resources as not only sources of conflict and violence but also as potential means for peacebuilding. While research on both fronts is rapidly progressing, the literature on the climate–conflict nexus and environmental peacebuilding has remained disconnected, although climate conflicts will (and already) require peacebuilding efforts. We address this gap by identifying overlaps that open opportunities for an integrated research agenda. Particularly, we call for a deeper exploration of the local dimensions of climate-related conflicts and environmental peacebuilding. Local actors, knowledge, networks, and identities shape peacebuilding outcomes and are key in building climate-resilient peace. However, romanticizing the local sphere might also mask significant inequalities, power differences, and ethical concerns.
Ultrasound-Enhancing Agent and IV Administration in Cardiac Sonography: How Sonographers Play a Key Role in Positively Affecting Key Performance Indicators
Authors: Kallstrom Eric
Published: February 2024

As the health system in the United States continuously searches for ways to reduce costs and improve the health care experience, cardiac sonographers are uniquely positioned to add to this initiative. Tasked with providing high-quality imaging studies in outpatient and inpatient areas, the scope of practice for sonographers continues to evolve. To ensure quality imaging, ultrasound-enhancing agents (UEAs) are needed in patients with suboptimal images to improve delineation of left ventricular endocardial borders. This process involves intravenous (IV) access and occurs in both patients in ambulatory clinics and hospitals. Historically, health care professionals delegated to perform these duties have been nursing, radiology, and nuclear medicine staff. Because these professionals have their own job responsibilities, the potential to complete a transthoracic echocardiogram (TTE) with UEA, in a timely fashion, may be compromised. Expanding the practice of cardiac sonographers to include these duties should be supported to facilitate uninterrupted patient care, efficiency, and stakeholder satisfaction.
Coordinated nasal mucosa-mediated immunity accelerates recovery from COVID-19
Authors: Cass Steven P. , Nicolau Dan V. , Baker Jonathan R. , Mwasuku Christine , Ramakrishnan Sanjay , Mahdi Mahdi , Barnes Peter J. , Donnelly Louise E. , Martinez-Nunez Rocio T. , Russell Richard E.K. , Bafadhel Mona
Published: February 2024

Introduction

Understanding the interplay of immune mediators in relation to clinical outcomes during acute infection has the potential to highlight immune networks critical to symptom recovery. The objective of the present study was to elucidate the immune networks critical to early symptom resolution following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Methods

In a community-based randomised clinical trial comparing inhaled budesonide against usual care in 139 participants with early onset SARS-CoV-2 (the STOIC study;clinicaltrials.govidentifierNCT04416399), significant clinical deterioration (reported need for urgent care, emergency department visit, hospitalisation: the primary outcome), self-reported symptom severity (Influenza Patient-Reported Outcome questionnaire) and immune mediator networks were assessed. Immune mediator networks were determined using pre-defined mathematical modelling of immune mediators, determined by the Meso Scale Discovery U-Plex platform, within the first 7 days of SARS-CoV-2 infection compared to 22 healthy controls.

Results

Interferon- and chemokine-dominant networks were associated with high viral burden. Elevated levels of the mucosal network (chemokine (C-C motif) ligand (CCL)13, CCL17, interleukin (IL)-33, IL-5, IL-4, CCL26, IL-2, IL-12 and granulocyte–macrophage colony-stimulating factor) was associated with a mean 3.7-day quicker recovery time, with no primary outcome events, irrespective of treatment arm. This mucosal network was associated with initial nasal and throat symptoms at day 0.

Conclusion

A nasal immune network is critical to accelerated recovery and improved patient outcomes in community-acquired viral infections. Overall, early prognostication and treatments aimed at inducing epithelial responses may prove clinically beneficial in enhancing early host response to virus.
Postdromal symptoms in migraine: a REFORM study
Authors: Thuraiaiyah Janu , Ashina Håkan , Christensen Rune Häckert , Al-Khazali Haidar M. , Ashina Messoud
Published: February 2024

Background

Migraine is a multiphasic neurovascular disorder, where headache can be succeeded by postdromal symptoms. However, there are limited research on postdromal symptoms. This study aimed to investigate the proportion of individuals with migraine from a tertiary care unit reporting postdromal symptoms in adherence with the ICHD-3 definition. We also aimed to examine how the means of enquiry might influence the estimated proportions. Additionally, we explored whether any clinical features might affect the likelihood of reporting postdromal symptoms. Finally, we assessed to what extend the postdromal symptoms might impact the disease burden.

Methods

In a cross-sectional study, we enrolled adult participants diagnosed with migraine who were asked to report their postdromal symptoms (i.e., unprompted reporting). Subsequently, a 16-item list was used to further ascertain the occurrence of postdromal symptoms (i.e., prompted reporting). Clinical characteristics were obtained through a semi-structured interview. Moreover, electronic questionnaires were used to assess the disease burden, i.e., the Six-Item Headache Impact Test (HIT-6), Migraine Disability Assessment (MIDAS), and the World Health Organization Disability Assessment 2.0 (WHODAS 2.0).

Results

Among 631 participants with migraine, a higher proportion experienced at least one postdromal symptom when prompted (n = 509 [80.7%]) compared with unprompted reporting (n = 421 [66.7%], P < 0.001). Furthermore, the total number of postdromal symptoms experienced was greater with prompted than unprompted reporting (medians 3 [IQR 1 – 6] versus 1 [IQR 0 – 2]; P < 0.001). Furthermore, the likelihood of reporting postdromal symptoms increased with the presence of premonitory symptoms and decreased with higher number of monthly migraine days. Weak correlations were identified between the number of postdromal symptoms reported and both HIT-6 (ρ = 0.14; P < 0.001) and WHODAS scores (ρ = 0.15; P < 0.001), whilst no correlation was observed with MIDAS score (ρ = 0.08; P = 0.054).

Conclusions

Postdromal symptoms are prevalent in individuals with migraine from a tertiary care unit. However, reported estimates warrant cautious interpretation as they depend on the means of enquiry, presence of premonitory symptoms, and frequency of monthly migraine days. Moreover, a weak correlation was identified between the number of postdromal symptoms and both HIT-6 and WHODAS scores, indicating only a marginal influence on the disease burden.

Graphical Abstract
The effect of cellular nuclear function alteration on the pathogenesis of shoulder adhesive capsulitis: an immunohistochemical study on lamin A/C expression
Authors: Candela Vittorio , Peruzzi Barbara , Leopizzi Martina , Porta Natale , Di Maio Valeria , Greenberg Benjamin , Della Rocca Carlo , Gumina Stefano
Published: February 2024

Background

The network of intermediate filament proteins underlying the inner nuclear membrane forms the nuclear lamina. Lamins have been associated with important cellular functions: DNA replication, chromatin organization, differentiation of the cell, apoptosis and in maintenance of nuclear structure.

Little is known regarding the etiopathogenesis of adhesive capsulitis (AC); recently, a dysregulating fibrotic response starting from a subpopulation has been described within the fibroblast compartment, which suddenly turns on an activated phenotype.

Considering the key role of A-type lamins in the regulation of cellular stability and function, our aim was to compare the lamin A/C expression between patients with AC and healthy controls.

Materials and methods

A case–control study was performed between January 2020 and December 2021. Tissue samples excised from the rotator interval were analysed for lamin A/C expression by immunohistochemistry. Patients with AC were arbitrarily distinguished according to the severity of shoulder flexion limitation: ≥ 90° and < 90°. Controls were represented by samples obtained by normal rotator interval excised from patients submitted to shoulder surgery. The intensity of staining was graded, and an H-score was assigned. Statistical analysis was performed (Chi-square analysis; significance was set at alpha = 0.05).

Results

We enrolled 26 patients [12 male and 14 female, mean age (SD): 52.3 (6.08)] and 15 controls [6 male and 9 female, mean age (SD): 57.1 (5.3)]. The expression of lamin A/C was found to be significantly lower in the fibroblasts of patients with adhesive capsulitis when compared with controls (intensity of staining: p: 0.005; H-score: 0.034); no differences were found regarding the synoviocytes (p: > 0.05). Considering only patients with AC, lamin A/C intensity staining was found to be significantly higher in samples where acute inflammatory infiltrate was detected (p: 0.004).

No significant changes in levels of lamin A/C expression were documented between the mild and severe adhesive capsulitis severity groups.

Conclusions

Our study demonstrated that the activity of lamin A/C in maintaining nuclear structural integrity and cell viability is decreased in patients with adhesive capsulitis. The phase of the pathogenetic process (freezing and early frozen) is the key factor for cell functionality. On the contrary, the clinical severity of adhesive capsulitis plays a marginal role in nuclear stability.

Level of evidence

III.
The ancestral type of the R-RAS protein has oncogenic potential
Authors: Talajić Antea , Dominko Kristina , Lončarić Marija , Ambriović-Ristov Andreja , Ćetković Helena
Published: February 2024

Background

The R-RAS2 is a small GTPase highly similar to classical RAS proteins at the regulatory and signaling levels. The high evolutionary conservation of R-RAS2, its links to basic cellular processes and its role in cancer, make R-RAS2 an interesting research topic. To elucidate the evolutionary history of R-RAS proteins, we investigated and compared structural and functional properties of ancestral type R-RAS protein with human R-RAS2.

Methods

Bioinformatics analysis were used to elucidate the evolution of R-RAS proteins. Intrinsic GTPase activity of purified human and sponge proteins was analyzed with GTPase-GloTM Assay kit. The cell model consisted of human breast cancer cell lines MCF-7 and MDA-MB-231 transiently transfected with EsuRRAS2-like or HsaRRAS2. Biological characterization of R-RAS2 proteins was performed by Western blot on whole cell lysates or cell adhesion protein isolates, immunofluorescence and confocal microscopy, MTT test, colony formation assay, wound healing and Boyden chamber migration assays.

Results

We found that the single sponge R-RAS2-like gene/protein probably reflects the properties of the ancestral R-RAS protein that existed prior to duplications during the transition to Bilateria, and to Vertebrata. Biochemical characterization of sponge and human R-RAS2 showed that they have the same intrinsic GTPase activity and RNA binding properties. By testing cell proliferation, migration and colony forming efficiency in MDA-MB-231 human breast cancer cells, we showed that the ancestral type of the R-RAS protein, sponge R-RAS2-like, enhances their oncogenic potential, similar to human R-RAS2. In addition, sponge and human R-RAS2 were not found in focal adhesions, but both homologs play a role in their regulation by increasing talin1 and vinculin.

Conclusions

This study suggests that the ancestor of all animals possessed an R-RAS2-like protein with oncogenic properties similar to evolutionarily more recent versions of the protein, even before the appearance of true tissue and the origin of tumors. Therefore, we have unraveled the evolutionary history of R-RAS2 in metazoans and improved our knowledge of R-RAS2 properties, including its structure, regulation and function.
Evaluation of drought-tolerant varieties based on root system architecture in cotton (Gossypium hirsutum L.)
Authors: Guo Congcong , Zhu Lingxiao , Sun Hongchun , Han Qiucheng , Wang Shijie , Zhu Jijie , Zhang Yongjiang , Zhang Ke , Bai Zhiying , Li Anchang , Liu Liantao , Li Cundong
Published: February 2024

Background

Root system architecture (RSA) exhibits significant genetic variability and is closely associated with drought tolerance. However, the evaluation of drought-tolerant cotton cultivars based on RSA in the field conditions is still underexplored.

Results

So, this study conducted a comprehensive analysis of drought tolerance based on physiological and morphological traits (i.e., aboveground and RSA, and yield) within a rain-out shelter, with two water treatments: well-watered (75 ± 5% soil relative water content) and drought stress (50 ± 5% soil relative water content). The results showed that principal component analysis identified six principal components, including highlighting the importance of root traits and canopy parameters in influencing drought tolerance. Moreover, the systematic cluster analysis was used to classify 80 cultivars into 5 categories, including drought-tolerant cultivars, relatively drought-tolerant cultivars, intermediate cultivars, relatively drought-sensitive cultivars, and drought-sensitive cultivars. Further validation of the drought tolerance index showed that the yield drought tolerance index and biomass drought tolerance index of the drought-tolerant cultivars were 8.97 and 5.05 times higher than those of the drought-sensitive cultivars, respectively.

Conclusions

The RSA of drought-tolerant cultivars was characterised by a significant increase in average length-all lateral roots, a significant decrease in average lateral root emergence angle and a moderate root/shoot ratio. In contrast, the drought-sensitive cultivars showed a significant decrease in average length-all lateral roots and a significant increase in both average lateral root emergence angle and root/shoot ratio. It is therefore more comprehensive and accurate to assess field crop drought tolerance by considering root performance.
Chinese Additive Anti-inflammatory Action for Aortopathy & Arteriopathy (5A) Registry protocol: rationale, design and methodology
Authors: Liu Hong , Qian Si-chong , Li Hai-yang , Shao Yong-feng , Zhang Hong-jia ,   the China Additive Anti-inflammatory Action for Aortopathy, Arteriopathy (5A) Investigators, Liu Hong , Qian Si-chong , Li Hai-yang , Han Lu , Zhang Ying-yuan , Wang Kai , Wu Ying , Hong Liang , Yang Ji-nong , Zhong Ji-sheng , Sun Bing-qi , Liu Xiao-cheng , Wu Dong-kai , Fan Guo-liang , Chen Jun-quan , Zhang Sheng-qiang , Jiang Yi-yao , Peng Xing-xing , Zeng Zhi-hua , Zhao Xin , Tang Peng-cheng , Feng Xiao-yan , Tang Cheng-bin , Zhang Hui-jun , Lu Zhan-jie , Zheng Si-qiang , Zhang Chen , Shao Yong-feng , Zhang Hong-jia , Zhu Peng-cheng , Yue Hong-hua , Huang Ling-chen , Wu Feng , Xu Xiao-han , Lu Xiao-hu , Gu Wei-dong
Published: February 2024

Background

Acute aortic syndrome (AAS) is a life-threatening condition. Inflammation plays a key role in the pathogenesis, development and progression of AAS, and is associated with significant mortality and morbidity. Understanding the inflammatory responses and inflammation resolutions is essential for an appropriate management of AAS.

Method

Thirty Chinese cardiovascular centers have collaborated to create a multicenter observational registry (named Chinese Additive Anti-inflammatory Action for Aortopathy & Arteriopathy [5A] registry), with consecutive enrollment of adult patients who underwent surgery for AAS that was started on Jan 1, 2016 and will be ended on December 31, 2040. Specially, the impact of inflammation and anti-inflammatory strategies on the early and late adverse events are investigated. Primary outcomes are severe systemic inflammatory response syndrome (SIRS), multiple organ dysfunction syndrome (MODS), Sequential Organ Failure Assessment (SOFA) scores at 7 days following this current surgery. Secondary outcomes are SISR, 30-day mortality, operative mortality, hospital mortality, new-onset stroke, acute kidney injury, surgical site infection, reoperation for bleeding, blood transfusion and length of stay in the intensive care unit.

Discussion

The analysis of this multicenter registry will allow our better knowledge of the prognostic importance of preoperative inflammation and different anti-inflammatory strategies in adverse events after surgery for AAS. This registry is expected to provide insights into novel different inflammatory resolutions in management of AAS beyond conventional surgical repair.

Trial registration

ClinicalTrials.gov Identifier: NCT04398992 (Initial Release: 05/19/2020).
Can the allocation of primary health care system resources affect efficiency? A spatial Dubin model study in China
Authors: Sun Xinyue , Lv Bo , Gao Xiaoyi , Meng Kai
Published: February 2024

Background

The primary health care (PHC) system plays an important role in China’s health care system, but there are challenges such as irrational allocation of health resources and inefficient operation, which need to be improved. The purpose of this study was to explore the impact of resource allocation on the efficiency of the PHC system in China.

Methods

The data in 31 provinces were collected from the China Statistical Yearbook 2017–2021 and the China Health Statistical Yearbook 2017–2021. The comprehensive health resource density index (CHRDI) was constructed based on the entropy method and the health resource density index (HRDI), which was used to analyze the allocation of primary health resources in each province. The adjusted efficiency of the PHC system in each province was calculated by the bootstrap data envelopment analysis (DEA). Finally, the spatial Dubin model was used to explore the effect of the CHRDI on efficiency.

Results

From 2016 to 2020, the allocation of primary health resources in 31 provinces showed an increasing trend, and the average efficiency after correction showed a decreasing state year by year. The spatial direct effect and spatial spillover effect coefficients of CHRDI were 0.820 and 1.471, which positively affect the efficiency. Per capita Gross Domestic Product (GDP), urbanization rate, and the proportion of the elderly were the factors affecting the efficiency of the PHC system.

Conclusions

The allocation of primary health resources in all provinces in China has improved each year, but there are still great differences, and efficiency must be further improved. Pay attention to the spatial spillover effect of the level of resource allocation and formulate differentiated measures for different regions. Attention should also be paid to the impact of population aging and economic development on the utilization of primary health resources by increasing health needs and choices.