bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comprehensive Survey on Federated Learning Techniques for Healthcare Informatics
Authors: Dasaradharami Reddy K. , Gadekallu Thippa Reddy
Published: March 2023

Healthcare is predominantly regarded as a crucial consideration in promoting the general physical and mental health and well‐being of people around the world. The amount of data generated by healthcare systems is enormous, making it challenging to manage. Many machine learning (ML) approaches were implemented to develop dependable and robust solutions to handle the data. ML cannot fully utilize data due to privacy concerns. This primarily happens in the case of medical data. Due to a lack of precise clinical data, the application of ML for the same is challenging and may not yield desired results. Federated learning (FL), which is a recent development in ML where the computation is offloaded to the source of data, appears to be a promising solution to this problem. In this study, we present a detailed survey of applications of FL for healthcare informatics. We initiate a discussion on the need for FL in the healthcare domain, followed by a review of recent review papers. We focus on the fundamentals of FL and the major motivations behind FL for healthcare applications. We then present the applications of FL along with recent state of the art in several verticals of healthcare. Then, lessons learned, open issues, and challenges that are yet to be solved are also highlighted. This is followed by future directions that give directions to the prospective researchers willing to do their research in this domain.
A Novel Glycolysis-Related Signature for Predicting the Prognosis and Immune Infiltration of Uveal Melanoma
Authors: Guo Xiaoyu , Yu Xin , Zhang Yuying , Luo Huijuan , Huang Rong , Zeng Yuyang , Duan Chaoye , Chen Changzheng
Published: March 2023

Introduction: As the most common aggressive intraocular cancer in adults, uveal melanoma (UVM) threatens the survival and vision of many people. Glycolysis is a novel hallmark of cancer, but the role of glycolysis-related genes in UVM prognosis remains unknown. The purpose of the study was to establish a glycolysis-related gene signature (GRGS) to predict UVM prognosis. Methods: Raw data were obtained from TCGA-UVM and GSE22138 datasets. The GRGS was established by univariate, LASSO, and multivariate Cox regression analyses. Kaplan-Meier survival and time-dependent receiver operating characteristic curves were used to evaluate the predictive ability of the GRGS. The relationships of the GRGS with infiltrating immune cell levels and mutations were analyzed with CIBERSORT and maftools. Results: A novel GRGS (risk score = 0.690861*ISG20 + 0.070991*MET − 0.227520*SDC2 + 0.690223*FBP1 + 0.048008*CLN6 − 0.128520*SDC3) was developed for predicting UVM prognosis. The GRGS had robust predictive stability in UVM. Enrichment annotation suggested that the high-risk group had stronger adaptive immune responses and that the low-risk group had more innate immune cell infiltration. Moreover, BAP1 mutation was related to high risk, and SF3B1 mutation was related to low risk. Conclusions: This study developed and validated a novel GRGS to predict UVM prognosis and immune infiltration. The signature revealed an association between glycolysis-related genes and the tumor microenvironment, providing new insights into the role of glycolysis in UVM.
Sex Differences in Vascular Response to Mental Stress and Adverse Cardiovascular Events Among Patients With Ischemic Heart Disease
Authors: Sullivan Samaah , Young An , Garcia Mariana , Almuwaqqat Zakaria , Moazzami Kasra , Hammadah Muhammad , Lima Bruno B. , Hu Yingtian , Jajeh Mohamad Nour , Alkhoder Ayman , Elon Lisa , Lewis Tené T. , Shah Amit J. , Mehta Puja K. , Bremner J. Douglas , Quyyumi Arshed A. , Vaccarino Viola
Published: March 2023

Background:

Microvascular measures of vascular dysfunction during acute mental stress may be important determinants of major adverse cardiovascular events (MACE), especially among younger and middle-aged women survivors of an acute myocardial infarction.

Methods:

In the MIMS2 study (Myocardial Infarction and Mental Stress 2), individuals who had been hospitalized for a myocardial infarction in the past 8 months were prospectively followed for 5 years. MACE was defined as a composite index of cardiovascular death and first/recurring events for nonfatal myocardial infarction and hospitalizations for heart failure. Reactive hyperemia index and flow-mediated dilation were used to measure microvascular and endothelial function, respectively, before and 30 minutes after a public-speaking mental stress task. Survival models for recurrent events were used to examine the association between vascular response to stress (difference between poststress and resting values) and MACE. Reactive hyperemia index and flow-mediated dilation were standardized in analyses.

Results:

Of 263 patients (the mean age was 51 years; range, 25–61), 48% were women, and 65% were Black. During a median follow-up of 4.3 years, 64 patients had 141 adverse cardiovascular events (first and repeated). Worse microvascular response to stress (for each SD decrease in the reactive hyperemia index) was associated with 50% greater risk of MACE (hazard ratio, 1.50 [95% CI, 1.05–2.13];
P
=0.03) among women only (sex interaction:
P
=0.03). Worse transient endothelial dysfunction in response to stress (for each SD decrease in flow-mediated dilation) was associated with a 35% greater risk of MACE (hazard ratio, 1.35 [95% CI, 1.07–1.71];
P
=0.01), and the association was similar in women and men.

Conclusions:

Peripheral microvascular dysfunction with mental stress was associated with adverse events among women but not men. In contrast, endothelial dysfunction was similarly related to MACE among both men and women. These results suggest a female-specific mechanism linking psychological stress to adverse outcomes.
Myocardial Metabolomics of Human Heart Failure With Preserved Ejection Fraction
Authors: Hahn Virginia S. , Petucci Christopher , Kim Min-Soo , Bedi Kenneth C. , Wang Hanghang , Mishra Sumita , Koleini Navid , Yoo Edwin J. , Margulies Kenneth B. , Arany Zoltan , Kelly Daniel P. , Kass David A. , Sharma Kavita
Published: March 2023

Background:

The human heart primarily metabolizes fatty acids, and this decreases as alternative fuel use rises in heart failure with reduced ejection fraction (HFrEF). Patients with severe obesity and diabetes are thought to have increased myocardial fatty acid metabolism, but whether this is found in those who also have heart failure with preserved ejection fraction (HFpEF) is unknown.

Methods:

Plasma and endomyocardial biopsies were obtained from HFpEF (n=38), HFrEF (n=30), and nonfailing donor controls (n=20). Quantitative targeted metabolomics measured organic acids, amino acids, and acylcarnitines in myocardium (72 metabolites) and plasma (69 metabolites). The results were integrated with reported RNA sequencing data. Metabolomics were analyzed using agnostic clustering tools, Kruskal-Wallis test with Dunn test, and machine learning.

Results:

Agnostic clustering of myocardial but not plasma metabolites separated disease groups. Despite more obesity and diabetes in HFpEF versus HFrEF (body mass index, 39.8 kg/m
2
versus 26.1 kg/m
2
; diabetes, 70% versus 30%; both
P
<0.0001), medium- and long-chain acylcarnitines (mostly metabolites of fatty acid oxidation) were markedly lower in myocardium from both heart failure groups versus control. In contrast, plasma levels were no different or higher than control. Gene expression linked to fatty acid metabolism was generally lower in HFpEF versus control. Myocardial pyruvate was higher in HFpEF whereas the tricarboxylic acid cycle intermediates succinate and fumarate were lower, as were several genes controlling glucose metabolism. Non–branched-chain and branched-chain amino acids (BCAA) were highest in HFpEF myocardium, yet downstream BCAA metabolites and genes controlling BCAA metabolism were lower. Ketone levels were higher in myocardium and plasma of patients with HFrEF but not HFpEF. HFpEF metabolomic-derived subgroups were differentiated by only a few differences in BCAA metabolites.

Conclusions:

Despite marked obesity and diabetes, HFpEF myocardium exhibited lower fatty acid metabolites compared with HFrEF. Ketones and metabolites of the tricarboxylic acid cycle and BCAA were also lower in HFpEF, suggesting insufficient use of alternative fuels. These differences were not detectable in plasma and challenge conventional views of myocardial fuel use in HFpEF with marked diabetes and obesity and suggest substantial fuel inflexibility in this syndrome.
A new species of Phyllogeiton (Rhamnaceae: Rhamneae) from Maputaland, South Africa
Authors: BOON RICHARD G.C. , VAN WYK ABRAHAM E.
Published: March 2023

Recently the genus Phyllogeiton was reinstated to accommodate the two currently recognized species of Berchemia, namely P. discolor and P. zeyheri, which are confined to Africa and Madagascar. In the present contribution a new species, Phyllogeiton trachybasis, is described, illustrated, mapped, and compared with the other members of the genus, especially with P. discolor with which it has hitherto been confused. An identification key and illustrations are provided for the three species of Phyllogeiton. The new species has a restricted range and is presently only known for certain from the KwaZulu-Natal part of the Maputaland Centre of Endemism in South Africa. Known trees of P. trachybasis are mostly old and there are no signs of recruitment in nature. Outside conservation areas, the bark of P. trachybasis is heavily utilised for biocultural purposes, most probably a main reason for the apparent demise of the species. A preliminary conservation assessment suggests that P. trachybasis should be classified as Endangered.
Typification and synonymizations in Jatropha martiusii (Euphorbiaceae)
Authors: MOREIRA ARIANE DOS SANTOS , DA SILVA OTÁVIO LUIS MARQUES , CORDEIRO INÊS , TORRES DANIELA SANTOS CARNEIRO
Published: March 2023

Jatropha Linnaeus (1753: 1006) belongs to subfamily Crotonoideae (Euphorbiaceae) and has ca. 180 species distributed in tropical and subtropical regions of the world (Dehgan 2012; Webster 2014). The genus is found throughout the Neotropical region, with Mexico (50 spp.) and Brazil (23 spp.) as its centers of diversity (Christensen et al. 2019).
Integrative taxonomy of Imparfinis (Siluriformes, Heptapteridae) from the Upper Paraná River basin, Brazil, with description of a new species
Authors: SILVA GABRIEL S. C.
Published: March 2023

The Neotropical family Heptapteridae comprises 228 valid species widely distributed in South America. Imparfinis is one of the most diverse genera of this family, with 25 valid species widely distributed, inhabiting streams from Costa Rica to Argentina. Old descriptions coupled with lack of recent systematic studies of the species of Imparfinis from the Upper Paraná river basin have led to a taxonomic impediment and hindered the advancement of studies in other areas, such as ecology, cytogenetic, phylogenetic, and evolution. We conducted the first integrative study analyzing both molecular and morphological data of Imparfinis from the Upper Paraná River basin. Our analyses strongly support the existence of four independent evolutionary lineages in this river system, three of them are the nominal species I. mirini, I. schubarti, and I. piperatus, and a new species from Goiás state described herein.
Digitalisation of the Welfare State: Lessons for the Emerging Economies
Authors: Gupta Asha
Published: March 2023

Of late, we find the post-Second World War welfare state being replaced by digital welfare states in advanced countries. It is supposed to be apolitical, cost-effective and more efficient. This revolution has taken place quietly and stealthily. As such, it is not possible to challenge its adverse effects legally by those excluded from the welfare benefits. Moreover, it is likely to create further barriers between some individuals and their social rights. Instead of ‘rule of law’ we now find ‘rule of web design’. It virtually amounts to a shift towards ‘digital governance’ where the major decisions are taken by the technocrats, corporate sector and the multinationals, disempowering the citizens and the states per se. Digitalisation of the welfare state, in fact, has helped in promoting the neoliberal agenda very cleverly by shifting some of the responsibilities to digital citizens, presuming them to be rational, capable and apolitical, which is not always true. Instead of providing shelter from market failures and other vicissitudes of life, the welfare states today seek to make their citizens more competitive, responsible and proactive. Digitalisation is seen as a step in the right direction in the name of economic gains, ignoring the dangerous centralisation tendencies in the process. The methodology adopted is analytical, comparative and empirical.
Experimental study on the supply air characteristics and thermal comfort of a novel personalized ventilation air terminal device
Authors: Feng Xuan , Liao Chunhui , Cheng Yong
Published: March 2023

Personalized ventilation (PV) has a significant potential for improving thermal comfort, inhaled air quality and energy efficiency. A novel PV air terminal device (ATD) based on the function of bath showers was evaluated to determine discomfort related to thermal sensation, draughts, dry eyes and skin irritation. The supply air characteristics and thermal comfort were analyzed using objective and subjective experiments in an environmental chamber. Thirty college students participated in the subjective experiments. Results showed that the proposed PV ATD could provide uniform distributions of air velocity at the human head and chest. Compared with the conventional round-monitor panel ATD, the proposed PV ATD can provide an improved cooling effect, wherein overall thermal sensation was reduced by 0.56 scale, showing a potential for energy saving. Moreover, the proposed PV ATD could produce a highly uniform distribution of local thermal sensation (LTS). Compared with the conventional PV, the proposed PV ATD could reduce the standard deviation of distribution of LTS by 41.7% and reduce overall thermal discomfort by 45.5%. Fewer sick building syndrome symptoms at a lower supply airflow rate of 6.3 L/s was achieved. Consequently, the proposed PV ATD could improve the comfort performance with the usage of lower supply airflow rates.
Eating Behaviours Among Healthcare Workers and Their Relationships With Work-Related Burnout
Authors: Utter Jennifer , McCray Sally , Denny Simon
Published: March 2023

The current research describes the indicators of good nutrition among staff working in a hospital setting and determines if dietary indicators are associated with work-related burnout. In total, 501 staff of a large healthcare organization in SouthEast Queensland, Australia completed a health and wellbeing survey. Multiple regression models were constructed to describe the associations between dietary indicators and burnout, while controlling for age, gender, work role and level of employment. Among the total sample of healthcare workers, indicators of healthy eating were poor. Fewer than 40% reported their overall diet as very good and fewer than 15% of healthcare workers reported eating the recommended 5 or more servings of vegetables per day. There was an inverse relationship between good nutrition and burnout, across a range of indicators (including rating of overall diet, fruit and vegetable consumption and sharing meals with family), such that healthier eating indicators were associate with less burnout. Given that rates of both poor nutrition and burnout among healthcare professionals are high, findings from the current study suggest that efforts to promote better nutrition among healthcare workers are warranted. Future research may evaluate if improving the nutrition of healthcare workers has a positive impact on work-related burnout.
The Support, Educate, Empower personalized glaucoma coaching trial design
Authors: Newman-Casey Paula Anne , Resnicow Ken , Winter Suzanne , Niziol Leslie M , Darnley-Fisch Deborah , Imami Nauman , McHaney-Conner Phalatha , Musch David C , Mitchell Jamie , Heisler Michele
Published: March 2023

Background:

Glaucoma is a chronic disease that affects 3 million Americans. Glaucoma is most often asymptomatic until very late in its course when treatment is more difficult and extensive peripheral vision loss has already occurred. Taking daily medications can mitigate this vision loss, but at least half of people with glaucoma do not take their prescribed medications regularly. The purpose of this study is to improve glaucoma medication adherence among those with medically treated glaucoma and poor self-reported adherence using the Support, Educate, Empower personalized coaching program.

Methods/design:

This study is a two-site randomized controlled trial enrolling 230 participants with poor self-reported glaucoma medication adherence. The trial has two arms, an intervention arm and a control arm. Participants in the intervention arm receive personalized glaucoma education and motivational interviewing-based coaching over 6 months from a trained non-physician interventionist for three in-person sessions with between visit phone calls for check-ins where current adherence level is reported to participants. Participants also can elect to have visual, audio, text or automated phone call medication dose reminders. Participants in the control arm continue usual care with their physician and receive non-personalized glaucoma educational materials via mail in parallel to the three in-person coaching sessions to control for glaucoma knowledge content. All participants receive a medication adherence monitor. The primary outcome is the proportion of prescribed doses taken on schedule during the 6-month period. The secondary outcome is glaucoma related distress. The exploratory outcome is intraocular pressure.

Discussion:

The personalized education and motivational-interviewing-based intervention that we are testing is comprehensive in that it addresses the wide range of barriers to adherence that people with glaucoma encounter. Leveraging a custom-built web-based application to generate the personalized content and the motivational-interviewing-based prompts to guide the coaching sessions will make this program both replicable and scalable and can be integrated into clinical care utilizing trained non-physician providers. Although this type of self-management support is not currently reimbursed for glaucoma as it is for diabetes, this trial could help shape future policy change should the intervention be found effective.
Proteomic analysis identifies dysregulated proteins and associated molecular pathways in a cohort of gallbladder cancer patients of African ancestry
Authors: Baichan Pavan , Naicker Previn , Augustine Tanya Nadine , Smith Martin , Candy Geoffrey , Devar John , Nweke Ekene Emmanuel
Published: March 2023

Background

Gallbladder cancer (GBC) is a lethal cancer with a poor prognosis. The lack of specific and sensitive biomarkers results in delayed diagnosis with most patients presenting at late stages of the disease. Furthermore, there is little known about the molecular mechanisms associated with GBC, especially in patients of African ancestry. This study aimed to determine dysregulated proteins in South African GBC patients to identify potential mechanisms of the disease progression and plausible biomarkers.

Methods

Tissues (27 GBC, 13 Gallstone disease, and 5 normal tissues) and blood plasma (54 GBC and 73 Benign biliary pathology) were obtained from consenting patients. Protein extraction was performed on all tissues and liquid chromatography-mass spectrometry was used for proteomic profiling. A project-specific spectral library was built using the Pulsar search algorithm. Principal component and Spearman’s rank correlation analyses were performed using PAST (V4.07b). Pathway and Network analyses were conducted using REACTOME (v3.7) and stringAPP (v1.7.0), respectively.

Results

In the tissue sample group, there were 62 and 194 dysregulated proteins in GBC compared to normal and gallstone groups, respectively. In the plasma group, there were 33 altered proteins in GBC compared to the benign biliary pathology group. We found 9 proteins (APOA1, APOA2, RET4, TTR, HEMO, HBB, HBA, PIGR, and APOE) to be commonly dysregulated in both tissue and plasma. Furthermore, a subset analysis demonstrated that 2 proteins, S100A8 and S100A9, were downregulated in GBC patients with GD history compared to those without. Pathway analysis showed that the dysregulated proteins in GBC patients were enriched in pathways involved in smooth muscle contraction, metabolism, ECM organization, and integrin cell surface interactions.

Conclusion

The identified dysregulated proteins help in understanding GBC molecular mechanisms in our patient group. Furthermore, the alteration of specific proteins in both tissue and plasma samples suggests their potential utility as biomarkers of GBC in this sample cohort.
Cost-effective duplex Kompetitive Allele Specific PCR markers for homologous genes facilitating wheat breeding
Authors: Jiang Peng , Fan Xiangyun , Zhang Guangxu , Wu Lei , He Yi , Li Chang , Zhang Xu
Published: March 2023

Background

Owing to successful cloning of wheat functional genes in recent years, more traits can be selected by diagnostic markers, and consequently, effective molecular markers will be powerful tools in wheat breeding programs.

Results

The present study proposed a cost-effective duplex Kompetitive Allele Specific PCR (dKASP) marker system that combined multiplex PCR and KASP™ technology to yield twice the efficiency at half the cost compared with the common KASP™ markers and provide great assistance in breeding selection. Three dKASP markers for the major genes controlling plant height (Rht-B1/Rht-D1), grain hardness (Pina-D1/Pinb-D1), and high-molecular-weight glutenin subunits (Glu-A1/Glu-D1) were successfully developed and applied in approved wheat varieties growing in the middle and lower reaches of the Yangtze River and advanced lines from our breeding program. Three markers were used to test six loci with high efficiency. In the approved wheat varieties,Rht-B1bwas the most important dwarfing allele, and the number of accessions carryingPinb-D1bwas much greater than that of the accessions carryingPina-D1b. Moreover, the number of accessions carrying favorable alleles for weak-gluten wheat (Null/Dx2) was much greater than that of the accessions carrying favorable alleles for strong-gluten wheat (Ax1orAx2*/Dx5). In the advanced lines,Rht-B1bandPinb-D1bshowed a significant increase compared with the approved varieties, and the strong-gluten (Ax1orAx2*/Dx5) and weak-gluten (Null/Dx2) types also increased.

Conclusion

A cost-effective dKASP marker system that combined multiplex PCR and KASP™ technology was proposed to achieve double the efficiency at half the cost compared with the common KASP™ markers. Three dKASP markers for the major genes controlling PH (Rht-B1/Rht-D1), GH (Pina-D1/Pinb-D1), and HMW-GS (Glu-A1/Glu-D1) were successfully developed, which would greatly improve the efficiency of marker-assisted selection of wheat.
Concurrent validity of the Ages and Stages Questionnaire Inventory and the Bayley Scales of Infant and Toddler Development in rural Bangladesh
Authors: Pitchik Helen O. , Tofail Fahmida , Akter Fahmida , Shoab Abul K. M. , Sultana Jesmin , Huda Tarique M. N. , Rahman Mahbubur , Winch Peter J. , Luby Stephen P. , Fernald Lia C. H.
Published: March 2023

Background

Reliable and valid measurement of early child development are necessary for the design of effective interventions, programs, and policies to improve early child outcomes. One widely used measure in low- and middle-income countries (LMICs) is the Bayley Scales of Infant and Toddler Development III (Bayley-III). Alternatively, the Bangladeshi-adapted Ages and Stages Questionnaire Inventory (ASQ:I) can be administered more quickly, inexpensively, and with less training than the Bayley-III. We aimed to assess the concurrent validity of the Bangladeshi-adapted ASQ:I with the Bayley-III in children 4–27 months old in rural Bangladesh.

Methods

The sample was a sub-sample (n = 244) of endline participants from an evaluation of an early child development intervention (July–August 2018). We assessed concurrent validity between internally age-standardized domain-specific and total scores using Pearson correlations both overall and stratified by age and intervention status. We also assessed correlations between scores and variables theoretically related to child development including maternal education and stimulation in the home.

Results

The overall correlation between ASQ:I and Bayley-III total scores was moderate (r = 0.42 95% CI: 0.30–0.53), with no systematic differences by intervention status. Overall, concurrent validity was highest for the gross motor domain (r = 0.51, 0.40–0.60), and lowest for the fine motor domain (r = 0.20, 0.04–0.33). Total ASQ:I and Bayley-III scores were positively correlated with child stimulation and maternal education.

Conclusion

The Bangladeshi-adapted ASQ:I is a low-cost tool that can be feasibly administered in rural Bangladesh, is moderately correlated with the Bayley-III, and can be used to measure child development when human, time, or financial resources are constrained.
Early exposure to infections increases the risk of allergic rhinitis—a systematic review and meta-analysis
Authors: Chen JunRong , Liu Xiaohua , Liu Zixin , Zhou Yaqian , Xie Li , Zhang Jialin , Tan Jin , Yang Yide , Tian Mei , Dong Yunpeng , Li Jian
Published: March 2023

Objective

The purpose of this study was to provide evidence for early life care by meta-analyzing the relationship between infection during pregnancy and up to 2 years of age and the risk of subsequent allergic rhinitis (AR).

Methods

Published studies up to April 2022 were systematically searched in PubMed, Embase, Web of Science, Cochrane Library, SinoMed, CNKI, Wanfang Database, and VIP. Literature screening, including quality assessment, was performed, and the effect values (OR, HR, RR) and 95% confidence intervals (95% CI) of infection during pregnancy and up to 2 years of age and allergic rhinitis were extracted from each qualified study.

Results

In total, 5 studies with a sample size of 82,256 reported the relationship between infection during pregnancy and offspring AR. Meta-analysis showed that maternal infection during pregnancy was associated with an increased risk of childhood AR in offspring (OR = 1.34, 95% CI: 1.08–1.67). Altogether, 13 studies with a sample size of 78,426 reported evidence of an association between infection within 2 years of age and subsequent AR in children. A pooled meta-analysis of all studies showed that early infection within 2 years of age was closely associated with childhood AR (OR = 1.25, 95% CI: 1.12–1.40), especially upper respiratory tract infection (OR = 1.32, 95% CI: 1.06–1.65) and gastrointestinal infections (OR = 1.37, 95% CI: 1.01–1.86), but ear infection showed similar results in the cohort study (OR = 1.13, 95% CI: 1.04–1.22).

Conclusion

Current evidence suggests that infection during pregnancy, early upper respiratory infection, gastrointestinal infections and ear infection within 2 years of age would increase the risk of AR in children. Therefore, the prevention of infection during pregnancy and in infancy and young children needs to be emphasized.
Effectiveness of antenatal dexamethasone in reducing respiratory distress syndrome and mortality in preterm neonates: a nested case control study
Authors: Kibanga Wema , Mutagonda Ritah F. , Moshiro Robert , Mareale Alphonce , Kilonzi Manase , Mlyuka Hamu J. , Mikomangwa Wigilya P. , Kunambi Peter P. , Kamuhabwa Appolinary , Minzi Omary Mashiku
Published: March 2023

Background

Respiratory distress syndrome (RDS) is a significant cause of preterm neonatal morbidity and mortality globally. Measures like the use of antenatal corticosteroids (ACS) and immediate resuscitation of the newborn after birth are taken to abate preterm related complications. Most studies that evidenced the benefit of ACS were done in high resource settings. Therefore, this study was conducted to assess the effectiveness of ACS in reducing RDS and neonatal mortality in preterm neonates in resource-limited settings.

Methods

A three months prospective nested case–control study (1:2 unmatched) was conducted at Muhimbili National Hospital and Amana regional referral hospital in Dar es salaam, Tanzania. Neonates delivered at 28 to 34 gestational weeks were enrolled and followed up until discharge. Data analysis was done using the statistical package of social sciences version 23. Logistic regression analysis was used to determine the effect of ACS on the RDS and mortality in the cohort, controlling for important maternal and neonatal variables. All tests were considered statistically significant at p < 0.05.

Results

Out of 330 preterm neonates enrolled, 110 were cases and 220 were controls. The median gestational age at delivery was 30 weeks and 6 days (IQR 4.68) among cases and 33 weeks (IQR 3) among controls. One-minute APGAR score of < 7 (AOR: 3.11; 95% CI 1.54–6.30), and neonatal birth weight (AOR: 0.998; 95% CI 0.997–0.999) were significantly associated with RDS. No significant association was observed between ACS exposure and RDS occurrence (AOR: 1.65; 95% CI 0.86 – 3.15). The overall mortality rate was 9 per 1000 neonates. Neonatal mortality occurred only among cases whereby, a unit increase in gestational age was associated with a 30% reduction in neonatal mortality (Adjusted hazard ratio, AHR: 0.70, 95% CI: 0.5–0.92, p = 0.011).

Conclusion

Decrease in gestational age, one minute APGAR score of < 7 and decreasing birth weight were associated with RDS among preterm neonates. ACS was not associated with reduced RDS occurrence and neonatal mortality rates. Moreover, increase in gestation age was the only factor found to be protective against preterm neonatal mortality.
Palestinian law to protect family and prevent violence: challenges with public opinion
Authors: Mahamid Fayez , Hattab Muayad , Berte Denise
Published: March 2023

The Palestinian Family Protection Law was submitted for ratification in November 2020 after much collaboration between advocates, attorneys and governmental officials, as well as community and international organizations. The draft bill addresses a myriad of social issues affecting vulnerable populations in the West Bank of Palestine, including: the legal age for marriage; gender inequality in inheritance; divorce; gender-based violence; and domestic violence. However, immediate feedback from local religious scholars, with increasing pressure from the general Palestinian population, was deeply divided, with negative perceptions relating to the perceived ‘foreign’ nature of the regulations and criticism that the law was not in accordance with Palestinian culture and Islamic Law. This criticism led to two years of inactivity regarding the bill. The current study sought to evaluate the attitudes, behavior and beliefs regarding the underlying human rights issues and assumptions concerning gender, marriage, and domestic violence that could be found in the codices of the proposed legislation as well as among the general population of Palestine. The data demonstrates that the population sampled viewed the underlying premise of the Family Protection Bill negatively. Individuals with a graduate degree or above tended to view the bill with less negativity, whilst females viewed the bill more positively than males. The results of this study illustrate that, with regard to legislation that relates to family life in Palestine, there is a wide gap between the points of view held by human rights advocates and NGO’s and those held by the general population. To further the agenda of family protection community education relating to social issues, the fundamentals of Sharia law and national sovereignty may be needed so as to clarify the core Islamic beliefs in relation to human rights and oppression, as well as to increase Palestinian ownership of the family protection agenda.
Characteristics of undergraduate and second speciality mental health programmes in Peru: a cross-sectional study
Authors: García-Serna Jackeline , Almeida-Huanca Guillermo , Huarcaya-Victoria Jeff , Vilela-Estrada Ana Lucia , Zafra-Tanaka Jessica Hanae , Villarreal-Zegarra David
Published: March 2023

Background

This study aims to describe the training offered and the availability of professionals required by the Ministry of Health for mental health problems management in the community.

Methods

A cross-sectional study was carried out on the training offered in mental health in Peruvian universities. A search for programs was conducted using the University Information System database and universities' websites, as well as using the Ministry of Health's database on health personnel and data on the number of enrolled and current students provided by the University Information System database and the Transparency section of the universities.

Results

There were 214 undergraduate, 55 specialty and 7 subspecialty programmes, of which 39%, 47% and 100%, respectively, were offered in the capital city. The duration ranged from 5 to 7 years for undergraduate programs and from 1 to 3 years for subspecialty and second specialty programs. The cost of undergraduate programs ranged from free of charge up to USD 6863.75 for the first semester of study. Second specialty programs ranged from 720 up to 11 986 USD and subspecialty programs ranged from 2267 up to 9138 USD, with medicine being the most expensive. On the other hand, there are a greater number of psychology students (n = 78 781) pursuing undergraduate studies than working professionals (n = 5368), while in the second specialty of psychiatry there are far fewer students pursuing the specialty (n = 67) than working professionals (n = 454).

Conclusions

The problem of professional training in mental health requires that the institutions involved in health and education develop policies to decentralize programs, communicate the demand for professionals in certain areas, make them accessible to the low-income population, respond to mental health problems and guarantee their quality. On the other hand, regarding the low number of mental health personnel working, it is suggested to increase the mental health budget to generate more mental health services and employment.
Stereotactic body radiotherapy for metastatic sarcoma to the lung: adding to the arsenal of local therapy
Authors: Gutkin Paulina M. , Gore Elizabeth , Charlson John , Neilson John C. , Johnstone Candice , King David M. , Hackbarth Donald A. , Wooldridge Adam , Mannem Rajeev , Bedi Meena
Published: March 2023

Introduction

Conventional treatment of pulmonary metastatic sarcoma primarily involves surgery, with systemic therapy added in select patients. However, broader applications of radiation therapy techniques have prompted investigation into the use of stereotactic body radiotherapy (SBRT) for treatment of metastatic sarcoma, an attractive non-invasive intervention with potential for lower rates of adverse events than surgery. Current data are limited to retrospective analyses. This study analyzed 2-year local control and overall survival and adverse events in patients prospectively treated with SBRT to pulmonary sarcoma metastases.

Methods

Patients prospectively treated with SBRT to the lung for biopsy-proven metastatic sarcoma at a single institution from 2010 to 2022 were included. SBRT dose/fractionation treatment regimens ranged from 34 to 54 Gy in 1–10 fractions using photons. Local recurrence, local progression-free survival (LPFS) and overall survival (OS) were calculated from the end of SBRT. Univariable analysis (UVA) was performed using the log-rank test. Multivariable analysis (MVA) was performed using the Cox proportional hazards model. Adverse events due to SBRT were graded based on the Common Terminology Criteria for Adverse Events, version 4.0.

Results

Eighteen patients with metastatic sarcoma were treated to 26 pulmonary metastases. The median local progression-free survival was not met. The median overall survival was not met. The local control rate at 2 years was 96%. 2-year LPFS was 95.5% and OS was 74%. Three patients (16.7%) developed grade 1 adverse events from SBRT. There were no adverse events attributed to radiation that were grade 2 or higher.

Conclusion

We report prospective data demonstrating that SBRT for sarcoma pulmonary metastases affords a high rate of local control and low toxicity, consistent with prior sarcoma SBRT retrospective data. This study adds to the wealth of information on SBRT in a radioresistant tumor. Though largely limited to retrospective reviews, current data indicate high rates of local control with favorable toxicity profiles. Therefore, SBRT for pulmonary sarcoma metastases may be considered for properly selected patients.
Age, sex, primary tumor type and site are associated with mortality after pathological fractures: an observational study of 1453 patients from the Swedish Fracture Register
Authors: Wänman Johan , Kjartansdóttir Sonja , Wolf Olof , Sundkvist Jonas , Wennergren David , Mukka Sebastian
Published: March 2023

Background

Pathological fractures are challenging in orthopedic surgery and oncology, with implications for the patient’s quality of life, mobility and mortality. The efficacy of oncological treatment on life expectancy for cancer patients has improved, but the metastatic pattern for bone metastases and survival is diverse for different tumor types. This study aimed to evaluate survival in relation to age, sex, primary tumor and site of the pathological fractures.

Methods

All pathological fractures due to cancer between 1 September 2014 and 31 December 2021 were included in this observational study from the Swedish Fracture Register (SFR). Data on age, sex, tumor type, fracture site and mortality were collected.

Results

A total of 1453 patients with pathological fractures were included (48% women, median age 73, range 18–100 years). Unknown primary tumors were the most common primary site (n = 308). The lower extremities were the most common site of pathological fractures. Lung cancer had the shortest median survival of 78 days (range 54–102), and multiple myeloma had the longest median survival of 432 days (range 232–629). The site at the lower extremity had the shortest (187 days, range 162–212), and the spine had the longest survival (386 days, range 211–561). Age, sex, primary type and site of the pathological fractures were all associated with mortality.

Interpretation

Age, sex, primary tumor type and site of pathological fractures were associated with survival. Survival time is short and correlated with primary tumor type, with lung cancer as the strongest negative predictor of survival.
The association between ADAM12 gene polymorphisms and osteoarthritis: an updated meta-analysis
Authors: Yang Su , Wang Yue-peng , Li Xi-yong , Han Peng-yong , Han Peng-fei
Published: March 2023

Background

Osteoarthritis of the knee is an irreversible disease that causes great pain, and genetic factors play an important role in its occurrence and development. There have been many studies on the correlation between ADAM12 polymorphisms and genetic susceptibility to osteoarthritis, but the results remain inconclusive.

Methods

Papers from PubMed, Web of Science, EMbase, Springer, SCOPUS, Google Scholar and other databases were systematically retrieved with a cut-off of January 2022. All case–control studies on ADAM12 rs3740199, rs1871054, rs1044122, and rs1278279 polymorphisms and osteoarthritis were searched. Fixed or random effects models were used for pooled analysis with OR values and 95% confidence intervals (CI), and publication bias was assessed. In addition, the false-positive reporting probability test was used to assess the confidence of a statistically significant association.

Results

Eleven articles were included, which included 3332 patients with osteoarthritis and 5108 healthy controls. Meta-analysis showed that the rs1871054 polymorphism of ADAM12 was associated with osteoarthritis in dominant, recessive, allelic, and homozygote genetic models [C vs. T: OR = 1.34 95% CI (1.05, 1.71), P < 0.001]. Our subgroup analysis revealed an association between the ADAM12 polymorphism rs1871054 in Asians and osteoarthritis [C vs. T: OR = 1.61, 95% CI (1.25, 2.08), P < 0.001], albeit this was only for three studies. In addition, the ADAM12 polymorphism rs1871054 is associated with osteoarthritis in patients younger than 60 years of age [C vs. T: OR = 1.39, 95% CI (1.01, 1.92), P = 0.289]; however, the ADAM12 gene rs3740199, rs1044122, and rs1278279 site polymorphisms were not significantly. Furthermore, when assessing the confidence of the positive results, the positive results were found to be credible (except for Age < 60).

Conclusion

Polymorphism at the rs1871054 site of ADAM12 is associated with genetic susceptibility to osteoarthritis, but rs3740199, rs1044122, and rs1278279 site polymorphisms are not.
Retrospective comparison of the effects of laryngeal mask and endotracheal tube on some cardio-respiratory variables in pet rabbits undergoing anaesthesia for elective gonadectomy
Authors: Bellini Luca , Schrank Magdalena , Veladiano Irene Alessandra , Contiero Barbara , Mollo Antonio
Published: March 2023

Background

Endotracheal intubation in rabbits is challenging and supraglottic airway devices, such as laryngeal masks (LMA), represent an alternative as they are easy to insert, and do not stimulate the larynx requiring therefore a lighter plane of anaesthesia for their insertion and positioning than the endotracheal tubes. We investigated whether, compared to an endotracheal tube, the LMA can reduce the negative effects of general anaesthetics on some cardiovascular and respiratory parameters routinely monitored in rabbits anaesthetized for elective gonadectomy. The records of 21 adult mixed breed pet rabbits were collected retrospectively. Rabbits were divided in two groups based on the type of airway device used. A laryngeal mask secured the airway in group LMA (n = 11), and in group ETT (n = 10) an endotracheal tube was used. The amount of propofol used before successful insertion of the airway device was recorded. A pitot-based spirometer was connected and ventilatory variables were measured immediately after insertion. Pulse rate, non-invasive arterial blood pressure, haemoglobin oxygen saturation, respiratory rate, end-tidal carbon dioxide and volatile anaesthetic consumption were also monitored during the surgical procedure; extubation time was noted as well.

Results

The use of LMA required significantly less propofol (0.8 to 4 mg/kg) for insertion than the ETT (1.2 to 5.6 mg/kg), and the difference was statistically significant (P < 0.01). No differences were observed in ventilatory variables measured immediately after airway positioning. Intraoperatively, there were no differences between groups for respiratory and cardiovascular variables, and amount of isoflurane administered. In all rabbits mean and diastolic blood pressure progressively decreased during surgery. Mean extubation time was shorter in group LMA (6 ± 2 min) than group ETT (8 ± 3 min, P < 0.01).

Conclusion

The airway device did not clinically affect the cardiovascular and respiratory variables during anaesthesia. Intraoperative hypoventilation was observed in most rabbits regardless of the device being used; therefore ventilatory support may be required. Rabbits with the laryngeal masks were extubated earlier.
Targeted therapy with vemurafenib in BRAF(V600E)-mutated anaplastic thyroid cancer
Authors: Lang Matthias , Longerich Thomas , Anamaterou Chrysanthi
Published: March 2023

Background

Anaplastic thyroid cancer (ATC) is one of the most aggressive malignancies, representing less than 5% of all thyroid carcinomas. Τhe median survival is limited to months due to the resistance of ATC to surgery, radioiodine therapy, radiotherapy and chemotherapy. This review will cover novel agents involving several cellular signaling pathways including the BRAF pathway. The BRAF inhibitor vemurafenib improves survival among patients with metastatic melanoma, hairy-cell leukemia and intracranial neoplasms with BRAF gene mutations. The frequency of a BRAF (V600E) mutation in ATC is about 25%.

Case presentation

We report the first case of a marked partial response to adjuvant first line monotherapy with vemurafenib in BRAF V600E-mutated ATC. The 78-year-old man showed a sustained response for 7 months, thereafter scans revealed progressive disease and the patient died 10 months after first diagnosis. This case report is accompanied by a comprehensive review of current strategies and tools for ATC treatment.

Conclusions

This case and the review of current data confirm the benefit of BRAF inhibition in BRAF-mutated ATC, limited by acquired resistance to targeted therapy.
Lineage plasticity enables low-ER luminal tumors to evolve and gain basal-like traits
Authors: Mohamed Gadisti Aisha , Mahmood Sundis , Ognjenovic Nevena B. , Lee Min Kyung , Wilkins Owen M. , Christensen Brock C. , Muller Kristen E. , Pattabiraman Diwakar R.
Published: March 2023

Stratifying breast cancer into specific molecular or histologic subtypes aids in therapeutic decision-making and predicting outcomes; however, these subtypes may not be as distinct as previously thought. Patients with luminal-like, estrogen receptor (ER)-expressing tumors have better prognosis than patients with more aggressive, triple-negative or basal-like tumors. There is, however, a subset of luminal-like tumors that express lower levels of ER, which exhibit more basal-like features. We have found that breast tumors expressing lower levels of ER, traditionally considered to be luminal-like, represent a distinct subset of breast cancer characterized by the emergence of basal-like features. Lineage tracing of low-ER tumors in the MMTV-PyMT mouse mammary tumor model revealed that basal marker-expressing cells arose from normal luminal epithelial cells, suggesting that luminal-to-basal plasticity is responsible for the evolution and emergence of basal-like characteristics. This plasticity allows tumor cells to gain a new lumino-basal phenotype, thus leading to intratumoral lumino-basal heterogeneity. Single-cell RNA sequencing revealed SOX10 as a potential driver for this plasticity, which is known among breast tumors to be almost exclusively expressed in triple-negative breast cancer (TNBC) and was also found to be highly expressed in low-ER tumors. These findings suggest that basal-like tumors may result from the evolutionary progression of luminal tumors with low ER expression.