bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Goal Phenytoin Levels After an Initial Intravenous Loading Dose at an Academic Medical Center
Authors: Kim Christine S. , Tran Lena K. , Goodberlet Melanie Z. , Szumita Paul M. , Marino Kaylee K.
Published: May 2023

Background:

Phenytoin intravenous loading doses are administered in status epilepticus to rapidly achieve therapeutic levels. Accurately assessing phenytoin levels after the initial load can be challenging because of its complex pharmacokinetic profile and nonstandardized weight-based loading doses.

Objectives:

The objectives of this analysis were to determine the incidence of patients achieving goal phenytoin levels after the initial loading dose and characterize factors that contribute to achieving the goal level.

Methods:

This single-center, retrospective cohort analysis was approved by our institutional review board and included adult patients who received a phenytoin load from May 2016 to March 2021. Patients were excluded if no total phenytoin level was drawn within 24 hours of the load, if the maintenance dose was given before the first level was drawn, or if the patient was on phenytoin before the load. The major endpoint was the percentage of patients achieving a corrected goal phenytoin level of ≥10 mcg/mL after the initial load. Multivariate regression was used to determine predictors of achieving the goal phenytoin level.

Results:

Of the 152 patients included, 139 patients (91.4%) achieved a corrected goal level after the first load. Patients at goal received a significantly higher median weight-based loading dose (19.1 mg/kg [15.0-20.0] vs 12.6 mg/kg [10.1-15.0], P < 0.01). The multivariate analysis identified weight-based dosing as a statistically significant predictor of achieving the corrected goal level (odds ratio, 1.30; 95% CI, 1.12-1.53; P < 0.01).

Conclusion and Relevance:

Most patients achieved a corrected goal phenytoin level after the initial load. A higher median weight-based loading dose was shown to be a predictor of achieving the goal level and should be encouraged for rapid seizure termination. Future studies are warranted to confirm patient-specific factors that affect rapid achievement of the goal phenytoin level.
Lipoid Congenital Adrenal Hyperplasia With a Novel StAR Gene Mutation
Authors: Bakkar Ayman A , Alsaedi Abdulaziz , Kamal Naglaa M , Althobaiti Enad , Aboulkhair Lujain A , Almalki Abdullah M , Alsalmi Shaima A , Alharthi Qaydah , Abosabie Sara A , Abosabie Salma AS
Published: May 2023

Lipoid congenital adrenal hyperplasia (LCAH) is characterized by disturbance of adrenal and gonadal steroidogenesis (OMIM:201710). It is caused by mutation in the Steroidogenic Acute Regulatory Protein (StAR). We report a classic case of LCAH in a neonate (46, XY) with phenotypic female genitalia who presented with significant salt loss with a novel homozygous variant mutation c.745-1G>C p. in StAR gene.
Social democratic party positions on the EU: The case of Brexit
Authors: Swatton Philip
Published: May 2023

In recent years, social democratic parties have been confronted with the rise of second dimension issues. These issues often see social democratic parties facing a choice between competing portions of their own electorate. A particularly prominent second dimension issue is that of the EU: should social democratic parties take pro or anti-EU positions? I look at the case of the UK as an instructive example of this debate. I estimate a narrow counterfactual, simulating how the Labour Party’s vote share and seat count would have changed as its position on Brexit changes. I call this counterfactual narrow because I only consider the effect of these position changes on vote choice and turnout, and not any broader consequences. I run two simulations to compare the implications of pure proximity and proximity-categorisation models of vote choice. I generate seat predictions from the simulation results by using Uniform National Swing and Uniform Regional Swing. Broadly, I find that being pro-Remain clearly benefited the party in terms of votes, but that results are more mixed in terms of seats.
Hot corrosion and CMAS degradation of laser-glazed YSZ coating with optimum parameter
Authors: Avcı Ali , Karabaş Muhammet , Akdoğan Eker Ayşegul , Akman Erhan , Aslan Caner
Published: May 2023

The purpose of this research is to look into the effect of laser surface modification on the hot corrosion and hot corrosion  +  calcium–magnesium aluminosilicate (CMAS) resistance of YSZ thermal barrier coating. Metco AMDRY 997 (Ni–22Cr–10Al–Y) powder was coated as a bond coat on the AISI 304L stainless steel substrate using a high-velocity oxy-fuel spray technique. As a ceramic top layer, 204 NS YSZ (ZrO2·8Y2O3) particles were plasma sprayed on the bond coat. Following that, the entire coating surface was treated with a 20-kHz pulsed CO2 laser to increase the coatings’ surface performance. A corrosion test was carried out in a box furnace for 20 h at 1050 °C. SEM images of laser-glazed coatings revealed denser surfaces than those of air-spraying coatings. The laser-modified coating is more resistant to hot corrosion than unmodified coatings. The X-ray diffraction analysis revealed that the reaction between yttria (Y2O3) and V2O5 resulted in the formation of YVO4 crystals as a corrosion product. According to energy dispersive spectroscopy results, laser-glazed coatings reduced molten salt diffusion from surface to bond coat. As a result, laser-glazed coatings demonstrated improved hot corrosion resistance and decreased corrosion products on the bond coat zone. After the hot corrosion test, the laser-treated composite had a 55% lower thermally grown oxide layer than untreated APS YSZ. The optimum laser parameter was used as 77.7 W laser power, 120 mm/s scanning speed, and 215 mm laser distance.
Effectiveness of digital technologies to engage and support the wellbeing of people with dementia and family carers at home and in care homes: A scoping review
Authors: Bradley Lyndsey , Shanker Shanti , Murphy Jane , Fenge Lee-Ann , Heward Michelle
Published: May 2023

Use of digital technologies to support meaningful engagement of people with dementia and carers increased during the COVID-19 pandemic. The purpose of this scoping review was to determine the effectiveness of digital technologies in supporting the engagement and wellbeing of people with dementia and family carers at home and in care homes. Studies published in peer reviewed literature were identified across four databases (CINAHL, Medline, PUBMED, PsychINFO). Sixteen studies met the inclusion criteria. Findings indicate that digital technologies can potentially support the wellbeing of people with dementia and family carers, although only a few studies had measured impact on wellbeing, as many were reporting on technology at proof-of-concept stage rather than commercially ready products. Moreover, current studies lacked meaningful involvement of people with dementia, family carers, and care professionals in the design of the technology. Future research should bring together people with dementia, family carers, care professionals and designers to coproduce digital technologies with researchers and evaluate them using robust methodologies. Codesign should start early in the intervention development phase and continue until implementation. There is a need for real world applications that nurture social relationships by focusing on how digital technologies can support more personalised, adaptive forms of care. Developing the evidence base to identify what makes digital technologies effective in supporting the wellbeing of people with dementia is crucial. Future interventions should therefore consider the needs and preferences of people with dementia, their families, and professional carers, as well as the suitability and sensitivity of wellbeing outcome measures.
Automated vision-based post-earthquake safety assessment for bridges using STF-PointRend and EfficientNetB0
Authors: Cheng Min-Yuan , Sholeh Moh Nur , Harsono Kenneth
Published: May 2023

Bridges are critical transportation infrastructure in Taiwan that are at high risk of structural damage during major earthquake incidents. The structural health monitoring method currently used to assess bridge safety nationwide is labor-intensive and expensive to implement. In this study, a novel automated bridge safety assessment system was developed to facilitate post-earthquake bridge inspections using symbiotic organism search-transfer learning-PointRend (STF-PointRend) for component and damage type detection, EfficientNetB0 for damage level detection, and earthquake resistance index for safety assessment. In the case studies, the STF-PointRend model obtained good testing results, with global mean Intersection over Union values of 76.31 and 75.47% for bridge-component and damage-type detections. Furthermore, the EfficientNetB0 model obtained an average F1 score of 0.86 for damage-level detection in the testing results. The developed model was used to conduct a safety evaluation of two bridges (Lempenge I and Luk I) that had suffered damage in a 2018 earthquake in Palu, Indonesia. The earthquake-resistance scores of 56.15 and 53.21 respectively earned by the two bridges indicate that both require immediate maintenance.
The integration of head and body cues during the perception of social interactions
Authors: Williams Elin H , Chakrabarti Bhismadev
Published: May 2023

Humans spend a large proportion of time participating in social interactions. The ability to accurately detect and respond to human interactions is vital for social functioning, from early childhood through to older adulthood. This detection ability arguably relies on integrating sensory information from the interactants. Within the visual modality, directional information from a person’s eyes, head, and body are integrated to inform where another person is looking and who they are interacting with. To date, social cue integration research has focused largely on the perception of isolated individuals. Across two experiments, we investigated whether observers integrate body information with head information when determining whether two people are interacting, and manipulated frame of reference (one of the interactants facing observer vs. facing away from observer) and the eye-region visibility of the interactant. Results demonstrate that individuals integrate information from the body with head information when perceiving dyadic interactions, and that integration is influenced by the frame of reference and visibility of the eye-region. Interestingly, self-reported autistics traits were associated with a stronger influence of body information on interaction perception, but only when the eye-region was visible. This study investigated the recognition of dyadic interactions using whole-body stimuli while manipulating eye visibility and frame of reference, and provides crucial insights into social cue integration, as well as how autistic traits affect cue integration, during perception of social interactions.
Collectivizing justice: Participatory witnessing, sense memory, and emotional communities
Authors: Yang Emilia
Published: May 2023

This article describes and analyzes the practices made possible by the temporary exhibition of AMA y No Olvida, Museum of Memory Against Impunity, a community and transmedia museum project in Nicaragua, in tandem with the embodied performances of the families of the victims of state violence and visitors during repression and a state of exception. I theorize how the witnessing performed by the audience surpasses the framework of memory museums for human rights with a participatory framework that uses activist and performative expressions. Participatory witnessing is made possible by expanding the exhibition into a performative and political space in which society at large can participate and witness the victims’ struggle for justice through sharing intimate experiences of embodied pain and grief and demands for justice and reparations. Such witnessing then creates an emotional community with solidarity and a moral and political commitment that recognizes and centers the victims as active survivors, activists, and protagonists.
Instructional Communication and Medium of Instruction: Content Instructors’ Perspectives
Authors: Alhamami Munassir
Published: May 2023

This paper hypothesizes that higher proficiency in the medium of instruction (MI) is a precondition for effective instructional communication (IC), with the latter being essential for higher cognitive processes, positive affects, and better performance in the learning environment. The reported study used questionnaires comprising open-ended questions to survey 341 content instructors who taught on 26 undergraduate programs with English as the MI (EMI) in a Saudi public university. Thematic analysis was used to analyze the resulting qualitative data, and the results reveal four themes. The first theme is the advantages of using the students’ mother tongue (Arabic in this case) as an MI; the findings show that doing so is related to robust IC, with the latter leading to better cognition, positive affects, and stronger performance in the learning environment. The second theme is the advantages of using EMI, which can be classified into three main areas: more educational resources, better international research collaboration, and more international job opportunities. The third theme is the use of code-switching in EMI classes because of poor IC; instructors code-switch for three purposes: cognitive, affective, and performance. The fourth theme is suggestions from participants for how to improve IC in EMI programs: the findings recommend the use of IC theory and linguistic relativity to examine EMI programs; also, collaboration among IC researchers, cognitive linguists, and EMI researchers will help understand how the MI influences students’ success; furthermore, policymakers must design curricula that consider the perspectives of content instructors and provide them with training to overcome several IC barriers in EMI programs.
Hsp70-Bim interaction facilitates mitophagy by recruiting parkin and TOMM20 into a complex
Authors: Song Ting , Yin Fangkui , Wang Ziqian , Zhang Hong , Liu Peng , Guo Yafei , Tang Yao , Zhang Zhichao
Published: May 2023

Background

For cancer therapy, the identification of both selective autophagy targets and small molecules that specifically regulate autophagy is greatly needed. Heat shock protein 70 (Hsp70) is a recently discovered BH3 receptor that forms a protein‒protein interaction (PPI) with Bcl-2-interacting mediator of cell death (Bim). Herein, a specific inhibitor of the Hsp70-Bim PPI, S1g-2, and its analog S1, which is a Bcl-2-Bim disruptor, were used as chemical tools to explore the role of Hsp70-Bim PPI in regulating mitophagy.

Methods

Co-immunoprecipitation and immunofluorescence assays were used to determine protein interactions and colocalization patterns. Organelle purification and immunodetection of LC3-II/LC3-I on mitochondria, endoplasmic reticulum (ER) and Golgi were applied to identify specific types of autophagy. Cell-based and in vitro ubiquitination studies were used to study the role of the Hsp70-Bim PPI in parkin-mediated ubiquitination of outer mitochondrial membrane 20 (TOMM20).

Results

We found that after the establishment of their PPI, Hsp70 and Bim form a complex with parkin and TOMM20, which in turn facilitates parkin translocation to mitochondria, TOMM20 ubiquitination and mitophagic flux independent of Bax/Bak. Moreover, S1g-2 selectively inhibits stress-induced mitophagy without interfering with basal autophagy.

Conclusions

The findings highlight the dual protective function of the Hsp70-Bim PPI in regulating both mitophagy and apoptosis. S1g-2 is thus a newly discovered antitumor drug candidate that drives both mitophagy and cell death via apoptosis.

Graphical Abstract
Membranous nephropathy caused by dimercaptosuccinic acid in a patient with Wilson’s disease: a case report and literature review
Authors: Li Xiang , Hu FengXin , Xu Gaosi
Published: May 2023

Background

Dimercaptosuccinic acid (DMSA) therapy is a kind of chelation therapy for patients with Wilson ‘s disease (WD). While there have been reports of side effects associated with DMSA, the development of membranous nephropathy as a result of this therapy is uncommon.

Case presentation

We present a case of a 19-year-old male patient with Wilson’s disease who experienced proteinuria while receiving long-term DMSA treatment. Further evaluation revealed abnormally low levels of serum ceruloplasmin and serum albumin, as well as a 24-hour urinary protein excretion of 4599.98 mg/24 h. A renal biopsy confirmed the presence of membranous nephropathy. After ruling out other potential causes, we determined that the patient’s membranous nephropathy was likely caused by DMSA. Following treatment with glucocorticoids, there was a significant reduction in proteinuria.

Conclusion

This case highlights the possibility of DMSA-induced membranous nephropathy and the importance of considering this diagnosis in patients receiving DMSA treatment. Given the widespread use of DMSA in the treatment of Wilson’s disease, further research is needed to fully understand the potential role of this drug in the development of membranous nephropathy.
Fatigue, depression, and product tolerability during long-term treatment with intravenous immunoglobulin (Gamunex® 10%) in patients with chronic inflammatory demyelinating polyneuropathy
Authors: Klehmet Juliane , Tackenberg Björn , Haas Judith , Kieseier Bernd C.
Published: May 2023

Introduction/Aims

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is characterized by progressive weakness and sensory loss, often affecting patient’s ability to walk and perform activities of daily living independently. Furthermore, patients often report fatigue and depression which can affect their quality of life. These symptoms were assessed in CIDP patients receiving long-term intravenous immunoglobulin (IVIG) treatment.

Methods

GAMEDIS was a multi-center, prospective, non-interventional study in adult CIDP patients treated with IVIG (10%) and followed for two years. Inflammatory Neuropathy Cause and Treatment (INCAT) disability score, Hughes Disability Scale (HDS), Fatigue Severity Scale (FSS), Beck Depression Inventory II (BDI), Short Form-36 health survey (SF-36) and Work Productivity and Activity Impairment Score Attributable to General Health (WPAI-GH) were assessed at baseline and quarterly. Dosing and treatment intervals, changes in outcome parameters, and adverse events (AEs) were analyzed.

Results

148 evaluable patients were followed for a mean of 83.3 weeks. The mean maintenance IVIG dose was 0.9 g/kg/cycle (mean cycle interval 38 days). Disability and fatigue remained stable throughout the study. Mean INCAT score: 2.4 ± 1.8 at baseline and 2.5 ± 1.9 at study end. HDS: 74.3% healthy/minor symptoms at baseline and 71.6% at study end. Mean FSS: 4.2 ± 1.6 at baseline and 4.1 ± 1.7 at study end. All patients reported minimal/no depression at baseline and throughout. SF-36 and WPAI-GH scores remained stable. Fifteen patients (9.5%) experienced potentially treatment-related AEs. There were no AEs in 99.3% of infusions.

Discussion

Long-term treatment of CIDP patients with IVIG 10% in real-world conditions maintained clinical stability on fatigue and depression over 96 weeks. This treatment was well-tolerated and safe.
CYD0281, a Bcl-2 BH4 domain antagonist, inhibits tumor angiogenesis and breast cancer tumor growth
Authors: Lin Yihua , Zhao Yiling , Chen Minggui , Li Zishuo , Liu Qiao , Chen Jian , Ding Yi , Ding Chunyong , Ding Ye , Qi Cuiling , Zheng Lingyun , Li Jiangchao , Zhang Rongxin , Zhou Jia , Wang Lijing , Zhang Qian-Qian
Published: May 2023

Background

B-cell lymphoma 2 (Bcl-2) family proteins are key regulators of apoptosis, which possess four conserved Bcl-2 homologies (BH) domains. Among the BH domains, the BH3 domain is considered as a potent ‘death domain’ while the BH4 domain is required for anti-apoptotic activity. Bcl-2 can be converted to a pro-apoptotic molecule through the removal or mutation of the BH4 domain. Bcl-2 is considered as an inducer of angiogenesis, which can promote tumor vascular network formation and further afford nutrients and oxygen to promote tumor progression. However, whether disrupting the function of the BH4 domain to convert Bcl-2 into a pro-apoptotic molecule could make Bcl-2 possess the potential for anti-angiogenic therapy remains to be defined.

Methods

CYD0281 was designed and synthesized according to the lead structure of BDA-366, and its function on inducing a conformational change of Bcl-2 was further evaluated via immunoprecipitation (IP) and immunofluorescence (IF) assays. Moreover, the function of CYD0281 on apoptosis of endothelial cells was analyzed via cell viability, flow cytometry, and western blotting assays. Additionally, the role of CYD0281 on angiogenesis in vitro was determined via endothelial cell migration and tube formation assays and rat aortic ring assay. Chick embryo chorioallantoic membrane (CAM) and yolk sac membrane (YSM) models, breast cancer cell xenograft tumor on CAM and in mouse models as well as the Matrigel plug angiogenesis assay were used to explore the effects of CYD0281 on angiogenesis in vivo.

Results

We identified a novel potent small-molecule Bcl-2-BH4 domain antagonist, CYD0281, which exhibited significant anti-angiogenic effects both in vitro and in vivo, and further inhibited breast cancer tumor growth. CYD0281 was found to induce conformational changes in Bcl-2 through the exposure of the BH3 domain and convert Bcl-2 from an anti-apoptotic molecule into a cell death inducer, thereby resulting in the apoptosis of vascular endothelial cells.

Conclusions

This study has revealed CYD0281 as a novel Bcl-2-BH4 antagonist that induces conformational changes of Bcl-2 to convert to a pro-apoptotic molecule. Our findings indicate that CYD0281 plays a crucial role in anti-angiogenesis and may be further developed as a potential anti-tumor drug candidate for breast cancer. This work also provides a potential anti-angiogenic strategy for breast cancer treatment.
Impact of digital economic development and environmental pollution on residents’ health: an empirical analysis based on 279 prefecture-level cities in China
Authors: He Yan-Ting , Zhang Yue-Chi , Huang Wen , Wang Ruo-Nan , He Luo-Xuan , Li Bei , Zhang Yi-Li
Published: May 2023

Background

The digital economy based on the internet and IT is developing rapidly in China, which makes a profound impact on urban environmental quality and residents’ health activities. Thus, this study introduces environmental pollution as a mediating variable based on Grossman’s health production function to explore the impact of digital economic development on the health of the population and its influence path.

Methods

Based on the panel data of 279 prefecture-level cities in China from 2011 to 2017, this paper investigates the acting mechanism of digital economic development on residents’ health by employing a combination of mediating effects model and spatial Durbin model.

Results

The development of digital economy makes direct improvement on residents’ health condition, which is also obtained indirectly by means of environmental pollution mitigation. Besides, from the perspective of spatial spillover effect, the development of digital economy also has a significant promoting effect on the health of adjacent urban residents, and further analysis reveals that the promoting effect in the central and western regions of China is more pronounced than that in the eastern region.

Conclusions

Digital economy can have a direct promoting effect on the health of residents, and environmental pollution has an intermediary effect between digital economy and residents’ health; At the same time, there is also a regional heterogeneity among the three relationships. Therefore, this paper believes that the government should continue to formulate and implement scientific digital economy development policies at the macro and micro levels to narrow the regional digital divide, improve environmental quality and enhance the health level of residents.
Leveraging social media to increase lung cancer screening awareness, knowledge and uptake among high-risk populations (The INSPIRE-Lung Study): study protocol of design and methods of a community-based randomized controlled trial
Authors: Carter-Bawa Lisa , Banerjee Smita C. , Comer Robert S. , Kale Minal S. , King Jennifer C. , Leopold Katherine T. , Monahan Patrick O. , Ostroff Jamie S. , Slaven James E. , Valenzona Francis , Wiener Renda Soylemez , Rawl Susan M.
Published: May 2023

Background

Lung cancer is the leading cause of cancer death for both men and women in the United States. The National Lung Screening Trial (NLST) demonstrated that low-dose computed tomography (LDCT) screening can reduce lung cancer mortality among high-risk individuals, but uptake of lung screening remains low. Social media platforms have the potential to reach a large number of people, including those who are at high risk for lung cancer but who may not be aware of or have access to lung screening.

Methods

This paper discusses the protocol for a randomized controlled trial (RCT) that leverages FBTA to reach screening-eligible individuals in the community at large and intervene with a public-facing, tailored health communication intervention (LungTalk) to increase awareness of, and knowledge about, lung screening.

Discussion

This study will provide important information to inform the ability to refine implementation processes for national population efforts to scale a public-facing health communication focused intervention using social media to increase screening uptake of appropriate, high-risk individuals.

Trial registration

The trial is registered at clinicaltrials.gov (#NCT05824273).
Changes and significance of vascular endothelial injury markers in patients with diabetes mellitus and pulmonary thromboembolism
Authors: Li Fan , Yuan Lianfang , Shao Na , Yang Xiaokun , Yang Shaohua , He Linjia , Ding Jie , Ding Ming , Yang Shengzhe , Fu Wenwen , Wang Congcong , Li Xiaochen , Cai Qiling
Published: May 2023

Background

To investigate the changes and clinical significance of vascular endothelial injury markers in type 2 diabetes mellitus (T2DM) complicated with pulmonary embolism (PE).

Methods

This prospective study enrolled patients with T2DM hospitalized in one hospital from January 2021 to June 2022. Soluble thrombomodulin (sTM) (ELISA), von Willebrand factor (vWF) (ELISA), and circulating endothelial cells (CECs) (flow cytometry) were measured. PE was diagnosed by computed tomography pulmonary angiography (CTPA).

Results

Thirty participants were enrolled in each group. The plasma levels of sTM (151.22 ± 120.57 vs. 532.93 ± 243.82 vs. 1016.51 ± 218.00 pg/mL, P < 0.001) and vWF (9.63 ± 2.73 vs. 11.50 ± 2.17 vs. 18.02 ± 3.40 ng/mL, P < 0.001) and the percentage of CECs (0.17 ± 0.46 vs. 0.30 ± 0.08 vs. 0.56 ± 0.18%, P < 0.001) gradually increased from the control group to the T2DM group to the T2DM + PE group. sTM (OR = 1.002, 95%CI: 1.002–1.025, P = 0.022) and vWF (OR = 1.168, 95%CI: 1.168–2.916, P = 0.009) were associated with T2DM + PE. sTM > 676.68 pg/mL for the diagnosis of T2DM + PE achieved an AUC of 0.973, while vWF > 13.75 ng/mL achieved an AUC of 0.954. The combination of sTM and vWF above their cutoff points achieved an AUC of 0.993, with 100% sensitivity and 96.7% specificity.

Conclusions

Patients with T2DM show endothelial injury and dysfunction, which were worse in patients with T2DM and PE. High sTM and vWF levels have certain clinical predictive values for screening T2DM accompanied by PE.
Discourse-based psychological intervention alleviates perioperative anxiety in patients with adolescent idiopathic scoliosis in China: a retrospective propensity score matching analysis
Authors: Bi Luosha , Pan Chengjun , Li Jiaxing , Zhou Jiahui , Wang Xiangyu , Cao Shiqi
Published: May 2023

Purpose

To evaluate the effectiveness of a discourse-based psychological intervention on perioperative anxiety, pain and life satisfaction of patients with AIS.

Methods

Between April 2018 and February 2021, 116 consecutive patients with AIS undergoing corrective surgery were enrolled in this study, including 51 with personalized psychological intervention (intervention group, IG) and 65 without (control group, CG). After propensity score matching (PSM), patient characteristics, perioperative scores of anxiety and life satisfaction, measured by values of Generalized Anxiety Disorder 7-item Scale (GAD-7) and Life Satisfaction Index Z scale (LSIZ), were recorded. Mixed linear models were used to estimate the influence of intervention group and time of measurement, as well as their interactions, in anxiety and life satisfaction. Data on post-surgical pain in both groups was also collected and analyzed.

Results

After PSM, a total of 90 patients (IG, n = 45; CG, n = 45) were enrolled in this study, and the 2 groups were comparable in patients’ demographic and baseline characteristics. There were no pre-intervention between-group differences in the degree of anxiety (IG: 3.98 ± 3.27 vs. CG: 3.93 ± 3.20, p = .948, Cohen’s d = 0.015), and life satisfaction (IG: 6.56 ± 1.70 vs. CG: 6.67 ± 2.09, p = .783, Cohen’s d = -0.058). After surgery, participants in both IG and CG showed improved the levels of anxiety (GAD-7: IG 2.18 ± 1.21; CG 2.87 ± 2.00) and life satisfaction (LSIZ: IG 9.84 ± 2.09; CG 9.02 ± 2.15). A stratified analysis of patients with generalized anxiety disorder showed improved anxiety (GAD-7: IG 3.50 ± 1.22 vs. CG 6.80 ± 2.05, p = .017, Cohen’s d = -1.956) and lower pain level (VAS: IG 4.50 ± 1.76 vs. CG 7.00 ± 1.00, p = .017, Cohen’s d = -1.747) in the IG than the CG after surgery.

Conclusions

Discourse-based psychological intervention before surgery can improve perioperative anxiety and life satisfaction, and postoperative painful condition, especially for patients with high-leveled pre-surgical anxiety.
Feasibility and efficacy of implementing group visits for women’s health conditions: a systematic review
Authors: Gerontakos Sophia , Leach Matthew , Steel Amie , Wardle Jon
Published: May 2023

Background

Shared medical appointments, also known as group visits, are a feasible and well-accepted approach for women receiving antenatal care, yet the feasibility and efficacy of this approach for female-specific reproductive conditions is uncertain.

Objective

The aim of this systematic review was to (a) determine the feasibility of group visits in adults with any female-specific reproductive condition, and (b) identify whether delivering group care for these conditions impacts clinical outcomes.

Method

Six databases and two clinical trials registries were searched from inception through to 26 January 2022 for original research examining group medical visits or group consultation interventions for adults with female reproductive conditions or pathologic conditions specific to the female reproductive system.

Results

The search yielded 2584 studies, of which four met the inclusion criteria. Included studies sampled women with breast cancer, chronic pelvic pain, polycystic ovary syndrome and gynaecological cancers. Studies reported high levels of patient satisfaction, with participants indicating their expectations had been met or exceeded. The impact of group visits on clinical outcomes was inconclusive however.

Discussion/conclusions

The studies in this review indicate delivery of female-specific healthcare via a group model maybe feasible and well-accepted. The review provides a solid basis for proposing larger and longer studies on group visits for female reproductive conditions.

Trial registration

The review protocol was registered with PROSPERO (CRD42020196995).
Multidomain and multilevel strategies to improve equity in maternal and newborn health services in Nepal: perspectives of health managers and policymakers
Authors: Khatri Resham B , Assefa Yibeltal , Durham Jo
Published: May 2023

Background

Nepal has committed to achieving universal coverage of quality maternal and newborn health (MNH) services by 2030. Achieving this, however, requires urgently addressing the widening inequity gradient in MNH care utilisation. This qualitative study examined the multidomain systemic and organisational challenges, operating in multi-level health systems, that influence equitable access to MNH services in Nepal.

Methods

Twenty-eight in-depth interviews were conducted with health policymakers and program managers to understand supply-side perspectives of drivers of inequity in MNH services. Braun and Clarke’s thematic approach was employed in analysing the data. Themes were generated and explained using a multidomain (structural, intermediary, and health system) and multi-level (micro, meso and macro) analytical framework.

Results

Participants identified underlying factors that intersect at the micro, meso and macro levels of the health system to create inequity in MNH services. Key challenges identified at the macro (federal) level included corruption and poor accountability, weak digital governance and institutionalisation of policies, politicisation of the health workforce, poor regulation of private MNH services, weak health management, and lack of integration of health in all policies. At the meso (provincial) level, identified factors included weak decentralisation, inadequate evidence-based planning, lack of contextualizing health services for the population, and non-health sector policies. Challenges at the micro (local) level were poor quality health care, inadequate empowerment in household decision making and lack of community participation. Structural drivers operated mostly at macro-level political factors; intermediary challenges were within the non-health sector but influenced supply and demand sides of health systems.

Conclusions

Multidomain systemic and organisational challenges, operating in multi-level health systems, influence the provision of equitable health services in Nepal. Policy reforms and institutional arrangements that align with the country’s federalised health system are needed to narrow the gap. Such reform efforts should include policy and strategic reforms at the federal level, contextualisation of macro-policies at the provincial level, and context-specific health service delivery at the local level. Macro-level policies should be guided by political commitment and strong accountability, including a policy framework for regulating private health services. The decentralisation of power, resources, and institutions at the provincial level is essential for technical support to the local health systems. Integrating health in all policies and implementation is critical in addressing contextual social determinants of health.
A novel Anti-ROS osteoblast-specific delivery system for ankylosing spondylitis treatment via suppression of both inflammation and pathological new bone formation
Authors: Zheng Guan , Peng Xiaoshuai , Zhang Yunhui , Wang Peng , Xie Zhongyu , Li Jinteng , Liu Wenjie , Ye Guiwen , Lin Yucong , Li Guojian , Liu Huatao , Zeng Chenying , Li Lihua , Wu Yanfeng , Shen Huiyong
Published: May 2023

Ankylosing spondylitis (AS) is a common rheumatic disorder distinguished by chronic inflammation and heterotopic ossification at local entheses sites. Currently available medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying anti-rheumatic drugs (DMARDs) and TNF inhibitors, are limited by side effects, high costs and unclear inhibitory effects on heterotopic ossification. Herein, we developed manganese ferrite nanoparticles modified by the aptamer CH6 (CH6-MF NPs) that can efficiently scavenge ROS and actively deliver siRNA into hMSCs and osteoblasts in vivo for effective AS treatment. CH6-MF NPs loaded with BMP2 siRNA (CH6-MF-Si NPs) effectively suppressed abnormal osteogenic differentiation under inflammatory conditions in vitro. During their circulation and passive accumulation in inflamed joints in the Zap70mut mouse model, CH6-MF-Si NPs attenuated local inflammation and rescued heterotopic ossification in the entheses. Thus, CH6-MF NPs may be an effective inflammation reliever and osteoblast-specific delivery system, and CH6-MF-Si NPs have potential for the dual treatment of chronic inflammation and heterotopic ossification in AS.
Effect of the gut microbiota and their metabolites on postoperative intestinal motility and its underlying mechanisms
Authors: Ma TianRong , Xue XiaoLei , Tian Hui , Zhou XinXiu , Wang JunKe , Zhao ZhiWen , Wang MingFei , Song JiYuan , Feng RenXiang , Li Leping , Jing Changqing , Tian Feng
Published: May 2023

Gut microbiota is closely related to human health and disease because, together with their metabolites, gut microbiota maintain normal intestinal peristalsis. The use of antibiotics or opioid anesthetics, or both, during surgical procedures can lead to dysbiosis and affect intestinal motility; however, the underlying mechanisms are not fully known. This review aims to discuss the effect of gut microbiota and their metabolites on postoperative intestinal motility, focusing on regulating the enteric nervous system, 5-hydroxytryptamine neurotransmitter, and aryl hydrocarbon receptor.
Advancing usability of an influenza hemagglutinin virus-like particle vaccine expressing a chimeric cytokine
Authors: Imagawa Toshifumi , Arasaki Youta , Maegawa Kenichi , Sugita Shigeo , Nerome Kuniaki
Published: May 2023

Vaccine efficacy of conventional influenza vaccines depend on the antigenic similarity between the selected vaccine strain and annual epidemic strain. Since the influenza virus evolves yearly, a vaccine which is independent from viral antigenic mutation is desired. We have developed chimeric cytokine (CC) and hemagglutinin (HA) incorporated virus-like particle (CCHA-VLP) as a universal influenza vaccine candidate. Using mouse models, it was shown that the vaccine provided broad-based protective activity against several types of human and avian influenza A viruses. In this report, nasal immunization and mixture form (CC- and HA-VLP) were tested to improve usability of this vaccine. Immunogenicity was evaluated by induction of IgG, IgA, and IFN-γ secreting cells. Protective activity was measured as mouse survival rate against lethal challenge with H1N1 and H5N1 viruses and against H3N2 virus by lung viral titer. Nasal immunization showed low immunogenicity and low protective efficacy, but the addition of a sesame oil adjuvant improved vaccine efficacy. Mixture form of CC- and HA-VLP showed comparable or higher vaccine efficacy when compared to the incorporated form, CCHA-VLP. These results contribute to improved usability, such as needle-less administration and easy HA subtypes alteration.
A randomised controlled trial of compression therapies for the treatment of venous leg ulcers (VenUS 6): study protocol for a pragmatic, multicentre, parallel-group, three-arm randomised controlled trial
Authors: Arundel C. E. , Welch C. , Saramago P. , Adderley U. , Atkinson R. , Chetter I. , Cullum N. , Davill T. , Griffiths J. , Hewitt C. , Hirst C. , Kletter M. , Mullings J. , Roberts G. , Smart B. , Soares M. , Stather P. , Strachan L. , Stubbs N. , Torgerson D. J. , Watson J. , Zahra S. , Dumville J.
Published: May 2023

Background

Venous leg ulcer(s) are common, recurring, open wounds on the lower leg, resulting from diseased or damaged leg veins impairing blood flow. Wound healing is the primary treatment aim for venous leg ulceration, alongside the management of pain, wound exudate and infection.

Full (high) compression therapy delivering 40 mmHg of pressure at the ankle is the recommended first-line treatment for venous leg ulcers. There are several different forms of compression therapy available including wraps, two-layer hosiery, and two-layer or four-layer bandages.

There is good evidence for the clinical and cost-effectiveness of four-layer bandage and two-layer hosiery but more limited evidence for other treatments (two-layer bandage and compression wraps). Robust evidence is required to compare clinical and cost-effectiveness of these and to investigate which is the best compression treatment for reducing time to healing of venous leg ulcers whilst offering value for money. VenUS 6 will therefore investigate the clinical and cost-effectiveness of evidence-based compression, two-layer bandage and compression wraps for time to healing of venous leg ulcers.

Methods

VenUS 6 is a pragmatic, multi-centre, three-arm, parallel-group, randomised controlled trial. Adult patients with a venous leg ulcer will be randomised to receive (1) compression wraps, (2) two-layer bandage or (3) evidence-based compression (two-layer hosiery or four-layer bandage).

Participants will be followed up for between 4 and 12 months. The primary outcome will be time to healing (full epithelial cover in the absence of a scab) in days since randomisation. Secondary outcomes will include key clinical events (e.g. healing of the reference leg, ulcer recurrence, ulcer/skin deterioration, amputation, admission/discharge, surgery to close/remove incompetent superficial veins, infection or death), treatment changes, adherence and ease of use, ulcer related pain, health-related quality of life and resource use.

Discussion

VenUS 6 will provide robust evidence on the clinical and cost-effectiveness of the different forms of compression therapies for venous leg ulceration.

VenUS 6 opened to recruitment in January 2021 and is currently recruiting across 30 participating centres.

Trial registration

ISRCTN67321719. Prospectively registered on 14 September 2020
Network consensus analysis and optimization of distributed FANETs based on multi-agent consensus theory
Authors: Tong Xin , Li Xu , Ding FuZhuang , Liu Ying
Published: May 2023

Distributed flying ad hoc networks (FANETs) have been widely used in collaborative reconnaissance, situation construction, and other scenarios. In distributed FANETs with multi-hop and intermittent links, nodes only maintain neighbors’ information and cannot obtain the whole network messages. There may be contradicting information collected across nodes, resulting in inconsistency problems. However, existing research on collaborative consensus focuses mainly on the control domain using multi-agent consensus theory. The study on distributed network consensus does not consider the effect of the multi-hop forwarding order, hence limiting the optimization of distributed FANETs. Based on this, we establish a network consensus model utilizing the multi-agent consensus theory and analyze the impact of the outage probability of links and untimely forwarding on the distributed consensus probability, considering the node density, link outage probability, and network maintenance times. Besides, using the election mechanism as an example, we establish distributed network performance analysis models considering consensus error to enhance the service delay and resource efficiency performance analysis of distributed FANETs. Finally, we construct a protocol-level simulation platform based on Visual Studio and extensive experiments to determine the optimal mechanism parameters under different network and channel parameters. The simulation results show that the optimal network maintenance times increase with the increasing outage probability of links. Moreover, distributed FANETs can achieve optimal resource efficiency without achieving complete consensus, that is, there is a tradeoff between network maintenance cost and network performance.
Field trial: disinfection of contaminated anesthetic masks for piglets
Authors: Friedrich L. , Winner E. , Härtel H. , Gumbert S. , Zöls S. , Ritzmann M. , Beisl M. , Kempf K. , von Altrock A. , Kemper N. , Schulz J.
Published: May 2023

This paper aimed to assess the success of cleaning and disinfection on microbiological contamination of anesthetic masks, which were used for automated isoflurane anesthesia for surgical castration of male piglets. Data collection took place on 11 farms in Southern Germany between September 2020 and June 2022. Each farm was visited three times (one farm having two different anesthesia devices was visited six times), and microbiological assessments took place at four sample points (SP): after unpacking the masks (SP0), after disinfection before anesthesia (SP1), after anesthesia of all piglets to be castrated in this run (SP2), and after disinfection after anesthesia (SP3). The microbiological assessment included the determination of total bacteria count, total count of hemolytic and non-hemolytic mesophilic aerotolerant bacteria and a qualitative detection of indicator bacteria Escherichia (E.) coli, extended-spectrum beta-lactamase-producing E. coli (ESBL) and methicillin-resistant Staphylococcus aureus (MRSA). For analysis, a generalized linear mixed model was applied using farms and farm visits as random effects and sampling points nested in farm visits as fixed effect. The fixed effect was highly significant for all three variables (total bacteria count, total count of hemolytic and non-hemolytic mesophilic aerotolerant bacteria) (p < 0.001). The bacterial counts at SP0 were about the same as at SP3. Concerning indicator bacteria, their presence was highest at SP2 and lowest at SP3. No indicator bacteria were present at SP1. It can be concluded that disinfection of anesthetic masks, especially before performing anesthesia, may effectively protect piglets of the following batch against unwanted transmission of pathogens. These findings will help farmers plan cleaning and disinfection activities.
Natural Language Processing Methods to Empirically Explore Social Contexts and Needs in Cancer Patient Notes
Authors: Derton Abigail , Guevara Marco , Chen Shan , Moningi Shalini , Kozono David E. , Liu Dianbo , Miller Timothy A. , Savova Guergana K. , Mak Raymond H. , Bitterman Danielle S.
Published: May 2023

PURPOSE

There is an unmet need to empirically explore and understand drivers of cancer disparities, particularly social determinants of health. We explored natural language processing methods to automatically and empirically extract clinical documentation of social contexts and needs that may underlie disparities.

METHODS

This was a retrospective analysis of 230,325 clinical notes from 5,285 patients treated with radiotherapy from 2007 to 2019. We compared linguistic features among White versus non-White, low-income insurance versus other insurance, and male versus female patients' notes. Log odds ratios with an informative Dirichlet prior were calculated to compare words over-represented in each group. A variational autoencoder topic model was applied, and topic probability was compared between groups. The presence of machine-learnable bias was explored by developing statistical and neural demographic group classifiers.

RESULTS

Terms associated with varied social contexts and needs were identified for all demographic group comparisons. For example, notes of non-White and low-income insurance patients were over-represented with terms associated with housing and transportation, whereas notes of White and other insurance patients were over-represented with terms related to physical activity. Topic models identified a social history topic, and topic probability varied significantly between the demographic group comparisons. Classification models performed poorly at classifying notes of non-White and low-income insurance patients (F1 of 0.30 and 0.23, respectively).

CONCLUSION

Exploration of linguistic differences in clinical notes between patients of different race/ethnicity, insurance status, and sex identified social contexts and needs in patients with cancer and revealed high-level differences in notes. Future work is needed to validate whether these findings may play a role in cancer disparities.