bluuebunny/crossref_metadata_2025 huggingface dataset:
Socioeconomic inequality in child health outcomes in India: analyzing trends between 1993 and 2021
Authors: Jain Anoop , Kim Rockli , Swaminathan Soumya , Subramanian SV
Published: July 2024

Background

The health of India’s children has improved over the past thirty years. Rates of morbidity and anthropometric failure have decreased. What remains unknown, however, is how those patterns have changed when examined by socioeconomic status. We examine changes in 11 indicators of child health by household wealth and maternal education between 1993 and 2021 to fill this critical gap in knowledge. Doing so could lead to policies that better target the most vulnerable children.

Methods

We used data from five rounds of India’s National Family Health Survey conducted in 1993, 1999, 2006, 2016, and 2021 for this repeated cross-sectional analysis. We studied mother-reported cases of acute respiratory illness and diarrhea, hemoglobin measurements for anemia, and height and weight measurements for anthropometric failure. We examined how the prevalence rates of each outcome changed between 1993 and 2021 by household wealth and maternal education. We repeated this analysis for urban and rural communities. 

Results

The socioeconomic gradient in 11 indicators of child health flattened between 1993 and 2021. This was in large part due to large reductions in the prevalence among children in the lowest socioeconomic groups. For most outcomes, the largest reductions occurred before 2016. Yet as of 2021, except for mild anemia, outcome prevalence remained the highest among children in the lowest socioeconomic groups. Furthermore, we show that increases in the prevalence of stunting and wasting between 2016 and 2021 are largely driven by increases in the severe forms of these outcomes among children in the highest socioeconomic groups. This finding underscores the importance of examining child health outcomes by severity.

Conclusions

Despite substantial reductions in the socioeconomic gradient in 11 indicators of child health between 1993 and 2021, outcome prevalence remained the highest among children in the lowest socioeconomic groups in most cases. Thus, our findings emphasize the need for a continued focus on India’s most vulnerable children.
Cytoreductive surgery without intra-peritoneal chemotherapy for metachronous colorectal peritoneal metastases
Authors: Ota Emi , Fukunaga Yosuke , Mukai Toshiki , Hiyoshi Yukiharu , Yamaguchi Tomohiro , Nagasaki Toshiya , Akiyoshi Takashi
Published: July 2024

Background

Cytoreductive surgery and chemotherapy reportedly improve the prognosis of patients with metachronous peritoneal metastases. However, the types of peritoneal metastases indicated for cytoreductive surgery remains unclear. Therefore, we aimed to clarify the category of cases for which cytoreductive surgery would be effective and report the prognosis associated with cytoreductive surgery for metachronous peritoneal metastases.

Methods

This study included 52 consecutive patients who underwent cytoreductive surgery for metachronous peritoneal metastases caused by colorectal cancer between January 2005 and December 2018 and fulfilled the selection criteria. The median follow-up period was 54.9 months. Relapse-free survival was calculated as the time from cytoreductive surgery of metachronous peritoneal metastases to recurrence. Overall survival was defined as the time from cytoreductive surgery of metachronous peritoneal metastases to death or the end of the follow-up period.

Results

The 5-year relapse-free survival rate was 30.0% and the 5-year overall survival rate was 72.3%. None of the patients underwent hyperthermic intraperitoneal chemotherapy. The analysis indicated no potential risk factors for 5-year relapse-free survival. However, for 5-year overall survival, the multivariate analysis revealed that time to diagnosis of metachronous peritoneal metastases of < 2 years after primary surgery (hazard ratio = 4.1, 95% confidence interval = 2.0–8.6, p = 0.0002) and number of metachronous peritoneal metastases ≥ 3 (hazard ratio = 9.8, 95% confidence interval = 2.3–42.3, p = 0.002) as independent factors associated with a poor prognosis.

Conclusions

Long intervals of more than 2 years after primary surgery and 2 or less metachronous peritoneal metastases were good selection criteria for cytoreductive surgery for metachronous peritoneal metastases from colorectal cancer.
“They don't have the luxury of time”: interviews exploring the determinants of public health research activity that contextualise embedded researcher roles in local government
Authors: Edwards Rachael C. , Kneale Dylan , Stansfield Claire , Lester Sarah
Published: July 2024

Background

Embedded researchers are a novel intervention to improve the translation of research evidence into policy and practice settings, including public health. These roles are being implemented with increasing popularity, but they often lack clear evaluative frameworks. Understanding initial levels of research activity, including associated barriers and opportunities, is essential to developing theories of change and thus shaping the roles and defining expectations. We aimed to identify the principal determinants of research activity in public health that contextualise embedded researcher roles, including attributes of the embedded researcher themselves.

Methods

We undertook seventeen semi-structured interviews with embedded researchers in diverse public health settings in English local government. Interviews were analysed using thematic analysis.

Results

We identified thirteen interlinked determinants of research activity within local government public health settings. Research and interpersonal skills, as well as pre-existing connections and knowledge within local government, were highly valued individual attributes for embedded researchers. Resource deficiencies (funding, time, and infrastructure) were primary barriers to research activity, whereas a strong local appetite for evidence informed decision making presented a valuable opportunity. However, there was inconsistencies across public health teams relating to perceptions of what constituted “research” and the resources that would be required.

Conclusions

Our results suggest that successful embedded researchers will have equally strong research and communication skills and should be offered mentorship and clear career progression pathways. Perceptions of research within local government are closely linked to resource deficiencies and senior endorsement. Embedded researchers could benefit from taking the time to develop locally contextualised knowledge of this research culture. Theories of change for embedded researchers should conceptualise the interconnections across individual, interpersonal, and organisational barriers and opportunities underlying local government research activity. Further research is needed to identify methods for exploring the influence of embedded researchers as well as to unpack the stages of research activity within local government and the associated behaviours.
Female legislators decrease epidemic deaths
Authors: Saito Takaharu
Published: July 2024

Recent discourse has lauded the efficacy of female leadership in national governments, particularly during the COVID-19 pandemic. This study employs two-way fixed effect (TWFE) and instrumental variable (IV) regression methodologies to reveal a more pronounced association between the proportion of female legislators and reduced epidemic-related mortality, rather than a direct correlation with female executive leadership. Further analysis elucidates that the effectiveness of female legislative representation is amplified through its interaction with the deliberative processes in governance. This suggests that policy diversity and inclusive decision-making mechanisms are instrumental in enhancing epidemic response efficacy.
Effect of patellofemoral joint overstuffing following total knee arthroplasty without patella resurfacing on clinical efficacy and related factors analysis
Authors: Wang Feida , Zhang Guohao , Wei Xiaochun
Published: July 2024

Objective

To analyze the influencing factors for patellofemoral joint (PFJ) overstuffing following total knee arthroplasty (TKA) without patella resurfacing, and explore the effect of PFJ overstuffing on clinical efficacy.

Methods

A retrospective analysis was conducted on 168 patients with end-stage knee osteoarthritis who underwent TKA without patella resurfacing at our hospital between Match 2019 and September 2021. The clinical data of these patients were retrospectively analyzed. In this study, PFJ overstuffing was defined as a postoperative PFJ distance greater than 1 mm compared to the preoperative measurement. The occurrence of postoperative PFJ overstuffing was counted. The patients were divided into the overstuffing group (n = 109) and the non-overstuffing group (n = 59) to count the patellar thickness and thickness of femoral anterior condyle in all patients before and after surgery, and analyze the influencing factors for postoperative PFJ overstuffing in such patients. Patients were followed up for 2 years to compare the recovery time of postoperative pain, score of visual analogue scale (VAS) and flexion activity between the two groups.

Results

There was no significant difference in patellar thickness between preoperative and postoperative measurements of the patients (P > 0.05). However, the thickness of the femoral anterior condyle and the PFJ distance after surgery increased significantly compared with those before surgery (P < 0.05). Among the 168 patients, 109 cases (64.88%) experienced PFJ overstuffing. The risk of PFJ overstuffing was higher in female patients than in male (P < 0.05). The preoperative thickness of the femoral anterior condyle in the overstuffing group was significantly smaller compared to the non-overstuffing group (P < 0.001). Compared with the non-overstuffing group, the overstuffing group had longer recovery time of postoperative pain (P < 0.05), and had lower flexion activity at 2 years after surgery (P < 0.001). However, no significant difference was found in VAS score between the overstuffing group and the non-overstuffing group at 2 years after surgery (P > 0.05). Spearman rank correlation analysis indicated females tend to have a lower preoperative thickness of the femoral anterior condyle (r=-0.424, P < 0.001), as well as a positive postoperative PFJ overstuffing (r = 0.237, P < 0.05). Furthermore, there was a negative correlation between preoperative thickness of the femoral anterior condyle and postoperative PFJ overstuffing (r=-0.540, P < 0.001).

Conclusion

Following TKA without patella resurfacing, there is a high risk of PFJ overstuffing, particularly among female patients and those with a small thickness of the femoral anterior condyle. Therefore, special attention should be given to these high-risk groups during clinical treatment.
Rare disease clinical trials in the European Union: navigating regulatory and clinical challenges
Authors: Mishra Sangita , Venkatesh MP
Published: July 2024

Background

Clinical development for orphan drugs presents significant difficulties and challenges. There is no unique or standard design, conduct, and outcome assessment methodology and it is sometimes impractical to fit design models of rare disease trials in any practiced and well-known framework. In the European Union (EU) these challenges encompass a broad array of subjects, including trial design, study outcomes, patient recruitment, trial conduct ethics, trial cost, and chances of success. This literature-based review study aims to provide a thorough overview of the critical aspects of rare disease trials in the EU by analyzing the current landscape of rare disease trials, highlighting key challenges, delving into regulatory and research initiatives and innovation in trial designs, and proposing multi-faceted solutions to implement effective rare disease clinical trials in the region.

Discussion

Traditional clinical trial designs, validation, and evaluation methodologies used for nonorphan drugs often prove unsuitable for orphan drugs, given the small patient populations, sometimes fewer than 1000 cases. There is an increasing need for accessible therapies and both regulators as well as industry are trying to develop affordable and effective drugs to address this need. Despite several steps that have been taken, the timely development of drugs remains a challenge. One of the reasons behind the long development timeline is the recruitment, retention, and conduct of rare disease trials. To optimize the development timelines of orphan drugs in the EU, it is important to ensure that the safety and efficacy of the product is not compromised. Industry and regulatory agencies must implement innovative trial designs, devise flexible policies, and incorporate real-world data for assessing clinical outcomes.

Conclusion

Collaboration among academic institutions, pharmaceutical companies (both small and major), patient groups, and health authorities is crucial in overcoming obstacles related to clinical trials and providing assistance and creative ideas. The ultimate objective of granting rare disease patients timely and affordable access to medications with a positive balance between benefits and risks is to be met.
A randomized clinical trial testing a health literacy intervention to reduce disparities in access to care among Justice-Impacted Adults (JIA)
Authors: Ojeda Victoria D. , Groneman Arthur , Hiller-Venegas Sarah , Moreno Melissa , Schuler Briana , Barksdale Jerrica , Berliant Emily , Romero Natalie , Edwards Todd M. , Lister Zephon , Gilmer Todd , Gaines Tommi , Bazzi Angela
Published: July 2024

Background

Low health literacy is costly and observed among justice-impacted adults (JIA), a group that often faces numerous barriers in accessing healthcare and a disproportionate burden of illness. Health literacy interventions for JIA are critically needed to improve healthcare access and related outcomes.

Methods

This manuscript describes the protocol for a longitudinal mixed-methods randomized clinical trial that assesses the effectiveness of a coach-guided health literacy intervention on JIA’s healthcare access. The intervention was previously piloted with justice impacted adults. We will recruit 300 JIA ages 18 + in San Diego, California. Participants will be randomized 1:1 to the Treatment Group (i.e., coach-guided intervention providing 12 sessions of individualized health coaching and service navigation over 6 months) or the Control Group (i.e., self-study of the health coaching program, and brief service navigation support). We will quantitatively assess JIA’s healthcare access defined as: use of healthcare, health insurance status, and regular source of care at 6-months as the primary outcomes. Participants will also be surveyed at 12-months. Statistical analyses will incorporate the intent-to-treat (ITT) principle and we will estimate mixed-effects logistic regression for the primary outcomes. We will also conduct qualitative interviews at 6 and 12-months with 40 purposively sampled participants, stratified by study arm, who reported healthcare access barriers at baseline. Interviews will explore participants’ satisfaction with the intervention, healthcare attitudes, self-efficacy for and barriers to healthcare access over time, perceived contribution of the intervention to health and well-being, and diffusion of intervention-related information within participants’ social networks. We will conduct deductive thematic analyses of qualitative data.

Discussion

Low health literacy among JIA is a foundational challenge requiring tailored intervention strategies. Findings from this trial may inform policies and the structure of service delivery models to build health literacy among JIA in institutional and community settings throughout the United States and elsewhere.

Trial registration

This study is registered with the United States’ ClinicalTrials.gov registry under protocol # 161,903.
Movement patterns of a small-bodied minnow suggest nomadism in a fragmented, desert river
Authors: Chavez Martinique J. , Budy Phaedra , Pennock Casey A. , Archdeacon Thomas P. , MacKinnon Peter D.
Published: July 2024

Background

Unfettered movement among habitats is crucial for fish to access patchily distributed resources and complete their life cycle, but many riverscapes in the American Southwest are fragmented by dams and dewatering. The endangered Rio Grande silvery minnow (Hybognathus amarus, RGSM) persists in a fragmented remnant of its former range (ca. 5%), and its movement ecology is understudied.

Methods

We tracked movements of hatchery-reared RGSM, tagged with passive integrated transponder tags, using stationary and mobile antennas from 2019 to 2022. We quantified probability of movement and total distance moved by RGSM released above and below a dam. We then assessed how well two prevailing riverine movement theories (i.e., restricted movement paradigm [RMP] and colonization cycle hypothesis [CCH]) explained RGSM movement patterns.

Results

We detected 36.8% of released RGSM (n = 37,215) making at least one movement. Movements were leptokurtic and substantially greater than expected based on the RMP for both stationary (1.7–5.9 m) and mobile (30.3–77.8 m) individuals. On average, RGSM were detected at large for 75 days and moved a total of 12.2 rkm within a year. The maximum total distance moved by RGSM was 103 rkm. Similarly, we observed a multimodal distribution of detected range sizes with a mean detected range of 2.4 rkm and a maximum detected range of 78.2 rkm. We found little support for an upstream movement bias, as expected under the CCH, and most movements (74%) were directed downstream.

Conclusions

Our data suggest RGSM are highly mobile, with the ability to make long-distance movements. Neither movement theory adequately described movement patterns of RGSM; instead, our findings support a nomadic movement pattern and an apparent drift paradox matching recent studies of other pelagic-broadcast spawning minnows where populations persist upstream despite experiencing downstream drift as larvae. Resolution of the drift paradox may be achieved through further, targeted studies into different aspects of the species’ life history. Quantification of RGSM movement provides crucial insights into the species’ movement ecology and may help define the appropriate scale of recovery efforts.
Pure argyrophilic grain disease revisited: independent effects on limbic, neocortical, and striato-pallido-nigral degeneration and the development of dementia in a series with a low to moderate Braak stage
Authors: Yokota Osamu , Miki Tomoko , Nakashima-Yasuda Hanae , Ishizu Hideki , Haraguchi Takashi , Ikeda Chikako , Hasegawa Masato , Miyashita Akinori , Ikeuchi Takeshi , Nishikawa Naoto , Takenoshita Shintaro , Sudo Koichiro , Terada Seishi , Takaki Manabu
Published: July 2024

Agyrophilic grains (AGs) are age-related limbic-predominant lesions in which four-repeat tau is selectively accumulated. Because previous methodologically heterogeneous studies have demonstrated inconsistent findings on the relationship between AGs and dementia, whether AGs affect cognitive function remains unclear. To address this question, we first comprehensively evaluated the distribution and quantity of Gallyas-positive AGs and the severity of neuronal loss in the limbic, neocortical, and subcortical regions in 30 cases of pure argyrophilic grain disease (pAGD) in Braak stages I–IV and without other degenerative diseases, and 34 control cases that had only neurofibrillary tangles with Braak stages I–IV and no or minimal Aβ deposits. Then, we examined whether AGs have independent effects on neuronal loss and dementia by employing multivariate ordered logistic regression and binomial logistic regression. Of 30 pAGD cases, three were classified in diffuse form pAGD, which had evident neuronal loss not only in the limbic region but also in the neocortex and subcortical nuclei. In all 30 pAGD cases, neuronal loss developed first in the amygdala, followed by temporo-frontal cortex, hippocampal CA1, substantia nigra, and finally, the striatum and globus pallidus with the progression of Saito AG stage. In multivariate analyses of 30 pAGD and 34 control cases, the Saito AG stage affected neuronal loss in the amygdala, hippocampal CA1, temporo-frontal cortex, striatum, globus pallidus, and substantia nigra independent of the age, Braak stage, and limbic-predominant age-related TDP-43 encephalopathy (LATE-NC) stage. In multivariate analyses of 23 pAGD and 28 control cases that lacked two or more lacunae and/or one or more large infarctions, 100 or more AGs per × 400 visual field in the amygdala (OR 10.02, 95% CI 1.12–89.43) and hippocampal CA1 (OR 12.22, 95% CI 1.70–87.81), and the presence of AGs in the inferior temporal cortex (OR 8.18, 95% CI 1.03–65.13) affected dementia independent of age, moderate Braak stages (III–IV), and LATE-NC. Given these findings, the high density of limbic AGs and the increase of AGs in the inferior temporal gyrus may contribute to the occurrence of dementia through neuronal loss, at least in cases in a low to moderate Braak stage.
Exploring the feasibility of a single-protoplast proteomic analysis
Authors: Vu Hung M. , Lee Ju Yeon , Kim Yongmin , Park Sanghoon , Izaguirre Fabiana , Lee Juhyeon , Lee Jung-Hyun , Jo Minjoung , Woo Hye Ryun , Kim Jin Young , Lim Pyung Ok , Kim Min-Sik
Published: July 2024

Background

Recent advances in high-resolution mass spectrometry have now enabled the study of proteomes at the single-cell level, offering the potential to unveil novel aspects of cellular processes. Remarkably, there has been no prior attempt to investigate single-plant cell proteomes. In this study, we aimed to explore the feasibility of conducting a proteomic analysis on individual protoplasts.

Findings

As a result, our analysis identified 978 proteins from the 180 protoplasts, aligning with well-known biological processes in plant leaves, such as photosynthetic electron transport in photosystem II. Employing the SCP package in the SCoPE2 workflow revealed a notable batch effect and extensive missing values in the data. Following correction, we observed the heterogeneity in single-protoplast proteome expression. Comparing the results of single-protoplast proteomics with those of bulk leaf proteomics, we noted that only a small fraction of bulk data was detected in the single-protoplast proteomics data, highlighting a technical limitation of the current single-cell proteomics method.

Conclusions

In summary, we demonstrated the feasibility of conducting a single-protoplast proteomic experiment, revealing heterogeneity in plant cellular proteome expression. This underscores the importance of analyzing a substantial number of plant cells to discern statistically significant changes in plant cell proteomes upon perturbation such as abscisic acid treatment in future studies. We anticipate that our study will contribute to advancing single-protoplast proteomics in the near future.
Posttraumatic aortic regurgitation and root pseudoaneurysm following blunt chest trauma: a case report
Authors: Aizawa Hiroaki , Yamauchi Haruo , Ando Masahiko , Ono Minoru
Published: July 2024

Background

The simultaneous diagnosis of severe aortic regurgitation and aortic root pseudoaneurysm resulting from traffic injury is extremely rare. This report presents the case of a patient with Marfan syndrome who experienced aortic root pseudoaneurysm and subacute severe aortic regurgitation following a traffic accident.

Case presentation

A 64-year-old woman was diagnosed with Marfan syndrome 16 years ago and is undergoing ongoing follow-up at an outpatient clinic. Eight years previously, the patient underwent total arch replacement combined with J-graft open stent graft® (JGOS; Japan Lifeline Co., Tokyo, Japan) deployment for acute type A dissection. Five months before presentation, the patient suffered a left rib fracture in a traffic accident and received conservative management at a local hospital. The patient presented to the emergency room with worsening shortness of breath and orthopnea. Echocardiography revealed severe aortic regurgitation and moderate tricuspid regurgitation. Computed tomography revealed new-onset pseudoaneurysm at the aortic root. Surgical repair was successfully performed using a modified Bentall procedure with a bioprosthetic valve and tricuspid annuloplasty. Intraoperative findings revealed pseudoaneurysm with perforation of the right sinus of Valsalva. Although the left and right aortic valve leaflets were normal, the noncoronary leaflet exhibited a ruptured fibrous strand of a cusp fenestration, resulting in acute aortic regurgitation.

Conclusions

This case report highlights the rare occurrence of aortic root pseudoaneurysm and subacute aortic regurgitation following a traffic accident. In cases of blunt chest trauma, particularly in patients with Marfan syndrome, frequent examination is crucial to assess the possibility of posttraumatic aortic regurgitation and aortic injury.
Learning Health System to rapidly improve the implementation of a school physical activity policy
Authors: Lane Cassandra , Nathan Nicole , Wiggers John , Hall Alix , Shoesmith Adam , Bauman Adrian , Groombridge Daniel , Sutherland Rachel , Wolfenden Luke
Published: July 2024

Background

Learning Health Systems (LHS) – characterised by cycles of evidence generation and application – are increasingly recognised for their potential to improve public health interventions and optimise health impacts; however there is little evidence of their application in the context of public health practice. Here, we describe how an Australian public health unit applied a LHS approach to successfully improve a model of support for implementation of a school-based physical activity policy.

Methods

This body of work was undertaken in the context of a strong research-practice partnership. Core LHS capabilities included: i) partnerships and stakeholder engagement; ii) workforce development and learning health communities; iii) multi-disciplinary scientific expertise; iv) practice data collection and management system; v) evidence surveillance and synthesis; and vi) governance and organisational processes of decision making. Three cycles of data generation and application were used. Within each cycle, randomised controlled trials conducted in NSW primary schools were used to generate data on the support model’s effectiveness for improving schools’ implementation of a government physical activity policy, its delivery costs, and process measures such as adoption and acceptability. Each type of data were analysed independently, synthesised, and then presented to a multi-disciplinary team of researchers and practitioners, in consult with stakeholders, leading to collaborative decisions for incremental improvements to the support model.

Results

Cycle 1 tested the first version of the support model (composed of five implementation strategies targeting identified barriers of policy implementation) and showed the model’s feasibility and efficacy for improving schools’ policy implementation. Data-informed changes were made to enhance impact, including the addition of three implementation strategies to address outstanding barriers. Cycle 2 (now, testing a package of eight implementation strategies) established the model’s effectiveness and cost-effectiveness for improving school's policy implementation. Data-informed changes were made to reduce delivery costs, specifically adapting the costliest strategies to reduce in-person contact from external support personnel. Cycle 3 showed that the adaptations minimised the relative cost of delivery without adversely impacting on the effect.

Conclusions

Through this process, we identified an effective, cost-effective, acceptable and scalable policy implementation support model for service delivery. This provides important information to inform or support LHS approaches for other agencies seeking to optimise the health impact of evidence-based interventions.
Simultaneous choledochal cyst excision and pancreaticojejunostomy (Puestow’s technique) for type IA cyst with associated chronic pancreatitis: a case report
Authors: Bashir Hamza , Abbas Ali , Khan Muhammad Arsalan
Published: July 2024

Introduction and importance

Choledochal cysts are congenital conditions that affect the biliary tree, typically identified during childhood. These cysts present as dilations in the biliary system, occurring either in the extrahepatic or intrahepatic regions or in some cases, in both areas. Occasionally, it may have associated chronic pancreatitis posing a challenge to the management of both conditions.

In the case reported, a female child was diagnosed with a choledochal cyst along with chronic pancreatitis. She had an excision of cyst and lateral pancreaticojejunostomy simultaneously for both conditions resulting in favorable outcomes.

Case presentation

An 8-year-old child visited the clinic with a complaint of upper abdominal pain accompanied by intermittent vomiting. An ultrasound was performed which showed a dilated common bile duct. To confirm the diagnosis, an MRCP and baseline labs including liver function tests were ordered. The findings were suggestive of a type IA choledochal cyst with concomitant chronic pancreatitis. Subsequently, she had choledochal cyst excision with Roux-en-Y hepaticojejunostomy reconstruction plus lateral pancreaticojejunostomy using the classical Puestow’s technique. The patient’s recovery post-surgery was uneventful, resulting in discharge on the fifth post-operative day for routine outpatient follow-up.

Clinical discussion

Patients afflicted with choledochal cysts are prone to recurrent pancreatitis, though the precise underlying mechanism is unknown. Certain studies propose an association between abnormal pancreatico-biliary junction and recurrent pancreatitis, often defined as a common channel surpassing 15 mm in length. However, this aberration could not be definitively established in the current case. Diagnosis of choledochal cysts can be confirmed through either ERCP or MRCP, with the latter preferred due to its non-invasive nature. The optimal management strategy for choledochal cysts necessitates cyst resection and Roux-en-Y hepaticojejunostomy reconstruction Moreover, in cases associated with chronic pancreatitis, longitudinal pancreatojejunostomy may be undertaken.

Conclusion

Thus, it is concluded that although rare choledochal cysts may have associated chronic pancreatitis. Surgical excision of the cyst and lateral pancreaticojejunostomy can be performed simultaneously resulting in favorable post-operative outcomes.
A mechanism to reduce shoulder strain of backpack wearers
Authors: Kalita Zahnupriya , Kaushik Manish , Deb Maulick , Barman Kul David
Published: July 2024

Backpacks are a convenient means of carrying the load. Its continuous usage has led to severe shoulder injuries and back pain due to the dynamic forces exerted by the weight of the backpack on the shoulders of the wearer during running or walking. A traditional backpack moves up and down repeatedly with the shoulder of the wearer during walking or running. Such repetitive movements of the backpack cause discomfort and strain on the wearer's shoulders. Hence, a mechanism is proposed here that can be assembled with the normal backpack in a way that the backpack stays at a constant position with respect to the ground by moving it relative to the wearer. The proposed mechanism was designed, fabricated, and assembled with a normal backpack and checked for the impact force experienced by the wearer with different loads of 10 kg, 12.5 kg, and 15 kg. An Arduino-based setup with a load cell sensor was implemented into the mechanism to measure the impact forces exerted on the wearer’s shoulder. The impact forces experienced by the wearer were found to be considerably lower when using the enhanced backpack with the mechanism compared to a normal backpack without the mechanism for a load equal to or more than 15 kg.
Distance-regularized level set inversion of magnetic data
Authors: Liu Jin , Xiong Shengqing , Wang Wanyin
Published: July 2024

Inversion is one of the key and difficult issues in potential field data processing and interpretation, and high-precision inversion has long been a popular research topic. We develop the distance-regularized level set inversion of the magnetic data (DRLSI-M) method. A double-well function is introduced into the objective function of the level set inversion, and we take advantage of its mathematical properties to minimize the gradient of the level set function so that it reaches a minimum value at points 0 and 1. As a result, the distance-regularized term not only replaces the costly reinitialization process so that the level set function maintains a signed distance property but also stabilizes the evolution of the level set function. When solving for the minimum value of the objective function, we transform the optimization problem into an initial-boundary value problem and solve it with the finite-difference method. The distance-regularized level set inversion method and the reinitialization level set inversion method are tested using three models: a single-level-set double-inclined plate model, a double-level-set double-inclined plate model, and a multiple-level-set three-cuboid model. Through model tests, the soundness of our method is verified and compared with the reinitialization level set inversion method. Our method avoids the limitations such as low efficiency and instability caused by the reinitialization of the level set inversion method. Furthermore, we apply our method for the inversion of aeromagnetic data from the Jinchuan copper-nickel mine. The results are consistent with the known geologic information, thus validating the practicality and effectiveness of DRLSI-M. The distance-regularized level set inversion method provides a theoretical basis for deep mine exploration.
Bayesian neural network and Bayesian physics-informed neural network via variational inference for seismic petrophysical inversion
Authors: Li Peng , Grana Dario , Liu Mingliang
Published: July 2024

Deep-learning methods are being successfully applied to seismic inversion and reservoir characterization problems; however, the uncertainty quantification process has not been fully studied. We investigate probabilistic approaches for seismic petrophysical inversion by using Bayesian formulations of neural networks. In particular, Bayesian neural network via variational inference (BNN-VI) aims to estimate the probability distribution of the training parameters of the neural network, which are difficult to compute with traditional methods, by proposing a family of densities and finding the candidates that are close to the target. Variational inference (VI) has the advantage of providing a faster tool than Markov chain Monte Carlo sampling algorithms. However, for accurate predictions, BNN-VI requires large training data that are not always available in geophysical inverse problems. Hence, we develop a method that combines a Bayesian approach with physics-informed neural networks (PINNs) via VI, namely Bayesian PINNs via VI (BPINN-VI), and we apply it to a geophysical inverse problem for the estimation of petrophysical properties from seismic data. The method is based on a Bayesian network approach in which the objective function is defined by the Kullback-Leibler divergence. In addition, the physical relations between data (seismic measurements) and model variables (petrophysical properties) are embedded into neural networks through a physics-dependent loss term. We test our method on a synthetic prestack seismic data set and a real data set including an oil-saturated clastic reservoir in the North Sea with a sequence of sand and shale layers. The outcome is the most likely model of petrophysical properties. Compared with BNN-VI, the BPINN-VI results show higher correlations and [Formula: see text] coefficients, lower mean-square errors, as well as lower uncertainty and higher lateral continuity.
Efficacy and Safety of Sacituzumab Govitecan in Patients With Advanced Solid Tumors (TROPiCS-03): Analysis in Patients With Advanced Endometrial Cancer
Authors: Santin Alessandro D. , Corr Bradley R. , Spira Alexander , Willmott Lyndsay , Butrynski James , Tse Ka Yu , Patel Jilpa , Mekan Sabeen , Wu Tia , Lin Kai-Wen , Kuo Peiwen , Dumbrava Ecaterina E.
Published: July 2024

PURPOSE

Patients with advanced endometrial cancer (EC) who progress on or after platinum-based therapy and immunotherapy have poor prognosis. We report efficacy and safety of sacituzumab govitecan (SG), a trophoblast cell-surface antigen 2 (Trop-2)–directed antibody-drug conjugate, in patients with advanced EC.

METHODS

TROPiCS-03 (ClinicalTrials.gov identifier:
NCT03964727
) is a multicohort, open-label, phase II basket study in patients with metastatic solid tumors. Eligible patients in the EC cohort received SG 10 mg/kg once on days 1 and 8 every 3 weeks. Primary end point was objective response rate (ORR) by investigator's assessment per RECIST v1.1. Secondary end points included clinical benefit rate (CBR; complete and partial response, and stable disease ≥6 months), duration of response (DOR), and progression-free survival (PFS) per investigator assessment, overall survival, and safety. Trop-2 expression of archival or baseline tumor specimens was analyzed by immunohistochemistry.

RESULTS

At data extraction date, 41 patients were enrolled. Median follow-up was 5.8 months (range, 0.7-19.3); median previous therapies was three (range, 1-6); and 85% of patients received previous chemotherapy and immunotherapy. ORR was 22% (95% CI, 11 to 38); CBR was 32% (95% CI, 18 to 48). Median DOR was 8.8 months (95% CI, 2.8 to not estimable); median PFS was 4.8 months (95% CI, 2.8 to 9.8). Trop-2 exploratory analysis was conducted retrospectively for 39 patients. Tumor Trop-2 protein was highly expressed in EC, showing limited correlation with efficacy. Grade ≥3 treatment-related adverse events (TRAEs) occurred in 73% of patients. Study drug discontinuation due to TRAEs was 5%. Two deaths occurred, deemed unrelated to SG.

CONCLUSION

Findings from TROPiCS-03 showed encouraging efficacy of SG with a manageable toxicity profile in a heavily pretreated population with advanced EC. Safety findings were consistent with the known SG safety profile.
Validation of optical conductivity and tailing parameter
Authors: Arbab Arbab I. , Sherfee Fatma O.
Published: July 2024

A quantum model for optical conductivity that treats light as a particle is presented. Based on this assumption, the optical characteristics of the material are calculated and compared to experimental findings. The band gap energy of a material changes with frequency and refractive index. We provided an equation of the line extrapolated in the Tauc plot. The obtained formula for optical conductivity reveals that the band tailing parameter in the Tauc formula is dependent on the speed of light, the Planck constant, and the material's refractive index. The determination of this constant helps establish the value of the band. The values of this constant are found to be consistent with various experimental results. Two electric conductivities distinguishing Abraham and Minkoswi's light momentum relationship inside materials are proposed.
Data-driven Cluster Analysis Reveals Increased Risk for Severe Insulin-deficient Diabetes in Black/African Americans
Authors: Lu Brian , Li Peng , Crouse Andrew B , Grimes Tiffany , Might Matthew , Ovalle Fernando , Shalev Anath
Published: July 2024

Context

Diabetes is a heterogenic disease and distinct clusters have emerged, but the implications for diverse populations have remained understudied.

Objective

Apply cluster analysis to a diverse diabetes cohort in the US Deep South.

Design

Retrospective hierarchical cluster analysis of electronic health records from 89 875 patients diagnosed with diabetes between January 1, 2010, and December 31, 2019, at the Kirklin Clinic of the University of Alabama at Birmingham, an ambulatory referral center.

Patients

Adult patients with International Classification of Diseases diabetes codes were selected based on available data for 6 established clustering parameters (glutamic acid decarboxylase autoantibody; hemoglobin A1c; body mass index; diagnosis age; HOMA2-B; HOMA2-IR); ∼42% were Black/African American.

Main Outcome Measure(s)

Diabetes subtypes and their associated characteristics in a diverse adult population based on clustering analysis. We hypothesized that racial background would affect the distribution of subtypes. Outcome and hypothesis were formulated prior to data collection.

Results

Diabetes cluster distribution was significantly different in Black/African Americans compared to Whites (P < .001). Black/African Americans were more likely to have severe insulin-deficient diabetes (OR, 1.83; 95% CI, 1.36-2.45; P < .001), associated with more serious metabolic perturbations and a higher risk for complications (OR, 1.42; 95% CI, 1.06-1.90; P = .020). Surprisingly, Black/African Americans specifically had more severe impairment of β-cell function (homoeostatic model assessment 2 estimates of β-cell function, C-peptide) (P < .001) but not being more obese or insulin resistant.

Conclusion

Racial background greatly influences diabetes cluster distribution and Black/African Americans are more frequently and more severely affected by severe insulin-deficient diabetes. This may further help explain the disparity in outcomes and have implications for treatment choice.
Treatment of Unresectable BRAF V600E, TERT-Mutated Differentiated Papillary Thyroid Cancer With Dabrafenib and Trametinib
Authors: Bapat Neha , Ferraro Tatiana , Esper Layal , Joshi Arjun S , Haroun Faysal , Baldwin Chelsey K
Published: July 2024

Complete surgical resection of differentiated papillary thyroid cancer (PTC) is associated with an excellent prognosis. However, for locally invasive PTC, disease-specific morbidity and mortality increases when microscopic margin negative resection (R0) or complete macroscopic resection (R1) is not feasible. Neoadjuvant dabrafenib and trametinib (DT) used in BRAF V600E–positive, unresectable anaplastic thyroid cancer has allowed for R0 or R1 resection and improved survival rates. We demonstrate feasibility of using neoadjuvant DT in a patient with BRAF V600E and TERT-mutated PTC for whom R0/R1 resection was initially aborted due to predicted unacceptable morbidity. The patient was treated with neoadjuvant DT for 5 months, at which time disease was undetectable on imaging with near resolution on final pathology; however, subsequent rapid recurrence after discontinuation of neoadjuvant DT occurred. Neoadjuvant DT offers promise in future cohorts of patients with locally invasive BRAF V600E and TERT-mutated PTC for whom neoadjuvant therapy can reduce surgical morbidity while still allowing for R0/R1 resection.
Management of a Twisted Flow Diverting Stent With a Balloon Mounted Cardiac Stent in a Pediatric Aneurysm: A Technical Report
Authors: Russell Keannette , Johnson William Chase , Al Saiegh Fadi , Birnbaum Lee , Coon Alexander , Mascitelli Justin
Published: July 2024

BACKGROUND AND IMPORTANCE:

Giant aneurysms can present technical challenges during treatment with flow diversion including inability to access the aneurysm outflow directly. Encircling the aneurysm with a microwire/microcatheter has been well described; however, it can result in a twisted stent because of catheter twisting during the reduction maneuver, which, in turn, could lead to thromboembolic complications.

CASE PRESENTATION:

Here, we describe a novel technique to manage the twist of the flow diverter in a giant internal carotid artery aneurysm using a combination of angioplasty and off-label placement of a balloon-mounted cardiac stent within the flow diverter.

CONCLUSION:

At 1 year, the aneurysm is completely occluded on digital subtraction angiography and MRI, and the patient is neurologically intact.
Macrophages of multiple hematopoietic origins reside in the developing prostate
Authors: Feng Sally W. , North Tanya M. , Wivell Peri , Pletcher Andrew , Popratiloff Anastas , Shibata Maho
Published: July 2024

Tissue-resident macrophages contribute to the organogenesis of many tissues. Growth of the prostate is regulated by androgens during puberty, yet androgens are considered immune suppressive. In this study, we characterized the localization, androgen receptor expression and hematopoietic origin of prostate macrophages, and transiently ablated macrophages during postnatal prostate organogenesis in the mouse. We show that myeloid cells were abundant in the prostate during puberty. However, nuclear androgen receptor expression was not detected in most macrophages. We found Cx3cr1, a marker for macrophages, monocytes and dendritic cells, expressed in interstitial macrophages surrounding the prostate and associated with nerve fibers. Furthermore, we provide evidence for the co-existence of embryonic origin, self-renewing, tissue-resident macrophages and recruited macrophages of bone-marrow monocyte origin in the prostate during puberty. Our findings suggest that prostate macrophages promote neural patterning and may shed further light on our understanding of the role of the innate immune system in prostate pathology in response to inflammation and in cancer.
Shaping the Habits of Teen Drivers
Authors: Moore Timothy J. , Morris Todd
Published: July 2024

We show that a targeted law can modify teens’ risky behavior. We examine the effects of an Australian intervention banning first-year drivers from driving late at night with multiple peers, which had accounted for one-fifth of their traffic fatalities. Using data on individual drivers linked to crash outcomes, we find the reform more than halves targeted crashes, casualties and deaths. There are large positive spillovers through lower crashes earlier in the evening and beyond the first year, suggesting broad and persistent declines in high-risk driving. Overall, the targeted intervention delivers gains comparable to harsher restrictions that delay teen driving. (JEL D91, J13, K32, R41)
Abolished frameshifting for predicted structure-stabilizing SARS-CoV-2 mutants: implications to alternative conformations and their statistical structural analyses
Authors: Dey Abhishek , Yan Shuting , Schlick Tamar , Laederach Alain
Published: July 2024

The SARS-CoV-2 frameshifting element (FSE) has been intensely studied and explored as a therapeutic target for coronavirus diseases, including COVID-19. Besides the intriguing virology, this small RNA is known to adopt many length-dependent conformations, as verified by multiple experimental and computational approaches. However, the role these alternative conformations play in the frameshifting mechanism and how to quantify this structural abundance has been an ongoing challenge. Here, we show by DMS and dual-luciferase functional assays that previously predicted FSE mutants (using the RAG graph theory approach) suppress structural transitions and abolish frameshifting. Furthermore, correlated mutation analysis of DMS data by three programs (DREEM, DRACO, and DANCE-MaP) reveals important differences in their estimation of specific RNA conformations, suggesting caution in the interpretation of such complex conformational landscapes. Overall, the abolished frameshifting in three different mutants confirms that all alternative conformations play a role in the pathways of ribosomal transition.