bluuebunny/crossref_metadata_2025 huggingface dataset:
Challenges of urban informality in Indian smart cities
Authors: Chatterji Tathagata
Published: November 2023

India's smart cities initiative signals a clear turn towards the corporatisation of urban governance by entrusting planning responsibilities to special purpose vehicles (SPV) constituted as public sector companies in place of elected municipal governments. This commentary argues that the depoliticised approach of the SPV-driven smart city plans could be detrimental to the informal economy in the long run. Municipal politics has been a useful platform for the urban poor to negotiate their claims over the city, as there is a clientelistic relationship between urban informality and political actors. The scope for such negotiations has considerably shrunk in smart cities, with elite coalition bureaucrats and technocrats steering planning decisions.
Effect of greening vacant houses on improvement in thermal environment using ENVI-met simulation: A case study on Busan metropolitan city
Authors: Kamata Yoko , Kang Jung Eun
Published: November 2023

This study aimed to analyze the improvement in outdoor thermal environment by greening of persistently vacant housing and open areas in a densely built old downtown area of Busan Metropolitan City using ENVI-met. Simulation was performed for a summer day by constructing four scenarios for four areas considering the building density and slope direction. The results indicate that compared to the current scenario, the concrete scenario had the worst thermal environment, where the average temperature, mean radiant temperature (MRT), and physiological equivalent temperature (PET) increased by 0.04°C, 1.49°C, and 0.51°C, respectively. In contrast, the tree scenario exhibited the most significant improvement. The average temperature, MRT, and PET decreased by 0.03°C, 1.66°C, and 0.65°C, respectively. Moreover, the removal of vacant houses in dense residential areas improved ventilation, and PET decreased by approximately 8°C locally. Planting trees higher than the demolished vacant houses mitigated the thermal environment considerably. The effect of greening was the strongest in the residential areas located on the south-facing slope with the worst thermal environment. This study provides essential data for implementing greening as a smart reduction strategy in the sustainable management of vacant houses.
Mobility and transit segregation in urban spaces
Authors: Iyer Nandini , Menezes Ronaldo , Barbosa Hugo
Published: November 2023

Segregation is a highly nuanced concept that researchers have worked to define and measure over the past several decades. Conventional approaches tend to estimate segregation based on residential patterns. However, the residential dimension does not fully comprise individuals’ interactions with their environment and, consequently, can misrepresent individuals’ lived experiences. To address this gap, we analyse how segregation extends to other dimensions of the urban life. We accomplish this by using the Index of Concentration at the Extremes (ICE) to measure socioeconomic segregation at amenities and on public transit lines. Moreover, we consider the pivotal role that transport plays in democratising access to opportunities. Using transport networks, amenity visitations, and census data, we leverage agent-based models to approximate socioeconomic composition at amenities and on transit lines. Consequently, we can estimate socioeconomic segregation within the United States, for various aspects of urban life. We find that neighbourhoods that are segregated in the residential domain tend to exhibit similar levels of segregation in amenity visitation patterns and transit usage, albeit to a lesser extent. Moreover, we discover that low-income neighbourhoods experience a greater decrease from residential to amenity segregation, than their high-income segregated counterparts, highlighting how mobility can be used as a tool for overcoming residential inequalities, given the proper infrastructure. We identify inequalities embedded into transit service, which impose constraints on residents from segregated areas, limiting the neighbourhoods that they can access within an hour to areas that are similarly disadvantaged. By exploring socioeconomic segregation from a transit perspective, we underscore the importance of conceptualising experiential segregation, while also highlighting how transport systems can contribute to a cycle of disadvantage.
Analysis and Experiment of a Bioinspired Multimode Octopod Robot
Authors: Sun Hongzhe , Wei Chaoran , Yao Yan-an , Wu Jianxu
Published: November 2023

Legged robots use isolated footholds to support, which have the merit of good terrain trafficability but lack speed ability. In contrast, wheeled robots have the advantages of high speed and efficiency but only run on flat roads. To improve the moving speed and terrain adaptability of the legged robot, this paper proposes a bioinspired multimode octopod robot with rolling, walking, and obstacle-surmounting modes. First, inspired by the multimode locomotion of the Cebrennus rechenbergi spider, the high-speed mobility of the legged robot is realized in involute kick-rolling mode through the extendable appendages. Then, the foot and appendage trajectories are analyzed by kinematic method and optimized for walking stability. Based on the static and the kinematic analyses, the terrain adaptability is improved by adhesive obstacle-surmounting mode with the assistance of the appendages affiliated to the main feet. The deformable trunk with one DoF is designed to switch between three modes. Finally, a series of dynamic simulations and experiments are carried out to verify the theoretical analyses of the adhesive obstacle-surmounting mode and the mobility of the involute kick-rolling mode. It is shown that the multimode octopod robot can integrate the advantages of high speed and good terrain trafficability from different types of robots and is suitable for performing tasks in unstructured terrains.
Arthrosis diagnosis and treatment recommendations in clinical practice: an exploratory investigation with the generative AI model GPT-4
Authors: Pagano Stefano , Holzapfel Sabrina , Kappenschneider Tobias , Meyer Matthias , Maderbacher Günther , Grifka Joachim , Holzapfel Dominik Emanuel
Published: November 2023

Background

The spread of artificial intelligence (AI) has led to transformative advancements in diverse sectors, including healthcare. Specifically, generative writing systems have shown potential in various applications, but their effectiveness in clinical settings has been barely investigated. In this context, we evaluated the proficiency of ChatGPT-4 in diagnosing gonarthrosis and coxarthrosis and recommending appropriate treatments compared with orthopaedic specialists.

Methods

A retrospective review was conducted using anonymized medical records of 100 patients previously diagnosed with either knee or hip arthrosis. ChatGPT-4 was employed to analyse these historical records, formulating both a diagnosis and potential treatment suggestions. Subsequently, a comparative analysis was conducted to assess the concordance between the AI’s conclusions and the original clinical decisions made by the physicians.

Results

In diagnostic evaluations, ChatGPT-4 consistently aligned with the conclusions previously drawn by physicians. In terms of treatment recommendations, there was an 83% agreement between the AI and orthopaedic specialists. The therapeutic concordance was verified by the calculation of a Cohen’s Kappa coefficient of 0.580 (p < 0.001). This indicates a moderate-to-good level of agreement. In recommendations pertaining to surgical treatment, the AI demonstrated a sensitivity and specificity of 78% and 80%, respectively. Multivariable logistic regression demonstrated that the variables reduced quality of life (OR 49.97, p < 0.001) and start-up pain (OR 12.54, p = 0.028) have an influence on ChatGPT-4’s recommendation for a surgery.

Conclusion

This study emphasises ChatGPT-4’s notable potential in diagnosing conditions such as gonarthrosis and coxarthrosis and in aligning its treatment recommendations with those of orthopaedic specialists. However, it is crucial to acknowledge that AI tools such as ChatGPT-4 are not meant to replace the nuanced expertise and clinical judgment of seasoned orthopaedic surgeons, particularly in complex decision-making scenarios regarding treatment indications. Due to the exploratory nature of the study, further research with larger patient populations and more complex diagnoses is necessary to validate the findings and explore the broader potential of AI in healthcare.

Level of Evidence: Level III evidence.
Proteomic analysis of chromophobe renal cell carcinoma and benign renal oncocytoma biopsies reveals shared metabolic dysregulation
Authors: Carvalho Luis B. , Jorge Susana , López-Fernández Hugo , Lodeiro Carlos , Dhir Rajiv , Campos Pinheiro Luis , Medeiros Mariana , Santos Hugo M. , Capelo José L.
Published: November 2023

Background

This study investigates the proteomic landscapes of chromophobe renal cell carcinoma (chRCC) and renal oncocytomas (RO), two subtypes of renal cell carcinoma that together account for approximately 10% of all renal tumors. Despite their histological similarities and shared origins, chRCC is a malignant tumor necessitating aggressive intervention, while RO, a benign growth, is often subject to overtreatment due to difficulties in accurate differentiation.

Methods

We conducted a label-free quantitative proteomic analysis on solid biopsies of chRCC (n = 5), RO (n = 5), and normal adjacent tissue (NAT, n = 5). The quantitative analysis was carried out by comparing protein abundances between tumor and NAT specimens. Our analysis identified a total of 1610 proteins across all samples, with 1379 (85.7%) of these proteins quantified in at least seven out of ten LC‒MS/MS runs for one renal tissue type (chRCC, RO, or NAT).

Results

Our findings revealed significant similarities in the dysregulation of key metabolic pathways, including carbohydrate, lipid, and amino acid metabolism, in both chRCC and RO. Compared to NAT, both chRCC and RO showed a marked downregulation in gluconeogenesis proteins, but a significant upregulation of proteins integral to the citrate cycle. Interestingly, we observed a distinct divergence in the oxidative phosphorylation pathway, with RO showing a significant increase in the number and degree of alterations in proteins, surpassing that observed in chRCC.

Conclusions

This study underscores the value of integrating high-resolution mass spectrometry protein quantification to effectively characterize and differentiate the proteomic landscapes of solid tumor biopsies diagnosed as chRCC and RO. The insights gained from this research offer valuable information for enhancing our understanding of these conditions and may aid in the development of improved diagnostic and therapeutic strategies.
Integrating future trends and uncertainties in urban mobility design via data-driven personas and scenarios
Authors: Gall Tjark , Hörl Sebastian , Vallet Flore , Yannou Bernard
Published: November 2023

Urban mobility contributes significantly to greenhouse gas emissions and comes with negative social impacts for various groups, such as limited accessibility to opportunity or basic services. Transitions towards sustainable and people-centred urban mobility systems are paramount. Yet, this is accompanied by various challenges. Complex urban systems are accompanied by high uncertainties (e.g., technological progress, demographics, climate change) which are currently not well integrated. Possible solutions originate from design, policymaking, and innovation, with a widespread disconnection due to non-compatible methods. This paper presents a method to improve the ability to design future urban mobility systems by integrating different approaches for modelling what the future could be and who could be the users. The research question is how diverse future user needs can be integrated in design processes for urban mobility systems. The proposed scenario-based design and personas allows to create data-driven proto-personas—a set of archetypical users with assigned characteristics and behaviours—test their validity, derive distributions across geographical areas, and transform them for different 2030 scenarios. This serves as input to create full personas and synthetic populations as intermediary design objects for the collaboration of designers and simulation experts. The methodology is exemplarily applied in the context of Paris. It contributes to urban mobility solution design that is more aware of future uncertainty and diverse needs of users, therefore, better capable to respond to today’s challenges. The approach is replicable with open data and accessible source code: https://github.com/TjarkGall/proto-persona-clustering.
Machine learning-based approaches for ubiquitination site prediction in human proteins
Authors: Pourmirzaei Mahdi , Ramazi Shahin , Esmaili Farzaneh , Shojaeilangari Seyedehsamaneh , Allahvardi Abdollah
Published: November 2023

Protein ubiquitination is a critical post-translational modification (PTMs) involved in numerous cellular processes. Identifying ubiquitination sites (Ubi-sites) on proteins offers valuable insights into their function and regulatory mechanisms. Due to the cost- and time-consuming nature of traditional approaches for Ubi-site detection, there has been a growing interest in leveraging artificial intelligence for computer-aided Ubi-site prediction. In this study, we collected experimentally verified Ubi-sites of human proteins from the dbPTM database, then conducted comprehensive state-of-the art computational methods along with standard evaluation metrics and a proper validation strategy for Ubi-site prediction. We presented the effectiveness of our framework by comparing ten machine learning (ML) based approaches in three different categories: feature-based conventional ML methods, end-to-end sequence-based deep learning (DL) techniques, and hybrid feature-based DL models. Our results revealed that DL approaches outperformed the classical ML methods, achieving a 0.902 F1-score, 0.8198 accuracy, 0.8786 precision, and 0.9147 recall as the best performance for a DL model using both raw amino acid sequences and hand-crafted features. Interestingly, our experimental results disclosed that the performance of DL methods had a positive correlation with the length of amino acid fragments, suggesting that utilizing the entire sequence can lead to more accurate predictions in future research endeavors. Additionally, we developed a meticulously curated benchmark for Ubi-site prediction in human proteins. This benchmark serves as a valuable resource for future studies, enabling fair and accurate comparisons between different methods. Overall, our work highlights the potential of ML, particularly DL techniques, in predicting Ubi-sites and furthering our knowledge of protein regulation through ubiquitination in cells.
Identification of genetic associations and functional SNPs of bovine KLF6 gene on milk production traits in Chinese holstein
Authors: Liu Yanan , Han Bo , Zheng Weijie , Peng Peng , Yang Chendong , Jiang Guie , Ma Yabin , Li Jianming , Ni Junqing , Sun Dongxiao
Published: November 2023

Background

Our previous research identified the Kruppel like factor 6 (KLF6) gene as a prospective candidate for milk production traits in dairy cattle. The expression of KLF6 in the livers of Holstein cows during the peak of lactation was significantly higher than that during the dry and early lactation periods. Notably, it plays an essential role in activating peroxisome proliferator-activated receptor α (PPARα) signaling pathways. The primary aim of this study was to further substantiate whether the KLF6 gene has significant genetic effects on milk traits in dairy cattle.

Results

Through direct sequencing of PCR products with pooled DNA, we totally identified 12 single nucleotide polymorphisms (SNPs) within the KLF6 gene. The set of SNPs encompasses 7 located in 5′ flanking region, 2 located in exon 2 and 3 located in 3′ untranslated region (UTR). Of these, the g.44601035G > A is a missense mutation that resulting in the replacement of arginine (CGG) with glutamine (CAG), consequently leading to alterations in the secondary structure of the KLF6 protein, as predicted by SOPMA. The remaining 7 regulatory SNPs significantly impacted the transcriptional activity of KLF6 following mutation (P < 0.005), manifesting as changes in transcription factor binding sites. Additionally, 4 SNPs located in both the UTR and exons were predicted to influence the secondary structure of KLF6 mRNA using the RNAfold web server. Furthermore, we performed the genotype-phenotype association analysis using SAS 9.2 which found all the 12 SNPs were significantly correlated to milk yield, fat yield, fat percentage, protein yield and protein percentage within both the first and second lactations (P < 0.0001 ~ 0.0441). Also, with Haploview 4.2 software, we found the 12 SNPs linked closely and formed a haplotype block, which was strongly associated with five milk traits (P < 0.0001 ~ 0.0203).

Conclusions

In summary, our study represented the KLF6 gene has significant impacts on milk yield and composition traits in dairy cattle. Among the identified SNPs, 7 were implicated in modulating milk traits by impacting transcriptional activity, 4 by altering mRNA secondary structure, and 1 by affecting the protein secondary structure of KLF6. These findings provided valuable molecular insights for genomic selection program of dairy cattle.
Community structure, environmental conditions and anthropogenic pressure on the habitat of the European endemic aquatic plant Luronium natans (L.) Raf.
Authors: Banaś Krzysztof , Ronowski Rafał , Chmara Rafał , Szmeja Józef
Published: November 2023

Luronium natans (L.) Raf. is a European endemic species and is becoming increasingly rare and endangered in most countries. This study aimed to compare the community structure and environmental conditions of shallow and deep-water habitats of Luronium, and related anthropogenic influences. A total of 21 Luronium lake habitats were surveyed at Pomerania Lakeland (NW Poland). Luronium occurs mainly with other isoetids, as well as bryophytes, specifically Sphagnum denticulatum. It can also be found in oligotrophic lakes at a depth of 1.0 ± 0.6 m and in water with a large pH range (4.52 – 8.76), as well having a low conductivity (38.3 ± 20.9 µS cm−1; 19.0 – 106.1) and calcium concentration (3.9 ± 2.4 mg dm−3; 1.6 – 11,7).

The largest Luronium cover occurs at a depth of 1.5 m (44.8 ± 35.3%), but occasionally as deep as 3.5 m. In the depth gradient, the structure of underwater vegetation and environmental conditions exhibit obvious changes, which presents a clear distinction between shallow and deep-water habitats of Luronium. The differences mainly pertain to the abundances of Isoëtes lacustris and Elodea canadensis in the community, as well as environmental factors, such as water calcium, nitrogen and phosphorus concentrations, PAR, conductivity, and water color.

Compared to other isoetids, Luronium usually occurs in habitats with intermediate features, which are characterized by values between the typical, but deep-water, Isoëtes and shallow water Lobelia and Littorella. However, Luronium clearly prefers waters with higher temperatures (23.8 ± 2.7 °C), which are thus less oxygenated (96.6 ± 20.0%). In terms of pH, conductivity, and calcium concentration, Luronium occurs in waters having slightly lower values compared to other isoetids. Therefore, Luronium is a species that significantly expands the diversity of habitat number 3110 in the Natura 2000 network. Therefore, it can be considered as an indicator species of lobelia lakes.

An increased anthropogenic pressure primarily results in an increased water conductivity and a decreased water transparency. Consequently, Luronium increasingly inhabits shallower waters that are more oxygenated. Moreover, Luronium abundance is decreasing, while the abundances of species comprising underwater communities are also decreasing, e.g., S. denticulatum and I. lacustris, with a concurrent increase in Myriophyllum alterniflorum and E. canadensis cover.
Effect the accumulation of bioactive constituents of a medicinal plant (Salvia Miltiorrhiza Bge.) by arbuscular mycorrhizal fungi community
Authors: Wu Yan-Hong , Qin Yong , Cai Qing-Qing , Liu Min , He Dong-Mei , Chen Xin , Wang Hai , Yan Zhu-Yun
Published: November 2023

Background

Arbuscular mycorrhizal fungi (AMF) form symbiotic relationships with various terrestrial plants and have attracted considerable interest as biofertilizers for improving the quality and yield of medicinal plants. Despite the widespread distribution of AMFs in Salvia miltiorrhiza Bunge's roots, research on the impact of multiple AMFs on biomass and active ingredient accumulations has not been conducted. In this study, the effects of five native AMFs (Glomus formosanum, Septoglomus constrictum, Rhizophagus manihotis, Acaulospora laevis, and Ambispora gerdemannii) and twenty-six communities on the root biomass and active ingredient concentrations of S. miltiorrhiza were assessed using the total factor design method.

Results

Thirty-one treatment groups formed symbiotic relationships with S. miltiorrhiza based on the pot culture results, and the colonization rate ranged from 54.83% to 89.97%. AMF communities had higher colonization rates and total phenolic acid concentration than single AMF, and communities also appeared to have higher root fresh weight, dry weight, and total phenolic acid concentration than single inoculations. As AMF richness increased, there was a rising trend in root biomass and total tanshinone accumulations (ATTS), while total phenolic acid accumulations (ATP) showed a decreasing trend. This suggests that plant productivity was influenced by the AMF richness, with higher inoculation benefits observed when the communities contained three or four AMFs. Additionally, the affinities of AMF members were also connected to plant productivity. The inoculation effect of closely related AMFs within the same family, such as G. formosanum, S. constrictum, and R. manihotis, consistently yielded lower than that of mono-inoculation when any combinations were applied. The co-inoculation of S. miltiorrhiza with nearby or distant AMFs from two families, such as G. formosanum, R. manihotis, and Ac. laevis or Am. gerdemannii resulted in an increase of ATP and ATTS by more than 50%. AMF communities appear to be more beneficial to the yield of bioactive constituents than the single AMF, but overall community inoculation effects are related to the composition of AMFs and the relationship between members.

Conclusion

This study reveals that the AMF community has great potential to improve the productivity and the accumulation of bioactive constituents in S. miltiorrhiza, indicating that it is an effective way to achieve sustainable agricultural development through using the AMF community.
Stomata variation in the process of polyploidization in Chinese chive (Allium tuberosum)
Authors: Yao Peng-Qiang , Chen Jian-Hua , Ma Pei-Fang , Xie Li-Hua , Cheng Shi-Ping
Published: November 2023

Background

Stomatal variation, including guard cell (GC) density, size and chloroplast number, is often used to differentiate polyploids from diploids. However, few works have focused on stomatal variation with respect to polyploidization, especially for consecutively different ploidy levels within a plant species. For example, Allium tuberosum, which is mainly a tetraploid (2n = 4x = 32), is also found at other ploidy levels which have not been widely studied yet.

Results

We recently found cultivars with different ploidy levels, including those that are diploid (2n = 2x = 16), triploid (2n = 3x = 24), pseudopentaploid (2n = 34–42, mostly 40) and pseudohexaploid (2n = 44–50, mostly 48). GCs were evaluated for their density, size (length and width) and chloroplast number. There was no correspondence between ploidy level and stomatal density, in which anisopolyploids (approximately 57 and 53 stomata/mm2 in triploid and pseudopentaploid, respectively) had a higher stomatal density than isopolyploids (approximately 36, 43, and 44 stomata/mm2 in diploid, tetraploid and pseudohexaploid, respectively). There was a positive relationship between ploidy level and GC chloroplast number (approximately 44, 45, 51, 72 and 90 in diploid to pseudohexaploid, respectively). GC length and width also increased with ploidy level. However, the length increased approximately 1.22 times faster than the width during polyploidization.

Conclusions

This study shows that GC size increased with increasing DNA content, but the rate of increase differed between length and width. In the process of polyploidization, plants evolved longer and narrower stomata with more chloroplasts in the GCs.
Relationship between serum interleukin-6 levels and severity of coronary artery disease undergoing percutaneous coronary intervention
Authors: Bouzidi Nadia , Gamra Habib
Published: November 2023

Background

Cytokines play a potential role in atherosclerosis pathogenesis and progression. We investigated the association of interleukin-6 (IL-6) with the angiographic severity of coronary artery disease (CAD).

Methods

Three hundred ten angiografically diagnosed CAD patients and 210 controls were enrolled in this study. CAD patients were stratified according to IL-6 cut-off value into high levels IL-6 group (≥ 9.5 pg/mL) and low levels IL-6 group (< 9.5 pg/mL). The severity of CAD was assessed according to Gensini score (GS), artery stenosis degree and the number of vessels involved. The mean age was 60.3 ± 11.0 years.

Results

The level of IL-6 in patients was increased compared to controls and ranged from 1.5 to 3640.0 pg/mL. High levels of IL-6 were significantly associated with high levels of GS (> 40) but not with stenosis degree and vessel score. GS levels were significantly more elevated in patients with high levels of IL-6 group than in low IL6 levels patients (60.6 ± 39.5 vs 46.7 ± 37.2; p = 0.027). The analysis of the ROC curve performed in myocardial infarction patients showed that IL-6 (AUC: 0.941 (CI 95% 0.886, 0.997; p < 0.001) could be a powerful predictor marker in evaluating the infarct size after myocardial infarction when compared to myonecrosis biomarkers.

Conclusions

IL-6 levels were associated with the severity of CAD assessed by the GS. Based on the highest levels of IL-6 measured in patients with STEMI, our study strongly suggests that IL-6 could be a powerful marker in evaluating the myocardial necrosis.

Trial registration

ClinicalTrials.gov Number: NCT03075566 (09/03/2017).
Association between high expression of intratumoral fibroblast activation protein and survival in patients with intrahepatic cholangiocarcinoma
Authors: Waki Yuhei , Morine Yuji , Noma Takayuki , Takasu Chie , Teraoku Hiroki , Yamada Shinichiro , Saito Yu , Ikemoto Tetsuya , Shimada Mitsuo
Published: November 2023

Background

Cancer-associated fibroblasts (CAFs) have been reported to exhibit protumorigenic effects. Among the well-known CAF markers such as smooth muscle actin (SMA) and fibroblast activation protein (FAP), high expression of SMA in the peritumoral stroma has been reported to be a prognostic factor in various cancers. However, the effect of high FAP expression in intrahepatic cholangiocarcinoma (IHCC) has not been fully clarified. We evaluated the expression of CAF markers, focusing on FAP expression in the peripheral and intratumoral regions, to clarify the association with survival in patients with IHCC.

Methods

The study cohort comprised 37 patients who underwent curative resection for IHCC. The FAP expressions were evaluated in the peripheral and intratumoral regions of the resected tissues. Clinicopathological factors and survival outcomes were investigated between patients with high versus low FAP expression. Uni- and multivariate analyses were performed to identify the prognostic factors for overall survival and relapse-free survival.

Results

The median area percentages of FAP expression in the peripheral and intratumoral regions were 15.5% and 17.8%, respectively. High FAP expression in the intratumoral region was significantly associated with worse overall survival and disease-free survival than low FAP expression in the intratumoral region. Multivariate analysis identified high intratumoral FAP expression as a risk factor for worse overall survival (hazard ratio, 2.450; p = 0.049) and relapse-free survival (hazard ratio, 2.743; p = 0.034).

Conclusions

High intratumoral FAP expression was associated with worse survival, suggesting that intratumoral FAP expression represents malignant progression in patients with IHCC.
The use of fully covered self-expandable metal stents in the endoscopic treatment of portal cavernoma cholangiopathy
Authors: Buyruk Abdullah Murat , Erdoğan Çağdaş , Tekin Fatih , Turan İlker , Özütemiz Ömer , Ersöz¹ Galip
Published: November 2023

Background and aims

There are different therapeutic approaches for biliary strictures and reducing portal hypertension in patients with symptomatic portal cavernoma cholangiopathy (PCC). Endoscopic treatment includes endoscopic biliary sphincterotomy (EST), dilation of stricture with a biliary balloon, placement of plastic stent(s) and stone extraction. Fully covered self-expandable metal stent (FCSEMS) is placed as a rescuer in case of haemobilia seen after EST, dilation of stricture and removal of plastic stent rather than the stricture treatment itself. In this retrospective observational study, we sought to assess the clinical outcomes of FCSEMS as the initial treatment for PCC-related biliary strictures.

Materials and methods

Twelve symptomatic patients with PCC both clinically and radiologically between July 2009 and February 2019 were examined. Magnetic resonance cholangiopancreatography (MRCP) and cholangiography were employed as the diagnostic imaging methods. Chandra–Sarin classification was used to distinguish between biliary abnormalities in terms of localization. Llop classification was used to group biliary abnormalities associated with PCC. Endoscopic partial sphincterotomy was performed in all the patients. If patients with dominant strictures 6-8-mm balloon dilation was first performed. This was followed by removal of the stones if exist. Finally, FCSEMS placed. The stents were removed 6–12 weeks later.

Results

The mean age of the patients was 40.9 ± 10.3 years, and 91.6% of the patients were male. Majority of the patients (n = 9) were noncirrhotic. Endoscopic retrograde cholangiopancreatography (ERCP) findings showed that 11 of the 12 patients were Chandra Type I and one was Chandra Type IIIa. All the 12 patients were Llop Grade 3. All patients had biliary involvement in the form of strictures. Stent placement was successful in all patients. FCSEMSs were retained for a median period of 45 days (30–60). Seven (58.3%) patients developed acute cholecystitis. There was no occurrence of bleeding or other complications associated with FCSEMS replacement or removal. All patients were asymptomatic during median 3 years (1–10) follow up period.

Conclusions

FCSEMS placement is an effective method in biliary strictures in case of PCC. Acute cholecystitis is encountered frequently after FCSEMS, but majority of patients respond to the medical treatment. Patients should be followed in terms of the relapse of biliary strictures.
Decreasing hospitalizations through geriatric hotlines: a prospective French multicenter study of people aged 75 and above
Authors: Goethals Luc , Barth Nathalie , Martinez Laure , Lacour Noémie , Tardy Magali , Bohatier Jérôme , Bonnefoy Marc , Annweiler Cédric , Dupre Caroline , Bongue Bienvenu , Celarier Thomas
Published: November 2023

Background

The Emergency unit of the hospital (Department) (ED) is the fastest and most common way for most French general practitioners (GPs) to respond to the complexity of managing older adults patients with multiple chronic diseases. In 2013, French regional health authorities proposed to set up telephone hotlines to promote interactions between GP clinics and hospitals. The main objective of our study was to analyze whether the hotlines and solutions proposed by the responding geriatrician reduced the number of hospital admissions, and more specifically the number of emergency room admissions.

Methods

We conducted a multicenter observational study from April 2018 to April 2020 at seven French investigative sites. A questionnaire was completed by all hotline physicians after each call.

Results

The study population consisted of 4,137 individuals who met the inclusion and exclusion criteria. Of the 4,137 phone calls received by the participants, 64.2% (n = 2 657) were requests for advice, and 35.8% (n = 1,480) were requests for emergency hospitalization. Of the 1,480 phone calls for emergency hospitalization, 285 calls resulted in hospital admission in the emergency room (19.3%), and 658 calls in the geriatric short stay (44.5%). Of the 2,657 calls for advice/consultation/delayed hospitalization, 9.7% were also duplicated by emergency hospital admission.

Conclusion

This study revealed the value of hotlines in guiding the care of older adults. The results showed the potential effectiveness of hotlines in preventing unnecessary hospital admissions or in identifying cases requiring hospital admission in the emergency room. Hotlines can help improve the care pathway for older adults and pave the way for future progress.

Trial registration

Registered under Clinical Trial Number NCT03959475. This study was approved and peer-reviewed by the Ethics Committee for the Protection of Persons of Sud Est V of Grenoble University Hospital Center (registered under 18-CETA-01 No.ID RCB 2018-A00609-46).
Testing the effectiveness and acceptability of online supportive supervision for mental health practitioners in humanitarian settings: a study protocol for the caring for carers project
Authors: Wells Ruth , Acarturk Ceren , Mozumder Muhammad Kamruzzaman , Kurt Gülşah , Klein Louis , Lekkeh Salah Addin , Beetar Ammar , Jahan Sabiha , Almeamari Fatema , Faruk Md. Omar , McGrath Michael , Alam Syeda Fatema , Alokoud Mustafa , Dewan Ranak , Vecih Ahmed El , El-Dardery Hafsa , Hadzi-Pavlovic Dusan , Hammadi Hanan , Hamoud Mounir Al Shekh , Hasan M. Tasdik , Joshi Rohina , Kothaa Sowmic , Lamia Fauzia Kabir Chowdhury , Mastrogiovanni Chiara , Najjar Hussam , Nemorin Shaun , Nicholson-Perry Kathryn , Prokrity Tahmina Sarker , Said Yousef Rania , Tawakol Mamoun , Uygun Ersin , Yasaki Wael , Wong Scarlett , Zarate Ariel , Steel Zachary , Rosenbaum Simon
Published: November 2023

Background

Local humanitarian workers in low and middle-income countries must often contend with potentially morally injurious situations, often with limited resources. This creates barriers to providing sustainable mental health and psychosocial support (MHPSS) to displaced individuals. Clinical supervision is an often neglected part of ensuring high-quality, sustainable care. The Caring for Carers (C4C) project aims to test the effectiveness and acceptability of online group-based supportive supervision on the well-being of MHPSS practitioners, as well as service-user-reported service satisfaction and quality when working with displaced communities in Türkiye, Syria, and Bangladesh. This protocol paper describes the aim, design, and methodology of the C4C project.

Method

A quasi-experimental, mixed-method, community-based participatory research study will be conducted to test the effectiveness of online group-based supportive clinical supervision provided to 50 Syrian and 50 Bangladeshi MHPSS practitioners working with Syrian and Rohingya displaced communities. Monthly data will be collected from the practitioners and their beneficiaries during the active control (six months) and supervision period (16 months over two terms). Outcomes are psychological distress (Kessler-6), burnout (the Copenhagen Burnout Inventory), compassion fatigue, compassion satisfaction, and secondary traumatic stress (Professional Quality of Life Scale), perceived injustice, clinical self-efficacy (Counseling Activity Self-Efficacy Scale), service satisfaction, and quality (Client Satisfaction Questionnaire and an 18-item measure developed in this project). A realist evaluation framework will be used to elucidate the contextual factors, mechanisms, and outcomes of the supervision intervention.

Discussion

There is a scarcity of evidence on the role of clinical supervision in improving the well-being of MHPSS practitioners and the quality of service they provide to displaced people. By combining qualitative and quantitative data collection, the C4C project will address the long-standing question of the effectiveness and acceptability of clinical supervision in humanitarian settings.
The dynamic interaction between symptoms and pharmacological treatment in patients with major depressive disorder: the role of network intervention analysis
Authors: Guerrera Claudia Savia , Platania Giuseppe Alessio , Boccaccio Francesco Maria , Sarti Pierfrancesco , Varrasi Simone , Colliva Chiara , Grasso Margherita , De Vivo Simona , Cavallaro Davide , Tascedda Fabio , Pirrone Concetta , Drago Filippo , Di Nuovo Santo , Blom Johanna M. C. , Caraci Filippo , Castellano Sabrina
Published: November 2023

Introduction

The Major Depressive Disorder (MDD) is a mental health disorder that affects millions of people worldwide. It is characterized by persistent feelings of sadness, hopelessness, and a loss of interest in activities that were once enjoyable. MDD is a major public health concern and is the leading cause of disability, morbidity, institutionalization, and excess mortality, conferring high suicide risk. Pharmacological treatment with Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin Noradrenaline Reuptake Inhibitors (SNRIs) is often the first choice for their efficacy and tolerability profile. However, a significant percentage of depressive individuals do not achieve remission even after an adequate trial of pharmacotherapy, a condition known as treatment-resistant depression (TRD).

Methods

To better understand the complexity of clinical phenotypes in MDD we propose Network Intervention Analysis (NIA) that can help health psychology in the detection of risky behaviors, in the primary and/or secondary prevention, as well as to monitor the treatment and verify its effectiveness. The paper aims to identify the interaction and changes in network nodes and connections of 14 continuous variables with nodes identified as "Treatment" in a cohort of MDD patients recruited for their recent history of partial response to antidepressant drugs. The study analyzed the network of MDD patients at baseline and after 12 weeks of drug treatment.

Results

At baseline, the network showed separate dimensions for cognitive and psychosocial-affective symptoms, with cognitive symptoms strongly affecting psychosocial functioning. The MoCA tool was identified as a potential psychometric tool for evaluating cognitive deficits and monitoring treatment response. After drug treatment, the network showed less interconnection between nodes, indicating greater stability, with antidepressants taking a central role in driving the network. Affective symptoms improved at follow-up, with the highest predictability for HDRS and BDI-II nodes being connected to the Antidepressants node.

Conclusion

NIA allows us to understand not only what symptoms enhance after pharmacological treatment, but especially the role it plays within the network and with which nodes it has stronger connections.
Variables associated with oral health-related self-efficacy – results of a cross-sectional study
Authors: Bantel David , Chmielewski Witold X. , Brähler Elmar , Stöbel-Richter Yve , Zenger Markus , Berth Hendrik
Published: November 2023

Background

Oral health-related self-efficacy (OH-SE) is pivotal for oral health and is associated with other oral-health related variables, such as dental fear and anxiety (DF/A) and dental hygiene behaviors (DHB). This study attempts to analyze associations between OH-SE and oral healthrelated variables in a German population to extend previous research by analyzing whether OH-SE can be predicted by these variables, as this might contribute to the development of treatment interventions.

Methods

OH-SE, DF/A, oral health-related quality of life (OHRQoL), self-perceived dental condition, satisfaction with general health, DHB, and socioeconomic status were assessed as a part of the Saxon Longitudinal Study in an adult sample (n = 309, 56.3% female, all Saxon secondary school 8th graders in 1987). The associations of OH-SE with these variables were examined by means of correlation, multiple linear regression analyses, and group comparisons. Significance (p), standardized regression coefficients (β), and effect size (Cohen’s d) were calculated.

Results

The correlation analyses revealed increased OH-SE to be accompanied by low levels of DF/A, high levels of OHRQoL, high levels of self-perceived dental condition, increased satisfaction with general health and socioeconomic status (all r ≥ 0.142; all p ≤ 0.013). In the regression analysis, OH-SE was mainly predicted by self-perceived dental condition and satisfaction with general health (R2 = 0.157) as well as by daily frequency of toothbrushing, OHRQoL, and socioeconomic status on a trend-level basis. In the group comparisons OH-SE was lower in participants with moderate for manifest DF/A and higher in individuals with higher OHRQoL, better self-perceived dental condition, increased satisfaction with general health, increased daily frequency of toothbrushing, more dental appointments, and above-average socioeconomic status (trend level; all t ≥ 1.57; p ≤ 0.059).

Conclusions

In this cross-sectional study, high levels of OH-SE were mainly predicted by general health as well as self-perceived dental condition. It was also associated with decreased DF/A, increased DHB, higher OHRQoL, and higher socioeconomic status. Future research should analyze these associations in longitudinal designs to address whether interventions focusing on adherence to good DHB improve (dental) health and thus OH-SE. This might be a promising approach, particularly in relation to the treatment of DF/A.
A hybrid stacked ensemble and Kernel SHAP-based model for intelligent cardiotocography classification and interpretability
Authors: Feng Junyuan , Liang Jincheng , Qiang Zihan , Hao Yuexing , Li Xia , Li Li , Chen Qinqun , Liu Guiqing , Wei Hang
Published: November 2023

Background

Intelligent cardiotocography (CTG) classification can assist obstetricians in evaluating fetal health. However, high classification performance is often achieved by complex machine learning (ML)-based models, which causes interpretability concerns. The trade-off between accuracy and interpretability makes it challenging for most existing ML-based CTG classification models to popularize in prenatal clinical applications.

Methods

Aiming to improve CTG classification performance and prediction interpretability, a hybrid model was proposed using a stacked ensemble strategy with mixed features and Kernel SHapley Additive exPlanations (SHAP) framework. Firstly, the stacked ensemble classifier was established by employing support vector machines (SVM), extreme gradient boosting (XGB), and random forests (RF) as base learners, and backpropagation (BP) as a meta learner whose input was mixed with the CTG features and the probability value of each category output by base learners. Then, the public and private CTG datasets were used to verify the discriminative performance. Furthermore, Kernel SHAP was applied to estimate the contribution values of features and their relationships to the fetal states.

Results

For intelligent CTG classification using 10-fold cross-validation, the accuracy and average F1 score were 0.9539 and 0.9249 in the public dataset, respectively; and those were 0.9201 and 0.8926 in the private dataset, respectively. For interpretability, the explanation results indicated that accelerations (AC) and the percentage of time with abnormal short-term variability (ASTV) were the key determinants. Specifically, the probability of abnormality increased and that of the normal state decreased as the value of ASTV grew. In addition, the likelihood of the normal status rose with the increase of AC.

Conclusions

The proposed model has high classification performance and reasonable interpretability for intelligent fetal monitoring.
Identifying patterns of reported findings on long-term cardiac complications of COVID-19: a systematic review and meta-analysis
Authors: Guo Boya , Zhao Chenya , He Mike Z. , Senter Camilla , Zhou Zhenwei , Peng Jin , Li Song , Fitzpatrick Annette L. , Lindström Sara , Stebbins Rebecca C. , Noppert Grace A. , Li Chihua
Published: November 2023

Introduction

Prior reviews synthesized findings of studies on long-term cardiac complications of COVID-19. However, the reporting and methodological quality of these studies has not been systematically evaluated. Here, we conducted a systematic review and meta-analysis on long-term cardiac complications of COVID-19 and examined patterns of reported findings by study quality and characteristics.

Methods

We searched for studies examining long-term cardiac complications of COVID-19 that persisted for 4 weeks and over. A customized Newcastle–Ottawa scale (NOS) was used to evaluate the quality of included studies. Meta-analysis was performed to generate prevalence estimates of long-term cardiac complications across studies. Stratified analyses were further conducted to examine the prevalence of each complication by study quality and characteristics. The GRADE approach was used to determine the level of evidence for complications included in the meta-analysis.

Results

A total number of 150 studies describing 57 long-term cardiac complications were included in this review, and 137 studies reporting 17 complications were included in the meta-analysis. Only 25.3% (n = 38) of studies were of high quality based on the NOS quality assessment. Chest pain and arrhythmia were the most widely examined long-term complications. When disregarding study quality and characteristics, summary prevalence estimates for chest and arrhythmia were 9.79% (95% CI 7.24–13.11) and 8.22% (95% CI 6.46–10.40), respectively. However, stratified analyses showed that studies with low-quality scores, small sample sizes, unsystematic sampling methods, and cross-sectional design were more likely to report a higher prevalence of complications. For example, the prevalence of chest pain was 22.17% (95% CI 14.40–32.55), 11.08% (95% CI 8.65–14.09), and 3.89% (95% CI 2.49–6.03) in studies of low, medium, and high quality, respectively. Similar patterns were observed for arrhythmia and other less examined long-term cardiac complications.

Conclusion

There is a wide spectrum of long-term cardiac complications of COVID-19. Reported findings from previous studies are strongly related to study quality, sample sizes, sampling methods, and designs, underscoring the need for high-quality epidemiologic studies to characterize these complications and understand their etiology.