bluuebunny/crossref_metadata_2025 huggingface dataset:
A review on oral novel delivery systems of insulin through the novel delivery system formulations: A review
Authors: Limenh Liknaw Workie
Published: January 2024

Parenteral administration of insulin remains the most common route of administration, causing local hypertrophy at the injection sites because of multiple daily injections. Because of this, there is an interest and effort in oral insulin administration that is convenient and mimics the physiology of endogenous insulin secreted in the liver. However, oral insulin encountered different challenges due to abundant enzyme degradation, the presence of a mucus layer, and the underlying intestinal epithelial membrane barrier in the gastrointestinal tract. This narrative review reviewed the literature dealing with novel oral insulin delivery approaches. Various pieces of literature were searched, filtered, and reviewed from different sources, and the information obtained was organized, formulated, and finalized. Oral insulin has been formulated and extensively studied in various novel delivery approaches, such as nanoparticles, microspheres, mucoadhesive patches, encapsulations, hydrogels, ionic liquids, liposomes, and complexation. The efficiency of these formulations demonstrated improved efficiency and potency compared to free oral insulin delivery, but none of them have greater or equivalent potency to subcutaneous insulin. Future studies regarding dose-dependent therapeutic efficacy and the development of new novel formulations to produce comparable oral insulin to subcutaneous insulin are warranted to further support the suitability of the current platform for oral insulin delivery.
Elexacaftor–tezacaftor–ivacaftor for cystic fibrosis with Phe508del mutation: Evidence from randomized controlled trials
Authors: He Rong , Lin Fei , Deng Zehui , Yu Bin
Published: January 2024

Objective:

This study aimed to conduct a systematic review and meta-analysis of randomized controlled trials to evaluate the effects of elexacaftor–tezacaftor–ivacaftor (ELX-TEZ-IVA) on patients with cystic fibrosis (CF).

Methods:

A systematic search was performed in PubMed, Embase, and the Cochrane Library from inception to August 1, 2022. Meta-analysis was conducted using Review Manager 5.3 software.

Results:

Six studies comprising seven reports involving a total of 1125 CF patients were included. The meta-analyses indicated that ELX-TEZ-IVA significantly improved the percentage predicted forced expiratory volume in 1 s (ppFEV1) by 10.29% (95% confidence interval (CI) (6.44, 14.14), p < 0.00001) and the CF questionnaire-revised respiratory domain (CFQ-R RD) by 14.59 points (95% CI (9.25, 19.94), p < 0.00001) compared to placebo, ivacaftor (IVA), or tezacaftor–ivacaftor (TEZ-IVA). In addition, the ELX-TEZ-IVA group showed significantly lower sweat chloride concentrations by 40.30 mmol/L (95% CI (−49.85, −30.74), p < 0.00001). However, the incidence of adverse events in the ELX-TEZ-IVA group was slightly higher than that in the placebo, IVA, or TEZ-IVA groups.

Conclusion:

ELX-TEZ-IVA demonstrated efficacy in improving ppFEV1, CFQ-R RD, and sweat chloride concentrations in patients with CF. However, caution should be exercised regarding the incidence of AEs, particularly mild and moderate ones.
Insights into craniosynostosis management in low- and middle-income countries: A narrative review of outcomes, shortcomings and paediatric neurosurgery capacity
Authors: Wireko Andrew Awuah , Ahluwalia Arjun , Ali Syed Hasham , Shah Muhammad Hamza , Aderinto Nicholas , Banerjee Sumitaksha , Roy Sakshi , Ferreira Tomas , Tan Joecelyn Kirani , Berjaoui Christin , Guggilapu Saibaba , Quarshie Louisa Sowah , Bharadwaj Hareesha Rishab , Adebusoye Favour Tope , Abdul-Rahman Toufik , Atallah Oday
Published: January 2024

Craniosynostosis, marked by premature cranial suture fusion, necessitates prompt intervention to avert developmental, neurological, and aesthetic issues. While high-income countries have advanced in managing this condition, low- and middle-income countries grapple with substantial healthcare access disparities. This narrative review explores current craniosynostosis management in low- and middle-income countries. The review focused on studies published between 2008 and 2023. The focus was neurosurgical outcomes, and the search utilised databases like PubMed, EMBASE, Google Scholar, the Cochrane Library and Scopus, incorporating specific keywords and phrases. An in-depth analysis of 21 included studies reveals noteworthy positive outcomes, including low mortality, successful corrections and sustained efficacy. These advancements stem from enhanced pre-operative strategies, surgical techniques and postoperative care. Nonetheless, challenges persist, encompassing complications, mortality, reoperations, and treatment disparities, particularly in low- and middle-income countries constrained by financial and expertise limitations. The enhancement of clinical practice and the formulation of effective policies in the future entail several key strategies. These include the reinforcement of specialised healthcare infrastructure and diagnostic capabilities, the ongoing training and retention of neurosurgeons, the improvement of funding mechanisms, and the promotion of equitable access. Additionally, a crucial focus is placed on fortifying paediatric neurosurgical care in low- and middle-income countries. The recommendations underscore the importance of collaborative initiatives, the development of specialised healthcare infrastructure, and the implementation of strategic policies to not only advance pediatric neurosurgical care but also to address existing gaps in management.
Does affective empathy capacity condition individual variation in support for military escalation? Evidence from a survey vignette
Authors: Plithides Max Constantine Corkan
Published: January 2024

Does individual variation in affective empathetic capacity systemically condition a person's willingness to support pre-emptive military action? In this note, I theorize that individuals who are more prone to feeling affective empathy are less likely to support conflict escalation. To evidence this theory, I conduct a survey asking individuals about their willingness to support a military attack against a non-specific rogue state that is on the verge of acquiring nuclear weapons. The results demonstrate that the probability of an individual supporting such a strike is strongly conditioned on their affective empathetic capacity. This finding holds regardless of model specification and controlling for rational beliefs about material outcomes. Affective empathy may, therefore, have a powerful palliating effect upon the processes that contribute to conflict escalation.
CT features of feline cystic bronchiectasis forming mass lesions
Authors: Moorhead William J , Mai Wilfried , Reetz Jennifer A , Hecht Silke , Noel Peter G
Published: January 2024

Case series summary

Cystic bronchiectasis was diagnosed in three cats with known histories of chronic coughing using CT and histopathology. CT of the lungs revealed large space-occupying lesions that compressed and displaced unaffected pulmonary parenchyma and vessels. The masses were soft tissue attenuating in two cases and gas-cavitated with areas of dependent fluid in one case. All three cats were found to have mineral attenuating material in lesions and in other dilatated airways. Generalized bronchial wall thickening was also present and indicative of chronic lower airway disease. These findings were supported by histopathology showing inflammatory changes and dilatated airways in the collected tissues. In the two cases in which post-contrast CT series were acquired, the lesions had rim-enhancement.

Relevance and novel information

Cystic bronchiectasis is a rare presentation of bronchiectasis in cats and may mimic a pulmonary mass lesion, which could be mistaken for neoplasia or abscessation. The lack of central enhancement or presence of gas cavitation on CT, concurrent presence of diffuse bronchial wall thickening, other areas of bronchiectasis and the presence of broncholithiasis may alert the clinician to the possibility of cystic bronchiectasis related to chronic lower airway disease.
Family Resilience With Stunted Children Aged Below 5 Years: A Qualitative Study in Depok City, Indonesia
Authors: Rahmadiyah Dwi Cahya , Sahar Junaiti , Widyatuti  , Sartika Ratu Ayu Dewi , Hassan Hamidah
Published: January 2024

Stunting is influenced by family and household factors that affect toddler nutrition. As the primary provider of both physical and psychological resources to prevent health problems, the family has a significant role in preventing stunting. Family resilience in supporting child health is mediated by family functioning. A qualitative descriptive study explored the influence of family resilience in fulfilling the nutritional needs of stunted children. This study involved in-depth interviews with 23 mothers of stunted children aged 24 to 59 months. Through content analysis, we identified three main themes: (1) family belief that stunting is hereditary, (2) family belief that stunted children will “grow up,” and (3) lack of communication between family members in discussing stunting. Future studies should explore intervention models to increase family resilience and prevent stunting in children under five.
Co-designing Healthcare Quality Improvement: The Kovacs Burns & George Orientation Guide
Authors: George Marian , Kovacs Burns Katharina
Published: January 2024

To prepare healthcare organizations and patients/families to be equally ready to become partners in co-designing healthcare policy, practices, and improvements, there is a need to (1) understand how “co-design ready” organizations and their staff and care providers are to co-design health care policies, practices, and improvements with patients and families; (2) understand how prepared patients and families, as users of the health system, are to step into co-designer roles with confidence so that their voices will be heard as they influence the development or changes to improve healthcare system policies, services, practices, and products; (3) anticipate and/or address challenges with meeting the expectations of what is involved with the co-design approach, including with recruiting, preparing, and training care setting leaders, staff/care providers, and patient/family advisors; (4) ensure care settings provided appropriate tools and resources to support co-design; and (5) guide the shift in culture from engagement to co-design. Recommendations for enabling co-design in care settings include providing an orientation and preparation workshop and guide/workbook. An example of an orientation and preparation workshop is shared.
We Are Done! Now What? Exploring End of Treatment Needs of Childhood Cancer Survivors and Their Parents
Authors: Keller Mary Conway , Needham Andrew , Holden Elizabeth , Engelke Karina , Foy Kelly , Hart Leigh , Hinderer Katherine
Published: January 2024

Background: Increased childhood cancer survival rates have spurred a new body of research pertaining to the cancer-survivorship continuum. Literature suggests a lack of research and guidelines for care at the end of treatment (EOT). To improve the transition to survivorship and determine any posttreatment challenges, this study explored the experiences of childhood cancer survivors (CCSs), parents/caregivers, and pediatric oncology health care professionals (HCPs) at EOT. Method: This study employed a mixed methods design. EOT Questionnaires were completed by CCSs and parents/caregivers within 6 months of completing treatment, and by pediatric oncology HCPs. Results: A total of 75 CCSs and parents/caregivers and 21 HCPs completed the study. The majority of parents/caregivers (78%) and older CCSs (94%) recalled having an EOT “meeting.” Most were satisfied with the meeting, but described unexpected worries/problems following EOT. Family members stating they were “very satisfied” with the EOT meeting increased significantly relative to the number of EOT topics addressed. In contrast, the omission of certain psychosocial discussion topics negatively correlated with satisfaction. Oncologists provided the majority of EOT services, with infrequent provision by other HCPs. Less than 20% of HCPs characterized families as “very satisfied” with EOT services and suggested improvements to meet families’ needs. Discussion: This study found unmet psychosocial and anticipatory guidance needs, indicating a lack of preparedness. The results suggest that end of cancer treatment requires a more standardized, comprehensive, and multidisciplinary approach. Enhanced education and support services are needed to promote the successful navigation of all families through this period of transition.
Glycemic Control in Patients Living With HIV Initiated on Integrase Inhibitor–Based Three-Drug Antiretroviral Therapy
Authors: Gerber Anthony , Fischetti Briann , Popova Olga , Longo Maria
Published: January 2024

Background: The increased risk of cardio-metabolic disorders associated with people living with human immunodeficiency virus (HIV) is of growing importance. Given the broad adoption of integrase strand-transfer inhibitor (INSTI)-based antiretroviral therapy (ART) as first-line therapy for HIV, additional data are needed regarding the metabolic effects of these regimens. Objective: The purpose of this study is to assess glycemic control in patients started on INSTI-based 3-drug regimens over a 2-year period. Methods: A retrospective study was conducted on patients seen in the Brooklyn Hospital Center. Men and nonpregnant, nonlactating women aged 18 years or older with a diagnosis of HIV who were initiated on or switched to an ART consisting of 2 nucleoside reverse transcriptase inhibitors (NRTIs) plus an INSTI were included in the analysis. The primary endpoint is change in A1C from baseline (pre-INSTI initiation) to 2 years after initiation. Results: Two hundred fifty-one patients were eligible based on specified inclusion and exclusion criteria. Overall, a statistically significant increase in A1C was seen in all patients started on INSTI-based regimen (95% CI, 0.10-0.36; P < 0.001). Primarily patients on both elvitegravir-based and bictegravir-based regimens saw the most significant increase in A1C: 0.16% (95% CI, 0.04-0.27; P = 0.006) and 0.39% (95% CI, 0.02-0.76; P = 0.038), respectively. Conclusion and Relevance: Integrase strand-transfer inhibitor-based 3-drug ART was associated with a small but statistically significant increase in A1C over a 2-year period, requiring additional monitoring by clinicians.
Application of an MCDM Model for Green Supply Chain Management Implementation Using Analytic Hierarchy Process
Authors: Kharat Manoj Govind , Diwan Hema , Parhi Shreyanshu , Kharat Mukesh Govind , Joshi Sarang Prakashrao , Kapoor Samridhi
Published: January 2024

Green supply chain management (GSCM) has been proposed as a potential remedy for business sustainability-related issues. This study offers key green practices that may be applied at the strategic, operational and tactical levels in order to combine conventional supply networks with sustainable supply chains. When establishing the criteria, professional opinions were taken into account in order to identify pertinent components. The analytic hierarchy process has been used to assess the relative weights and relevance of the GSCM criteria. The expert opinions from academic and industrial specialists were used to make pair-wise comparisons. Green practices have been prioritised, and a framework with 4 major factors and 16 sub-factors has been proposed for making intelligent judgements. Findings point out that top leadership commitment to sustainability-related issues, legal compliance, environmentally friendly design, green purchasing, health and safety, and regulatory compliance practices are crucial for implementing sustainability across the supply chain. It might be claimed that adopting GSCM practices can boost a company’s long-term performance while also increasing its operational eco-efficiency reaping cost and efficiency benefits. The results of the study would assist GSCM practitioners in selecting appropriate strategies in consonance with the governing rules and regulations and customers’ requirements.
Aqueous dispersion characteristics of PMN-PT powder prepared by partial oxalate route
Authors: Prabhakaran K. , Jayasingh E. M. , Raghunath S. , Durgaprasad C. , Sharma S. C.
Published: January 2024

Aqueous dispersion of PMN-PT powder prepared by partial oxalate process has been studied using ammonium poly(acrylate) dispersant. Parameters such as dispersant concentration and pH to achieve well dispersed suspensions have been determined by measurement of viscosity and gravitational sediment density. Suspension with PMN-PT powder loading in the range of 50 to 58 vol.-% showed very low viscosity in the range of 0·125–0·325 Pa s at a shear rate of 93 s−1. The suspensions are shear thinning and obey Casson model. PMN-PT powder suspensions of solids loading in the range of 50 to 58 vol.-% showed yield stress in the range of 0·625 to 9·5 Pa respectively. The green body prepared by casting the suspensions in an open mould followed by drying in air showed high density (63·4% TD) and narrow pore size distribution with a median pore size of 0·14 μm.
Stromal alterations in patients with monoclonal gammopathy of undetermined significance, smoldering myeloma, and multiple myeloma
Authors: Bogun Lucienne , Koch Annemarie , Scherer Bo , Fenk Roland , Maus Uwe , Bormann Felix , Köhrer Karl , Petzsch Patrick , Wachtmeister Thorsten , Zukovs Romans , Dietrich Sascha , Haas Rainer , Schroeder Thomas , Jäger Paul , Geyh Stefanie
Published: January 2024

The hallmark of multiple myeloma (MM) is a clonal plasma cell infiltration in the bone marrow accompanied by myelosuppression and osteolysis. Premalignant stages such as monoclonal gammopathy of undetermined significance (MGUS) and asymptomatic stages such as smoldering myeloma (SMM) can progress to MM. Mesenchymal stromal cells (MSCs) are an integral component of the bone marrow microenvironment and play an important role in osteoblast differentiation and hematopoietic support. Although stromal alterations have been reported in MM contributing to hematopoietic insufficiency and osteolysis, it is not clear whether alterations in MSC already occur in MGUS or SMM. In this study, we analyzed MSCs from MGUS, SMM, and MM regarding their properties and functionality and performed messenger RNA sequencing to find underlying molecular signatures in different disease stages. A high number of senescent cells and a reduced osteogenic differentiation capacity and hematopoietic support were already present in MGUS MSC. As shown by RNA sequencing, there was a broad spectrum of differentially expressed genes including genes of the BMP/TGF-signaling pathway, detected already in MGUS and that clearly increases in patients with SMM and MM. Our data may help to block these signaling pathways in the future to hinder progression to MM.
Anti-CGRP antibody galcanezumab modifies the function of the trigeminovascular nocisensor complex in the rat
Authors: Friedrich Nadine , Németh Krisztina , Tanner Martin , Rosta Judit , Dobos Ildikó , Oszlács Orsolya , Jancsó Gábor , Messlinger Karl , Dux Mária
Published: January 2024

Background

Monoclonal antibodies directed against the neuropeptide calcitonin gene-related peptide (CGRP) are effective in the prevention of chronic and frequent episodic migraine. Since the antibodies do not cross the blood brain barrier, their antinociceptive effect is attributed to effects in meningeal tissues. We aimed to probe if such an antibody can be visualized within the dura mater and the trigeminal ganglia following its administration to rats and to examine if the activity of the trigeminovascular nocisensor complex is influenced by this treatment.

Methods

Effects of the anti-CGRP antibody galcanezumab on the trigeminovascular nocisensor complex was examined by measuring release of sensory neuropeptides and histamine from the rat dura mater. Deposits of galcanezumab were visualized by fluorescence microscopy in the trigeminal ganglion and the dura mater.

Results

Fluorophore-labelled galcanezumab was detected in the dura mater and the trigeminal ganglion up to 30 days after treatment affirming the long-lasting modulatory effect of this antibody. In female rats, seven days after systemic treatment with galcanezumab the capsaicin-induced release of CGRP was decreased, while that of substance P (SP) was increased in the dura mater. In control rats, release of the inhibitory neuropeptide somatostatin (SOM) was higher in females than in males. Stimulation with high concentration of KCl did not significantly change the release of SOM in control animals, while in rats treated with galcanezumab SOM release was slightly reduced. Galcanezumab treatment also reduced the amount of histamine released from dural mast cells upon stimulation with CGRP, while the effect of compound 48/80 on histamine release was not changed.

Conclusions

Galcanezumab treatment is followed by multiple changes in the release of neuropeptides and histamine in the trigeminal nocisensor complex, which may contribute to the migraine preventing effect of anti-CGRP antibodies. These changes affecting the communication between the components of the trigeminal nocisensor complex may reduce pain susceptibility in migraine patients treated with CGRP targeting monoclonal antibodies.
FFAR4 activation inhibits lung adenocarcinoma via blocking respiratory chain complex assembly associated mitochondrial metabolism
Authors: Wang Zhe , Li Jinyou , Wang LongFei , Liu Yaowei , Wang Wei , Chen JiaYao , Liang HuiJun , Chen Y. Q. , Zhu ShengLong
Published: January 2024

Despite notable advancements in the investigation and management of lung adenocarcinoma (LUAD), the mortality rate for individuals afflicted with LUAD remains elevated, and attaining an accurate prognosis is challenging. LUAD exhibits intricate genetic and environmental components, and it is plausible that free fatty acid receptors (FFARs) may bridge the genetic and dietary aspects. The objective of this study is to ascertain whether a correlation exists between FFAR4, which functions as the primary receptor for dietary fatty acids, and various characteristics of LUAD, while also delving into the potential underlying mechanism. The findings of this study indicate a decrease in FFAR4 expression in LUAD, with a positive correlation (P < 0.01) between FFAR4 levels and overall patient survival (OS). Receiver operating characteristic (ROC) curve analysis demonstrated a significant diagnostic value [area under the curve (AUC) of 0.933] associated with FFAR4 expression. Functional investigations revealed that the FFAR4-specific agonist (TUG891) effectively suppressed cell proliferation and induced cell cycle arrest. Furthermore, FFAR4 activation resulted in significant metabolic shifts, including a decrease in oxygen consumption rate (OCR) and an increase in extracellular acidification rate (ECAR) in A549 cells. In detail, the activation of FFAR4 has been observed to impact the assembly process of the mitochondrial respiratory chain complex and the malate–aspartate shuttle process, resulting in a decrease in the transition of NAD+ to NADH and the inhibition of LUAD. These discoveries reveal a previously unrecognized function of FFAR4 in the negative regulation of mitochondrial metabolism and the inhibition of LUAD, indicating its potential as a promising therapeutic target for the treatment and diagnosis of LUAD.
Spatiotemporal transcriptomic plasticity in barley roots: unravelling water deficit responses in distinct root zones
Authors: Klaus Alina , Marcon Caroline , Hochholdinger Frank
Published: January 2024

Background

Drought poses a major threat to agricultural production and thus food security. Understanding the processes shaping plant responses to water deficit is essential for global food safety. Though many studies examined the effect of water deficit on the whole-root level, the distinct functions of each root zone and their specific stress responses remain masked by this approach.

Results

In this study, we investigated the effect of water deficit on root development of the spring barley (Hordeum vulgare L.) cultivar Morex and examined transcriptomic responses at the level of longitudinal root zones. Water deficit significantly reduced root growth rates after two days of treatment. RNA-sequencing revealed root zone and temporal gene expression changes depending on the duration of water deficit treatment. The majority of water deficit-regulated genes were unique for their respective root zone-by-treatment combination, though they were associated with commonly enriched gene ontology terms. Among these, we found terms associated with transport, detoxification, or cell wall formation affected by water deficit. Integration of weighted gene co-expression analyses identified differential hub genes, that highlighted the importance of modulating energy and protein metabolism and stress response.

Conclusion

Our findings provide new insights into the highly dynamic and spatiotemporal response cascade triggered by water deficit and the underlying genetic regulations on the level of root zones in the barley cultivar Morex, providing potential targets to enhance plant resilience against environmental constraints. This study further emphasizes the importance of considering spatial and temporal resolution when examining stress responses.
Integrative effects of phytohormones in the phenolic acids production in Salvia verticillata L. under multi-walled carbon nanotubes and methyl jasmonate elicitation
Authors: Rahmani Nosrat , Radjabian Tayebeh
Published: January 2024

Salvia verticillata L. is a well-known herb rich in rosmarinic acid (RA) and with therapeutic values. To better understand the possible roles of phytohormones in the production of phenolic acids in S. verticillata, in this work, we investigated some physiological and biochemical responses of the species to methyl jasmonate (MJ) and multi-walled carbon nanotubes (MWCNTs) as two effective elicitors. The leaves were sprayed with aqueous solutions containing 100 mg L−1 MWCNTs and 100 µM MJ and then harvested during interval times of exposure up to 96 h. The level of abscisic acid, as the first effective phytohormone, was altered in the leaves in response to MJ and MWCNTs elicitation (2.26- and 3.06-fold more than the control, respectively), followed by significant increases (P ˂ 0.05) detected in jasmonic acid and salicylic acid contents up to 8 h after exposure. Obtained data revealed that simultaneously with changes in phytohormone profiles, significant (P ˂ 0.05) rises were observed in the content of H2O2 (8.85- and 9.74-folds of control), and the amount of lipid peroxidation (10.18- and 17.01-folds of control) during the initial times after exposure to MJ and MWCNTs, respectively. Later, the content of phenolic acids increased in the elicited leaves due to changes in the transcription levels of key enzymes involved in their biosynthesis pathways, so 2.71- and 11.52-fold enhances observed in the RA content of the leaves after exposure to MJ and MWCNTs, respectively. It is reasonable to conclude that putative linkages between changes in some phytohormone pools lead to the accumulation of phenolic acids in the leaves of S. verticillata under elicitation. Overall, the current findings help us improve our understanding of the signal transduction pathways of the applied stimuli that led to enhanced secondary metabolite production in medicinal plants.
Triglyceride glucose-body mass index as a novel predictor of slow coronary flow phenomenon in patients with ischemia and nonobstructive coronary arteries (INOCA)
Authors: Li Zhi-peng , Chen Juan , Xin Qi , Pei Xiao-yang , Wu Hong-li , Tan Zhi-xu
Published: January 2024

Background

The triglyceride glucose-body mass index (TyG-BMI index) has been suggested as a novel predictor of insulin resistance. However, its predictive value for slow coronary flow phenomenon (SCFP) in patients with ischemia and nonobstructive coronary arteries (INOCA) remains unclear.

Methods

We consecutively recruited 1625 patients with INOCA from February 2019 to February 2023 and divided them into two groups based on thrombolysis in myocardial infarction (TIMI) frame counts (TFCs): the SCFP group (n = 79) and the control group. A 1:2 age-matched case–control study was then performed. The TyG-BMI index was calculated as ln [plasma triglyceride (mg/dL) × fasting blood glucose (mg/dL)/2] × BMI.

Results

TyG-BMI index in the SCFP group (218.3 ± 25.2 vs 201.0 ± 26.5, P < .001) was significantly higher than in the normal controls. TyG-BMI index also increased with the number of coronary arteries involved in the SCFP. Multivariate logistic regression analysis showed that TyG-BMI, BMI, and TG were independent predictors for SCFP. Receiver operating characteristic (ROC) curve analysis showed that when the TyG-BMI index was above 206.7, the sensitivity and specificity were 88.6% and 68.5%, respectively, with an AUC of 0.809 (95% CI: 0.756–0.863, P = .027). Combined BMI with TG, the TyG-BMI index had a better predictive value for SCFP than BMI and TG (P < .001).

Conclusion

The TyG-BMI index was an independent predictor for SCFP in INOCA patients, and it had a better predictive value than BMI and TG.
Evaluation and comparison of spatial cluster detection methods for improved decision making of disease surveillance: a case study of national dengue surveillance in Thailand
Authors: Rotejanaprasert Chawarat , Chinpong Kawin , Lawson Andrew B. , Chienwichai Peerut , Maude Richard J.
Published: January 2024

Background

Dengue is a mosquito-borne disease that causes over 300 million infections worldwide each year with no specific treatment available. Effective surveillance systems are needed for outbreak detection and resource allocation. Spatial cluster detection methods are commonly used, but no general guidance exists on the most appropriate method for dengue surveillance. Therefore, a comprehensive study is needed to assess different methods and provide guidance for dengue surveillance programs.

Methods

To evaluate the effectiveness of different cluster detection methods for dengue surveillance, we selected and assessed commonly used methods: Getis Ord $${G}_{i}^{*}$$

G

i

∗

, Local Moran, SaTScan, and Bayesian modeling. We conducted a simulation study to compare their performance in detecting clusters, and applied all methods to a case study of dengue surveillance in Thailand in 2019 to further evaluate their practical utility.

Results

In the simulation study, Getis Ord $${G}_{i}^{*}$$

G

i

∗

and Local Moran had similar performance, with most misdetections occurring at cluster boundaries and isolated hotspots. SaTScan showed better precision but was less effective at detecting inner outliers, although it performed well on large outbreaks. Bayesian convolution modeling had the highest overall precision in the simulation study. In the dengue case study in Thailand, Getis Ord $${G}_{i}^{*}$$

G

i

∗

and Local Moran missed most disease clusters, while SaTScan was mostly able to detect a large cluster. Bayesian disease mapping seemed to be the most effective, with adaptive detection of irregularly shaped disease anomalies.

Conclusions

Bayesian modeling showed to be the most effective method, demonstrating the best accuracy in adaptively identifying irregularly shaped disease anomalies. In contrast, SaTScan excelled in detecting large outbreaks and regular forms. This study provides empirical evidence for the selection of appropriate tools for dengue surveillance in Thailand, with potential applicability to other disease control programs in similar settings.
Extension of a conditional performance score for sample size recalculation rules to the setting of binary endpoints
Authors: Bokelmann Björn , Rauch Geraldine , Meis Jan , Kieser Meinhard , Herrmann Carolin
Published: January 2024

Background

Sample size calculation is a central aspect in planning of clinical trials. The sample size is calculated based on parameter assumptions, like the treatment effect and the endpoint’s variance. A fundamental problem of this approach is that the true distribution parameters are not known before the trial. Hence, sample size calculation always contains a certain degree of uncertainty, leading to the risk of underpowering or oversizing a trial. One way to cope with this uncertainty are adaptive designs. Adaptive designs allow to adjust the sample size during an interim analysis. There is a large number of such recalculation rules to choose from. To guide the choice of a suitable adaptive design with sample size recalculation, previous literature suggests a conditional performance score for studies with a normally distributed endpoint. However, binary endpoints are also frequently applied in clinical trials and the application of the conditional performance score to binary endpoints is not yet investigated.

Methods

We extend the theory of the conditional performance score to binary endpoints by suggesting a related one-dimensional score parametrization. We moreover perform a simulation study to evaluate the operational characteristics and to illustrate application.

Results

We find that the score definition can be extended without modification to the case of binary endpoints. We represent the score results by a single distribution parameter, and therefore derive a single effect measure, which contains the difference in proportions $$p_{I}-p_{C}$$

p
I

-

p
C

between the intervention and the control group, as well as the endpoint proportion $$p_{C}$$

p
C

in the control group.

Conclusions

This research extends the theory of the conditional performance score to binary endpoints and demonstrates its application in practice.
Interaction between diabetes and body mass index on severe headache or migraine in adults: a cross-sectional study
Authors: Tian Sheng , Cheng Zhijuan , Zheng Heqing , Zhong Xianhui , Yu Xinping , Zhang Jingling , Wu Lanxiang , Wu Wei
Published: January 2024

Background

Research on the effects of body mass index (BMI) on severe headache or migraine is limited and controversial. The aim of this study was to explore the association between BMI and the prevalence of migraine, with particular interest in diabetes status difference.

Methods

The present study used analyzed data from people who participated in the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2004. Logistic regression models and restricted cubic spline (RCS) models were applied to investigate the relationship between body mass index and migraine.

Results

A total of 10,074 adults aged 20 years or older were included in this study. Body mass index was positively related to migraine, and the corresponding odds ratio (OR; 95% CI) was 1.02 (1.01, 1.03;p < 0.001). And compared to participants in the lowest group of body mass index (< 25 kg/m2), the adjusted ORs for migraine in medium group (25-29.9 kg/m2), and highest group (≥ 30 kg/m2) were 1.14 (95% CI: 0.98–1.32,p = 0.09) and 1.30 (95% CI: 1.11–1.52,p = 0.0022), respectively. The relationship between BMI and migraine exhibited a linear in overall in the RCS. Our findings also suggested an interaction between BMI and diabetes. The relationship between BMI and migraine in adults with diabetes was non-linear. The OR of developing migraine was 1.30 (95% CI: 1.10–1.54) in individuals with BMI ≥ 29.71 kg/m2in adults with diabetes.

Conclusion

A higher body mass index is significantly associated with an increased prevalence of migraine, and diabetes status can modify the association between them.
State transitions across the Strep A disease spectrum: scoping review and evidence gaps
Authors: Parajulee Prerana , Lee Jung-Seok , Abbas Kaja , Cannon Jeffrey , Excler Jean Louis , Kim Jerome H. , Mogasale Vittal
Published: January 2024

The spectrum of diseases caused by Streptococcus pyogenes (Strep A) ranges from superficial to serious life-threatening invasive infections. We conducted a scoping review of published articles between 1980 and 2021 to synthesize evidence of state transitions across the Strep A disease spectrum. We identified 175 articles reporting 262 distinct observations of Strep A disease state transitions. Among the included articles, the transition from an invasive or toxin-mediated disease state to another disease state (i.e., to recurrent ARF, RHD or death) was described 115 times (43.9% of all included transition pairs) while the transition to and from locally invasive category was the lowest (n = 7; 0.02%). Transitions from well to any other state was most frequently reported (49%) whereas a relatively higher number of studies (n = 71) reported transition from invasive disease to death. Transitions from any disease state to locally invasive, Strep A pharyngitis to invasive disease, and chronic kidney disease to death were lacking. Transitions related to severe invasive diseases were more frequently reported than superficial ones. Most evidence originated from high-income countries and there is a critical need for new studies in low- and middle-income countries to infer the state transitions across the Strep A disease spectrum in these high-burden settings.
A rare case of anti-DPPX encephalitis combined with neuroleptospirosis
Authors: Jin Yong , Lan Wei , Chen Xiaodong , Liu Wu , Luo Weiliang , Chen Suqin
Published: January 2024

Background

Neuroleptospirosis and anti-dipeptidyl-peptidase-like protein 6 (DPPX) encephalitis are both very rare and have only been reported in the form of respective case reports. There are no reports of anti-DPPX encephalitis combined with neuroleptospirosis in the literature. We reported the first case of neuroleptospirosis combined with elevated DPPX antibodies in serum and cerebrospinal fluid (CSF).

Case presentation

A previously healthy 53-year-old Chinese male farmer with a history of drinking raw stream water and flood sewage exposure was brought to the hospital due to an acute onset of neuropsychiatric symptoms. No fever or meningeal irritation signs were detected on physical examination. Routine laboratory investigations, including infection indicators, leukocyte and protein in CSF, electroencephalogram and gadolinium-enhanced magnetic resonance imaging of the brain, all revealed normal. While metagenomic next-generation sequencing (mNGS) identified the DNA genome of Leptospira interrogans in the CSF. Anti-DPPX antibody was detected both in blood and in CSF. A diagnosis of neuroleptospirosis combined with autoimmune encephalitis associated with DPPX-Ab was eventually made. He resolved completely after adequate amount of penicillin combined with immunotherapy.

Conclusion

We highlight that in patients with acute or subacute behavioral changes, even in the absence of fever, if the most recent freshwater exposure is clear, physicians should pay attention to leptospirosis. Due to the low sensitivity of routine microscopy, culture, polymerase chain reaction and antibody testing, mNGS may have more advantages in diagnosing neuroleptospirosis. As autoimmune encephalitis can be triggered by various infections, neuroleptospirosis may be one of the causes of autoimmune encephalitis. Since neuronal antibody measurements themselves are not that common in neuroleptospirosis, future studies are needed to determine whether the detection of anti-DPPX antibodies is a rare event in leptospirosis. Early identification of autoimmune encephalitis and timely administration of immunotherapy may lead to a better outcome.
Simultaneous evaluation of iris area and subfoveal choroidal thickness in Fuchs uveitis syndrome
Authors: Ruiz-Cruz Matilde , Navarro-López Patricia , Hernández-Valero Gerardo Marcelo , Concha-del-Rio Luz Elena
Published: January 2024

Background/aims

To simultaneously evaluate iris area (IA) and subfoveal choroidal thickness (SFCT) in eyes with Fuchs Uveitis Syndrome (FUS).

Methods

We prospectively recruited a case series of patients with FUS at our institution, simultaneously measuring IA with anterior segment spectral domain optical coherence tomography (SD-OCT) and SFCT with enhanced depth imaging optical coherence tomography (EDI-OCT). Iris images were analyzed by ImageJ software. We tested the differences in intereye IA and SFCT with the healthy eye (HE) using the Wilcoxon test, and clinical interpretation was controlled by intraclass correlation coefficient (ICC) between two masked specialists.

Results

Sixteen patients with unilateral FUS were included. Six were female, and the age range was 37 to 67 (median age 48 years, IQR 41–60). ICC of 98.9%, with a lower confidence interval of 97%. Eyes with FUS had a significant thinning of the total iris median area (p < 0.002), restricted to the temporal and nasal areas compared to the HE (p < 0.01 and < 0.001, respectively). SFCT was also significantly thinner compared to the HE (p < 0.0001). A low correlation was found between iris and choroidal thinning in FUS eyes (rs = 0.21; p = 0.4).

Conclusions

This study found reduced iris area and subfoveal choroidal thickness in eyes with FUS compared to the normal fellow eye.
Neonatal upper limb fractures – a narrative overview of the literature
Authors: Carvalho Marcos , Barreto Maria Inês , Cabral João , Balacó Inês , Alves Cristina
Published: January 2024

The aim of this paper is to review the topic of neonatal fractures of the upper limb, describing the different types of fractures focusing on the etiology, epidemiology, risk factors, clinical approach, diagnosis, treatment and prognosis of these injuries. We included all types of research studies, both experimental and observational, published in English, French, Portuguese and Spanish. The information was obtained using the keywords neonatal upper limb fracture, clavicle fracture or humerus fracture from the following resources: MEDLINE database, Embase® database and LILACS database. Other resources such as hand searches of the references of retrieved literature and authoritative texts, personal and hospital libraries searching for texts on upper limb neonatal fractures, discussions with experts in the field of upper limb neonatal fractures and personal experience, were also considered for the completion of the article.

Neonatal fractures of the upper limb are consensually considered to have a good prognosis and no long-term sequelae. Conservative treatment is the option in the vast majority of the fractures and is associated with excellent results, with good healing, full range of motion, adequate remodeling without obvious deformity, neurologic impairment or functional implications.
Risk factors for moderate acute malnutrition among children with acute diarrhoea in India and Tanzania: a secondary analysis of data from a randomized trial
Authors: Kisenge Rodrick , Dhingra Usha , Rees Chris A. , Liu Enju , Dutta Arup , Saikat Deb , Dhingra Pratibha , Somji Sarah , Sudfeld Chris , Simon Jon , Ashorn Per , Sazawal Sunil , Duggan Christopher P. , Manji Karim
Published: January 2024

Background

Moderate acute malnutrition (MAM) affects over 30 million children aged < 5 years worldwide. MAM may confer a greater risk of developing severe malnutrition and even mortality in children. Assessing risk factors for MAM may allow for earlier recognition of children at risk of deleterious health outcomes.

Objective

To determine risk factors associated with the prevalence and development of MAM among children aged 6 to 59 months with acute diarrhoea who received treatment with oral rehydration solution and zinc supplementation.

Methods

We conducted a secondary analysis of data from a randomized, dose-finding trial of zinc among children with acute diarrhoea in India and Tanzania. We used regression models to assess risk factors for prevalent MAM at the start of diarrhoea treatment and to identify risk factors associated with the development of MAM at 60 days. MAM was defined as weight for length (or height) Z score ≤—2 and > -3 or mid-upper arm circumference < 12.5 and ≥ 11.5 cm.

Results

A total of 4,500 children were enrolled; 593 (13.2%) had MAM at the baseline. MAM at baseline was significantly less common among children in Tanzania than in India (adjusted risk ratio [aRR] 0.37, 95% confidence interval [CI]: 0.30, 0.44, P < 0.001), in children aged 24- < 60 months versus 6- < 12 months (aRR 0.46, 95% CI: 0.38, 0.56, P < 0.001), and in families with household wealth index higher than the median (aRR 0.79, 95% CI: 0.68, 0.92, P = 0.002). Sixty days after outpatient treatment and follow-up, 87 (2.5%) children developed MAM. When compared to children aged 6- < 12 months, children aged 24- < 60 months had a 52% lower risk of developing MAM. Every one unit increase in weight for length (or height) Z score at enrolment was associated with a 93% lower risk of developing MAM during follow-up.

Conclusions

Among children with diarrhoea, younger children and those from households with lower wealth were at greater risk of MAM. These children may benefit from targeted interventions focusing on feeding (targeted nutrition support for at-risk households) and follow up in order to reduce the occurrence of MAM and its consequences.
Respiratory patterns and physical fitness in healthy adults: a cross-sectional study
Authors: Liang Wen-Ming , Ji Yu-Xuan , Xiao Jing , Truskauskaitė Inga , Hendrixson Adomas , Bai Zhen-Min , Ruksenas Osvaldas
Published: January 2024

Background

The altered respiratory patterns have a significant impact on our health. However, the links between respiration patterns during spontaneous breathing and physical fitness remain unknown. Therefore, we sought to examine how the respiratory pattern during spontaneous breathing interacts with physical fitness.

Methods

A total of 610 participants (aged 20-59 years) were enrolled; 163 men (age = 41 ± 11) and 401 women (age = 42 ± 9) were included for analysis. The parameters of the respiration pattern were respiration rate (RR) and inhalation/exhalation (I/E) ratio. The physical fitness components were body size, visuomotor reaction time, balance, flexibility, hand grip strength, back extension strength, vertical jump height, number of push-ups, number of sit-ups, and the maximum rate of oxygen consumption. The data were analyzed separately for two gender groups. Participants within each gender group were further divided into two age categories (young: 20−39 years, middle-aged: 40−59 years) for the analysis, and both correlational and comparative tests were used to solidify the results.

Results

Neither RRs nor the I/E ratios were substantially correlated with physical fitness in women. In addition, the I/E ratios showed no significant correlation with physical fitness in young men, while the results from correlational and comparative tests were inconsistent in middle-aged men. Consistently, men with lower RRs exhibited significantly shorter visuomotor reaction times in two age groups, and demonstrated significantly higher vertical jump heights in the middle-aged group.

Conclusions

In women, respiratory patterns were not correlated with physical fitness. The relationship between middle-aged men’s I/E ratios and their physical fitness warrants further investigation. Men with lower RRs may have better visual-motor coordination and/or sustained attention, while middle-aged men with lower RRs may also have greater leg explosive power and neuromuscular coordination, which should be considered for physical assessment and health improvement.