bluuebunny/crossref_metadata_2025 huggingface dataset:
Short (23-hour)-stay robotic-assisted radical prostatectomy in a state-funded national health service – Is it safe and feasible?
Authors: Tay Li June , Gilanliogullari Kemal , Maitra Neil , Samson Lourdes , Patil Vishal , Lamb Benjamin W , Shah Nimish
Published: September 2023

Objectives:

The COVID-19 pandemic has led to a long waiting list for elective surgery and increasing bed pressures from acute admissions. This led to widespread cancellations on the day of surgery even for cancer procedures. To address this, all inpatient stay robotic-assisted radical prostatectomy (RARP) cases were managed via our day surgery unit as a 23-hour stay. We report the safety and feasibility of our initial implementation.

Methods:

A standard operating procedure for admission via the day surgery unit, including a modified enhanced recovery pathway, for patients undergoing RARP with or without pelvic lymph node dissection (PLND) was devised. All pre-operative variables were collected, and all perioperative outcomes analysed. Primary outcomes were number of on the day cancellations, discharge failure as 23-hour stay and 30-day readmissions.

Results:

Between November 2021 and June 2022, 135 patients underwent RARP with or without PLND via the day surgery unit. Mean patient age was 65 (46–76) years. Mean operative time and estimated blood loss were 153 (67–281) minutes and 197 (50–700) mL, respectively. Concomitant lymph node dissection was performed in 32.7% of cases. No patient required blood transfusion or conversion to open. We had 3 (2.2%) discharge failures, all of which were due to clinical reasons. Our 30-day hospital readmission rate was 3.7%, while another 5.2% attended emergency department and were discharged without admission.

Conclusion:

Short (23-hour)-stay RARP is safe and feasible and reduces pressure on inpatient beds but requires a multidisciplinary approach and engagement from all stakeholders.

Level of evidence:

2
The Struggle for Authentic Teaching
Authors: Thakore Bhoomi K.
Published: September 2023

Higher education has inextricably become a part of political platforms, specifically in calls for limits on social sciences and humanities perspectives in the classroom. As instructors, we have become front-line soldiers in this fight, managing hostile students and their parents, while struggling to remain authentic to our academic selves. In this article, I reflect on my authentic teaching, the COVID-19 pandemic in Florida, and the Stop WOKE Act, and offer a contribution on how we might change the course.
Does a coaxial double pigtail stent reduce adverse events after lumen apposing metal stent placement for pancreatic fluid collections? A systematic review and meta-analysis
Authors: Giri Suprabhat , Harindranath Sidharth , Afzalpurkar Shivaraj , Angadi Sumaswi , Sundaram Sridhar
Published: September 2023

Background:

Lumen apposing metal stents (LAMSs) have a higher clinical success rate for managing pancreatic fluid collections. But they are associated with adverse events (AEs) like bleeding, migration, buried stent, occlusion, and infection. It has been hypothesized that placing a double pigtail stent (DPS) within LAMS may mitigate these AEs. The present systematic review and meta-analysis were conducted to compare the outcome and AEs associated with LAMS with or without a coaxial DPS (LAMS-DPS).

Methods:

A comprehensive literature search of three databases from January 2010 to August 2022 was conducted for studies comparing the outcome and AEs of LAMS alone and LAMS-DPS. Pooled incidence and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated for all the dichotomous outcomes.

Results:

Overall, eight studies ( n = 460) were included in the final analysis. The clinical success rate (RR 1.00, 95% CI: 0.87–1.14) and the risk of overall AEs (RR 1.60, 95% CI: 0.95–2.68) remained comparable between both groups. There was no difference in the risk of bleeding between LAMS alone and LAMS-DPS (RR 1.80, 95% CI: 0.83–3.88). Individual analysis of other AEs, including infection, stent migration, occlusion, and reintervention, showed no difference in the risk between both procedures.

Conclusion:

The present meta-analysis shows that coaxial DPS within LAMS may not reduce AE rates or improve clinical outcomes. Further larger studies, including patients with walled-off necrosis, are required to demonstrate the benefit of coaxial DPS within LAMS.
Multi-scaled city networks based on automotive industry value chain: a case study from Urban Agglomeration in the Middle Reaches of the Yangtze River
Authors: Xiong Zhifei , Zheng Wensheng , Wang Xiaofang
Published: September 2023

Researchers are increasingly focusing on city networks, but there has been little in-depth research on the spatial heterogeneity of city networks at different scales, which makes it easy to overlook the functional differences of various actors in the network at different scales. To fill this gap, this research employs a case study of the Urban Agglomeration in the Middle Reaches of the Yangtze River, using a combination of quantitative and qualitative methods to supplement multi-scaled data on the subject. This study reveals the emergence of three models of city networks in central China as a result of the automotive industry value chain, which spans from spare parts to automakers and sale/service. The first model is strongly connected city networks centered on the ‘Wuhan–Xiangyang–Shiyan’ economic belt and embeds itself in Hubei province. The second model is city networks centered on the ‘Changsha–Zhuzhou–Xiangtan’ Urban Agglomeration and embeds itself in Hunan province. The third model is flattened city networks that expand on their own in Jiangxi Province. The demand for vehicles fueled the growth of these city networks through spatial division of labor. However, there are still boundaries and distance that hinder expansion, and the fact that some automotive companies are state-owned has made them an essential instrument for the Chinese government to control regional city networks.
Serum tau protein elevation in migraine: a cross-sectional case–control study
Authors: Overeem Lucas Hendrik , Raffaelli Bianca , Fleischmann Robert , Süße Marie , Vogelgesang Antje , Maceski Aleksandra Maleska , Papadopoulou Athina , Ruprecht Klemens , Su Wendy , Koch Mirja , Siebert Anke , Arkuszewski Michal , Tenenbaum Nadia , Kuhle Jens , Reuter Uwe
Published: September 2023

Background

Migraine is a disorder associated with neuropeptide release, pain and inflammation. Tau protein has recently been linked to inflammatory diseases and can be influenced by neuropeptides such as CGRP, a key neurotransmitter in migraine. Here, we report serum concentrations of total-tau protein in migraine patients and healthy controls.

Methods

In this cross-sectional study, interictal blood samples from n = 92 patients with episodic migraine (EM), n = 93 patients with chronic migraine (CM), and n = 42 healthy matched controls (HC) were studied. We assessed serum total-tau protein (t-tau) and for comparison neurofilament light chain protein (NfL), glial fibrillary acidic protein (GFAP), and ubiquitin carboxy-terminal hydrolase L (UCH-L1) concentrations using the Neurology 4-plex kit, on a single molecule array HD-X Analyzer (Quanterix Corp Lexington, MA). Matched serum/cerebrospinal fluid (CSF) samples were used for post-hoc evaluations of a central nervous system (CNS) source of relevant findings. We applied non-parametric tests to compare groups and assess correlations.

Results

Serum t-tau concentrations were elevated in EM [0.320 (0.204 to 0.466) pg/mL] and CM [0.304 (0.158 to 0.406) pg/mL] patients compared to HC [0.200 (0.114 to 0.288) pg/mL] (p = 0.002 vs. EM; p = 0.025 vs. CM). EM with aura [0.291 (0.184 to 0.486 pg/mL); p = 0.013] and EM without aura [0.332 (0.234 to 0.449) pg/mL; p = 0.008] patients had higher t-tau levels than HC but did not differ between each other. Subgroup analysis of CM with/without preventive treatment revealed elevated t-tau levels compared to HC only in the non-prevention group [0.322 (0.181 to 0.463) pg/mL; p = 0.009]. T-tau was elevated in serum (p = 0.028) but not in cerebrospinal fluid (p = 0.760). In contrast to t-tau, all proteins associated with cell damage (NfL, GFAP, and UCH-L1), did not differ between groups.

Discussion

Migraine is associated with t-tau elevation in serum but not in the CSF. Our clinical study identifies t-tau as a new target for migraine research.
Legally binding and ambitious biodiversity protection under the CBD, the global biodiversity framework, and human rights law
Authors: Ekardt Felix , Günther Philipp , Hagemann Katharina , Garske Beatrice , Heyl Katharine , Weyland Raphael
Published: September 2023

Beyond climate change, the planet faces several other environmental challenges that are at least as threatening, such as the loss of biodiversity. In each case, the problems are driven by similar factors, such as fossil fuels and intensive livestock farming. This paper presents a legal analysis concerning the binding nature of the Convention on Biological Diversity’s (CBD) overarching objective to halt biodiversity loss, within the framework of international environmental and human rights law. Using the established legal techniques encompassing grammatical, systematic, teleological, and historical interpretations, the article demonstrates that the CBD’s objective to halt biodiversity loss is indeed legally binding and justiciable. This conclusion is directly drawn from interpreting Article 1 CBD. Furthermore, a comparable obligation emerges indirectly from international climate law. The imperative to curtail biodiversity loss also finds grounding in human rights law, albeit necessitating a re-evaluation of certain aspects of freedom, similar to what has been explored in the context of climate protection. Moreover, the article underscores that various other biodiversity-related regulations within international law, including those laid out in the CBD, the Aichi Targets, and the Kunming–Montreal Global Biodiversity Framework, also carry partial legal significance. Nonetheless, it is crucial to note that these regulations, including the Kunming–Montreal Framework, do not modify the obligation mandate to halt biodiversity loss, which was established at the latest when the CBD entered into force in 1993. Because this obligation has been violated since then, states could potentially be subject to legal action before international or domestic courts for their actions or inactions contributing to global biodiversity loss.
Jasmonate signaling drives defense responses against Alternaria alternata in chrysanthemum
Authors: Zhang Shuhuan , Miao Weihao , Liu Ye , Jiang Jiafu , Chen Sumei , Chen Fadi , Guan Zhiyong
Published: September 2023

Background

Black spot disease caused by the necrotrophic fungus Alternaria spp. is one of the most devastating diseases affecting Chrysanthemum morifolium. There is currently no effective way to prevent chrysanthemum black spot.

Results

We revealed that pre-treatment of chrysanthemum leaves with the methy jasmonate (MeJA) significantly reduces their susceptibility to Alternaria alternata. To understand how MeJA treatment induces resistance, we monitored the dynamics of metabolites and the transcriptome in leaves after MeJA treatment following A. alternata infection. JA signaling affected the resistance of plants to pathogens through cell wall modification, Ca2+ regulation, reactive oxygen species (ROS) regulation, mitogen‐activated protein kinase cascade and hormonal signaling processes, and the accumulation of anti-fungal and anti-oxidant metabolites. Furthermore, the expression of genes associated with these functions was verified by reverse transcription quantitative PCR and transgenic assays.

Conclusion

Our findings indicate that MeJA pre-treatment could be a potential orchestrator of a broad-spectrum defense response that may help establish an ecologically friendly pest control strategy and offer a promising way of priming plants to induce defense responses against A. alternata.
Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis
Authors: Creber Anna , Leo Donato Giuseppe , Buckley Benjamin J. R. , Chowdhury Mahin , Harrison Stephanie L. , Isanejad Masoud , Lane Deirdre A. ,   on behalf of the TAILOR investigators
Published: September 2023

Background

Telemonitoring for the remote patient self-management of chronic conditions can be a cost-effective method for delivering care in chronic disease; nonetheless, its implementation in clinical practice remains low. The aim of this meta-synthesis is to explore barriers and facilitators associated with the use of remote patient monitoring of chronic disease, drawing on qualitative research, and assessing participant interactions with this technology.

Method

A meta-synthesis of qualitative studies was performed. MEDLINE, SCOPUS and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from database date of inception to 5 February 2021. The Critical Appraisal Skills Programme (CASP) was used to critically appraise each study. Thematic synthesis was performed to identify user (patients, carers and healthcare professionals) perspectives and experiences of patient remote monitoring of chronic disease (Type 2 diabetes mellitus, chronic obstructive pulmonary disease, and cardiovascular disease).

Results

Searches returned 10,401 studies and following independent screening by two reviewers, nine studies were included in this meta-synthesis. Data were synthesised and categorised into four key themes: (1) Improved care; (2) Communication; (3) Technology feasibility & acceptability; and (4) Intervention concerns. Most patients using patient remote devices felt motivated in managing their own lifestyles and felt reassured by the close monitoring and increased communication. Barriers identified involved generational differences and difficulties with the technology used.

Conclusion

Most studies showed a positive attitude to telemonitoring, with patients preferring the convenience of telemonitoring in comparison to attending regular clinics. Further research is required to assess the most effective technology for chronic disease management, how to maintain long-term patient adherence, and identify effective approaches to address generational variation in telemonitoring up-take.
Factors associated with complications in ST-elevation myocardial infarction: a single-center experience
Authors: Mavungu Mbuku Jean-Michel , Mukombola Kasongo Aldophe , Goube Pascale , Miltoni Laetitia , Nkodila Natuhoyila Aliocha , M’Buyamba-Kabangu Jean-Réné , Longo-Mbenza Benjamin , Kianu Phanzu Bernard
Published: September 2023

Background

ST-elevation myocardial infarction (STEMI) is a major public health problem. This study aimed to determine the prevalence and identify the determinants of STEMI-related complications in the Cardiology Intensive Care Unit of the Sud Francilien Hospital Center (SFHC).

Methods

We retrospectively analyzed the data of 315 patients with STEMI aged ≥ 18 years. Logistic regression was used to identify factors independently associated with the occurrence of complications.

Results

Overall, 315 patients aged 61.7 ± 13.4 years, of whom 261 were men, had STEMI during the study period. The hospital frequency of STEMI was 12.7%. Arrhythmias and acute heart failure were the main complications. Age ≥ 75 years (adjusted odds ratio [aOR], 5.18; 95% confidence interval [CI], 3.92–8.75), hypertension (aOR, 3.38; 95% CI, 1.68–5.82), and cigarette smoking (aOR, 3.52; 95% CI, 1.69–7.33) were independent determinants of acute heart failure. Meanwhile, diabetes mellitus (aOR, 1.74; 95% CI, 1.09–3.37), history of atrial fibrillation (aOR, 2.79; 95% CI, 1.66–4.76), history of stroke or transient ischemic attack (aOR, 1.99; 95% CI, 1.31–2.89), and low high-density lipoprotein-cholesterol (HDL-C) levels (aOR, 3.70; 95% CI, 1.08–6.64) were independent determinants of arrhythmias.

Conclusion

STEMI is a frequent condition at SFHC and is often complicated by acute heart failure and arrhythmias. Patients aged ≥ 75 years, those with hypertension or diabetes mellitus, smokers, those with a history of atrial fibrillation or stroke, and those with low HDL-C levels require careful monitoring for the early diagnosis and management of these complications.
Relationship between systolic blood pressure and mortality in older vs younger trauma patients – a retrospective multicentre observational study
Authors: Benhamed Axel , Batomen Brice , Boucher Valérie , Yadav Krishan , Isaac Chartelin Jean , Mercier Eric , Bernard Francis , Blais-L’écuyer Julien , Tazarourte Karim , Emond Marcel
Published: September 2023

Background

The population of older trauma patients is increasing. Those patients have heterogeneous presentations and need senior-friendly triaging tools. Systolic blood pressure (SBP) is commonly used to assess injury severity, and some authors advocated adjusting SBP threshold for older patients. We aimed to describe and compare the relationship between mortality and SBP in older trauma patients and their younger counterparts.

Methods

We included patients admitted to three level-I trauma centres and performed logistic regressions with age and SBP to obtain mortality curves. Multivariable Logistic regressions were performed to measure the association between age and mortality at different SBP ranges. Subgroup analyses were conducted for major trauma and severe traumatic brain injury admissions.

Results

A total of 47,661 patients were included, among which 12.9% were aged 65–74 years and 27.3% were ≥ 75 years. Overall mortality rates were 3.9%, 8.1%, and 11.7% in the groups aged 16–64, 65–74, and ≥ 75 years, respectively. The relationship between prehospital SBP and mortality was nonlinear (U-shape), mortality increased with each 10 mmHg SBP decrement from 130 to 50 mmHg and each 10-mmHg increment from 150 to 220 mmHg across all age groups. Older patients were at higher odd for mortality in all ranges of SBP. The highest OR in patients aged 65–74 years was 3.67 [95% CI: 2.08–6.45] in the 90–99 mmHg SBP range and 7.92 [95% CI: 5.13–12.23] for those aged ≥ 75 years in the 100–109 mmHg SBP range.

Conclusion

The relationship between SBP and mortality is nonlinear, regardless of trauma severity and age. Older age was associated with a higher odd of mortality at all SBP points. Future triage tools should therefore consider SBP as a continuous rather than a dichotomized predictor.
Exploring the variable importance in random forests under correlations: a general concept applied to donor organ quality in post-transplant survival
Authors: Wies Christoph , Miltenberger Robert , Grieser Gunter , Jahn-Eimermacher Antje
Published: September 2023

Random Forests are a powerful and frequently applied Machine Learning tool. The permutation variable importance (VIMP) has been proposed to improve the explainability of such a pure prediction model. It describes the expected increase in prediction error after randomly permuting a variable and disturbing its association with the outcome. However, VIMPs measure a variable’s marginal influence only, that can make its interpretation difficult or even misleading. In the present work we address the general need for improving the explainability of prediction models by exploring VIMPs in the presence of correlated variables. In particular, we propose to use a variable’s residual information for investigating if its permutation importance partially or totally originates from correlated predictors. Hypotheses tests are derived by a resampling algorithm that can further support results by providing test decisions and p-values. In simulation studies we show that the proposed test controls type I error rates. When applying the methods to a Random Forest analysis of post-transplant survival after kidney transplantation, the importance of kidney donor quality for predicting post-transplant survival is shown to be high. However, the transplant allocation policy introduces correlations with other well-known predictors, which raises the concern that the importance of kidney donor quality may simply originate from these predictors. By using the proposed method, this concern is addressed and it is demonstrated that kidney donor quality plays an important role in post-transplant survival, regardless of correlations with other predictors.
Usability and feasibility of a tablet-based e-coach for older adults in rehabilitation units to improve nutrition and physical activity: a prospective pilot study
Authors: Happe Lisa , Sgraja Marie , Hein Andreas , Quinten Vincent , Diekmann Rebecca
Published: September 2023

Background

For older adults (≥ 70 years), it is often challenging to maintain new nutrition and physical activity behaviours learned in rehabilitation. To minimize the risk of negative health consequences when returning home, an e-coach can be helpful. Aligning the program with an established concept such as the Transtheoretical Model of Behaviour Change (TTM) and guidance from healthcare professionals can optimize behaviour change.

Objective

This prospective single-arm pilot study aimed to assess the usability and feasibility of a nutrition and mobility e-coach for older adults during and after rehabilitation for a period of 9 weeks. In addition, we examined the change in the TTM phase as an indicator of the participant’s readiness to change or the changes made.

Methods

Older adults (≥ 70 years) with nutrition deficits and/ or mobility limitations were recruited in a rehabilitation centre. Participants’ phases of behaviour change in the TTM were identified by comparing current nutrition and physical activity habits via self-report with age-specific nutrition and physical activity recommendations. They received a tablet with the e-coach containing educational and interactive elements on the topics of nutrition and physical activity in older age. Participants used the e-coach and received support from healthcare professionals. The TTM phases were assessed at five times; the e-coach content was adjusted accordingly. Usability was assessed using the System Usability Scale (SUS, Score range: 0-100). Timestamps were used to evaluate how frequently participants used the e-coach: high (≥ 67% of the days), medium (66 − 33% of the days), and low (< 33% of the days).

Results

Approximately 140 patients were approached and n = 30 recruited. Complete data sets of n = 21 persons were analysed (38% female, mean age 79.0 ± 6.0 years). The SUS was 78.6 points, 11 participants (42%) were classified as high users, 6 (39%) as medium users and 4 (19%) as low users. After nine weeks, 15 participants (71%) achieved the physical activity recommendations (baseline: 33%, n = 7). Nutrition recommendations were achieved by 14 participants (66%) after nine weeks (baseline: 24%, n = 5).

Conclusion

The e-coach seems to be usable and feasible for older adults. We identified some optimization potentials for our application that can be transferred to the development of comparable e-health interventions for vulnerable older adults.
Stakeholder perspectives on the preferred service ecosystem for senior citizens living at home: a qualitative interview study
Authors: Kattouw Christophe Eward , Aase Karina , Viksveen Petter
Published: September 2023

Background

Most senior citizens want to live independently at home as long as possible. The World Health Organization recommends an age-friendly community approach by transforming the service ecosystem for senior citizens and basing it on the question “What matters to you?”. However, there is limited research-based knowledge to determine the characteristics of the preferred service ecosystem from the perspectives of multiple stakeholders. Therefore, the aim of the study was to gain a deeper understanding of multiple stakeholder perspectives on the preferred service ecosystem for senior citizens living at home.

Methods

Four stakeholder groups (n = 57) from a Norwegian municipality participated in an interview study in 2019 and 2020: senior citizens, carers, healthcare professionals, and managers. Data were analysed according to qualitative content analysis.

Results

Overall, there was considerable correspondence between the four stakeholder groups’ perspectives on the preferred service ecosystem for senior citizens. Six themes were developed: (1) “self-reliance – living independently at home as long as possible”; (2) “remaining active and social within the community”; (3) “support for living at home as long as possible”; (4) “accessible information and services”; (5) “continuity of services”; and (6) “compassionate and competent healthcare professionals”.

Conclusions

In order to adapt and meet changing needs, the preferred service ecosystem should support senior citizens’ autonomy through interpersonal relationships and involvement. Healthcare managers and decision makers should consider a broader range of practical and social support services. Municipalities should plan for and develop age-friendly infrastructures, while healthcare professionals should rely on their compassion and competence to meet senior citizens’ needs.
Intestinal parasitic infections and their potential risk factors among prison inmates in Valencia, Spain
Authors: Muñoz-Antoli Carla , Irisarri-Gutiérrez María José , Acosta Lucrecia , Bonet María José , Esteban J. Guillermo , Toledo Rafael
Published: September 2023

Background

Despite the fact that prison inmates are a population at higher risk than other groups of suffering from intestinal parasite infections in relation to their living conditions, information about these diseases in prison environments is still scarce. Herein, we analyze the status of intestinal parasite infections in a Spanish prison.

Methods

A cross-sectional study involving 528 inmates was conducted from April to June 2022 among inmates at Centro Penitenciario Picassent (Valencia, Spain). Stool specimens were examined using the direct wet mount technique, the formol-ether concentration technique, and the Ziehl-Neelsen staining method. We used STATA 16.1 for data analysis. We consider a p-value less than 0.05 significant at a 95% confidence level.

Results

Of the 528 inmates (471 men and 57 women; a mean age of 41.94 years) enrolled in the study, 83 (15.7%) were infected. Only six species of protozoa were detected. The gut potential microeukaryotic pathobiont Blastocystis sp. was the predominant parasite, accounting for 37 (44.6%) of the infections. Gut parasite amebas (6.6%) and pathobionts (5.3%) were more prevalent than flagellates (2.3%). The prevalence of infection with pathogenic species (8.9%) was similar to that of non-pathogenic species (8.7%). Infection among men (15.2%) was higher than in women (0.6%) (p < 0.0001). In multivariate analysis, the country of birth (AOR = 0.31, 95% CI = 0.18–0.52) and the time spent in prison (AOR = 1.83, 95% CI = 1.06–3.14) were statistically significant associated to intestinal parasite infections (p < 0.0001 and p = 0.028, respectively).

Conclusion

This study found low levels of intestinal parasite infections in the CPP which could be indicative of the implementation of sanitary measures in prison environments in Spain. The less time spent in prison favor the risk of having infection while the Spanish nationality of inmates could reduce the risk of infection. The main recommendation would be to introduce routine parasitological tests upon foreigners entering prison.
Ultrasonographic characteristics, genetic features, and maternal and fetal outcomes in fetuses with omphalocele in China: a single tertiary center study
Authors: Que Yanting , Cai Meiying , Yang Fang , Ji Qingqiang , Zhang Shuqi , Huang Wenhui , Gao Yashi , Zhou Bojing , Huang Hailong , Cao Hua , Lin Na
Published: September 2023

Background

Patients with omphalocele, a midline abdominal wall defect at the umbilical cord base, have a low survival rate. However, the long-term outcomes of fetuses with prenatally diagnosed omphalocele have scarcely been studied. Therefore, we investigated the ultrasonographic features, genetic characteristics, and maternal and fetal outcomes of fetuses with omphalocele and provided a reference for the perinatal management of such cases.

Methods

A total of 120 pregnant females with fetal omphalocele were diagnosed using prenatal ultrasonography at the Fujian Provincial Maternity and Child Health Hospital from January 2015 to March 2022. Amniotic fluid or cord blood samples were drawn at different gestational weeks for routine karyotype analysis, chromosomal microarray analysis (CMA) detection, and whole exome sequencing (WES). The maternal and fetal outcomes were followed up.

Results

Among the 120 fetuses, 27 were diagnosed with isolated omphalocele and 93 with nonisolated omphalocele using prenatal ultrasonography. Cardiac anomalies were the most observed cause in 17 fetuses. Routine karyotyping and CMA were performed on 35 patients, and chromosomal abnormalities were observed in five patients, trisomy 18 in three, trisomy 13 in one, and chromosome 8–11 translocation in one patient; all were non-isolated omphalocele cases. Six nonisolated cases had normal CMA results and conventional karyotype tests, and further WES examination revealed one pathogenic variant and two suspected pathogenic variants. Of the 120 fetuses, 112 were successfully followed up. Eighty of the 112 patients requested pregnancy termination. Seven of the cases died in utero. A 72% 1-year survival rate was observed from the successful 25 live births.

Conclusion

The prognosis of fetuses with nonisolated omphalocele varies greatly, and individualized analysis should be performed to determine fetal retention carefully. Routine karyotyping with CMA testing should be provided for fetuses with omphalocele. WES is an option if karyotype and CMA tests are normal. If the fetal karyotype is normal and no associated abnormalities are observed, fetuses with omphalocele could have a high survival rate, and most will have a good prognosis.
Evaluating atezolizumab in patients with urinary tract squamous cell carcinoma (AURORA): study protocol for a single arm, open-label, multicentre, phase II clinical trial
Authors: Crabb Simon , Wickens Robin , Jane-Bibby Sarah , Dunkley Denise , Lawrence Megan , Knight Allen , Jones Robert , Birtle Alison , Huddart Robert , Linch Mark , Martin Jonathan , Coleman Adam , Boukas Konstantinos , Markham Hannah , Griffiths Gareth
Published: September 2023

Background

Bladder and urinary tract cancers account for approximately 21,000 new diagnoses and 5,000 deaths annually in the UK. Approximately 90% are transitional cell carcinomas where advanced disease is treated with platinum based chemotherapy and PD-1/PD-L1 directed immunotherapy. Urinary tract squamous cell carcinoma (UTSCC) accounts for about 5% of urinary tract cancers overall making this a rare disease. We have yet to establish definitive systemic treatment options for advanced UTSCC.

Preliminary translational data, from UTSCC patient tumour samples, indicate high PD-L1 expression and tumour infiltrating lymphocytes in a proportion of cases. Both of these features are associated with differential gene expression consistent with a tumour/immune microenvironment predicted to be susceptible to immune checkpoint directed immunotherapy which we will evaluate in the AURORA trial.

Methods

AURORA is a single arm, open-label, multicentre,UK phase II clinical trial. 33 patients will be recruited from UK secondary care sites. Patients with UTSCC, suitable for treatment with palliative intent, will receive atezolizumab PD-L1 directed immunotherapy (IV infusion, 1680 mg, every 28 days) for one year if tolerated. Response assessment, by cross sectional imaging will occur every 12 weeks. AURORA uses a Simon’s 2-stage optimal design with best overall objective response rate (ORR, by RECIST v1.1) at a minimum of 12 weeks from commencing treatment as the primary endpoint. Secondary endpoints will include overall survival, progression-free survival, duration of response, magnitude of response using waterfall plots of target lesion measurements, quality of life using the EORTC QLQ-C30 tool, safety and tolerability (CTCAE v5) and evaluation of potential biomarkers of treatment response including PD-L1 expression. Archival tumour samples and blood samples will be collected for translational analyses.

Discussion

If this trial shows atezolizumab to be safe and effective it may lead to a future late phase randomised controlled trial in UTSCC. Ultimately, we hope to provide a new option for treatment for such patients.

Trial registrations

EudraCT Number: 2021-001995-32 (issued 8th September 2021); ISRCTN83474167 (registered 11 May 2022); NCT05038657 (issued 9th September 2021).
Measurement of work-related psychological injury with depressive symptoms
Authors: Tanaka Mari , Hirano Yoshiyuki , Takanashi Rieko , Numata Noriko , Sutoh Chihiro , Yoshikawa Tomohiro , Shimizu Eiji
Published: September 2023

Objective

This study aimed to measure the level of psychological injury caused by work-related stress as well as the severity of depression among workers.

Method

First, we conducted an online survey and recruited 500 workers diagnosed with depression or adjustment disorder to investigate what type of stress they experienced within six months before onset. Second, we conducted another online survey and recruited 767 participants who experienced some form of work-related stress. All the participants were classified into four groups by whether or not they were diagnosed with depression and whether or not they quit their jobs due to work-related stress. We used the Impact of Event Scale-Revised (IES-R) to measure psychological injury caused by work-related stressful events and the Patient Health Questionnaire (PHQ)-9 to assess the severity of depression.

Results

In study 1, 62.4% of workers diagnosed with depression or adjustment disorder experienced work-related stress within six months before onset. In study 2, the IES-R mean scores were 40.7 (SD = 23.1) for Group A (workers with depression and quit their jobs) and 36.67 (SD = 23.4) for Group B (workers with depression but stayed at their jobs), with both exceeding the cut-off point (24/25) of PTSD (Post-Traumatic Stress Disorder), while the mean score of Group C (workers who did not have depression but quit their jobs because of work-related stress) was 20.74 (SD = 21.2), and it was 13.89 (SD = 17.4) for Group D (workers who had work-related stress but stayed at their jobs), with both of them below the cut-off point of PTSD. The total scores of IES-R of Group A and Group B were significantly higher than those of Group C and Group D(p < 0.001). There was a significant positive correlation between the scores of IES-R and PHQ-9 for all four groups (r = 0.708).

Conclusions

This study suggests that it is necessary to measure not only depressive symptoms but also the level of psychological injury resulting from stressful events in the workplace to assess workers with depression.
Pharmacotherapy literacy level and predictors of low literacy among diabetes mellitus type 2 patients in Serbia
Authors: Levic Marija , Bogavac-Stanojevic Natasa , Ubavic Stana , Krajnovic Dusanka
Published: September 2023

Background

Pharmacotherapy literacy (PTHL) is a specific ability to safely access, appraise and understand the available information concerning medication and to calculate and act accordingly. The concept of PTHL is mostly unknown for the majority of diabetes mellitus type 2 (DMT2) patients in Serbia. With diabetes being one of the major public health problems in Serbia with a prevalence of 9.1%, this two-study research aims at constructing performance-based instrument and estimating the prevalence of PTHL levels and identification of predictors of low PTHL scores in patients with DMT2.

Methods

Multistage study was performed to adapt the existing performance–based instrument (PTHL-SR) into specific questionnaire for DMT2 population (PTHL-DM instrument). PTHL levels were assessed through cross-sectional study categorising patients into groups of low, medium, and high PTHL levels. We considered 19 predictors for low PTHL scores, from sociodemographic characteristics, health behaviours and health characteristics, access to health-related information and empowerment-related indicators. Univariate and multivariate logistic regression analyses were used to determine independent predictors of low PTHL.

Results

The final 15-item PTHL-DM instrument proved to have satisfactory reliability (KR20 = 0.475) and internal reliability [ICC for the whole instrument was 0.97 with 95% confidence intervals (0.95–0.99)]. Positive correlation (rho = 0.69) between PTHL-DM score (15 questions) and the total PTHL-SR score (14 questions) was also observed.

It was demonstrated that the majority of 350 patients had low PTHL (62%), and only 5% high PTHL level. Mean score on PTHL-DM was 7.8 ± 2.3. Probability of low PTHL increased among smokers, patients with low interest in health and those who estimated their health as bad. Patients who used pharmacists as sourse of information were less likely to be pharmacotherapy illiterate. Combined therapy with insulin and Oral Hypoglycemic Agents was associated with higher PTHL.

Conclusions

Our data indicate that specific PTHL-DM tool is objective, valid, and reliable. It was found that low level of PTHL prevailed among DMT2 patients. Medication literacy is influenced by age, residence, education, and family status. Patients with better health literacy also reported better health behaviours. Different patient empowerment programs and approaches aimed at raising PTHL would be essential to improve self-management and control of this widespread chronic disease in Serbia.
Developmental implications of prenatal opioid exposure among school-aged children: a mixed methods and community-initiated analysis
Authors: Wilkinson Andra , Rackers H. S. , Harmon T. M.
Published: September 2023

Background

Growing research points to potential long-term developmental implications of prenatal opioid exposure for children. Yet, polysubstance use and adverse childhood experiences are raised as potential confounders. Further, there is a lack of data on school-age children and the children’s strengths.

Methods

Parents and caregivers of children with prenatal opioid exposure worked with the study team to design, collect, and descriptively analyze mixed method data. Data were collected through survey (n = 148) and two focus groups (n = 15) from a convenience sample in mostly West Virginia and Massachusetts.

Results

Nearly half of the children in the sample were diagnosed with multiple developmental delays, behavioral health conditions, and specific learning disorders. Roughly 85% of children have behavioral challenges. Associations between prenatal opioid exposure and negative developmental outcomes did not vary by type of opioid nor by polysubstance use, while controlling for adverse childhood experiences. Importantly, over 80% of families also reported their child’s strengths, including empathy, social magnetism, and their resilience.

Conclusions

The challenges for children born with prenatal opioid exposure may extend into school-age. The results are consistent with prior research on younger children, suggesting a need for best practices for caring for these children beyond the neonatal stage.
Measuring COVID-19 related stress and its associated factors among the parents of school-aged children during the first lockdown in France
Authors: Bourion-Bédès Stéphanie , Rousseau Hélène , Batt Martine , Beltrand Carole , Machane Rabah , Tarquinio Pascale , Tarquinio Cyril , Baumann Cédric
Published: September 2023

Background

The COVID-19 pandemic placed important challenges on parents, as they had to meet various demands during lockdown, including childcare, work and homeschooling. Therefore, the current study aimed to investigate perceived stress levels among the parents of school-aged children and explore their association with sociodemographic, environmental and psychological factors during lockdown.

Methods

A cross-sectional study was conducted among the parents of school-aged children ages 8 to 18, who lived in the Grand Est region of France during the first wave of the pandemic. An online survey collected sociodemographic data, living and working conditions, and exposure to COVID-19 as well as parent’s levels of perceived stress (PSS-10), self-perceived health status (SF-12), social support (MSPSS) and resilience (BRS). Multivariable logistic regression models were conducted to evaluate the association between moderate to severe perceived stress and various factors.

Results

In total, 734 parents were included. The results indicated that 47% were experiencing moderate stress and 7.2% were experiencing severe stress. Factors most strongly associated with risk of moderate to severe levels of stress were lower levels of parental resilience (OR = 3.8, 95% CI: 2.2–6.6) and poor self-perceived mental health status (OR = 7.3, 95% CI: 5.0–10.8). The following risk factors were also identified: female sex; being in the age range of 35–44; difficulties isolating and contracting COVID-19, which involved hospitalization and separation or isolation from family. The support of friends (OR = 0.8, 95% CI: 0.7–1.0) and family (OR = 0.5, 95% CI: 0.3–0.8) were protective factors.

Conclusions

These findings suggest that supportive and preventive programs should focus on the improvement of resilience and mental health management to promote parents’ wellbeing. Research has to focus both on individuals’ inner potential for increasing resilience and the environmental resources to be activated. Building and boosting resilience among parents could serve as a protective factor against negative outcomes for them and their families.
A dietary pattern of frequent plant-based foods intake reduced the associated risks for atopic dermatitis exacerbation: Insights from the Singapore/Malaysia cross-sectional genetics epidemiology cohort
Authors: Lim Jun Jie , Reginald Kavita , Say Yee-How , Liu Mei Hui , Chew Fook Tim
Published: September 2023

Background

The prevalence of atopic dermatitis (AD) has been increasing in recent years, especially in Asia. There is growing evidence to suggest the importance of dietary patterns in the development and management of AD. Here, we seek to understand how certain dietary patterns in a Singapore/Malaysia population are associated with various risks of AD development and exacerbation.

Methods

A standardized questionnaire following the International Study of Asthma and Allergies in Childhood (ISAAC) guidelines was investigator-administered to a clinically and epidemiology well-defined allergic cohort of 13,561 young Chinese adults aged 19–22. Information on their sociodemographic, lifestyle, dietary habits, and personal and family medical atopic histories were obtained. Allergic sensitization was assessed by a skin prick test to mite allergens. Spearman’s rank-order correlation was used to assess the correlation between the intake frequencies of 16 food types. Dietary patterns were identified using principal component analysis. Four corresponding dietary scores were derived to examine the association of identified dietary patterns with allergic sensitization and AD exacerbations through a multivariable logistic regression that controlled for age, gender, parental eczema, BMI, and lifestyle factors.

Results

The correlation is the strongest between the intake of butter and margarine (R = 0.65). We identified four dietary patterns, “high-calorie foods”, “plant-based foods”, “meat and rice”, and “probiotics, milk and eggs”, and these accounted for 47.4% of the variance in the dietary habits among the subjects. Among these patterns, moderate-to-high intake of “plant-based foods” conferred a negative association for chronic (Adjusted odds ratio (AOR): 0.706; 95% confidence interval (CI): 0.589–0.847; p < 0.001) and moderate-to-severe AD (AOR: 0.756; 95% CI: 0.638–0.897; p < 0.01). “Meat and rice” and “probiotics, milk and eggs” were not significantly associated with AD exacerbation. While frequent adherence to “high-calorie foods” increased the associated risks for ever AD and moderate-to-severe AD, having a higher adherence to “plant-based foods” diminished the overall associated risks.

Conclusions

Frequent adherence to “plant-based foods” was associated with reduced risks for AD exacerbation in young Chinese adults from Singapore/Malaysia. This provides the initial evidence to support the association between dietary factors and AD. Further research is needed to better understand the pathomechanisms underlying diet and AD exacerbations.
Association of living arrangements with all-cause mortality among older adults: a propensity score–matched cohort study
Authors: Pu Lining , Zhang Jingni , He Xiaoxue , Pan Degong , Wang Huihui , Zhang Xue , Sun Xian , Liu Xiaojuan , He Shulan , Li Jiangping
Published: September 2023

Background

Many studies exist on the living arrangements and health status of older adults, but the findings have been inconsistent. Therefore, we examined the relationship between living arrangements and all-cause mortality in older adults.

Methods

This perspective study was based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2011 to 2018. We used a sample aged 65 years and over included in the study in 2011. Propensity score matching was performed to minimize bias and Cox proportional hazards regression models were conducted.

Results

A total of 7,963 participants were included. Of these, 1,383 were living alone, 6,424 were living with families, and 156 were living in nursing homes. In the propensity score-matched cohort, older adults living alone had a significantly lower risk of all-cause mortality than those living with families (hazard ratio 0.85; 95% confidence intervals 0.76 to 0.95). Living alone was prominently associated with a decline in mortality compared with living in nursing homes (hazard ratio 0.61; 95% confidence intervals 0.44 to 0.84). There was no significant difference in mortality between living in nursing homes and living with families (hazard ratio 1.19; 95% confidence intervals 0.89 to 1.60). Subgroup analyses indicated that there was no significant interaction with age, sex, education, or residence.

Conclusions

The risk of all-cause mortality was significantly lower in older adults living alone than in those living with families or living in nursing homes. This article’s findings suggest the need to adopt multiple approaches to meet the needs of senior care services.
Laparoscopic resection for gastric schwannoma larger than 30 mm with long-term outcomes
Authors: Jiang Xuetong , Zhao Mingzuo , Wu Jianqiang , Ding Yang , Wang Jian
Published: September 2023

Background and aims

Laparoscopic resection has been reported as effective and safe for gastric schwannoma (GS) in the form of case reports. However, study on laparoscopic surgery in patients with GS larger than 30 mm has been rarely reported. To this end, the present study aimed to evaluate the safety and efficacy of laparoscopic resection for the treatment of GS larger than 30 mm and its long-term outcomes.

Methods

This is a retrospective case series study of patients with GS larger than 30 mm who underwent laparoscopic resection at our hospital between January 2014 and December 2020. Clinical pathology, surgical and follow-up data were collected and analyzed.

Results

A total of 10 patients with a mean age of 51.6 years were included. Seven tumors were located in gastric body, 2 in antrum and 1 in fundus. Laparoscopic gastric wedge resection was performed in 7 patients, while laparoscopic gastric local resection was performed in 3 patients. All patients achieved complete resection. The mean operation time was 112.6 ± 34.3 min, and the mean postoperative hospital stay was 13.8 ± 5.1 days. Postoperative gastroplegia occurred in 2 patients and was treated with conservative therapy. No recurrence, metastasis or residue was found during the follow-up of mean 45.1 months.

Conclusions

Laparoscopic resection is a safe and effective method for treating GS larger than 30 mm with favorable long-term follow-up outcomes. Laparoscopic resection may be considered as the first-line treatment for GS larger than 30 mm.