bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical, Radiographic and Fusion Comparison of Oblique Lumbar Interbody Fusion (OLIF) stand-alone and OLIF with posterior pedicle screw fixation in patients with degenerative spondylolisthesis
Authors: Zhao Wenhao , Zhou Chuanli , Zhang Hao , Guo Jianwei , Han Jialuo , Lin Antao , Wang Yan , Ma Xuexiao
Published: October 2023

Purpose

To compare the outcomes and characteristics of oblique lumbar interbody fusion stand-alone (OLIF-SA) and OLIF with posterior pedicle screw fixation (OLIF-PPS) in the treatment of Grade I or Grade II degenerative lumbar spondylolisthesis.

Patients and methods

Between January 2019 and May 2022, 139 patients with degenerative spondylolisthesis were treated with OLIF-SA (n = 85) or OLIF-PPS (n = 54). The clinical and radiographic records were reviewed.

Results

The clinical and radiographic outcomes were similar in both groups. The operative time and intraoperative blood loss in the OLIF-SA group were lower than those in the OLIF-PPS group (P < 0.05). However, the OLIF-PPS group had significantly better disc height (DH) and postoperative forward spondylolisthesis distance (FSD) improvement at 6 months (P < 0.05). The OLIF-PPS group had a significantly lower cage subsidence value than the OLIF-SA group (P < 0.05). Improvement of the lumbar lordotic angle (LA) and fusion segmental lordotic angle (FSA) in the OLIF-PPS group was significantly better than that in the OLIF-SA group (P < 0.05). In terms of fusion types, the OLIF-SA group tended to undergo fusion from the edge of the vertebral body. Fusion in the OLIF-PPS group began more often in the bone graft area of the central cage of the vertebral body. The fusion speed of the OLIF-SA group was faster than that of the OLIF-PPS group.

Conclusion

OLIF-SA has the advantages of a short operative time, less intraoperative blood loss, and reduced financial burden, while PPS has incomparable advantages in the reduction of spondylolisthesis, restoration of lumbar physiological curvature, and long-term maintenance of intervertebral DH. In addition, the SA group had a unique vertebral edge fusion method and faster fusion speed.
Educational value of mixed reality combined with a three-dimensional printed model of aortic disease for vascular surgery in the standardized residency training of surgical residents in China: a case control study
Authors: Li Weihao , Liu Yuanfeng , Wang Yonghui , Zhang Xuemin , Liu Kun , Jiao Yang , Zhang Xiaoming , Chen Jie , Zhang Tao
Published: October 2023

Background

The simulated three-dimensional (3D) printed anatomical model of the aorta, which has become the norm in medical education, has poor authenticity, tactility, feasibility, and interactivity. Therefore, this study explored the educational value and effect of mixed reality (MR) combined with a 3D printed model of aortic disease in training surgical residents.

Method

Fifty-one resident physicians who rotated in vascular surgery were selected and divided into traditional (27) and experimental (24) teaching groups using the random number table method. After undergoing the experimental and traditional training routines on aortic disease, both the groups took a theoretical test on aortic disease and an assessment of the simulation based on the Michigan Standard Simulation Experience Scale (MiSSES) template. Their scores and assessment results were compared. The study was conducted at the Department of Vascular Surgery of Peking University People’s Hospital, Beijing, China.

Results

In the theoretical test on aortic disease, the experimental teaching group obtained higher mean total scores (79.0 ± 9.1 vs. 72.6 ± 7.5, P = 0.013) and higher scores in anatomy/ pathophysiology (30.8 ± 5.4 vs. 24.8 ± 5.8; P < 0.001) than the traditional teaching group. The differences in their scores in the differential diagnosis (25.8 ± 3.0 vs. 23.3 ± 4.9; P = 0.078) and treatment (22.5 ± 11.8 vs. 24.5 ± 8.2; P = 0.603) sessions were insignificant. The MR-assisted teaching stratified the vascular residents through the MiSSES survey. Overall, 95.8% residents (23/24) strongly or somewhat agreed that the MR was adequately realistic and the curriculum helped improve the ability to understanding aortic diseases. Further, 91.7% residents (22/24) strongly or somewhat agreed that the MR-assisted teaching was a good training tool for knowledge on aortic diseases. All residents responded with “Good” or “Outstanding” on the overall rating of the MR experience.

Conclusions

MR combined with the 3D printed model helped residents understand and master aortic disease, particularly regarding anatomy and pathophysiology. Additionally, the realistic 3D printing and MR models improved the self-efficacy of residents in studying aortic diseases, thus greatly stimulating their enthusiasm and initiative to study.
The automatic detection of diabetic kidney disease from retinal vascular parameters combined with clinical variables using artificial intelligence in type-2 diabetes patients
Authors: Shi Shaomin , Gao Ling , Zhang Juan , Zhang Baifang , Xiao Jing , Xu Wan , Tian Yuan , Ni Lihua , Wu Xiaoyan
Published: October 2023

Background

Diabetic kidney disease (DKD) has become the largest cause of end-stage kidney disease. Early and accurate detection of DKD is beneficial for patients. The present detection depends on the measurement of albuminuria or the estimated glomerular filtration rate, which is invasive and not optimal; therefore, new detection tools are urgently needed. Meanwhile, a close relationship between diabetic retinopathy and DKD has been reported; thus, we aimed to develop a novel detection algorithm for DKD using artificial intelligence technology based on retinal vascular parameters combined with several easily available clinical parameters in patients with type-2 diabetes.

Methods

A total of 515 consecutive patients with type-2 diabetes mellitus from Xiangyang Central Hospital were included. Patients were stratified by DKD diagnosis and split randomly into either the training set (70%, N = 360) or the testing set (30%, N = 155) (random seed = 1). Data from the training set were used to develop the machine learning algorithm (MLA), while those from the testing set were used to validate the MLA. Model performances were evaluated.

Results

The MLA using the random forest classifier presented optimal performance compared with other classifiers. When validated, the accuracy, sensitivity, specificity, F1 score, and AUC for the optimal model were 84.5%(95% CI 83.3–85.7), 84.5%(82.3–86.7), 84.5%(82.7–86.3), 0.845(0.831–0.859), and 0.914(0.903–0.925), respectively.

Conclusions

A new machine learning algorithm for DKD diagnosis based on fundus images and 8 easily available clinical parameters was developed, which indicated that retinal vascular changes can assist in DKD screening and detection.
Assessment of left atrioventricular coupling and left atrial function impairment in diabetes with and without hypertension using CMR feature tracking
Authors: Shi Rui , Jiang Yi-Ning , Qian Wen-Lei , Guo Ying-Kun , Gao Yue , Shen Li-Ting , Jiang Li , Li Xue-Ming , Yang Zhi-Gang , Li Yuan
Published: October 2023

Purpose

The study was designed to assess the effect of co-occurrence of diabetes mellitus (DM) and hypertension on the deterioration of left atrioventricular coupling index (LACI) and left atrial (LA) function in comparison to individuals suffering from DM only.

Methods

From December 2015 to June 2022, we consecutively recruited patients with clinically diagnosed DM who underwent cardiac magnetic resonance (CMR) at our hospital. The study comprised a total of 176 patients with DM, who were divided into two groups based on their blood pressure status: 103 with hypertension (DM + HP) and 73 without hypertension (DM-HP). LA reservoir function (reservoir strain (εs), total LA ejection fraction (LAEF)), conduit function (conduit strain (εe), passive LAEF), booster-pump function (booster strain (εa) and active LAEF), LA volume index (LAVI), LV global longitudinal strain (LVGLS), and LACI were evaluated and compared between the two groups.

Results

After adjusting for age, sex, body surface area (BSA), and history of current smoking, total LAEF (61.16 ± 14.04 vs. 56.05 ± 12.72, p = 0.013) and active LAEF (43.98 ± 14.33 vs. 38.72 ± 13.51, p = 0.017) were lower, while passive LAEF (33.22 ± 14.11 vs. 31.28 ± 15.01, p = 0.807) remained unchanged in the DM + HP group compared to the DM-HP group. The DM + HP group had decreased εs (41.27 ± 18.89 vs. 33.41 ± 13.94, p = 0.006), εe (23.69 ± 12.96 vs. 18.90 ± 9.90, p = 0.037), εa (17.83 ± 8.09 vs. 14.93 ± 6.63, p = 0.019), and increased LACI (17.40±10.28 vs. 22.72±15.01, p = 0.049) when compared to the DM-HP group. In patients with DM, multivariate analysis revealed significant independent associations between LV GLS and εs (β=-1.286, p < 0.001), εe (β=-0.919, p < 0.001), and εa (β=-0.324, p = 0.036). However, there was no significant association observed between LV GLS and LACI (β=-0.003, p = 0.075). Additionally, hypertension was found to independently contribute to decreased εa (β=-2.508, p = 0.027) and increased LACI in individuals with DM (β = 0.05, p = 0.011).

Conclusions

In DM patients, LV GLS showed a significant association with LA phasic strain. Hypertension was found to exacerbate the decline in LA booster strain and increase LACI in DM patients, indicating potential atrioventricular coupling index alterations.
Common mechanisms underlying diabetic vascular complications: focus on the interaction of metabolic disorders, immuno-inflammation, and endothelial dysfunction
Authors: Xue Chongxiang , Chen Keyu , Gao Zezheng , Bao Tingting , Dong LiShuo , Zhao Linhua , Tong Xiaolin , Li Xiuyang
Published: October 2023

Diabetic vascular complications (DVCs), including macro- and micro- angiopathy, account for a high percentage of mortality in patients with diabetes mellitus (DM). Endothelial dysfunction is the initial and role step for the pathogenesis of DVCs. Hyperglycemia and lipid metabolism disorders contribute to endothelial dysfunction via direct injury of metabolism products, crosstalk between immunity and inflammation, as well as related interaction network. Although physiological and phenotypic differences support their specified changes in different targeted organs, there are still several common mechanisms underlying DVCs. Also, inhibitors of these common mechanisms may decrease the incidence of DVCs effectively. Thus, this review may provide new insights into the possible measures for the secondary prevention of DM. And we discussed the current limitations of those present preventive measures in DVCs research.
Extracorporeal shock wave therapy inhibits osteoclast differentiation by targeting NF-κB signaling pathway
Authors: Chen Bei , Luo Yeqiang , Zhang Zhongxiu , Lin Shanghui , Wang Renkai , Li Baofeng
Published: October 2023

Background

Extracorporeal shock wave therapy (ESWT) has been reported to promote osteoblast differentiation. However, the role of ESWT on osteoclast differentiation is still elusive.

Methods

This study analyzed the differentiation of osteoclasts in the shock wave group and the control group in vitro, and TRAP staining, RT-PCR, WB assays, and MTT assays were assessed between the two groups. Furthermore, we analyzed the bone formation in these two groups in vivo and micro-CT and trap staining were assessed between the two groups.

Results

We found that ESWT inhibited osteoclast maturation in vitro and ESW treatment of femur promoted bone formation in vivo. Mechanically, osteoclast differentiation was inhibited as the number of impulses increased and ESWT decreased endogenous levels of NTAFc1 and P65 protein.

Conclusions

ESWT may be a potential therapy of osteoporosis through NF-κB signaling pathway.
miR-3195 suppresses the malignant progression of osteosarcoma cells via targeting SOX4
Authors: Liang Jianwei , Bao Dandan , Ye Zhan , Cao Binhao , Jin Guojun , Lu Zhenyu , Chen Jianjun
Published: October 2023

Background

Osteosarcoma (OS) is a highly invasive primary malignancy of the bone that is common in children and adolescents. MicroRNAs (miRNAs) are novel diagnostic and predictive biomarkers for cancers. The miRNA miR-3195 is aberrantly expressed in multiple types of tumors. However, the expression levels and biological functions of miR-3195 in OS remain unclear.

Methods

Two Gene Expression Omnibus (GEO) datasets (GSE69470 and GSE16088) were used to analyze differentially expressed miRNAs and mRNAs in osteosarcoma cell lines and OS tissues. Quantitative RT-PCR was used to detect the expression levels of miR-3195 and the SRY-box transcription factor 4 (SOX4) mRNA in OS tissues and cell lines. The relationship between miR-3195 and the 3’-upstream region (3’-UTR) in the SOX4 mRNA (predicted through bioinformatics) was analyzed using Pearson's correlation analysis and confirmed by a dual-luciferase reporter gene experiment. Cell counting kit-8 assays, colony formation assays, flow cytometry, wound healing assays, transwell assays, and western blotting were performed to explore the effects of miR-3195 levels on SOX4 affected OS cell biological behavior.

Results

Our results revealed that miR-3195 was the most down-regulated miRNA and SOX4 was the most up-regulated mRNA by Bioinformatic analysis. It was further confirmed miR-3195 had low expression, and SOX4 had high expression levels in clinical OS tissue samples; the expression levels of both genes were negatively correlated with each other in OS tissues. Overexpression of miR-3195 in OS cell lines significantly inhibited cell proliferation, migration, and invasiveness, while promoting apoptosis; all these effects were reversed by increasing SOX4 expression levels. We also found that miR-3195 could directly bind with the SOX4 gene and down-regulate SOX4 expression.

Conclusions

miR-3195 can modulate proliferation, migration, invasiveness, and apoptosis in OS cells by regulating the SOX4 gene. Thus, the miR-3195/SOX4 signaling may be a novel therapeutic target in OS treatment.
Comparison of erector spinae plane block with paravertebral block for thoracoscopic surgery: a meta-analysis of randomized controlled trials
Authors: Pang Jinghua , You Jiawen , Chen Yong , Song Chengjun
Published: October 2023

Introduction

The efficacy of erector spinae plane block versus paravertebral block for thoracoscopic surgery remains controversial. We conduct a systematic review and meta-analysis to explore the impact of erector spinae plane block versus paravertebral block on thoracoscopic surgery.

Methods

We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through March 2022 for randomized controlled trials (RCTs) assessing the effect of erector spinae plane block versus paravertebral block on thoracoscopic surgery. This meta-analysis is performed using the random-effect model.

Results

Seven RCTs are included in the meta-analysis. Overall, compared with erector spinae plane block for thoracoscopic surgery, paravertebral block results in significantly reduced pain scores at 12 h (SMD = 1.12; 95% CI 0.42 to 1.81; P = 0.002) and postoperative anesthesia consumption (SMD = 1.27; 95% CI 0.30 to 2.23; P = 0.01), but these two groups have similar pain scores at 1-2 h (SMD = 1.01; 95% CI − 0.13 to 2.15; P 0.08) and 4–6 h (SMD = 0.33; 95% CI − 0.16 to 0.81; P = 0.19), as well as incidence of nausea and vomiting (OR 0.93; 95% CI 0.38 to 2.29; P = 0.88).

Conclusions

Paravertebral block may be better for the pain relief after thoracoscopic surgery than erector spinae plane block.
A new approach for reconstruction of the gunshot defect of the flexor surface of the ungual (distal) phalanx by the proper transverse branch of the digital artery: a case report of combat patient injured in the Russo-Ukrainian war
Authors: Tertyshnyi Serhii V. , Lurin Igor , Khomenko Igor P. , Gumeniuk Kostiantyn V. , Shapovalov Volodymyr Yu. , Nehoduiko Volodymyr V. , Gorobeiko Maksym , Dinets Andrii
Published: October 2023

Background

Gunshot injury to the hand is severe trauma, requiring complicated reconstruction surgery for the damaged anatomic site to restore all the hand functions. The aim of this study was to show the example of the distal phalanx reconstruction by using a flap with distal transverse digital artery (DTDA) blood supply as well as to demonstrate the utility of the audio Doppler application at the reconstruction stage in the combat patient injured in the Russo-Ukrainian war.

Case presentation

In this report, we present a case of a 26-year-old service member of the Ukrainian Armed Forces delivered to the Military Medical Clinical Centre on the fourth day after the gunshot gutter shrapnel wound of the distal flexor of the 2nd digit with a gunshot fracture of the ungula (distal) and middle phalanges of the 2nd digit of the right hand along with a bone deficiency of the osseous structure of the distal and middle phalanges, volar soft tissues. The dorsal metacarpal artery (DMCA) flap is a universal variant among the tools of the reconstructive plastic surgeon engaged in reconstructing defects of the digital dorsum and flexors with a limited range of flaps. We consider this to be a key that conforms with the majority of the reconstructive principles, such as ‘analog replacement’, and which is simple, adequate, and easy for operating with a minimal sequela of the donor site.

Conclusions

The distal transverse digital artery (DTDA) could be considered for hand reconstructive surgery for repairing defects of the flexor surface of the digit injury and hands after severe gunshot injury.
Efficacy and safety of tirzepatide, dual GLP-1/GIP receptor agonists, in the management of type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials
Authors: Zhou Qian , Lei Xingxing , Fu Shunlian , Liu Pan , Long Cong , Wang Yanmei , Li Zinan , Xie Qian , Chen Qiu
Published: October 2023

Background

Glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 are the main incretin hormones, and be responsible for the insulinotropic incretin effect. The addition of a GIP agonist to a GLP-1agonist has been hypothesized to significantly potentiate the weight-losing and glycemia control effect, which might offer a new therapeutic option in the treatment of type 2 diabetes. The current meta-analysis aims to synthesize evidence of primary efficacy and safety outcomes through clinically randomized controlled trials to evaluate integrated potency and signaling properties.

Method

We conducted comprehensive literature searches in Cochrane Library, Web of Science, Embase and PubMed for relevant literatures investigating the efficacy and/or safety of Tirzepatide published in the English as of May 30, 2023 was retrieved. We synthesized results using standardized mean differences (SMDs) and 95% confidence intervals (95 CIs) for continuous outcomes, and odds ratios (ORs) along with 95 Cis for dichotomous outcomes. All analyses were done using Revman version 5.3, STATA version 15.1 and the statistical package ‘meta’.

Results

Participants treated with weekly Tirzepatide achieved HbA1c and body weight target values significantly lower than any other comparator without clinically significant increase in the incidence of hypoglycemic events, serious and all-cause fatal adverse events. However, gastrointestinal adverse events and decreased appetite events were reported more frequently with Tirzepatide treatment than with placebo/controls.

Conclusion

The Tirzepatide, a dual GIP/GLP-1 receptor co-agonist, for diabetes therapy has opened a new era on personalized glycemia control and weight loss in a safe manner with broad and promising clinical implications.
Parents’ perspectives of anorexia nervosa treatment in adolescents: a systematic review and metasynthesis of qualitative data
Authors: Oketah Ngozi O. , Hur Jacqueline O. , Talebloo Jonanne , Cheng Chloe M. , Nagata Jason M.
Published: October 2023

Background

Studies have established the central role of the family in the recognition, treatment, and recovery of anorexia nervosa. The objective of this study was to review, synthesize, and critically appraise the literature on parents’ views on the treatment and recovery process of anorexia nervosa in their adolescent child.

Method

A systematic search of Medline, PsychINFO, CINHAL, EMBASE, Cochrane library, and SSCI was conducted for qualitative studies published regarding parents’ views about the treatment of anorexia nervosa. The quality of articles was assessed using the critical appraisal skills program (CASP) and findings were analysed using thematic synthesis.

Results

A total of 25 studies from nine countries reporting the views of 357 parents met the inclusion criteria. Four major themes were developed from the analysis: understanding the child and the disease, experience of services and treatment modalities, the role of professionals, and the experience of recovery.

Conclusion

Parents report struggles with delays in finding help, judgmental attitudes of professionals, and uncertainty about the future. Recognition of the challenges faced by parents and families empowers clinicians to build stronger therapeutic relationships essential for long-term recovery from anorexia nervosa.
Damage assessment and restoration proposal following the 2023 Türkiye earthquakes: UNESCO World Heritage Site Diyarbakır City Walls, Türkiye
Authors: Karataş Lale , Bayhan Beyhan
Published: October 2023

Diyarbakır City Walls, one of the longest defensive structures in the world, following the Great Wall of China, the walls of Antakya, and the walls of Istanbul, is a UNESCO World Heritage site since 2015. With a history of approximately 5000 years, the Diyarbakır City Walls have been affected by consecutive earthquakes centered in Kahramanmaraş in 2023, resulting in damages to various sections. Urgent restoration and repair interventions are needed for these sections of the Diyarbakır City Walls due to earthquake-induced damages. Although there are limited studies presenting stone analysis of the Diyarbakır City Walls in the literature, no studies focusing on mortar analysis have been found. The objectives of this study are as follows: (I) to identify the mechanisms and factors of earthquake damages in the Diyarbakır City Walls, (II) to conduct necessary analyses for the selection of mortar materials for post-earthquake repairs, and (III) to provide restoration and strengthening recommendations to ensure the sustainability of the original structure. Observational, petrographic, chemical, and SEM analysis techniques were used, and the findings were interpreted comparatively. The results demonstrate that the most severe damages after the earthquake in the Diyarbakır City Walls were caused by the inadequate adhesion of missing mortar joints and different types of materials used between double-walled structures. Additionally, the presence of clay minerals identified in the mineralogy of the mortar through experimental analysis was defined as an internal issue causing the loss of mortar due to osmotic pressure created by water absorption. Another factor causing the loss of mortar is the presence of chloride-type salts, which were found to be present in a significant amount in all samples and were attributed to the use of Portland cement in previous faulty repairs. It was also determined that recent faulty repointing works contributed to the loss of mortar. Finally, this article presents original restoration and strengthening recommendations to repair the earthquake-induced damages and prevent their reoccurrence in the future.
The pattern and clinical outcomes of non-diabetic pediatric endocrine disorders, Al-Baha, Saudi Arabia: a retrospective study
Authors: Al-Ghamdi Ahmed Hassan , Fureeh Abdelhamid Ahmed , Alshawikhat Rawan Ibrahim , Jafar Fatimah Ali Alshaikh , Alamri Saad Khalid , Alzahrani Abdulrhman K. , Alzahrani Abdulghani A. , Alghamdi Ahmed Saleh , Almathammi Ali Abdulrraheem
Published: October 2023

Purpose

Pediatric endocrine disorders (PED) are a common component of medical health challenges in Saudi Arabia. We aimed to describe the pattern and clinical outcomes of different non-diabetic pediatric endocrine disorders in Al-Baha Region, Saudi Arabia, aiming for early diagnosis and management.

Methods

The clinical and laboratory data of 744 children and adolescents who presented with non-diabetic endocrine disorders and received medical care at the pediatric endocrine clinic et al.-Baha during the period from 2018 to 2022 were retrospectively analyzed based on the records.

Results

A total of 744 patients were recruited, 377 were females and 361 were males with a female/male ratio of 1.04/1. The patients’ ages ranged from 2 months to 17 years, with a mean age of 9.87 ± 4.59 years. The commonest endocrine disorders were thyroid disorders 234 (31.5%), short stature 176 (23.7%), obesity 123 (16.5%), and calcium phosphate metabolism disorders 117 (15.7%). Other disorders seen were pubertal disorders 27 (3.6%), adrenal gland disorders 22 (3%), syndromes with endocrine features 14 (1.9%), sex development and gender disorders 6 (0.8%), pituitary and hypothalamic disorders 4 (0.5%), and mixed endocrine disorders 4 (0.5%). PED is a substantial source of morbidity in 26 cases and mortality in 2 cases.

Conclusions

Thyroid, growth, and obesity disorders were the most common PED. Pediatric endocrine disorders have a substantial source of morbidity and mortality among Saudi children and adolescents. This baseline data is useful for planning PED care at institutional and national levels.
Investigating the impact of undiagnosed anxiety and depression on health and social care costs and quality of life: cross-sectional study using household health survey data
Authors: Collins Brendan , Downing Jennifer , Head Anna , Comerford Terence , Nathan Rajan , Barr Benjamin
Published: October 2023

Background

There is uncertainty around the costs and health impacts of undiagnosed mental health problems.

Aims

Using survey data, we aim to understand the costs and health-related quality-of-life decrements from undiagnosed anxiety/depression.

Method

We analysed survey data from two waves of the North West Coast Household Health Survey, which included questions on disease, medications, and Patient Health Questionnaire 9 (PHQ-9) and Generalised Anxiety Disorder 7 (GAD-7) scores (depression and anxiety scales). People were judged as having undiagnosed anxiety/depression problems if they scored ≥5 on the PHQ-9 or GAD-7, and did not declare a mental health issue or antidepressant prescription. Linear regression for EuroQol 5-Dimension 3-Level (EQ-5D-3L) index scores, and Tweedie regression for health and social care costs, were used to estimate the impact of undiagnosed mental health problems, controlling for age, gender, deprivation and other health conditions.

Results

Around 26.5% of participants had undiagnosed anxiety/depression. The presence of undiagnosed anxiety/depression was associated with reduced EQ-5D-3L index scores (0.040 lower on average) and increased costs (£250 ($310) per year on average). Using a higher cut-off score of 10 on the PHQ-9 and GAD-7 for undiagnosed anxiety/depression had similar increased costs but a greater reduction in EQ-5D-3L index scores (0.076 on average), indicating a larger impact on health-related quality of life.

Conclusions

Having undiagnosed anxiety or depression increases costs and reduces health-related quality of life. Reducing stigma and increasing access to cost-effective treatments will have population health benefits.
Women Writing in Cairo
Authors: Šabasevičiūtė Giedrė
Published: October 2023

While literature produced by Arab women has received sustained academic attention, little commentary exists on the way fiction writing is interspersed with their ordinary lives defined by domesticity. Drawing on ethnographic fieldwork conducted between 2017 and 2020 in Cairo, this article explores fiction writing as a powerful means of midlife self-reinvention among Cairene women. It considers their pursuit of literary careers in light of the recent opening of Egyptian literary markets to new writing publics and as part of women’s midlife transition, defined by their emancipation from outdated versions of their gendered selves. Viewing writing as an embodied practice of self-care, the article argues that fiction provides individuals with an “elsewhere” in which they can escape their rigid selves and reimagine their existence.
Multihoming and Oligopolistic Platform Competition
Authors: Teh Tat-How , Liu Chunchun , Wright Julian , Zhou Junjie
Published: October 2023

We provide a general framework to analyze competition between any number of symmetric two-sided transaction platforms, in which buyers and sellers can multihome. We show how key primitives such as the number of platforms, the fraction of buyers that find multihoming costly, the value of transactions, and the degree of user heterogeneity jointly determine the level and structure of platform fees. Even though platform entry always reduces the total fee level, whether it shifts the fee structure in favor of buyers or sellers depends on whether most of the buyers are singlehoming or multihoming. (JEL D43, L11, L13, L40)
A Model of Sequential Crisis Management
Authors: Li Fei , Zhou Jidong
Published: October 2023

We propose a model of how multiple societies respond to a common crisis. A government faces a “damned-either-way” policymaking dilemma: aggressive intervention contains the crisis, but the resulting good outcome makes people skeptical about the costly response; light intervention worsens the crisis and causes the government to be faulted for not doing enough. When multiple societies encounter the crisis sequentially, due to this policymaking dilemma, late societies may underperform despite having more information, while early societies can benefit from a dynamic counterfactual effect. (JEL D72, D82, D83, H12)
Historical trends in breast cancer presentation among women in Pakistan from join-point regression analysis
Authors: Zaheer Sidra , Yasmeen Farah
Published: October 2023

Objective: Breast cancer prevalence in Pakistan is among the highest in Asian countries. Recent changes in the temporal trends of breast cancer are largely unknown and examination of these trends can provide a direction in national planning for future health programs. The aim of this study was to examine recent changes in breast cancer incidence in Pakistan.

Methods: A total of 9,771 diagnosed breast cancer women were registered from 2004 to 2015 in three hospitals of Karachi. Join-point regression analysis was applied to assessing the age-standardized breast cancer presentation trends for each five-year age group. Age-specific average annual percentage changes were also calculated to assess the proportion of women with increased or decreased incidence of breast cancer.

Results: Age-standardized rates of breast cancer steadily increased from 24.7 per 100,000 in 2004, to 45.4 per 100,000 in 2015. The analytical trend based on the join-point model showed an average percentage increase breast cancer prevalence of 5.4 (95% CI = 3.1, 7.8). Significantly higher prevalence rates were identified among women aged 40-44 years and 65-69 years with an average percentage change of 18.5 (95% CI = 2.3, 37.2) and 14.3 (95% CI = 2.2, 27.9) respectively in the four years from 2011 to 2015.

Conclusion: The findings indicate the trend in age-standardized prevalence increased significantly in all age groups with noticeably larger increases observed among older and post-menopausal women from 2011 to 2015. The results warrant the need for more targeted interventions to high-risk groups and a sound foundation for cancer control program planning and policy development in Pakistan to reduce the increasing incidence of breast cancer.

doi: https://doi.org/10.12669/pjms.40.1.7123

How to cite this: Zaheer S, Yasmeen F. Historical trends in breast cancer presentation among women in Pakistan from join-point regression analysis. Pak J Med Sci. 2024;40(1):---------. doi: https://doi.org/10.12669/pjms.40.1.7123

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
The impact of telemedicine enabled pre-hospital triage in acute stroke – a protocol for a mixed methods systematic review
Authors: McCartan Deirdre , Lee Stuart , Bejleri Jorin , Murphy Paul , Hickey Anne , Williams David
Published: October 2023

Introduction Increasing access to thrombolysis and thrombectomy through improved pathway organisation remains a health service challenge that requires contextualisation to the geographic, demographic and resourcing status of any regional stroke service. Pre-hospital delays or delays during inter-hospital transfers can result in patients being outside the window for one or both interventions. Pre-hospital triage using technology-enabled interdisciplinary communication networks may facilitate rapid individualized care decisions, permitting streamlined care pathways to hospital sites most appropriate to their clinical presentation and history in the first instance. Understanding the experience of those involved in efforts to improve or reorganise care may help to explain the impact observed. Objectives 1. To review the impact of pre-hospital telemedicine enabled workflow intervention strategies on patient outcomes and on service process metrics in hyper-acute stroke care 2. To examine how the experience of those involved in providing or receiving such interventions might identify key characteristics of effective interventions Inclusion criteria Quantitative, qualitative and primary mixed methods studies will be included. Quantitative studies will assess effectiveness of telemedicine-enabled interventions that facilitate pre-hospital acute stroke triage. Intervention effects on functional outcomes of patients, on intervention rates and on key time metrics in hyperacute stroke care will be assessed. Qualitative studies will explore the experiences of people involved in or impacted by these interventions. Methods and analysis A convergent segregated mixed methods systematic review will synthesise and integrate primary qualitative, quantitative and mixed methods studies using the Joanna Briggs Institute methodology. Database searches will include OVID (MEDLINE), EMBASE, The Cochrane Library, CINAHL and Web of Science. Critical appraisal will include the Mixed Methods Assessment Tool. Results of quantitative studies and findings of qualitative studies will be integrated and configured to explore and contextualize each single method synthesis. Systematic review registration This protocol has been submitted for registration with PROSPERO.
Interventions to support adolescents and young adults with the healthcare transition from paediatric to adult nephrology health services: A scoping review protocol
Authors: Kinch Melissa , Kroll Thilo , Stokes Diarmuid , Somanadhan Suja
Published: October 2023

Background Due to technological advancements and improved medical management of adolescents and young adults (AYAs) living with renal disease, there has been an exponential increase noted in the number of patients advancing from the paediatric to the adult nephrology healthcare setting. Subsequently, more AYAs are required to undergo the process of healthcare transition from paediatric to adult healthcare services. This process can be challenging period for young people and families and is often associated with a decline in physical and psychosocial health outcomes of AYAs with renal disorders. To ensure a successful transition, AYAs must develop the ability to manage their renal condition, including the medical and psychosocial aspects of their condition, independently. Despite significant research into the transition from paediatric to adult healthcare for this unique patient cohort, the transition period remains a challenge at times. This scoping review aims to map, explore, and understand the interventions that are currently available to offer positive perceptions and experiences of transition for both AYAs living with renal disorders and their families. Methods A systematic literature search will be conducted of PubMed, PsycInfo, CINAHL, ASSIA, EMBASE and Web of Science databases from the year 2000 to present. Two independent reviewers will screen the peer-reviewed literature obtained and assess them against the inclusion criteria to determine their inclusion eligibility. Data will be extracted and synthesised using a template refined by the authors. The scoping review will be undertaken in accordance with PRISMA-ScR guidelines. Data will undergo a formal critical appraisal using recognised appraisal tools. Conclusions Through mapping this knowledge, the scoping review will aim to identify interventions that are currently available and identify gaps within the literature. This evidence may support the development of transitional care interventions in the future, promote patient satisfaction, and improve patient outcome measures and experiences.
Human dignity and the moral status of bio-cybernetic cerebral organoids in Synthetic Biological Intelligences
Authors: Siminiuc Razvan-Marian , Tirdea Cosmin , Ion Oana-Mihaela , Hostiuc Sorin
Published: October 2023

Recent developments in the research field of artificial intelligence (AI) based on neural networks provide challenging questions regarding the ethical principles that should be applied in this complex domain. Kagan et al.’s published study highlights the fact that their synthetic biological intelligence (SBI) called ”DishBrain”, made of neurons from embryonic mice or human pluripotent stem cells grown on electronic chips connected to a computer, is capable of learning to play the arcade game Pong and shows signs of sentience. Based on this study, we tried to address some ethical questions regarding the bio-cybernetic cerebral organoids in SBI’s. Firstly, we approach the ethical aspects of human-animal chimeras in SBI’s based on the concept of human dignity and if it can or cannot be attributed to those hybrid systems. Secondly, we focus on if we can and what type of moral status should we attribute to SBI’s starting from different conceptualizations of human and animal moral status to different model-based arguments considering the capacity of sentience and the presence of human cells in this type of construct. We highlight how many arguments are in favor of starting an ethical debate on the emergent technology of bio-cybernetic cerebral organoids to obtain a consensus on how these organoids will exist and will be accepted in society.
Understanding the genetic basis of the incompatibility of IncK1 and IncK2 plasmids
Authors: Rozwandowicz Marta , Kant Arie , Wagenaar Jaap , Mevius Dik , Hordijk Joost , Brouwer Michael
Published: October 2023

Antimicrobial resistance is a persistent challenge in human and veterinary medicine, which is often encoded on plasmids which are transmissible between bacterial cells. Incompatibility is the inability of two plasmids to be stably maintained in one cell which is caused by the presence of identical or closely related shared determinants between two plasmids originating from partition or replication mechanisms. For I-complex plasmids in Enterobacteriacae, replication- based incompatibility is caused by the small antisense RNA stem-loop structure called RNAI. The I-complex plasmid group IncK consists of two compatible subgroups, IncK1 and IncK2, for which the RNAI differs only by five nucleotides. In this study we focussed on the interaction of the IncK1 and IncK2 RNAI structures by constructing minireplicons containing the replication region of IncK1 or IncK2 plasmids coupled with a kanamycin resistance marker. Using minireplicons excludes involvement of incompatibility mechanisms other than RNAI. Additionally, we performed single nucleotide mutagenesis targeting the five nucleotides that differ between the IncK1 and IncK2 RNAI sequences of these minireplicons. The obtained results show that a single nucleotide change in the RNAI structure is responsible for the compatible phenotype of IncK1 with IncK2 plasmids. Only nucleotides in the RNAI top loop and interior loop have an effect on minireplicon incompatibility with wild type plasmids, while mutations in the stem of the RNAI structure had no significant effect on incompatibility. Understanding the molecular basis of incompatibility is relevant for future in silico predictions of plasmid incompatibility.
Browsing the Aisles or Browsing the App? How Online Grocery Shopping is Changing What We Buy
Authors: Chintala Sai Chand , Liaukonytė Jūra , Yang Nathan
Published: October 2023

How Online Grocery Shopping is Changing What We Buy
A Stochastic Sequential Quadratic Optimization Algorithm for Nonlinear-Equality-Constrained Optimization with Rank-Deficient Jacobians
Authors: Berahas Albert S. , Curtis Frank E. , O’Neill Michael J. , Robinson Daniel P.
Published: October 2023

A sequential quadratic optimization algorithm is proposed for solving smooth nonlinear-equality-constrained optimization problems in which the objective function is defined by an expectation. The algorithmic structure of the proposed method is based on a step decomposition strategy that is known in the literature to be widely effective in practice, wherein each search direction is computed as the sum of a normal step (toward linearized feasibility) and a tangential step (toward objective decrease in the null space of the constraint Jacobian). However, the proposed method is unique from others in the literature in that it both allows the use of stochastic objective gradient estimates and possesses convergence guarantees even in the setting in which the constraint Jacobians may be rank-deficient. The results of numerical experiments demonstrate that the algorithm offers superior performance when compared with popular alternatives.

Funding: This material is based upon work supported by the U.S. National Science Foundation’s Division of Computing and Communication Foundations under award [CF-1740796], by the Office of Naval Research under award [N00014-21-1-2532], and by the National Science Foundation under award [2030859] to the Computing Research Association for the CIFellows Project.
The causes, diagnostics, and treatment of psychogenic blindness – a systematic review
Authors: Sikorski Piotr , Sikorska Ewa , Fudalej Marcin , Michalska Milena , Łapiński Marcin , Lubaszka Zuzanna , Żurek Urszula , Fiega Jakub , Szewczyk Dorota , Gurdak Kinga , Gurdak Agata , Fudalej Sylwia
Published: October 2023

Introduction: Conversion disorders are characterized by the presence of motor or sensory dysfunction, resulting in significant discomfort or disability, the occurrence of which is not justified by any somatic disease. Psychogenic blindness, a specific manifestation of conversion disorders, refers to the loss or impairment of vision that cannot be attributed to any organic abnormalities in the eyes or visual system. The exact mechanisms underlying psychogenic blindness are not fully understood, but it is believed to involve complex interactions between the brain, visual pathways, and psychological processes. This systematic review aims to summarize reported cases of blindness in conversion disorders.
Material and methods: A comprehensive search of the MEDLINE and Embase databases identified 13 relevant articles reporting a total of 17 patients with psychogenic blindness.
Results: The risk and triggering factors for psychogenic blindness included acute stress (for example acute physical injury), chronic stressful situations (such as chronic health problems, disruptions in family relationships), and multiple factors including coexisting psychiatric conditions (like anxiety or other conversion disorders). The course of blindness varied among patients, with duration ranging from hours to years. Diagnostic methods involved thorough ophthalmic and neurological examinations, brain imaging, and psychiatric evaluations.
Conclusions: This review provides valuable insights into managing patients with psychogenic blindness. The findings highlight the need for a multidisciplinary approach involving ophthalmologists, neurologists, and mental health specialists. Further research is required to elucidate the underlying mechanisms and develop effective treatment strategies for individuals with psychogenic blindness.

Keywords: psychogenic blindness, conversion disorders, causes
Cauda equina syndrome
Authors: Miller James K , West Jasmine , Khawar Haseeb , Middleton Rory
Published: October 2023

Cauda equina syndrome is an uncommon but serious cause of lower back pain resulting from compression of the cauda equina nerve roots, most commonly by lumbar disc herniation. Red flag symptoms, such as bladder dysfunction, saddle anaesthesia and sciatica, should lead to high clinical suspicion of cauda equina syndrome. The British Association of Spinal Surgeons has published an updated standard of care for these patients because of the potentially debilitating effects of missed cases of cauda equina syndrome. This review summarises these standards and provides a framework to support quick triage of at-risk patients. Immediate magnetic resonance imaging, within 1 hour of presentation to the emergency department, is crucial in patients with suspected cauda equina syndrome to allow prompt diagnosis and treatment. Urgent decompressive surgery is usually recommended for the best outcomes, to reduce morbidity and complication rates.
Wind Power Deviation Charge Reduction using Machine Learning
Authors: Kumari Sandhya , Sreekumar Sreenu , Singh Sonika , Kothari D. P.
Published: October 2023

High penetration of wind power plants in power systems resulted in various challenges such as frequent system imbalances due to highly uncertain and variable wind generation. Additional spinning reserves and specific balancing products such as flexible ramp products are used to handle such frequent imbalances. Incorporation of these ancillary services leads to increased total operational costs. Increased operational costs should be transferred to wind power producers as it is caused by wind power plants. This leads to penalizing the wind power producers for the deviation of power generation from forecasts, called deviation charges. These deviation charges can be reduced by improving the forecasting accuracy. Existing forecasting models show performance in terms of error matrices. Such error matrices do not indicate the financial loss associated with it. This can be overcome by expressing forecasting performance in terms of deviation charge and it will directly encourage wind power producers to improve forecasting accuracy or arrange reserves to accommodate the error. This paper proposes a backpropagation-based artificial neural network model for reducing deviation charges in this context. An analysis is conducted on the data collected from the Bonneville Power Administration (BPA) Balancing Area. Seasonal analysis (Spring, Summer, Fall, and Winter) is conducted to show the performance of the proposed model throughout the year. The proposed model performance is compared with linear regression and ARIMA models. The comparison shows that the proposed ANN model gives the least deviation charges in the Spring, Summer, and Winter seasons and deviation charges in the Fall season are higher than the ARIMA model.