bluuebunny/crossref_metadata_2025 huggingface dataset:
The early life immune dynamics and cellular drivers at single-cell resolution in lamb forestomachs and abomasum
Authors: Huang Kailang , Yang Bin , Xu Zebang , Chen Hongwei , Wang Jiakun
Published: October 2023

Background

Four-chambered stomach including the forestomachs (rumen, reticulum, and omasum) and abomasum allows ruminants convert plant fiber into high-quality animal products. The early development of this four-chambered stomach is crucial for the health and well-being of young ruminants, especially the immune development. However, the dynamics of immune development are poorly understood.

Results

We investigated the early gene expression patterns across the four-chambered stomach in Hu sheep, at 5, 10, 15, and 25 days of age. We found that forestomachs share similar gene expression patterns, all four stomachs underwent widespread activation of both innate and adaptive immune responses from d 5 to 25, whereas the metabolic function were significantly downregulated with age. We constructed a cell landscape of the four-chambered stomach using single-cell sequencing. Integrating transcriptomic and single-cell transcriptomic analyses revealed that the immune-associated module hub genes were highly expressed in T cells, monocytes and macrophages, as well as the defense-associated module hub genes were highly expressed in endothelial cells in the four-stomach tissues. Moreover, the non-immune cells such as epithelial cells play key roles in immune maturation. Cell communication analysis predicted that in addition to immune cells, non-immune cells recruit immune cells through macrophage migration inhibitory factor signaling in the forestomachs.

Conclusions

Our results demonstrate that the immune and defense responses of four stomachs are quickly developing with age in lamb's early life. We also identified the gene expression patterns and functional cells associated with immune development. Additionally, we identified some key receptors and signaling involved in immune regulation. These results help to understand the early life immune development at single-cell resolution, which has implications to develop nutritional manipulation and health management strategies based on specific targets including key receptors and signaling pathways.
A case series to test the acceptability, feasibility and preliminary efficacy of AVATAR therapy in anorexia nervosa
Authors: Thompson Alistair , Calissano Chiara , Treasure Janet , Ball Hannah , Montague Alice , Ward Thomas , Cardi Valentina
Published: October 2023

Background

Patients with anorexia nervosa tend to experience an inner “eating disorder” voice. They struggle to recognise and assert their own identity over the illness’s identity and relate to it from a powerless and subordinate position. AVATAR therapy was developed to help patients with psychosis to gain greater power and control over distressing voices. The goal of this study was to test the feasibility, acceptability, safety and preliminary efficacy of an adaptation of AVATAR therapy for anorexia nervosa.

Methods

Twelve adult patients with anorexia nervosa were recruited. Ten completed an assessment session and between five to seven therapy sessions. The assessment session consisted in the creation of an avatar to represent the “eating disorder”. This was accomplished by manipulating auditory and visual characteristics through a specialist computer software. During the therapy sessions, patients interacted with the avatar to assert their own desires and will. Patients completed baseline, end of intervention and follow-up (4-week) online questionnaires. A non-concurrent multiple baselines single case experimental design (SCED) was used (A1BA2). Feasibility, acceptability, safety and preliminary efficacy of the intervention were assessed.

Results

The therapy met pre-specified criteria relating to (1) Feasibility: sample recruited within three months; retention rate at the end of the treatment phase = 81.9%; therapy completion rate = 90.1%. (2) Safety: no serious adverse events associated with the intervention. (3) Acceptability: mean ratings = 7.5 (SD = 2.61) out of ten, on a 0–10 scale of acceptability (10 = complete satisfaction). With regards to efficacy, participants reported significantly lower levels of distress associated with the eating disorder voice and higher levels of self-compassion at the end of treatment. No other significant changes were observed in frequency of the eating disorder voice, voice’s characteristics, such as omnipotence and malevolence, eating disorder symptoms and symptoms of anxiety, depression and stress. Patients’ feedback indicated that the therapy had helped with their ability to stand up to the illness, make positive changes around eating, and increase their motivation to recover and self-compassion.

Conclusion

AVATAR therapy for anorexia nervosa is feasible, acceptable and safe for patients. Larger studies are needed to test clinical efficacy.

Trial registration

The study was pre-registered on the clinicaltrials.gov registry (https://clinicaltrials.gov/ct2/show/NCT04778423).
From distributed machine to distributed deep learning: a comprehensive survey
Authors: Dehghani Mohammad , Yazdanparast Zahra
Published: October 2023

Artificial intelligence has made remarkable progress in handling complex tasks, thanks to advances in hardware acceleration and machine learning algorithms. However, to acquire more accurate outcomes and solve more complex issues, algorithms should be trained with more data. Processing this huge amount of data could be time-consuming and require a great deal of computation. To address these issues, distributed machine learning has been proposed, which involves distributing the data and algorithm across several machines. There has been considerable effort put into developing distributed machine learning algorithms, and different methods have been proposed so far. We divide these algorithms in classification and clustering (traditional machine learning), deep learning and deep reinforcement learning groups. Distributed deep learning has gained more attention in recent years and most of the studies have focused on this approach. Therefore, we mostly concentrate on this category. Based on the investigation of the mentioned algorithms, we highlighted the limitations that should be addressed in future research.
Development of a physical activity counseling intervention for people with chronic respiratory disease based on the health action process approach
Authors: Tappan Rachel S. , Ettinger Jennifer R. , Mahon Delaney , Mroz Sarah E. , Hall Walter , Maajid Estelle , Stratton Chelsea , Zynda Denise Trotter , Conroy David E. , Danilovich Margaret
Published: October 2023

Background

Physical activity (PA) counseling holds promise for increasing PA levels in people with chronic respiratory disease, though little long-term change has been shown to date. Here, we describe the development of a Health Action Process Approach-based PA counseling intervention that aims to promote PA and exercise in people with chronic respiratory disease who are enrolled in pulmonary rehabilitation.

Methods

To collaborate in defining and refining the intervention, we convened a varied team of authors that included a panel of five stakeholder partners: three patients, one clinician, and one health behavior change researcher. We completed three steps in the intervention development process: (1) initial intervention creation, (2) iterative intervention refinement, and (3) assessment of intervention acceptability. In step 1, we created an initial draft of the PA counseling intervention based on the HAPA theoretical framework, previous evidence in people with chronic respiratory disease, and clinical experience. In step 2, we used qualitative methods of focus groups and interviews to further develop and refine the intervention. Fifteen meetings occurred with the five-member stakeholder partner panel (six focus groups with the three patient partners, four interviews with the clinician partner, and five interviews with the researcher partner) over 5 months to systematically elicit input and incorporate it into the intervention. In step 3, we measured the intervention acceptability using five-point Likert scale ratings.

Results

Intervention materials included the eligibility screen, participant workbook, and leader guide. We identified key themes in the input from the stakeholder partners and incorporated this input into the intervention content and methods. Ratings of the intervention by the stakeholder partners (n=5) were high with mean ratings ranging 4.0–5.0 on a five-point scale.

Conclusions

This development process successfully engaged an intervention development team with diverse perspectives and resulted in a PA counseling intervention for people with chronic respiratory disease. The intervention’s strong theoretical underpinning, person-centeredness, and the contributions from varied perspectives during intervention development position it well for future evaluations of feasibility, efficacy, and effectiveness.
Molecular techniques for the improvement of microbial biocontrol agents against plant pathogens
Authors: Majumdar Anik
Published: October 2023

Biological control is a sustainable and ecologically effective method for bringing down pest population to an acceptable level. Implementing microbial biocontrol agents (MBCAs) to manage plant diseases necessitates the use of environmentally friendly practices that can increase global food production and guarantee the safety of food supply. Recent advancements in biotechnology have made it easier to find and characterize new beneficial microbes as well as to identify their genetic byproducts. These findings have made it possible to clone these microbes in plants in an effort to strengthen their resistance to biotic and abiotic stresses. The technological improvements have strengthened the symbiotic interaction between microbes and plants while also enabling the modification of the processes through which MBCAs exert their effects, ultimately enhancing their potential in managing plant diseases. The genome sequencing of MBCAs has yielded useful information about their genomes, which has helped to characterize them for efficiently. This article offers a thorough summary of the already existing and recent molecular advances used to increase the efficiency of MBCAs for managing plant diseases as well as to understand their biocontrol mechanisms through various omics technologies. These approaches are important for assuring food security and increasing agricultural outputs by minimizing yield loss due to plant diseases.
Evaluation of the effectiveness of some mycorrhizal fungi isolates against charcoal rot disease
Authors: Ahmed Waleed Khalid , Alsalim Hutaf A. A. , Mohammed Ashwaq Talip , Youssef Hiba Mohammed
Published: October 2023

Background

The sunflower plants are attacked by serious seed and soil-borne pathogens including charcoal rot disease that caused by Macrophomina phaseolina. This disease has serious damages to sunflower crop. This study aimed to assess the efficacy of Arbuscular mycorrhizal fungus against charcoal rot disease as fungicide alternative.

Results

Morphological and molecular identification was done, using universal primers for molecular identification. Finally, a greenhouse experiment was conducted, and the length and weight of the plant shoot and root as well as disease incidence and severity percentages were estimated for the treatments infected with the M. phaseolina pathogen. The results showed that molecular identification indicates their subordination to Claroideoglomus etunicatum and Funneliformis mosseae. The greenhouse experiment showed that combined inoculation treatments (C. etunicatum + F. mosseae and C. etunicatum + F. mosseae + M.phaseolina) had the highest averages of length and weight of the plant shoot and root in the non-infected and pathogen-infected (M. phaseolina) treatments. F. mosseae and F. mosseae + M.phaseolina treatments had better effects on plant growth. M. phaseolina pathogen had suppression effects than the C. etunicatum inoculum (C. etunicatum and C. etunicatum + M. phaseolina treatments). The disease incidence and severity percentages decreased significantly in the inoculated plants than in non-inoculated plants. F. mosseae inoculum showed more efficiency in reducing DI and DS than C. etunicatum inoculum, while adding both, resulting in an extra significant reduction. The combined inoculation, which functions as a biofungicide and a biofertilizer, presented a viable biocontrol technique for crop protection.

Conclusions

Such the AM fungi treatments are considered good and biological safe. The symbiotic relationship of AM fungi with plants can also be utilized to gain successful management of agricultural against soil-borne diseases for getting rid of the negative effects of pesticides.
Frequency and satisfaction of conventional and complementary or alternative therapies for neuromuscular disorders
Authors: Böhne Lene Änne , Wirner Corinna , Schoser Benedikt , Schröter Carsten , Baum Petra
Published: October 2023

Background

Causal therapies are not yet available for most neuromuscular diseases. Additionally, data on the use of complementary or alternative therapies (CAM) in patients groups with a variety of different neuromuscular diseases are rare. This retrospective cross-sectional study aims to record the frequency of use and satisfaction of conventional therapies and complementary or alternative medicine (CAM) in patients with neuromuscular disorders in order to compare them afterwards.

Methods

Patients from the University of Leipzig (Department and Outpatient Department of Neurology), the Friedrich-Baur-Institute (Department of Neurology), the Hoher Meißner Clinic (Department of Neurology) and the German Society for Muscular Diseases (DGM e.V.) were included. The focus of this study has been on patients with chronic neuromuscular diseases. Our data are based on standardised questionnaires in analogue form from three German neuromuscular centres and in digital form from the official website of the German Society for Muscular Diseases. Therapy satisfaction was assessed with the Patient Evaluation of Global Response (PEGR) ranking scale (very satisfactory + 2 to very unsatisfactory − 2).

Results

Of 192 questionnaires analysed, the most common diagnoses were spinal muscular atrophy (n = 42; 21.9%), muscular dystrophies (n = 41; 21.4%) and myotonic dystrophies (n = 38; 19.8%). More than half (n = 112; 58.3%) used both conventional and CAM treatments. Physiotherapy (n = 165) was used most frequently within all treatments with conventional manual (PEGR 1.25, p = 0.013; CI 95%) and aquatic therapy (PEGR 1.3, p = 0.038) showing significantly higher satisfaction compared to therapy on training equipment. Less-used therapies such as psychotherapy (n = 53; PEGR 1.2) were also satisfactory. Within CAM, massages (n = 96) were the most reported and meditation (PEGR 1.5) was best rated. Massage therapy was significantly more satisfactory than progressive muscle relaxation (p = 0.003) and chiropractic treatment (p = 0.036). Chiropractic treatment (PEGR − 0.1) was rated most negatively. No significant differences were found between the group of conventional therapies and CAM users regarding social and disease-dependent factors.

Conclusions

Treatment with conventional therapy (manual, aquatic therapy) and some CAM therapies can be recommended if adequately indicated.
Clinical and radiological features associated with EGFR mutation in non-small-cell lung cancer: a study of 149 cases
Authors: Mourabiti Abdelaali Yahya , Sqalli Houssaini Meryem , Benfares Anass , El Bouardi Nizar , Alaoui Lamrani Moulay Youssef , El Fatemi Hind , Serraj Mounia , Amara Bouchra , Qjidaa Hassan , Smahi Mohammed , Maaroufi Mustapha , Alami Badereddine
Published: October 2023

Background

Lung cancer is the leading cause of cancer death in the world. Non-small-cell lung cancer (NSCLC) accounts for 85% of primary lung tumors. Epidermal growth factor receptors (EGFRs) are found on the surface of tumor cells, and their role is to send a growth signal to the cell nucleus. Tumor cells with EGFR mutations are very sensitive to cancer treatments called "Targeted Therapies." The search for EGFR mutations requires lung biopsies. Some studies have shown a correlation between clinico-radiological characteristics and the EGFR mutation. In this study, an attempt was made to identify the relevant clinico-radiological characteristics associated with the EGFR mutation in patients with NSCLC.

Objectives

The main objective of this study was to evaluate the clinico-radiological characteristics useful for predicting the risk of EGFR mutation in patients with NSCLC.

Materials and methods

This is a retrospective cross-sectional study, carried out in 149 patients followed up for lung adenocarcinoma who benefited from an EGFR mutation study at the anatomopathology department of the University Hospital of Fez, spread over a period of 4 years (between January 2018 and December 2021). A database was compiled from this study, including sociodemographic, clinical, anatomopathological and radiological data. A statistical analysis was carried out in order to identify the factors associated with EGFR mutation.

Results

According to the inclusion and exclusion criteria, of the 149 patients included, the mean age was 61.05 + / − 11.095 years. Males predominated with a percentage of 70.5% (n = 105). Fifty-seven point seven percent of patients were smokers or ex-smokers. Forty-one patients had an EGFR mutation, representing a percentage of 27.5%. Multivariate analysis by logistic regression revealed an association of the EGFR mutation with irregular contours (ORA = 6.43; CI95% 1.26;32.78), with the presence of spiculations (ORA = 5.81; CI95% 1.96;17.22), with pleural attachment (ORA = 3.53; CI95% 1.32;9.42), with heterogeneous enhancement (ORA = 30.679; CI95% 5.149;182.778), with absence of emphysema (ORA = 4.815; CI95% 1.966;17.220) and with presence of distant metastasis (ORA = 4.123; CI95% 1.373;12.383).

Conclusions

This study provides substantial evidence to support the assertion that irregular contours, the presence of spiculations, pleural attachment, heterogeneous enhancement, the absence of emphysema and the presence of distant metastasis are statistically correlated with EGFR mutations. The model developed within this study, encompassing all relevant clinical and CT characteristics, has demonstrated its effectiveness as a reliable predictor for EGFR mutations (AUC: 0.7659) and consequently as a key determinant of EGFR-TKI treatment response.
Group physical therapy for knee osteoarthritis: protocol for a hybrid type III effectiveness-implementation trial
Authors: Webb Sara , Drake Connor , Coffman Cynthia J. , Sullivan Caitlin , Sperber Nina , Tucker Matthew , Zullig Leah L. , Hughes Jaime M. , Kaufman Brystana G. , Pura John A. , Anderson Livia , Hastings Susan N. , Van Houtven Courtney H. , Abbate Lauren M. , Hoenig Helen , Ballengee Lindsay A. , Wang Virginia , Allen Kelli D.
Published: October 2023

Background

Knee osteoarthritis (OA) is a leading cause of chronic pain and disability and one of the most common conditions treated in outpatient physical therapy (PT). Because of the high and growing prevalence of knee OA, there is a need for efficient approaches for delivering exercise-based PT to patients with knee OA. A prior randomized controlled trial (RCT) showed that a 6-session Group Physical Therapy Program for Knee OA (Group PT) yields equivalent or greater improvements in pain and functional outcomes compared with traditional individual PT, while requiring fewer clinician hours per patient to deliver. This manuscript describes the protocol for a hybrid type III effectiveness-implementation trial comparing two implementation packages to support delivery of Group PT.

Methods

In this 12-month embedded trial, a minimum of 16 Veterans Affairs Medical Centers (VAMCs) will be randomized to receive one of two implementation support packages for their Group PT programs: a standard, low-touch support based on Replicating Effective Programs (REP) versus enhanced REP (enREP), which adds tailored, high-touch support if sites do not meet Group PT adoption and sustainment benchmarks at 6 and 9 months following launch. Implementation outcomes, including penetration (primary), adoption, and fidelity, will be assessed at 6 and 12 months (primary assessment time point). Additional analyses will include patient-level effectiveness outcomes (pain, function, satisfaction) and staffing and labor costs. A robust qualitative evaluation of site implementation context and experience, as well as site-led adaptations to the Group PT program, will be conducted.

Discussion

To our knowledge, this study is the first to evaluate the impact of tailored, high-touch implementation support on implementation outcomes when compared to standardized, low-touch support for delivering a PT-based intervention. The Group PT program has strong potential to become a standard offering for PT, improving function and pain-related outcomes for patients with knee OA. Results will provide information regarding the effectiveness and value of this implementation approach and a deeper understanding of how healthcare systems can support wide-scale adoption of Group PT.

Trial registration

This study was registered on March 7, 2022 at ClinicalTrials.gov (identifier NCT05282927).
Performance comparison of steel fiber reinforced concrete and conventional reinforced concrete cast-in-place half-scale concrete bridge decks under bending
Authors: Kafaji Sam , Azzawi Raad
Published: October 2023

The most time-consuming processes involved in bridge deck construction are laying and tying conventional reinforcement and verifying the required cover. Thus, there is a need within bridge construction technology to identify opportunities for utilizing steel fibers and replacing more conventional reinforcing bars on bridge decks and this could be a significant step in speeding up bridge construction. Although the bending strength performance of reinforced concrete decks has been the subject of many experiments and research, many considerations still need to be explored. Hence, the current experiment aims to compare and evaluate the bending strength and ductility of two half-scale concrete bridge decks reinforced by steel fiber reinforcement (SFRC) with two half-scale concrete bridge decks reinforced by conventional reinforcement (RC), 27.6 MPa (4000 psi) concrete compressive strength is used in this study, all four decks were tested under flexural loads. Load–displacement curves (P-∆) are recorded as a tool to measure the ductility index (μE) (Spadea et al.). The result showed that the flexural stiffness of the SFRC concrete deck specimens is improved and load carrying capacity increased by 12.3% compared to RC decks. Moreover, crack width and crack are reduced by 14% since the SFRC decks offer more concrete ductility than RC decks, meaning less future maintenance and corrosion. Therefore, the use of steel fiber in concrete mixtures could be a significant step in speeding up bridge construction since it does not require laying, tying, and verifying clear cover, in addition to increasing the lifespan of bridge decks.
Cost-effectiveness of twice-weekly versus once-weekly sessions of cognitive–behavioural therapy and interpersonal psychotherapy for depression at 12 months after start of treatment: randomised controlled trial
Authors: Bosmans Judith E. , Bruijniks Sanne J. E. , El Alili Mohamed , Hollon Steven D. , Peeters Frenk P. M. L. , Arntz Arnoud , Cuijpers Pim , Lemmens Lotte H. J. M. , Dingemanse Pieter , Willems Linda , van Oppen Patricia , van den Boogaard Michael , Spijker Jan , Twisk Jos W. R. , Huibers Marcus J. H.
Published: October 2023

Background

Cost-effective treatments are needed to reduce the burden of depression. One way to improve the cost-effectiveness of psychotherapy might be to increase session frequency, but keep the total number of sessions constant.

Aim

To evaluate the cost-effectiveness of twice-weekly compared with once-weekly psychotherapy sessions after 12 months, from a societal perspective.

Method

An economic evaluation was conducted alongside a randomised controlled trial comparing twice-weekly versus once-weekly sessions of psychotherapy (cognitive–behavioural therapy or interpersonal psychotherapy) for depression. Missing data were handled by multiple imputation. Statistical uncertainty was estimated with bootstrapping and presented with cost-effectiveness acceptability curves.

Results

Differences between the two groups in depressive symptoms, physical and social functioning, and quality-adjusted life-years (QALY) at 12-month follow-up were small and not statistically significant. Total societal costs in the twice-weekly session group were higher, albeit not statistically significantly so, than in the once-weekly session group (mean difference €2065, 95% CI −686 to 5146). The probability that twice-weekly sessions are cost-effective compared with once-weekly sessions was 0.40 at a ceiling ratio of €1000 per point improvement in Beck Depression Inventory-II score, 0.32 at a ceiling ratio of €50 000 per QALY gained, 0.23 at a ceiling ratio of €1000 per point improvement in physical functioning score and 0.62 at a ceiling ratio of €1000 per point improvement in social functioning score.

Conclusions

Based on the current results, twice-weekly sessions of psychotherapy for depression are not cost-effective over the long term compared with once-weekly sessions.
Multidisciplinary development of guidelines for ketamine treatment for treatment-resistant major depression disorder for use by adult specialist mental health services in New Zealand
Authors: Beaglehole Ben , Glue Paul , Clarke Mike , Porter Richard
Published: October 2023

Background

The evidence base for racemic ketamine treatment for treatment-resistant major depressive disorder (TRD) continues to expand, but there are major challenges translating this evidence base into routine clinical care.

Aim

To prepare guidelines for ketamine treatment of TRD that are suitable for routine use by publicly funded specialist mental health services.

Method

We consulted with senior leadership, clinical pharmacy, psychiatrists, nursing, service users and Māori mental health workers on issues relating to ketamine treatment. We prepared treatment guidelines taking the evidence base for ketamine treatment and the consultation into account.

Results

Ketamine treatment guidance is reported. This offers two treatment pathways, including a test of ketamine responsiveness with intramuscular ketamine and the dominant use of oral ketamine for a 3-month course to maximise the opportunity for the short-term benefits of ketamine to accumulate.

Conclusions

We have responded to the challenges of translating the evidence base for ketamine treatment into a form suitable for routine care.
Risk Factors for Progression to Type 2 Diabetes in a Pediatric Prediabetes Clinic Population
Authors: Belsky Natasha , Tamaroff Jaclyn , Shoemaker Ashley H
Published: October 2023

Background

Pediatric type 2 diabetes (T2D) is increasing in prevalence, yet it is unclear what definition of pediatric prediabetes predicts progression to T2D. Strategies are needed to better identify at risk individuals who could benefit from early intervention.

Methods

Retrospective chart review of a pediatric prediabetes clinic over 7 years. Inclusion criteria include hemoglobin A1c (HbA1C) and ≥1 glucose from oral glucose tolerance test. Exclusion criteria include type 1 diabetes, maturity onset diabetes of the young, or T2D on initial visit.

Results

A total of 552 patients were included, 6.5% (n = 36) progressed to T2D over 2.4 ± 1.5 years. At initial visit, T2D progressors had a higher body mass index (38.6 ± 6.5 vs 34.2 ± 8.4 kg/m2, P = .002), HbA1C (6.0 ± 0.3%, vs 5.7± 0.3, P < .001), 2-hour glucose (141 ± 28 vs 114 ± 29 mg/dL, P < .001), and C-peptide (4.8 vs 3.6 ng/mL, P = .001). Fasting glucose was not significantly different. In a multivariable model, male sex (hazard ratio [HR], 2.4; P = .012), initial visit HbA1C (HR, 1.3 per 0.1% increase; P < .001), and 2-hour glucose level (HR, 1.2 per 10 mg/dL increase; P = .014) were all predictive of T2D progression. Patients who progressed to T2D had an increase in body mass index of 4.2 kg/m2 and children consistently taking metformin took longer to progress (43 ± 21 vs 26 ± 16 months; P = .016).

Discussion

A total of 6.5% of patients with prediabetes developed T2D over a 7-year period. Initial visit laboratory values and weight trajectory may allow for risk stratification, whereas fasting plasma glucose is less helpful. Weight stabilization and metformin therapy could be important interventions for diabetes prevention in children.
Revisiting the WFNS Score: Native Computed Tomography Imaging Improves Identification of Patients With “False Poor Grade” Aneurysmal Subarachnoid Hemorrhage
Authors: Hofmann Björn B. , Fischer Igor , Neyazi Milad , Karadag Cihat , Donaldson Daniel M. , Abusabha Yousef , Muhammad Sajjad , Beseoglu Kerim , Cornelius Jan F. , Hänggi Daniel
Published: October 2023

BACKGROUND AND OBJECTIVES:

In patients suffering from aneurysmal subarachnoid hemorrhage (aSAH), the optimal time to determine the World Federation of Neurosurgical Societies (WFNS) score remains controversial because of possible confounding factors. Goals of this study were (1) to analyze the most sensitive timepoint to determine the WFNS score in patients with aSAH and (2) to evaluate the impact of initial native computed tomography (CT) imaging on reducing the mismatch of “false poor grade” patients.

METHODS:

We retrospectively analyzed daily WFNS scores from admission until day 7 in 535 aSAH patients and evaluated their predictive value for the modified Rankin Scale at discharge and 6 months postbleeding. Patients with an initial WFNS score of IV–V who showed improvement to a WFNS score of I–II within the first 7 days (even short-term) were defined as “false poor grade” patients. We tried to identify the “false poor grade” patients using parameters of the initial native CT imaging.

RESULTS:

Later determination of the WFNS score (day 1 vs 7; pseudo-R2 = 0.13 vs 0.21) increasingly improved its predictive value for neurological outcome at discharge (P < .001). We identified 39 “false poor grade” patients who had significantly better outcomes than “real poor grade” patients (N = 220) (modified Rankin Scale-discharge: 0-2, 56% vs 1%, P < .001; 3-5: 41% vs 56%, P = .12; 6: 3% vs 43%, P < .001). “False poor grade” patients differed significantly in initial CT parameters. A predictive model called “initial CT WFNS” (ICTWFNS) was developed, incorporating SEBES, Hijdra score, and LeRoux score (sensitivity = 0.95, specificity = 0.84, accuracy = 0.859, F1 = 0.673). ICTWFNS scores of ≤4.6 classified patients as “false poor grade.”

CONCLUSION:

The initial WFNS score may misclassify a subgroup of patients with aSAH as poor grade, which can be avoided by later determination of the WFNS score, at days 3–4 losing its usefulness. Alternatively, the initial WFNS score can be improved in its predictive value, especially in poor-grade patients, using criteria from the initial native CT imaging, such as the Hijdra, LeRoux, and Subarachnoid Hemorrhage Early Brain Edema score, combined in the ICTWFNS score with even higher predictive power.
Biologically Effective Dose and Prediction of Obliteration of Arteriovenous Malformations in Pediatric Patients Treated by Gamma Knife Radiosurgery
Authors: Grogan Dayton , Dumot Chloe , Tewari Anant , Mantziaris Georgios , Dayawansa Sam , Schlesinger David , Sheehan Jason
Published: October 2023

BACKGROUND AND OBJECTIVES:

Stereotactic radiosurgery (SRS) represents an effective treatment for pediatric arteriovenous malformations (AVMs). Biological effective dose (BED) has shown promising results in 2 previous studies as a predictive variable for outcomes in adults, but its role has never been studied in pediatric outcomes.

METHODS:

Retrospective data for patients 18 years or younger treated with a single-session SRS for AVMs were collected from 1989 to 2019. BED calculations were performed using an α/β ratio of 2.47. Kaplan-Meier analysis was used to evaluate obliteration, new hemorrhage, and radiation-induced changes (RIC). Cox-regression analysis was used for obliteration prediction using 2 models (margin dose vs BED).

RESULTS:

One hundred ninety-seven patients (median age = 13.1 years, IQR = 5.2) were included; 72.6% (143/197) of them presented initially with spontaneous hemorrhage. A median margin dose of 22 Gy (IQR = 4.0) with a median BED of 183.2 Gy (IQR = 70.54) was used to treat AVM with a median volume of 2.8 cm3 (IQR = 2.9). After SRS, obliteration was confirmed in 115/197 patients (58.4%) using magnetic resonance imaging and angiography at a median follow-up of 2.85 years (IQR = 2.26). The cumulative obliteration probability was 43.6% (95% CI = 36.1-50.3), 60.5% (95% CI+ = 2.2-67.4), and 66.0% (95% CI = 56.0-73.7) at 3, 5, and 10 years, respectively. In Cox multivariate analysis, a BED >180 Gy (hazard ratio [HR] = 2.11, 95% CI = 1.30-3.40, P = .002) in model 1 and a margin dose >20 Gy (HR = 1.90, 95% CI = 1.15-3.13, P = .019) in model 2 were associated with obliteration. An AVM nidus volume >4 cm3 was associated with lower obliteration rates in both models. The probability of symptomatic RIC at 10 years was 8.6% (95% CI = 3.5-13.4). Neither BED nor margin dose was associated with RIC occurrence, with the only predictive factor being deep AVM location (HR = 3, 95% CI = 1-9.1, P = .048).

CONCLUSION:

This study confirms BED as a predictor for pediatric AVM obliteration. Optimization of BED in pediatric AVM SRS planning may improve cumulative obliteration rates.
Effectiveness of balance training on pain and functional outcomes in knee osteoarthritis: A systematic review and meta-analysis
Authors: Prabhakar Ashish John , R Shruthi , Thomas Dias Tina , Nayak Pradeepa , Joshua Abraham M. , Prabhu Srikanth , Kamat Yogeesh Dattakumar
Published: October 2023

Background: Knee osteoarthritis (OA) is a musculoskeletal disorder that causes pain and increasing loss of function, resulting in reduced proprioceptive accuracy and balance. Therefore, the goal of this systematic review and meta-analysis is to evaluate the effectiveness of balance training on pain and functional outcomes in knee OA. Methods: “PubMed”, “Scopus”, “Web of Science”, “Cochrane”, and “Physiotherapy Evidence Database” were searched for studies conducted between January 2000 and December 2021. Randomized controlled trials (RCTs) that investigated the effectiveness of balance training in knee OA, as well as its effects on pain and functional outcome measures, were included. Conference abstracts, case reports, observational studies, and clinical commentaries were not included. Meta-analysis was conducted for the common outcomes, i.e., Visual Analog Scale (VAS), The Timed Up and Go (TUG), Western Ontario and McMaster Universities Arthritis Index (WOMAC). The PEDro scale was used to determine the quality of the included studies. Results: This review includes 22 RCTs of which 17 articles were included for meta-analysis. The included articles had 1456 participants. The meta-analysis showed improvement in the VAS scores in the experimental group compared to the control group [I 2= 92%; mean difference= -0.79; 95% CI= -1.59 to 0.01; p<0.05] and for the WOMAC scores the heterogeneity (I 2) was 81% with a mean difference of -0.02 [95% CI= -0.44 to 0.40; p<0.0001]. The TUG score was analyzed, the I 2 was 95% with a mean difference of -1.71 [95% CI= -3.09 to -0.33; p<0.0001] for the intervention against the control group. Conclusions: Balance training significantly reduced knee pain and improved functional outcomes measured with TUG. However, there was no difference observed in WOMAC. Although due to the heterogeneity of the included articles the treatment impact may be overestimated. Registration: The current systematic review was registered in PROSPERO on 7th October 2021 (registration number CRD42021276674).
Case Report: Concomitant spontaneous dissection of the coronary artery and internal carotid artery in a young man
Authors: Laajimi Sondes , Mbarek Rabeb , Dhaoui Randa , Bradai Haifa , Loghmari Dorra , Nouira Semir
Published: October 2023

Introduction: Spontaneous coronary artery dissection (SCAD) is a relatively rare cause of acute coronary syndrome (ACS), generally affecting young or middle-aged women and people with few conventional atherosclerosis risk factors. Its association with dissection of the internal carotid artery is exceptional. Through our observation of a concomitant spontaneous coronary and carotid dissection, we discuss its clinical presentation, therapeutic management, pathogenesis and factors favouring its occurrence.

Case: We report the case of a 34-year-old man admitted to emergency with a segment elevation myocardial infarction (STEMI). The patient developed right hemiplegia and aphasia. Cerebral CT revealed a left ischaemic stroke in the anterior junctional territory, and CT angiography of the supra-aortic arteries revealed a dissection of the left internal carotid artery. However, CT angiography of the aorta revealed no abnormalities. Coronary angiography performed after 48 hours showed a dissection of the anterior inter-ventricular artery.

Conclusions: Concurrent dissection of the coronary and internal carotid arteries with an uninjured aorta is a rare entity. This association suggests a congenital pathology of the vessels such as Marfan's disease or Ehlers-Danlos syndrome.
Impact of slice thickness on reproducibility of CT radiomic features of lung tumors
Authors: Gupta Sanat , Nayak Kaushik , Pendem Saikiran
Published: October 2023

Background: Radiomics, a field of research, relies on the theory that quantified characteristics from radiographic images would reflect underlying pathophysiology. Lung cancer continues to stand as one of the prevalent and well-known forms of cancer, causing mortality. The slice thickness (ST) of computed tomography (CT) images would be key concern regarding generalizability of radiomic features (RF) results in oncology. There is scarcity of research that has delved into how ST affects variability of RF in lung tumors. Hence, aim of the study is to evaluate influence of ST on reproducibility of CT-RF for lung tumors.

Methods: This is a prospective study, 32 patients with confirmed histopathological diagnosis of lung tumors were included. Contrast Enhanced CT (CECT) thorax was performed using a 128- Incisive CT (Philips Health Care). The image acquisition was performed with 5-mm and 2 mm ST, and was reconstructed retrospectively. RF were extracted from the CECT thorax images of 5-mm and 2-mm ST. We conducted a paired t-test to evaluate the disparity in RF between the two thicknesses. Lin’s Concordance Correlation Coefficient (CCC) was performed to identify the reproducibility of RF between the two thicknesses.

Results: Out of 107 RF extracted, 66 (61.6%) exhibited a statistically significant distinction (p<0.05) when comparing two slice thicknesses and while 41 (38.3%) RF did not show significant distinction (p>0.05) between the two ST measurements. 29 features (CCC ≥ 0.90) showed excellent to moderate reproducibility, and 78 features (CCC ≤ 0.90) showed poor reproducibility. Among the 7 RF categories, the shape-based features (57.1%) showed the maximum reproducibility whereas NGTDM-based features showed negligible reproducibility.

Conclusions: The slice thickness had a notable impact on the majority of CT-RF of lung tumors. Shape based features (57.1%). First order (44.4%) features showed highest reproducibility compared to other RF categories.
Case Report: An infant with agenesis of the corpus callosum (AgCC) with normal developmental milestones
Authors: Lamture Varsha , Lamture Prajwal , Lamture Yeshwant
Published: October 2023

Background: Agenesis of the corpus callosum (AgCC) is a unique and rare brain malformation that can have long-term effects on the cognitive and neurological development of those affected. Individuals with AgCC must undergo regular neuropsychological screening to secure conceivable problems and diagnose and tackle them at the appropriate times.

Case report: This case is of a male-term infant born through vaginal delivery to a primigravida mother. Antenatal history was insignificant. Fetal Ultrasonography (USG) done at 24 weeks of gestation showed AgCC. The risk factor was explained to the parents, but they wanted to continue the pregnancy. The infant was delivered at term gestation and weighed 2500 gm. The baby was discharged from the hospital and was advised for follow-up. On follow-up, milestones were normal. Magnetic resonance imaging (MRI) of his brain at 24 months during follow-up showed total AgCC. Surprisingly, milestones were not delayed for his age, so he was advised to screen for neurocognitive in the subsequent follow-up.

Discussion: AgCC is typically diagnosed through antenatal MRI or genetic testing, but it may be isolated in cases where no additional anomalies are present. It is also associated with various hereditary syndromes, and prenatal diagnosis through Ultrasonography (USG) can be performed between 18 and 22 weeks of gestation to identify features suggestive of AgCC so that early intervention can be done. Though we do not have exact treatment, supporting treatment is equally important to combat further complications.

Conclusions: Despite diagnostic tools for AgCC, many physicians are not familiar with the neurological and cognitive features of AgCC, which can lead to delayed management and treatment. Therefore, medical professionals must receive education and training on this condition to manage individuals with AgCC and receive the most supportive care they need.
Promoting men’s awareness, self-examination, and help-seeking for testicular disorders: a systematic review of interventions
Authors: Saab Mohamad M. , Davoren Martin P. , Murphy Aileen , Murphy David , Cooke Eoghan , Landers Margaret , Fitzgerald Serena , Richardson Noel , Rovito Michael J. , Von Wagner Christian , Murphy Mike , Dahly Darren , Hegarty Josephine
Published: October 2023

Background: Testicular cancer (TC) is among the most commonly diagnosed cancers in men aged 15–40 years. The incidence of TC is on the rise. Benign testicular disorders, such as testicular torsion and epididymitis, can lead to testicular ischemia, sepsis, and infertility if left untreated. This updated systematic review aims to evaluate the effectiveness of studies promoting men’s knowledge and awareness of testicular disorders and/or self-examination, behaviours and/or intentions to examine their testes, and help-seeking behaviours and/or intentions for testicular disorder symptoms. Methods: Academic Search Complete, Medline, CINAHL, PsycINFO, ERIC, the Cochrane Library, the World Health Organisation International Clinical Trials Registry Platform, and Clinicaltrials.gov were searched for studies published between April 2018 and August 2023. Methodological quality was assessed and results were synthesised meta-narratively. Results: Five studies were included. The majority of the reviewed interventions were successful in increasing men’s awareness of TC and self-examination, including a PowerPoint presentation, an online educational brochure, video-assisted teaching, a motivational video, and a virtual reality game. Only one study addressed help-seeking for testicular symptoms and promoted men’s awareness of benign as well as malignant testicular diseases. Conclusions: This review highlights the importance of evaluating innovative educational interventions aimed at younger men, whilst raising their awareness of testicular disorders and increasing their help-seeking intentions for testicular disorder symptoms. Given the lack of consensus around scheduled testicular self-examination among younger men, clinicians are encouraged to instruct men to familiarise themselves with the look and feel of their own testes and to seek timely medical attention for abnormalities. Registration: The protocol of the previous version of this review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42018093671.
X-ray beam quality after a mirror reflection: Experimental and simulated results for a toroidal mirror in a 4th generation storage-ring beamline
Authors: Reyes-Herrera Juan , Celestre Rafael , Cammarata Marco , Barrett Raymond , Levantino Matteo , Sanchez del Rio Manuel
Published: October 2023

Background The surface errors found in X-ray mirrors constitute a limiting factor for preserving beam quality. This is particularly important when the X-ray beam has low emittance and a significant coherence fraction, like in newly upgraded synchrotron storage rings. Methods We studied the fringes observed in the image of an undulator-produced X-ray beam reflected by a high-quality toroidal mirror. The measurements and simulations were performed using different conditions: a photon beam either monochromatic or with large bandwidth, reflected by a mirror with variable curvature. Results The experimental data are compared with up-to-date simulation including partial coherence. Conclusions The observed fringes in the unfocused beam correlate with low spatial frequency structures in mirror profiles, irrespective of beam coherence. Both classical ray tracing and partially coherent simulations through coherent mode decomposition are confirmed as accurate methods for such simulations.
The urban hydrosocial cycle: why should engineers care?
Authors: Popartan Lucia Alexandra , Poch Manel , Pueyo-Ros Josep , Rodriguez-Roda Ignasi
Published: October 2023

The research in urban water management, especially in the Global North, has so far been predominantly driven by the pursuit of technological innovation, with the overarching goal of managing demand and supply of the resource, seeking cost efficiency, quality and sustainability standards. Thus, the urban water cycle has been envisioned and shaped by technical knowledge and interventions. However, in recent years, the complex challenges faced by cities and their water systems increased the awareness about the importance of the governance of water that cannot be treated simply a resource to be exploited. Critical scholars, coming especially from social sciences have explored the concept of hydrosocial cycle, aiming to capture the human and socio-political dimension of the water cycle. While interdisciplinarity remains a desiderate in the water sector, in practice, the interaction between disciplines has so far been scarce, given the differences in worldviews, epistemological and methodological postures. In this piece, we explore how the concept of urban hydrosocial cycle can form the basis for a critical research agenda which informs not only a reimagining of water management but also the planning and technological processes. We illustrate this in two different relevant research topics, taking a critical perspective to nature-based solutions and digitalisation.