bluuebunny/crossref_metadata_2025 huggingface dataset:
A nomogram model for assessing predictors and prognosis of postoperative delirium in patients receiving acute type A aortic dissection surgery
Authors: Lin Jian-Ling , Zheng Guo-Zhong , Chen Liang-Wan , Luo Zeng-Rong
Published: February 2023

Background

Postoperative delirium (POD) complicates the postoperative course. There is limited information on POD-related risk factors (RFs) and prognosis in patients with acute type A aortic dissection (ATAAD) after modified triple-branched stent graft implantation (MTBSG) surgery.

Methods

We retrospectively examined consecutive ATAAD patients who received MTBSG surgery in our hospital between January 2013 and December 2019. We employed univariate and multivariate analyses to identify stand-alone RFs for POD. A nomogram was next generated to estimate POD occurrence. The primary outcome was the development of POD, and the secondary outcomes were intensive care unit (ICU) and hospital stays, hospitalization costs, and in-hospital and follow-up mortality.

Results

We selected 692 patients, of whom 220 experienced POD (31.8%). Based on our analysis, the following factors enhanced the likelihood of POD development: alcohol consumption (p < 0.001), acute physiology and chronic health evaluation II score (p = 0.023), serum total bilirubin (p = 0.007), stage 3 acute kidney injury (p < 0.001), serum interleukin-6 (p = 0.031), post-operative analgesics usage (p = 0.015), and ventilation duration (p = 0.008). POD patients had significantly longer ventilator times (p = 0.003), ICU stays (p < 0.001), and hospital stays (p = 0.038), together with increased hospitalization costs (p < 0.001) and in-hospital mortality (p = 0.019). However, POD was not a RF for mortality during follow-up (log-rank p = 0.611).

Conclusions

We demonstrated a strong link between POD and poor prognosis in ATAAD patients. We also constructed a prognosis estimator model which will benefit early management guidance to minimize the incidence of POD.
A comparison of four epidemic waves of COVID-19 in Malawi; an observational cohort study
Authors: Anscombe Catherine , Lissauer Samantha , Thole Herbert , Rylance Jamie , Dula Dingase , Menyere Mavis , Kutambe Belson , van der Veer Charlotte , Phiri Tamara , Banda Ndaziona P. , Mndolo Kwazizira S. , Mponda Kelvin , Phiri Chimota , Mallewa Jane , Nyirenda Mulinda , Katha Grace , Mwandumba Henry , Gordon Stephen B. , Jambo Kondwani C. , Cornick Jennifer , Feasey Nicholas , Barnes Kayla G. , Morton Ben , Ashton Philip M. ,   Blantyre COVID-19 Consortium, Kalua Wezzie , Mandala Peter , Katutula Barbara , Ng’oma Rosaleen , Lanken Steven , Phulusa Jacob , Mkandawire Mercy , Kaimba Sylvester , Nthala Sharon , Nsomba Edna , Keyala Lucy , Chinoko Beatrice , Gmeiner Markus , Kaudzu Vella , Freyne Bridget , Swarthout Todd D. , Tam Pui-Ying Iroh , Sichone Simon , Ahmadu Ajisa , Stima Grace , Masina Mazuba , Kanjewa Oscar , Nyasulu Vita , Chinyama End , Zuza Allan , Denis Brigitte , Storey Evance , Bondera Nedson , Matchado Danford , Chande Adams , Chingota Arthur , Ntwea Chimenya , Mkandawire Langford , Mhango Chimwemwe , Lakudzala Agness , Chaponda Mphatso , Mwenechanya Percy , Mvaya Leonard , Tembo Dumizulu , Henrion Marc Y. R. , Chirombo James , Kambiya Paul , Masesa Clemens , Gondwe Joel
Published: February 2023

Background

Compared to the abundance of clinical and genomic information available on patients hospitalised with COVID-19 disease from high-income countries, there is a paucity of data from low-income countries. Our aim was to explore the relationship between viral lineage and patient outcome.

Methods

We enrolled a prospective observational cohort of adult patients hospitalised with PCR-confirmed COVID-19 disease between July 2020 and March 2022 from Blantyre, Malawi, covering four waves of SARS-CoV-2 infections. Clinical and diagnostic data were collected using an adapted ISARIC clinical characterization protocol for COVID-19. SARS-CoV-2 isolates were sequenced using the MinION™ in Blantyre.

Results

We enrolled 314 patients, good quality sequencing data was available for 55 patients. The sequencing data showed that 8 of 11 participants recruited in wave one had B.1 infections, 6/6 in wave two had Beta, 25/26 in wave three had Delta and 11/12 in wave four had Omicron. Patients infected during the Delta and Omicron waves reported fewer underlying chronic conditions and a shorter time to presentation. Significantly fewer patients required oxygen (22.7% [17/75] vs. 58.6% [140/239], p < 0.001) and steroids (38.7% [29/75] vs. 70.3% [167/239], p < 0.001) in the Omicron wave compared with the other waves. Multivariable logistic-regression demonstrated a trend toward increased mortality in the Delta wave (OR 4.99 [95% CI 1.0–25.0 p = 0.05) compared to the first wave of infection.

Conclusions

Our data show that each wave of patients hospitalised with SARS-CoV-2 was infected with a distinct viral variant. The clinical data suggests that patients with severe COVID-19 disease were more likely to die during the Delta wave.
Psychometric evaluation of the Connor-Davidson Resilience Scale among Iranian population
Authors: Sharif Nia Hamid , She Long , Froelicher Erika Sivarajan , Marôco João , Moshtagh Mozhgan , Hejazi Sima
Published: February 2023

Background

The resilience construct is considered a personal trait composed of multiple aspects. Connor–Davidson Resilience Scale is a standard tool composed of five factors and 25 items. This study aimed to determine the psychometric properties of this scale.

Methods

In this cross-sectional study, after the scale translation, the factorial structural validity was assessed via the confirmatory factor analysis with 70 180 samples. Internal consistency, composite reliability, convergent validity were assessed by calculating Cronbach’s alpha, composite reliability, maximum reliability, and Average Variance Extracted. The discriminant validity was assessed using Heterotrait-monotrait ratio of correlations matrix and also, measure invariance was evaluated.

Results

The original five-factor model had good model fit indices but due to low factor loading of item 2 and 20, the model was modified. The Cronbach’s alpha and composite reliability for four factors were above 0.7 (except for factor 5). The convergent validity for all five factors were achieved. Between factors 1 with 2 and 4, 2 with 3 and 4 discriminant validity was not established (correlations > 0.9) and the results suggested that there might be a second-order latent construct behind these factors. Therefore, a second-order assessment was performed. The results of the second-order latent construct assessment showed a good goodness-of fit and strong measurement invariance for both men and women.

Conclusion

The 23-item version of Connor-Davidson Resilience Scale is a reliable and valid scale to measure resilience as a complex construct in the Iran context.
Factors associated with childhood pneumonia and care seeking practices in Nepal: further analysis of 2019 Nepal Multiple Indicator Cluster Survey
Authors: Dharel Sunita , Shrestha Binjwala , Basel Prem
Published: February 2023

Background

Acute Respiratory Infection (ARI) is still a major public health problem in Nepal. The prevalence of ARI among under five children was 2.1% in 2019 and many children from marginalized families suffer disproportionately and many of them die without proper care and treatment. The objective of this study was to identify factors associated with childhood pneumonia and care-seeking practices in Nepal.

Methods

This was a secondary analysis of the Nepal Multiple Indicator Cluster Survey (MICS) 2019, which uses multi-stage Probability Proportional to Size sampling. Data from 6658 children were analyzed using SPSS 22. Chi-square test and logistic regression analysis were conducted with odds ratio and its corresponding 95% confidence interval after adjusting for confounders.

Results

Children aged 0 to 23 months had1.5 times higher odds of pneumonia compared to the age group 24 to 59 months (AOR = 1.5, CI 1.0–2.3) and children from rural area had 1.9 times the odds of having pneumonia than urban children (AOR = 1.9, CI 1.2–3.2). Underweight children had 2.3 times greater odds of having pneumonia than normal weight children (AOR = 2.3, CI 1.4–3.9). The odds of having pneumonia were 2.5 higher among children of current smoking mothers compared those with non-smoking mothers (AOR = 2.5, CI 1.1–5.7). Similarly, children from disadvantaged families had 0.6 times protective odds of pneumonia than children from non-disadvantaged families (AOR = 0.6, CI 0.4–1.0). Only one quarter of children received treatment from public facilities. Of those who received treatment, nearly half of the children received inappropriate treatment for pneumonia. One in ten children with pneumonia did not receive any kind of treatment at all.

Conclusions

Pneumonia is still a public health problem in low-income countries. Public health program and treatment services should be targeted to younger children, careful attention should be given to underweight children, and awareness and nutrition related activities should be focused on rural areas. Addressing inequity in access to and utilization of treatment of childhood illnesses should be prioritized. Keywords: Childhood pneumonia, epidemiology, health care seeking behavior, Nepal.
Associations between changes in physical activity and perceived social exclusion and loneliness within middle-aged adults – longitudinal evidence from the German ageing survey
Authors: Baumbach Linda , König Hans-Helmut , Hajek André
Published: February 2023

Background

Previous research showed negative associations between physical activity and loneliness in older adults. However, information on associations among middle-aged adults is scarce. In this prognostic factor study, we investigated if starting or stopping to follow the WHO physical activity recommendations was associated with changes in perceived social exclusion and loneliness in this age bracket.

Methods

We used longitudinal representative data of participants aged 40 to 64 years from the German Ageing Survey waves in 2014 and 2017 (analytical sample = 4,264 observations, 54% women). Perceived social exclusion was investigated with the scale from Bude and Lantermann. Loneliness was quantified with the 6-items loneliness scale from De Jong Gierveld. Information from the International Physical Activity Survey items on the time spend in moderate and vigorous physical activity per week was dichotomized. Participants were coded as either following or not following the WHO´s physical activity recommendations of spending at least 150 min of moderate, 75 min of vigorous or an appropriated combination of physical activity per week. We investigated the within (individual) association between starting and stopping to follow WHO´s physical activity recommendations and perceived social exclusion as well as loneliness in asymmetric fixed effects regressions. Analyses were adjusted for age, marital status, employment status, social-network size, general self-efficacy, depressive symptoms, self-rated health, BMI, comorbidities, and physical functioning (SF-36).

Results

Stopping to follow the physical activity recommendations from the WHO was associated with perceived social exclusion (ß= 0.09 p = 0.04) but not with loneliness (ß=-0.01, p = 0.71). Starting to follow the WHO physical activity recommendations was neither associated with social exclusion (ß=-0.02, p = 0.54) nor with loneliness (ß=-0.01, p = 0.74) in adjusted asymmetric fixed effects regressions.

Conclusion

In middle-aged adults, longitudinal associations were found for physical activity and perceived social exclusion. Perceived social exclusion may be prevented by maintaining at least 150 min of moderate physical activities per week, which is the WHO physical activity recommendation. Future research should investigate moderators and mediators in the association between physical activity and social exclusion as well as loneliness.
Bronchoalveolar lavage fluid polymerase chain reaction for invasive pulmonary aspergillosis among high-risk patients: a diagnostic meta-analysis
Authors: Han Yinling , Wu Xiang , Jiang Guangwei , Guo Anyi , Jin Zhangchu , Ying Yinghua , Lai Jianxing , Li Wen , Yan Fugui
Published: February 2023

Background

Polymerase chain reaction (PCR) assays are perceived to facilitate the diagnosis of fungal infections. However, due to lack of standardization, the value of bronchoalveolar lavage (BAL) fluid PCR in diagnosis of invasive pulmonary aspergillosis (IPA) remains unclear.

Methods

We conducted a systematic meta-analysis to evaluate the accuracy of BAL fluid PCR in IPA diagnosis among high-risk patients. All studies involving patients at risk for IPA were included. The sensitivity, specificity, positive and negative likelihood ratios of BAL fluid PCR were summarized for diagnosis of proven/probable IPA, or proven IPA only. Potential heterogeneity was assessed by subgroup analyses and meta-regression.

Results

Forty-one studies involving 5668 patients were analyzed. The summary sensitivity, specificity, positive and negative likelihood ratios of BAL fluid PCR for proven/probable IPA were 0.75 (95% CI = 0.67–0.81), 0.94 (95% CI = 0.90–0.96), 11.8 (95% CI = 7.7–18.1) and 0.27 (95% CI = 0.20–0.36), respectively. Whereas for proven IPA only, sensitivity and specificity were 0.91 (95% CI = 0.68–0.98) and 0.80 (95% CI = 0.74–0.85) in fourteen studies involving 2061 patients. Significant heterogeneity was present due to the underlying disease, antifungal treatment and differences in DNA extraction techniques and choice of PCR assay. Compared to patients with hematological malignancies (HM) and hematopoietic stem cell/solid organ transplantation (HSCT/SOT), sensitivity was higher in the population with disease such as chronic obstructive pulmonary disease, solid tumor, autoimmune disease with prolonged use of corticosteroids, etc. (0.88 vs. 0.68, P < 0.001), which was related to the concurrent use of antifungal prophylaxis among patients with HM and HSCT/SOT.

Conclusion

BAL fluid PCR is a useful diagnostic tool for IPA in immunocompromised patients and is also effective for diagnosing IPA in patients without HM and HSCT/SOT. Furthermore, standard protocols for DNA extraction and PCR assays should be focused on to improve the diagnostic accuracy.

Trial registration PROSPERO, registration number CRD42021239028.
Clinical characteristics and predictive model of pulmonary tuberculosis patients with pulmonary fungal coinfection
Authors: Yan Hongxuan , Guo Li , Pang Yu , Liu Fangchao , Liu Tianhui , Gao Mengqiu
Published: February 2023

Background

In clinical settings, pulmonary tuberculosis (PTB) patients were often found to have pulmonary fungal coinfection. This study aimed to assess the clinical characteristics of patients suffering from coinfection with TB and pulmonary fungal and construct a predictive model for evaluating the probability of pulmonary fungal coinfection in patients with pulmonary tuberculosis.

Methods

The present case–control study retrospectively collected information from 286 patients affected by PTB who received treatment from December 6,2016- December 6,2021 at Beijing Chest Hospital, Capital Medical University. As control subjects, patients with sex and address corresponding to those of the case subjects were included in the study in a ratio of 1:1. These 286 patients were randomly divided into the training and internal validation sets in a ratio of 3:1. Chi-square test and logistic regression analysis were performed for the training set, and a predictive model was developed using the selected predictors. Bootstrapping was performed for internal validation.

Results

Seven variables [illness course, pulmonary cavitation, broad-spectrum antibiotics use for at least 1 week, chemotherapy or immunosuppressants, surgery, bacterial pneumonia, and hypoproteinemia] were validated and used to develop a predictive model which showed good discrimination capability for both training set [area under the curve (AUC) = 0.860, 95% confidence interval (CI) = 0.811–0.909] and internal validation set (AUC = 0.884, 95% CI = 0.799–0.970). The calibration curves also showed that the probabilities predicted using the predictive model had satisfactory consistency with the actual probability for both training and internal validation sets.

Conclusions

We developed a predictive model that can predict the probability of pulmonary fungal coinfection in pulmonary tuberculosis patients. It showed potential clinical utility.
Combined preoperative prognostic nutritional index and D-dimer score predicts outcome in colorectal cancer
Authors: Zhu Shibin , Yin Jianyuan , Ye Qianwen , Xiang Jia , Zhang Zihao , Yan Bing
Published: February 2023

Background

The prognostic nutritional index (PNI) and D-dimer (DD) levels represent useful prognostic indicators in colorectal cancer (CRC); however, a combination of these indicators, namely, the PNI and DD score (PDS) was less addressed.

Methods

A retrospective study with 183 patients after curative surgery was conducted. Patients were divided into 3 subgroups: PDS 0, decreased PNI and increased DD levels; PDS 1, decreased or increased PNI and DD levels; PDS 2, increased PNI and decreased DD levels. The differences in disease-free survival (DFS) and overall survival (OS) were compared among these subgroups, and risk factors for outcome were determined.

Results

A total of 56, 65 and 62 patients were assigned to the PDS 0, 1 and 2 subgroups, respectively. PDS was significant in predicting both the DFS (area under the curve (AUC) = 0.68, P < 0.001) and OS (AUC = 0.74, P < 0.001). PDS 0 patients were more likely to be associated with old age (P = 0.032), laparotomy (P < 0.001), elevated CEA (P = 0.001), T3 + T4 (P = 0.001) and advanced TNM stage (P = 0.031). PDS 0 patients had significantly inferior DFS (log rank = 18.35, P < 0.001) and OS (log rank = 28.34, P < 0.001) than PDS 1 or 2 patients. PDS was identified as an independent risk factor for both DFS (PDS 1: HR = 0.54, 95% CI: 0.30–1.00, P = 0.049; PDS 2: HR = 0.40, 95% CI: 0.20–0.79, P = 0.009) and OS (PDS 1: HR = 0.44, 95% CI: 0.22–0.88, P = 0.020; PDS 2: HR = 0.17, 95% CI: 0.06–0.45, P < 0.001).

Conclusion

The PDS is a useful prognostic indicator for CRC patients after curative surgery, and PDS 0 patients have inferior survival. Additional future studies are needed to validate these findings.
Longitudinal association between adiposity changes and lung function deterioration
Authors: Park Youngmok , Kim Jiyoung , Kim Young Sam , Leem Ah Young , Jo Jinyeon , Chung Kyungsoo , Park Moo Suk , Won Sungho , Jung Ji Ye
Published: February 2023

Background

The longitudinal relationship between adiposity and lung function is controversial. We aimed to investigate the long-term association between adiposity changes and lung function in a middle-aged general Asian population.

Methods

In total, 5011 participants (average age, 54 years; 45% men) were enrolled from a community-based prospective cohort. During the follow-up period (median 8 years), both spirometry and bio-electrical impedance analysis were performed biannually. Individual slopes of the fat mass index (FMI; fat mass divided by the square of height in meters) and waist-to-hip ratio (WHR) were calculated using linear regression analysis. Multivariate linear mixed regression analysis was used to determine the long-term association between adiposity changes and lung function.

Results

The FMI was inversely associated with forced vital capacity (FVC) (estimated: − 31.8 mL in men, − 27.8 mL in women) and forced expiratory volume in 1 s (FEV1) (estimated: − 38.2 mL in men, − 17.8 mL in women) after adjusting for baseline age, height, residential area, smoking exposure (pack-years, men only), initial adiposity indices, and baseline lung function. The WHR was also inversely associated with FVC (estimated = − 1242.2 mL) and FEV1 (estimated = − 849.8 mL) in men. The WHR-increased group showed a more rapid decline in lung function than the WHR-decreased group in both the fat-gain and fat-loss groups.

Conclusion

Adiposity was associated with the long-term impairment of lung function. Central obesity was the main driver of lung function impairment in the middle-aged general Asian population, regardless of fat mass changes.
Perceived barriers, benefits, facilitators, and attitudes of health professionals towards type 2 diabetes management in Oujda, Morocco: a qualitative focus group study
Authors: Dankoly Usman Sani , Vissers Dirk , El Mostafa Souad Ben , Ziyyat Abderrahim , Van Rompaey Bart , Van Royen Paul , Maamri Abdellatif
Published: February 2023

Background

In Morocco, the treatment of type 2 diabetes (T2D) is mainly focused on medication and only 2% of patients are coached towards a healthier lifestyle. In Oujda, Eastern Morocco the prevalence of T2D is 10.2%, and the current trend is alarming, especially for women. Therefore, the aim of this study is to explore healthcare professionals (HCP) views on the perceived barriers and benefits of an integrated care approach in primary healthcare centers (PHCCs) to T2D management in Oujda.

Methods

A qualitative descriptive study using focus groups in 8 PHCCs. This resulted in a sample of 5 doctors and 25 nurses caring for diabetes patients. The transcripts of all conversations were coded to allow for thematic analysis.

Results

The participants mentioned different barriers to an integrated approach to DM management:: excessive workload; poor reimbursement policy; lack of staff and equipment; interrupted drug supply; poor working environment; limited referral; gap in the knowledge of general practitioners; health beliefs; poverty; advanced age; gender; the use of psychotropic drugs. An integrated approach could be facilitated by simplified electronic records and referrals; uninterrupted free care; staff recruitment; continuous professional development; internships. Benefits: structured care; promotion of care in PHCCs; empowerment of self-management.

Conclusion

HCP views reflect the urge to strengthen the management of T2D in PHCCs. There is a need for HCP with expertise in physical activity and nutrition to solve the current gap in the multidisciplinary integrated care approach. The specific local context in this Eastern Moroccan region, with limited resources and remote hard-to-reach rural areas, can contribute to patients’ reluctance to change their lifestyles, and is a challenge to provide care in an efficient and sustainable manner. More research is needed to see how a patient-centered multidisciplinary approach to T2D management can help motivate patients in Morocco to change to a healthier lifestyle.
Glucose metabolic reprogramming and its therapeutic potential in obesity-associated endometrial cancer
Authors: Huang Pengzhu , Fan Xiangqin , Yu Hongfei , Zhang Kaiwen , Li Huanrong , Wang Yingmei , Xue Fengxia
Published: February 2023

Endometrial cancer (EC) is a common gynecological cancer that endangers women health. Although substantial progresses of EC management have been achieved in recent years, the incidence of EC still remains high. Obesity has been a common phenomenon worldwide that increases the risk of EC. However, the mechanism associating obesity and EC has not been fully understood. Metabolic reprogramming as a remarkable characteristic of EC is currently emerging. As the primary factor of metabolic syndrome, obesity promotes insulin resistance, hyperinsulinemia and hyperglycaemia. This metabolic disorder remodels systemic status, which increases EC risk and is related with poor prognosis. Glucose metabolism in EC cells is complex and mediated by glycolysis and mitochondria to ensure energy requirement. Factors that affect glucose metabolism may have an impact on EC initiation and progression. In this study, we review the glucose metabolic reprogramming of EC not only systemic metabolism but also inherent tumor cell metabolism. In particular, the role of glucose metabolic regulation in malignant properties of EC will be focused. Understanding of metabolic profile and glucose metabolism-associated regulation mechanism in EC may provide novel perspective for treatment.
Can allele-specific loop-mediated isothermal amplification be used for rapid detection of target-site herbicide resistance in Lolium spp.?
Authors: Panozzo Silvia , Farinati Silvia , Sattin Maurizio , Scarabel Laura
Published: February 2023

Background

Herbicide resistance is one of the threats to modern agriculture and its early detection is one of the most effective components for sustainable resistance management strategies. Many techniques have been used for target-site-resistance detection. Allele-Specific Loop-Mediated Isothermal Amplification (AS-LAMP) was evaluated as a possible rapid diagnostic method for acetyl-CoA carboxylase (ACCase) and acetolactate synthase (ALS) inhibiting herbicides resistance in Lolium spp.

Results

AS-LAMP protocols were set up for the most frequent mutations responsible for herbicide resistance to ALS (positions 197, 376 and 574) and ACCase (positions 1781, 2041 and 2078) inhibitors in previously characterized and genotyped Lolium spp. populations. A validation step on new putative resistant populations gave the overview of a possible use of this tool for herbicide resistance diagnosis in Lolium spp. Regarding the ACCase inhibitor pinoxaden, in more than 65% of the analysed plants, the LAMP assay and genotyping were in keeping, whereas the results were not consistent when ALS inhibitors resistance was considered. Limitations on the use of this technique for herbicide resistance detection in the allogamous Lolium spp. are discussed.

Conclusions

The LAMP method used for the detection of target-site resistance in weed species could be applicable with target genes that do not have high genetic variability, such as ACCase gene in Lolium spp.
Clinical implementation of magnetic resonance imaging simulation for radiation oncology planning: 5 year experience
Authors: Moore-Palhares Daniel , Ho Ling , Lu Lin , Chugh Brige , Vesprini Danny , Karam Irene , Soliman Hany , Symons Sean , Leung Eric , Loblaw Andrew , Myrehaug Sten , Stanisz Greg , Sahgal Arjun , Czarnota Gregory J.
Published: February 2023

Purpose

Integrating magnetic resonance (MR) into radiotherapy planning has several advantages. This report details the clinical implementation of an MR simulation (MR-planning) program for external beam radiotherapy (EBRT) in one of North America's largest radiotherapy programs.

Methods and materials

An MR radiotherapy planning program was developed and implemented at Sunnybrook Health Sciences Center in 2016 with two dedicated wide-bore MR platforms (1.5 and 3.0 Tesla). Planning MR was sequentially implemented every 3 months for separate treatment sites, including the central nervous system (CNS), gynecologic (GYN), head and neck (HN), genitourinary (GU), gastrointestinal (GI), breast, and brachial plexus. Essential protocols and processes were detailed in this report, including clinical workflow, optimized MR-image acquisition protocols, MR-adapted patient setup, strategies to overcome risks and challenges, and an MR-planning quality assurance program. This study retrospectively reviewed simulation site data for all MR-planning sessions performed for EBRT over the past 5 years.

Results

From July 2016 to December 2021, 8798 MR-planning sessions were carried out, which corresponds to 25% of all computer tomography (CT) simulations (CT-planning) performed during the same period at our institution. There was a progressive rise from 80 MR-planning sessions in 2016 to 1126 in 2017, 1492 in 2018, 1824 in 2019, 2040 in 2020, and 2236 in 2021. As a result, the relative number of planning MR/CT increased from 3% of all planning sessions in 2016 to 36% in 2021. The most common site of MR-planning was CNS (49%), HN (13%), GYN (12%), GU (12%), and others (8%).

Conclusion

Detailed clinical processes and protocols of our MR-planning program were presented, which have been improved over more than 5 years of robust experience. Strategies to overcome risks and challenges in the implementation process are highlighted. Our work provides details that can be used by institutions interested in implementing an MR-planning program.
Investigating the molecular mechanisms of delirium-like neuropsychiatric disorder induced by electromagnetic pulse based on bioinformatics analysis
Authors: Zhang Xia-Jing , Xiao Zhi-Bin , Gu Jun-Xiang , Chen Kun , Wang Jian , Xu Sheng-Long , Xing Ke-Ke , Chen Tao
Published: February 2023

Electromagnetic pulse (EMP), a unique type of electromagnetic radiation, may induce diverse neuropsychiatric disorders, such as irritability, hyperkinesis, retardation of learning and memory. However, the underlying mechanism of EMP exposure on neuronal injury has not been elucidated. Here, we aimed to delineate the regulatory expression networks based on high-throughput sequencing data to explore the possible molecular mechanisms related to EMP-induced delirium-like neuropsychiatric disorder in rats. It’s shown that EMP exposure induced anxiety, cognitive decline and short-term memory impairment. The expression profiles of the long noncoding RNAs (lncRNAs) and mRNAs, along with their biological function and regulatory network, were explored in rats after EMP exposure. We identified 41 differentially expressed lncRNAs (DELs) and 266 differentially expressed mRNAs (DEMs) between EMP and sham groups. Sixty-one co-expression relationships between 18 DELs and 56 DEMs were mostly associated with synapse- and metabolic-related pathways. We predicted 51 DEL-miRNA pairs and 290 miRNA-mRNA pairs using the miRanda database to constructed a DEL-miRNA-DEM network. LncRNA AABR07042999.1 and mRNA Tph2, Slc6a4, Dbh and Th were upregulated, and the contents of serotonin, dopamine and norepinephrine were increased in both PFC and HIP after EMP exposure. The current study provided a better understanding of the ceRNA network, which might reveal the pathological mechanism and provide more treatment options for the EMP-induced neurobehavioral disorder.
GPX8 regulates clear cell renal cell carcinoma tumorigenesis through promoting lipogenesis by NNMT
Authors: Nguyen Tin Tin Manh , Nguyen Thi Ha , Kim Han Sun , Dao Thien T. P. , Moon Yechan , Seo Munjun , Kang Sunmi , Mai Van-Hieu , An Yong Jin , Jung Cho-Rok , Kim Jin-Mo , Park Sunghyouk
Published: February 2023

Background

Clear cell renal cell carcinoma (ccRCC), with its hallmark phenotype of high cytosolic lipid content, is considered a metabolic cancer. Despite the implication of this lipid-rich phenotype in ccRCC tumorigenesis, the roles and regulators of de novo lipid synthesis (DNL) in ccRCC remain largely unexplained.

Methods

Our bioinformatic screening focused on ccRCC-lipid phenotypes identified glutathione peroxidase 8 (GPX8), as a clinically relevant upstream regulator of DNL. GPX8 genetic silencing was performed with CRISPR-Cas9 or shRNA in ccRCC cell lines to dissect its roles. Untargeted metabolomics, RNA-seq analyses, and other biochemical assays (e.g., lipid droplets staining, fatty acid uptake, cell proliferation, xenograft, etc.) were carried out to investigate the GPX8’s involvement in lipid metabolism and tumorigenesis in ccRCC. The lipid metabolic function of GPX8 and its downstream were also measured by isotope-tracing-based DNL flux measurement.

Results

GPX8 knockout or downregulation substantially reduced lipid droplet levels (independent of lipid uptake), fatty acid de novo synthesis, triglyceride esterification in vitro, and tumor growth in vivo. The downstream regulator was identified as nicotinamide N-methyltransferase (NNMT): its knockdown phenocopied, and its expression rescued, GPX8 silencing both in vitro and in vivo. Mechanically, GPX8 regulated NNMT via IL6-STAT3 signaling, and blocking this axis suppressed ccRCC survival by activating AMPK. Notably, neither the GPX8-NNMT axis nor the DNL flux was affected by the von Hippel Lindau (VHL) status, the conventional regulator of ccRCC high lipid content.

Conclusions

Taken together, our findings unravel the roles of the VHL-independent GPX8-NNMT axis in ccRCC lipid metabolism as related to the phenotypes and growth of ccRCC, which may be targeted for therapeutic purposes.

Graphical abstract
Clinical characteristics and risk factors of ovarian reserve decreases in women with Crohn’s disease: a case-control study
Authors: Xiang Peng , Yao Jia-yin , Li Xiao-lan , Zhang Min , Hu Pin-jin , Zhi Min
Published: February 2023

Background

Crohn’s disease (CD), often occurring in women of child-bearing age, can decline the fertility rate. However, whether it reduces ovarian reserve has been rarely reported. This study aimed to evaluate the ovarian reserve in women with CD from the perspective of anti-Müllerian hormone (AMH), and explore the factors that can decrease ovarian reserve.

Methods

A case-control retrospective study was designed. We analyzed the AMH levels in a total of 135 CD women and 878 healthy controls. Through propensity score matching, the subjects were assigned in a ratio of 1:3 to CD group (n = 121) and control group (n = 324). Both groups shared similar basic characteristics, like age, body mass index and smoking status. Serum AMH levels were measured by chemiluminescence.

Results

The AMH level in the CD group was significantly lower than that in the control group (2.17 ± 2.23 μg/L vs 3.95 ± 2.01 μg/L, 95%CI [1.34-2.21], P < 0.001). In both groups, the AMH levels decreased as age increased, but without between-group difference in the decreasing rate (P = 0.639). Multivariate analysis showed that age > 30 years (OR, 2.905; 95%CI [1.053-8.531], P = 0.017), disease activity (OR,4.314; 95%CI [1.561-12.910], P = 0.002) and thalidomide use (OR,12.628; 95%CI [4.351 -42.820], P < 0.001) were independent risk factors associated with decreased ovarian reserve (AMH<1.1μg/L).

Conclusion

Ovarian reserve is lower in CD women than in healthy women. Age, CD activity and medication of thalidomide are risk factors that can aggravate the decline of ovarian reserve.
Levosimendan in patients undergoing extracorporeal membrane oxygenation after cardiac surgery: an emulated target trial using observational data
Authors: Massol Julien , Simon-Tillaux Noémie , Tohme Joanna , Hariri Geoffroy , Dureau Pauline , Duceau Baptiste , Belin Lisa , Hajage David , De Rycke Yann , Charfeddine Ahmed , Lebreton Guillaume , Combes Alain , Bouglé Adrien
Published: February 2023

Background

Retrospective cohorts have suggested that levosimendan may facilitate the weaning of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). We therefore studied this clinical question by emulating a randomized trial with observational data.

Methods

All patients with refractory postcardiotomy cardiogenic shock and assisted with VA-ECMO, admitted to a surgical intensive care unit at La Pitié-Salpêtrière Hospital between 2016 and 2019, were eligible. To avoid immortal-time bias, we emulated a target trial sequentially comparing levosimendan administration versus no levosimendan administration in patients treated with VA-ECMO. The primary outcome was time to successful ECMO weaning. The secondary outcomes were 30-day and 1-year mortality. We performed a multivariable analysis to adjust for confounding at baseline.

Results

Two hundred and thirty-nine patients were included in the study allowing building a nested trials cohort of 1434 copies of patients. No association of levosimendan treatment and VA-ECMO weaning was found (HR = 0.91, [0.57; 1.45], p = 0.659 in multivariable analysis), or 30-day mortality (OR = 1.03, [0.52; 2.03], p = 0.940) and 1-year mortality (OR = 1.00, [0.53; 1.89], p = 0.999).

Conclusions

Using the emulated target trial framework, this study did not find any association of levosimendan treatment and ECMO weaning success after postcardiotomy cardiogenic shock. However, the population of interest remains heterogeneous and subgroups might benefit from levosimendan.
Knee pain in young sports players aged 6–15 years: a cross-sectional study in Japan
Authors: Iwatsu Jun , Yabe Yutaka , Sekiguchi Takuya , Momma Haruki , Tsuchiya Masahiro , Kanazawa Kenji , Yoshida Shinichirou , Sogi Yasuhito , Nagatomi Ryoichi , Hagiwara Yoshihiro
Published: February 2023

Background

Knee is the most commonly injured part of the body in young athletes. Knee pain in several studies have been seen to be more prevalent in active adolescents compared to inactive, although common in both groups. Nevertheless, few studies with large sample size have been published reporting the difference of the prevalence of knee pain for each sport among young sports players. This study investigated the point prevalence of knee pain among young sports players aged 6–15 years old according to age, sex, and sports discipline. Furthermore, this study investigated the association between knee pain and sports discipline among young sports players.

Methods

A cross-sectional study was conducted using a self-reported questionnaire on young sports players aged 6–15 years from the Miyagi Amateur Sports Association. Multivariable logistic regression models were used to examine the association between knee pain and sports discipline and were adjusted for age, sex, body mass index (BMI), training days per week, and training hours per weekday and weekend.

Results

A total of 7234 young sports players were included. The point prevalence of knee pain was 10.9%. Females (13.3%) had more knee pain than males (9.8%). Young, 13-year-old sports players had the highest prevalence of knee pain (19.1%). The multivariable analysis showed that the highest odds ratio [95% confidence interval] was observed for handball players (2.42 [1.01–5.81]). In addition, hand ball, mini-basketball (odds ratio 1.85; 95% CI 1.38–2.47), and basketball (odds ratio 1.66; 95% CI 1.23–2.26) were significantly associated with knee pain, compared with football. The lowest odds ratio was observed for swimming (0.34 [0.05–2.54]), followed by karate (odds ratio 0.38; 95% CI 0.16–0.89) and baseball (odds ratio 0.47; 95% CI 0.35–0.64).

Conclusion

The prevalence of knee pain among young athletes differed according to age, sex, and sports discipline. Their parents and clinicians should recognize this information to manage knee pain among young sports players.
Outcomes after cardiac rehabilitation in patients following repair of thoracic aortic aneurysm or dissection: a protocol for a systematic review and meta-analysis
Authors: Koenders Niek , van Zetten Henrita , Smulders Michelle , Verra Martin L. , van Kimmenade Roland R. J. , van Brakel Thomas , Eijsvogels Thijs M. H. , Smith Tim
Published: February 2023

Background

Patients receiving thoracic aortic repair suffer from long-term impairment in daily functioning and quality of life following intervention due to a combination of their life-threatening condition (i.e. aortic aneurysm or dissection), undergoing major surgery, as well as long-term exercise restrictions thereafter. Despite the known risks of exercise, it is vital that patients regain physical activity in order to recover their daily functioning and quality of life. Cardiac rehabilitation could be a safe and effective treatment to support patients to become physically active by providing exercise training, comprehensive rehabilitation services, and safety recommendations. Despite new insights in recent literature and clinical practice, international guidelines do not recommend cardiac rehabilitation due to limited evidence. We aim to fill this knowledge gap by performing a systematic review and meta-analysis on the effectiveness of cardiac rehabilitation in patients following thoracic aortic repair.

Methods

This protocol has been developed following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). MEDLINE, Embase, and CINAHL will be searched for eligible observational and interventional studies from inception up to April 2022. Screening (title/abstract and full text), data extraction, risk of bias assessment, and therapeutic validity rating will be conducted by two independent reviewers. A random-effects model will be used to meta-analyse performance-based outcomes, patient-reported outcomes, clinician-reported outcomes, and researcher-reported outcomes. Subsequently, meta-bias and confidence in evidence will be analysed by two independent reviewers.

Discussion

To exercise or not to exercise in patients following thoracic aortic repair has been a topic of discussion for years. The intended systematic review and meta-analysis will provide comprehensive evidence on the effectiveness of phase III outpatient exercise-based cardiac rehabilitation in patients following thoracic aortic repair. Findings from this review may inform future guidelines for the management of patients with thoracic aortic disease.

Systematic review registration

PROSPERO CRD42022301204.
Impacts of small-scale irrigation water use on environmental flow of ungauged rivers in Africa
Authors: Geleta Yohannes , Simane Belay , Assefa Engdawork , Haileslassie Amare
Published: February 2023

Failure in Environmental flow in quantity, timing, and quality leads to failure to support ecosystems, human livelihoods, and well-being. Irrigation water use is one of the main actors in impacting the water flow of rivers in quantity and time but was not well investigated in many ungauged catchments under smallholder irrigation systems. This study examined the impact of irrigation water use on environmental flow in Arata's small ungauged catchment. The study estimated the flow in sub-catchment using the area ratio method, the crop irrigation water requirement using F.A.O. cropwat 8.0, and the water balance in the Water Evaluation and Planning System tool and the environmental flow in Tennants, Q95, asnd local area thumb rule. The result showed that the minimum environmental flow of the Arata catchment is 290, 310, and 60 li/sec in the Tennant, Q95, and the local thumb rule. Irrigation consumes only 9% of the water resources of the catchment while 91% is contributed to downstream lake Ziway via Ketar river. January and February have unmet water demand and zero environmental flow. In December Tennant's 10% and Q95 recommended environmental flow had 19% and 24% deficit while the thumb rule environmental flow is 291% more than the minimum requirement. The rest of the months are by far more than the minimum environmental flow requirement. Given the result, meeting the environmental flow of the system throughout the year needs the installation of a water storage facility from upstream to downstream, the introduction of different water-saving irrigation technologies, farmers' capacity building in irrigation water management, and a standardized environmental flow estimation mechanism.
Coping with COVID in corrections: a qualitative study among the recently incarcerated on infection control and the acceptability of wastewater-based surveillance
Authors: Riback Lindsey R. , Dickson Peter , Ralph Keyanna , Saber Lindsay B. , Devine Rachel , Pett Lindsay A. , Clausen Alyssa J. , Pluznik Jacob A. , Bowden Chava J. , Sarrett Jennifer C. , Wurcel Alysse G. , Phillips Victoria L. , Spaulding Anne C. , Akiyama Matthew J.
Published: February 2023

Background

Correctional settings are hotspots for SARS-CoV-2 transmission. Social and biological risk factors contribute to higher rates of COVID-19 morbidity and mortality among justice-involved individuals. Rapidly identifying new cases in congregate settings is essential to promote proper isolation and quarantine. We sought perspectives of individuals incarcerated during COVID-19 on how to improve carceral infection control and their perspectives on acceptability of wastewater-based surveillance (WBS) accompanying individual testing.

Methods

We conducted semi-structured interviews with 20 adults who self-reported being incarcerated throughout the United States between March 2020 and May 2021. We asked participants about facility enforcement of the Centers for Disease Control and Prevention (CDC) COVID-19 guidelines, and acceptability of integrating WBS into SARS-CoV-2 monitoring strategies at their most recent facility. We used descriptive statistics to characterize the study sample and report on acceptability of WBS. We analyzed qualitative data thematically using an iterative process.

Results

Participants were predominantly Black or multiple races (50%) and men (75%); 46 years old on average. Most received a mask during their most recent incarceration (90%), although only 40% received counseling on proper mask wearing. A quarter of participants were tested for SARS-CoV-2 at intake. Most (70%) believed they were exposed to the virus while incarcerated. Reoccurring themes included (1) Correctional facility environment leading to a sense of insecurity, (2) Perceptions that punitive conditions in correctional settings were exacerbated by the pandemic; (3) Importance of peers as a source of information about mitigation measures; (4) Perceptions that the safety of correctional environments differed from that of the community during the pandemic; and (5) WBS as a logical strategy, with most (68%) believing WBS would work in the last correctional facility they were in, and 79% preferred monitoring SARS-CoV-2 levels through WBS rather than relying on just individual testing.

Conclusion

Participants supported routine WBS to monitor for SARS-CoV-2. Integrating WBS into existing surveillance strategies at correctional facilities may minimize the impact of future COVID-19 outbreaks while conserving already constrained resources. To enhance the perception and reality that correctional systems are maximizing mitigation, future measures might include focusing on closer adherence to CDC recommendations and clarity about disease pathogenesis with residents.
The role of artificial intelligence in the treatment of obstructive sleep apnea
Authors: Brennan Hannah L. , Kirby Simon D.
Published: February 2023

Background

The first-line and most common treatment for obstructive sleep apnea is nasal continuous positive airway pressure, which serves as a pneumatic splint to stabilize the upper airway and is effective when used with appropriate adherence. Continuous positive airway pressure compliance rates remain significantly low despite machine improvements and compliance intervention. Other treatment options include oral appliances, myofunctional therapy, and surgery. The aim of this project is to elucidate the role of artificial intelligence within improving the treatment of obstructive sleep apnea.

Methods

Related publications between 1999 and 2022 were reviewed from PubMed and Embase databases utilizing search terms “artificial intelligence,” “machine learning,” “obstructive sleep apnea,” and “treatment.” Both authors independently screened the results by title/abstract then by full text review. 126 non-duplicate articles were screened, 38 articles were included after title and abstract screen and 30 articles were included after full text review. The inclusion criteria are outline in the PICO framework and involved studies focused on artificial intelligence application in guiding and evaluating obstructive sleep apnea treatment. Non-English articles were excluded.

Results

The role of artificial intelligence in the treatment of OSA was categorized into the following sections: Predicting treatment outcomes of various treatment options, Improving/Evaluating treatment, and Personalizing treatment with improving understanding of underlying mechanisms of OSA.

Conclusions

Artificial intelligence has the capacity to improve the treatment of OSA through predicting outcomes of treatment options, evaluating the treatment the patient is currently utilizing and increasing understanding of the mechanisms that contribute to OSA disease process and physiology. Implementing AI in guiding treatment decisions allows patients to connect with treatment methods that would be most effective on an individual basis.