bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of complicated diaphragmatic hernia in the acute setting: a WSES position paper
Authors: Giuffrida Mario , Perrone Gennaro , Abu-Zidan Fikri , Agnoletti Vanni , Ansaloni Luca , Baiocchi Gian Luca , Bendinelli Cino , Biffl Walter L. , Bonavina Luigi , Bravi Francesca , Carcoforo Paolo , Ceresoli Marco , Chichom-Mefire Alain , Coccolini Federico , Coimbra Raul , de’Angelis Nicola , de Moya Marc , De Simone Belinda , Di Saverio Salomone , Fraga Gustavo Pereira , Galante Joseph , Ivatury Rao , Kashuk Jeffry , Kelly Michael Denis , Kirkpatrick Andrew W. , Kluger Yoram , Koike Kaoru , Leppaniemi Ari , Maier Ronald V. , Moore Ernest Eugene , Peitzmann Andrew , Sakakushev Boris , Sartelli Massimo , Sugrue Michael , Tian Brian W. C. A. , Broek Richard Ten , Vallicelli Carlo , Wani Imtaz , Weber Dieter G. , Docimo Giovanni , Catena Fausto
Published: July 2023

Background

Diaphragmatic hernia (DH) presenting acutely can be a potentially life-threatening condition. Its management continues to be debatable.

Methods

A bibliographic search using major databases was performed using the terms “emergency surgery” “diaphragmatic hernia,” “traumatic diaphragmatic rupture” and “congenital diaphragmatic hernia.” GRADE methodology was used to evaluate the evidence and give recommendations.

Results

CT scan of the chest and abdomen is the diagnostic gold standard to evaluate complicated DH. Appropriate preoperative assessment and prompt surgical intervention are important for a clinical success. Complicated DH repair is best performed via the use of biological and bioabsorbable meshes which have proven to reduce recurrence. The laparoscopic approach is the preferred technique in hemodynamically stable patients without significant comorbidities because it facilitates early diagnosis of small diaphragmatic injuries from traumatic wounds in the thoraco-abdominal area and reduces postoperative complications. Open surgery should be reserved for situations when skills and equipment for laparoscopy are not available, where exploratory laparotomy is needed, or if the patient is hemodynamically unstable. Damage Control Surgery is an option in the management of critical and unstable patients.

Conclusions

Complicated diaphragmatic hernia is a rare life-threatening condition. CT scan of the chest and abdomen is the gold standard for diagnosing the diaphragmatic hernia. Laparoscopic repair is the best treatment option for stable patients with complicated diaphragmatic hernias. Open repair is considered necessary in majority of unstable patients in whom Damage Control Surgery can be life-saving.
The patient-related factors in revision procedures on tibia of patients with osteogenesis imperfecta treated with the Peter-Williams nail
Authors: Zhu Wenbiao , Xiong Yang , Li Bo , Yang Hongjiang , Xing Cong , Ren Xiuzhi , Ning Guangzhi
Published: July 2023

Objective

To investigate the patient-related factors that affect the revision rate for the tibia in patients with osteogenesis imperfecta treated with the Peter-Williams nail, and to explore the relationship between the risk factors and complications postsurgery.

Methods

We retrospectively analysed the data of 211 patients (93 females (44.08%) and 118 males (55.92%)) with osteogenesis imperfecta treated with Peter-Williams. The factors affecting surgical revision were analysed by performing binary logistic regression. Then, a total of 211 patients with type III, type I or type IV OI were divided into five groups according to the results of regression. Statistical comparison of these groups was performed to further investigate the relationship between patient-related factors and revision procedures. Statistical comparison was also performed to analyse the relationship between the classification and postoperative complications.

Results

Among the 211 patients who underwent surgery, 40 had type I OI, 109 had type IV OI, and 62 had type III OI. Binary logistic regression revealed that the classification (OR = 3.32, 95% CI 1.06–10.39, P = 0.039) and initial operation age (OR = 0.83, 95% CI 0.76–0.92, P < 0.001) were significantly correlated with revision procedures. In type III patients, the initial operation age was significantly correlated with revision procedures (P < 0.001), and the revision rate was lower in patients aged 9 to12 years (P = 0.001). In type I and IV patients, the initial operation age was not significantly correlated with revision procedures (P = 0.281). Classification had a significant effect on postoperative deformity (P = 0.003).

Conclusions

The study reported that the age of initial surgery and classification were the influencing factors affecting the revision procedures of tibia in patients with osteogenesis imperfecta treated with the Peter-Williams nail. In patients with type III disease, the revision rate was lower individuals aged 9–12 years old, and a higher incidence of postoperative deformity was observed.
Identification and evaluation of circulating exosomal miRNAs for the diagnosis of postmenopausal osteoporosis
Authors: Sun Zhibang , Shi Junjie , Yang Chenyang , Chen Xukun , Chu Jiaqi , Chen Jing , Wang Yuan , Zhu Chenxin , Xu Jinze , Tang Guozhen , Shao Song
Published: July 2023

Background

Postmenopausal osteoporosis (PMOP) is a common condition that leads to a loss of bone density and an increased risk of fractures in women. Recent evidence suggests that exosomal miRNAs are involved in regulating bone development and osteogenesis. However, exosomal miRNAs as biomarkers for PMOP diagnosis have not been systematically evaluated. In this study, we aim to identify PMOP-associated circulating exosomal miRNAs and evaluate their diagnostic performance.

Methods

We performed next-generation sequencing and bioinformatics analysis of plasma exosomal miRNAs from 12 PMOP patients and 12 non-osteoporosis controls to identify PMOP-associated exosomal miRNAs, and then validated them in an independent natural community cohort with 26 PMOP patients and 21 non-osteoporosis controls. Exosomes were isolated with the size exclusion chromatography method from the plasma of elder postmenopausal women. The plasma exosomal miRNA profiles were characterized in PMOP paired with controls with next-generation sequencing. Potential plasma exosomal miRNAs were validated by qRT-PCR in the validation cohort, and their performance in diagnosing PMOP was systematically evaluated with the receiver operating characteristic curve.

Results

Twenty-seven miRNAs were identified as differentially expressed in PMOP versus controls in sequencing data, of which six exosomal miRNAs (miR-196-5p, miR-224-5p, miR320d, miR-34a-5p, miR-9-5p, and miR-98-5p) were confirmed to be differentially expressed in PMOP patients by qRT-PCR in the validation cohort. The three miRNAs combination (miR-34a-5p + miR-9-5p + miR-98-5p) demonstrated the best diagnostic performance, with an AUC = 0.734. In addition, the number of pregnancies was found to be an independent risk factor that can improve the performance of exosomal miRNAs in diagnosing PMOP.

Conclusions

These results suggested that the plasma exosomal miRNAs had the potential to serve as noninvasive diagnostic biomarkers for PMOP.
Biochemical and molecular features of chinese patients with glutaric acidemia type 1 from Fujian Province, southeastern China
Authors: Zhou Jinfu , Li Guilin , Deng Lin , Zhao Peiran , Zeng Yinglin , Qiu Xiaolong , Luo Jinying , Xu Liangpu
Published: July 2023

Background

Glutaric acidemia type 1 (GA1) is a rare autosomal recessive inherited metabolic disorder caused by variants in the gene encoding the enzyme glutaryl-CoA dehydrogenase (GCDH). The estimated prevalence of GA1 and the mutational spectrum of theGCDHgene vary widely according to race and region. The aim of this study was to assess the acylcarnitine profiles and genetic characteristics of patients with GA1 in Fujian Province, southeastern China.

Results

From January 2014 to December 2022, a total of 1,151,069 newborns (631,016 males and 520,053 females) were screened using MS/MS in six newborn screening (NBS) centers in Fujian Province and recruited for this study. Through NBS, 18 newborns (13 females and 5 males) were diagnosed with GA1. Thus, the estimated incidence of GA1 was 1 in 63,948 newborns in Fujian province. In addition, 17 patients with GA1 were recruited after clinical diagnosis. All but one patient with GA1 had a remarkable increase in glutarylcarnitine (C5DC) concentrations. The results of urinary organic acid analyses in 33 patients showed that the concentration of glutaric acid (GA) increased in all patients. The levels of C5DC and GA in patients identifiedviaNBS were higher than those in patients identifiedviaclinical diagnosis (P < 0.05). A total of 71 variants of 70 alleles were detected in patients with GA1, with 19 different pathogenic variants identified. The three most prevalent variants represented 73.23% of the total and were c.1244-2 A > C, p.(?) (63.38%), c.1261G > A, p.Ala421Thr (5.63%), and c.406G > T, p.Gly136Cys (4.22%). The most abundant genotype observed was c.[1244-2 A > C]; [1244-2 A > C] (18/35, 52.43%) and its phenotype corresponded to high excretors (HE, GA > 100 mmol/mol Cr).

Conclusions

In conclusion, we investigated the biochemical and molecular features of 35 unrelated patients with GA1. C5DC concentrations in dried blood spots and urinary GA are effective indicators for a GA1 diagnosis. Our study also identified aGCDHvariant spectrum in patients with GA1 from Fujian Province, southeastern China. Correlation analysis between genotypes and phenotypes provides preliminary and valuable information for genetic counseling and management.
Cancerogenic parasites in veterinary medicine: a narrative literature review
Authors: Fonti Niccolò , Parisi Francesca , Mancianti Francesca , Freer Giulia , Poli Alessandro
Published: July 2023

Parasite infection is one of the many environmental factors that can significantly contribute to carcinogenesis and is already known to be associated with a variety of malignancies in both human and veterinary medicine. However, the actual number of cancerogenic parasites and their relationship to tumor development is far from being fully understood, especially in veterinary medicine. Thus, the aim of this review is to investigate parasite-related cancers in domestic and wild animals and their burden in veterinary oncology. Spontaneous neoplasia with ascertained or putative parasite etiology in domestic and wild animals will be reviewed, and the multifarious mechanisms of protozoan and metazoan cancer induction will be discussed.
Pre-notifications increase retention in a 17-year follow-up of adolescents born very preterm
Authors: Helin Minttu , Karukivi Max , Rautava Päivi , Hirvonen Milka , Huhtala Mira , Setänen Sirkku ,   on behalf of the PIPARI Study Group, Ekblad Mikael , Ekblad Satu , Ekholm Eeva , Grönroos Linda , Haataja Leena , Haveri Laura , Joensuu Eveliina , Kero Pentti , Korja Riikka , Lahti Katri , Lapinleimu Helena , Lehtonen Liisa , Lehtonen Tuomo , Leppänen Marika , Lind Annika , Maunu Jonna , Munck Petriina , Mäkilä Eeva , Nyman Anna , Parkkola Riitta , Saarinen Katriina , Saarinen Tiina , Salomäki Susanna , Saunavaara Virva , Sillanpää Matti , Stolt Suvi , Uusitalo Karoliina , Ylijoki Milla
Published: July 2023

Objective

Retention is essential in follow-up studies to reduce missing data, which can cause bias and limit the generalizability of the results. We investigated whether pre-notification letters would increase the response rates of approval forms and questionnaires and reduce the need for post-notifications in a prospective follow-up study of 17-year-old adolescents.

Study design

and settings

This long-term follow-up study included 269 adolescents were randomized (1:1) into a pre-notification group (n = 132) and a no pre-notification group (n = 137). The pre-notification letter was sent prior to the approval form and questionnaires. The outcome measures were the response rates to the approval forms and questionnaires and the rate of post-notifications required.

Results

The adolescents who received the pre-notifications were more likely to return approval forms (n = 88/132, 67%) than the adolescents who did not receive the pre-notifications (n = 79/137, 58%) (OR 1.5, 95% CI 0.9–2.4). The rates of returned questionnaires were higher in the pre-notification group (n = 82/88, 93%) than in the no pre-notification group (n = 68/79, 86%) (OR 2.2, 95% CI 0.8–6.3). The adolescents who did not receive the pre-notifications were more likely to need the post-notifications than the adolescents who received the pre-notifications (OR 3.0, 95% CI 1.4 to 6.5).

Conclusions

Pre-notifications decreased the need for post-notifications and may increase retention in 17-year-old adolescents. Based on our findings, pre-notification letters are recommended in future follow-up studies in adolescents.

Trial registration

The Ethics Review Committee of the Hospital District of South-West Finland approved the 17-year PIPARI Study protocol in January 2018 (23.1.2018; 2/180/2012). The study has been registered to the SWAT repository as SWAT 179. Filetoupload,1457904,en.pdf (qub.ac.uk).
Synthetic strategy towards novel composite based on substituted pyrido[2,1-b][1,3,4]oxadiazine-dialdehyde chitosan conjugate with antimicrobial and anticancer activities
Authors: Mohamed-Ezzat Reham A. , Hashem Amr H. , Dacrory Sawsan
Published: July 2023

Synthesis of new compounds that have biological activity is an indispensible issue in order to deal with the drug resistant bacteria. This wok reports preparation of a novel composite based on substituted pyrido[2,1-b][1,3,4] oxadiazine-dialdehyde chitosan (PODACs) conjugate. Firstly, a novel approach of synthesizing of a new substituted pyrido[2,1-b][1,3,4]oxadiazine-7-carboxylic acid (PO) is reported through reacting(Z)-N’-(1-(3-aminophenyl)ethylidene)-2-cyanoacetohydrazide with (Z)-ethyl 2-cyano-3-(pyridin-3-yl)acrylate. Then Dialdehyde chitosan (DACs) has prepared via periodat oxidation of chitosan (Cs). The synthesized compounds have studied via various spectroscopic instruments to validate their chemical structure such as nuclear magnetic resonance 1 H NMR, 13 C NMR, fourier transform infrared spectroscopy (FTIR), X-ray powder diffraction (XRD), and scanning electron microscopy (SEM). The substituted pyrido [2,1-b][1,3,4]oxadiazine and the composite were evaluated for antimicrobial activity against pathogenic bacteria and unicellular fungi. The results revealed that, the composite exhibited promising antimicrobial activity against E. coli, S. aureus, B. subtilis and C. albicans where inhibition zones were 19, 18, 36 and 20 mm respectively. Furthermore, the substituted pyrido [2,1-b][1,3,4]oxadiazine and the composite were evaluated for cytotoxic activity against MCF-7 human breast cancer cell line as well as vero normal cell line. Results illustrated the prepared composite has anticancer activity against MCF7 where IC50 was 238 µg/ml.
Comparative risk of infections between JAK inhibitors versus TNF inhibitors among patients with rheumatoid arthritis: a cohort study
Authors: Choi Se Rim , Shin Anna , Ha You-Jung , Lee Yun Jong , Lee Eun Bong , Kang Eun Ha
Published: July 2023

Background

To compare infectious risk between JAK inhibitors (JAKis) versus TNF inhibitors (TNFis) among rheumatoid arthritis (RA) patients in Korea.

Methods

Using 2009–2019 Korea National Health Insurance Service database, we conducted a cohort study on RA patients initiating a JAKi or TNFi. The primary outcomes were herpes zoster (HZ), serious bacterial (SBI), and opportunistic infections (OI). Propensity-score fine-stratification (PSS) and weighting were applied to adjust for > 70 baseline covariates. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazard models comparing JAKi versus TNFi users.

Results

We included 2963 JAKi initiators PSS-weighted on 5169 TNFi initiators. During a follow-up of 1.16 years, the most frequent type of infections was HZ with incidence rate (IR) per 100 person-years of 11.54 and 4.88 in JAKi and TNFi users, respectively. The IR of SBI was 1.39 and 1.32, respectively. The OI was rare with a majority being tuberculosis and showed an IR of 0.11 and 0.49 in JAKi and TNFi users, respectively. The PSS-weighted HR (95% CI) for individual types of infections was 2.37 (2.00–2.80) for HZ, 1.04 (0.71–1.52) for SBI, and 0.25 (0.09–0.73) for OI.

Conclusions

This population-based cohort study on RA patients treated with JAKi or TNFi in Korea showed an exceptionally high IR of HZ in both treatment groups compared to that from Western countries, with an approximately doubled risk associated with JAKi versus TNFi use. The risk of SBI was comparable, but the risk of OI, particularly tuberculosis, was less among JAKi than TNFi initiators.
Therapy resistant urticaria as a long-term symptom of an incomplete Schnitzler syndrome
Authors: Puxkandl Viktoria , Currie Antonia , Hoetzenecker Wolfram , Altrichter Sabine
Published: July 2023

Background

Recurring therapy resistant hives, accompanied by IgM-gammopathy, fever and joint pain can indicate Schnitzler syndrome, a rare autoimmune disorder. There is currently no approved treatment, but complete remission of symptoms can be induced with IL-1 antagonists.

Case presentation

A patient with a history of chronic urticaria presented frequently at the outpatient clinic with severe hives and was treated unsuccessfully with antihistamines and omalizumab. After several years, additional symptoms such as joint pain, recurrent fever, and IgM-gammopathy developed. After the diagnostic criteria for Schnitzler syndrome were met, treatment with anakinra was initiated and resulted in an improvement of the symptoms. Shortly after the first injection, the patient developed large and painful erythematous lesions at the injection sites, leading to discontinuation of treatment and a rapid recurrence of symptoms. Subsequently, treatment with a longer-acting IL-1 antagonist (canakinumab) was initiated, resulting in a complete remission of symptoms.

Conclusion

This case report demonstrates that patients with urticarial symptoms that are not relieved by typical treatments should prompt repeated reassessments of the diagnosis, even years later, because gammopathy and other diagnostic criteria for Schnitzler syndrome can occur with a delay.
Pemphigus vulgaris after the second dose of COVID-19 vaccination: a case report
Authors: Khalayli Naram , Omar Abdullah , Kudsi Mayssoun
Published: July 2023

Background

As many people worldwide have been vaccinated, more triggered autoimmune bullous diseases have been noticed. We reported a case of new-onset pemphigus Vulgaris after COVID-19 vaccinations.

Case presentation

A 50 years old Syrian female presented with multiple erosions on her extremities, in addition to oral erosions and genital ulcers, after the 2nd dose of the mRNA COVID-19 vaccine. The lesions were multiple tenders and well-defined, reddish erythematous oral ulcers. At the same time the Skin examination showed hyper-pigmented patches over the extremities, a sequel of ruptured bullae. Pemphigus Vulgaris was diagnosed by histology. She continued on 35 mg/day of prednisone for another 2 weeks.

Conclusions

Pemphigus is not a contraindication to vaccination, although it may be worse or present as a first onset.
RETRACTED ARTICLE: Fusion of transformer and ML-CNN-BiLSTM for network intrusion detection
Authors: Xiang Zelin , Li Xuwei
Published: July 2023

Network intrusion detection system (NIDS) can effectively sense network attacks, which is of great significance for maintaining the security of cyberspace. To meet the requirements of efficient and accurate network status monitoring, a NIDS model using Transformer-based fusion deep learning architecture is proposed. Firstly, GAN-Cross is used to expand minority class sample data, thereby alleviating the issues of imbalanced minority class about the original dataset. Then, the Transformer module is used to adjust the ML-CNN-BiLSTM model to enhance the feature encoding ability of the intrusion model. Finally, the data enhancement model and feature enhancement model are integrated into the NIDS model, the detection model is optimized, the features of network state data are extracted at a deeper level, and the generalization ability of the detection model is enhanced. Some simulation experiments using UNSW-NB15 datasets show that the proposed fusion architecture can achieve efficient analysis of complex network traffic datasets, with an accuracy of 0.903, effectively improving the detection accuracy of NIDS and its ability to detect unknown attacks. The proposed model has good application value in ensuring the stable operation of network systems.
Optimizing task offloading and resource allocation in edge-cloud networks: a DRL approach
Authors: Ullah Ihsan , Lim Hyun-Kyo , Seok Yeong-Jun , Han Youn-Hee
Published: July 2023

Edge-cloud computing is an emerging approach in which tasks are offloaded from mobile devices to edge or cloud servers. However, Task offloading may result in increased energy consumption and delays, and the decision to offload the task is dependent on various factors such as time-varying radio channels, available computation resources, and the location of devices. As edge-cloud computing is a dynamic and resource-constrained environment, making optimal offloading decisions is a challenging task. This paper aims to optimize offloading and resource allocation to minimize delay and meet computation and communication needs in edge-cloud computing. The problem of optimizing task offloading in the edge-cloud computing environment is a multi-objective problem, for which we employ deep reinforcement learning to find the optimal solution. To accomplish this, we formulate the problem as a Markov decision process and use a Double Deep Q-Network (DDQN) algorithm. Our DDQN-edge-cloud (DDQNEC) scheme dynamically makes offloading decisions by analyzing resource utilization, task constraints, and the current status of the edge-cloud network. Simulation results demonstrate that DDQNEC outperforms heuristic approaches in terms of resource utilization, task offloading, and task rejection.
A practical hybrid approach to the problem of surveying a working historical bell considering innovative measurement methods
Authors: Skrzypczak Izabela , Oleniacz Grzegorz , Leśniak Agnieszka , Mrówczyńska Maria , Rymar Marta , Oleksy Mariusz
Published: July 2023

The article proposes using a novel hybrid measurement method, with expected precision results, to determine the characteristic of the historic, 17th-century bell. In an interdisciplinary approach, modern and non-invasive physical and chemical measurement methods were used. Based on the monitoring (measurements and laser scanning), a three-dimensional geometric model was built to calculate the bell size and analyze its condition depending on material consumption. Next, chemical measures of the bell samples were carried out to determine the material properties. For that purpose, advanced precision microscopic techniques were used. Based on the geometric model and chemical studies, the material properties and density of the bronze were determined using additive assumptions. Measurement accuracy and data quality were evaluated statistically. The method allows reliably determining the bell's weight without needing to dismantle it or external intervention. The approach is helpful for practitioners performing conservation work on such objects.
Artificial intelligence and ChatGPT in Orthopaedics and sports medicine
Authors: Fayed Aly M. , Mansur Nacime Salomao Barbachan , de Carvalho Kepler Alencar , Behrens Andrew , D’Hooghe Pieter , de Cesar Netto Cesar
Published: July 2023

Artificial intelligence (AI) is looked upon nowadays as the potential major catalyst for the fourth industrial revolution. In the last decade, AI use in Orthopaedics increased approximately tenfold. Artificial intelligence helps with tracking activities, evaluating diagnostic images, predicting injury risk, and several other uses. Chat Generated Pre‐trained Transformer (ChatGPT), which is an AI‐chatbot, represents an extremely controversial topic in the academic community. The aim of this review article is to simplify the concept of AI and study the extent of AI use in Orthopaedics and sports medicine literature. Additionally, the article will also evaluate the role of ChatGPT in scientific research and publications.

Level of evidence: Level V, letter to review.
Development, feasibility testing and perceived benefits of a new app to help with adherence to antiretroviral therapy in people living with HIV in Brazil
Authors: Schaab Bruno Luis , Remor Eduardo
Published: July 2023

Background

Despite the availability of antiretroviral therapy (ART) in many countries, people living with HIV still experience difficulties with treatment. We propose a new smartphone mobile application to assist in adherence to ART. This study aimed to describe this new mobile application’s development (content construction and usability), feasibility testing (recruitment, retention rates [attendance], satisfaction) and primary perceived benefits.

Methods

Two consecutive studies were conducted. First, people living with HIV, health care workers and experts in information technology provided feedback to improve the content and usability of the app. After changes in the app were implemented according to the feedback, a second study was performed to assess the feasibility and perceived benefits. Effects on self-reported adherence and perceived well-being were also assessed.

Results

Scores of participants (N = 11) showed differences in adherence (effect size .43) and well-being (effect size .45) after using the app. However, the differences did not reach statistical significance. Observing scores individually, six out of 11 participants improved their overall adherence scores, and seven out of 11 participants improved their perceived well-being scores. Recruitment was 95%, and attendance at sessions was 62.5%. In general, the participants were satisfied with the intervention and viewed the app as an informative tool.

Conclusion

The results are promising and allow us to recommend further studies with the app.
Comparative study of exclusive breastfeeding practice among employed mothers and housewives in Tanzania
Authors: Ngao Oscar D. , Mboineki Joanes Faustine
Published: July 2023

Background

Exclusive breastfeeding (EBF) is a global concern as it is associated with infant protection against gastrointestinal infections, reduces newborn mortality and prevents a child from becoming overweight or obese. Even though some studies have reported high EBF practices among housewives compared to employed mothers, the influences of practices among the two groups are little documented.

Objectives

The study aimed at comparing the EBF among employed mothers and housewives in Tanzania.

Methodology

The study was a facility-based comparative cross-sectional study, with a sample size of 246 mothers of children less than 6 months. Convenience sampling was used to select participants. Data were collected by using a validated questionnaire and analyzed by Statistical Package for Social Science, version 23, through descriptive statistics (frequency, proportion and mean) and inferential statistics (Chi-square test (χ2) and binary logistic regression).

Results

The findings show that 106 (80.9%) of housewives had good EBF compared to 78 (67.8%) employed mothers, which was a significant difference (χ2 = 5.57; P = 0.019). One hundred and seven (81.7%) housewives had adequate knowledge of EBF compared to 84 (73%) employed mothers, but the knowledge between them was not significantly different (χ2 = 2.63; P = 0.071). For employed mothers, only age was significantly associated with EBF (χ2 = 39.49; P = 0.006), while for housewives, none of the sociodemographic characteristics was significantly associated with EBF.

Conclusion

EBF practice was higher among housewives as compared to employed mothers. Age was significantly associated with good practice of EBF among employed mothers. The effort should be strengthened to help employed mothers aged below 28 years to practice EBF. Different programs and approaches that are developed and implemented should target this age group to increase the rate of EBF.
Combined evaluation of blood flow and tissue perfusion in diabetic feet by intra-arterial dynamic 4DCT imaging
Authors: Boonen Pieter T. , Buls Nico , Vandemeulebroucke Jef , Van Gompel Gert , Van Den Bergh Frans , Leiner Tim , Aerden Dimitri , de Mey Johan
Published: July 2023

Critical limb ischemia is associated with high mortality and major amputations. Intra-arterial digital subtraction angiography (IADSA) has been the reference standard but has some shortcomings including the two-dimensional projection and the lack of tissue perfusion information. The aim of this exploratory study is to examine four-dimensional computed tomography (4DCT) angiography and perfusion imaging using low-volume intra-arterial contrast injections for an improved anatomic and hemodynamic assessment in patients with foot ulcers. Three patients underwent a low-volume (2 mL) intra-arterial contrast-enhanced 4DCT examination combined with a diagnostic IADSA. An automated assessment of blood flow and tissue perfusion from the 4DCT data was performed. Vascular structures and corresponding blood flows were successfully assessed and correlated well with the IADSA results. Perfusion values of the affected tissue were significantly higher compared to the unaffected tissue. The proposed 4DCT protocol combined with the minimal usage of contrast agent (2 mL) provides superior images compared to IADSA as three phases (arterial, perfusion, and venous) are captured. The obtained parameters could allow for an improved diagnosis of critical limb ischemia as both the proximal vasculature and the extent of the perfusion deficit in the microvasculature can be assessed.

Relevance statement

Intra-arterial 4DCT allows for assessing three phases (arterial, perfusion and venous) using minimal contrast (2 mL). This method could lead to an improved diagnosis of critical limb ischemia as both proximal vasculature and the extent of the perfusion deficit are assessed.

Trial registration

ISRCTN, ISRCTN95737449. Registered 14 March 2023—retrospectively registered, https://www.isrctn.com/ISRCTN95737449

Key points

• Three phases (arterial, perfusion, and venous) are obtained from 2 mL intra-arterial 4DCT.

• The obtained hemodynamic parameters correlated well with the IADSA findings.

• 4DCT surpassed IADSA in terms of assessment of venous blood flow and inflammatory hyperperfusion.

• The assessment of tissue perfusion could lead to optimizing the revascularization strategy.

Graphical Abstract
Potency and safety analysis of hemp delta-9 products: the hemp vs. cannabis demarcation problem
Authors: Johnson Lee , Malone Marc , Paulson Erik , Swider Josh , Marelius David , Andersen Susan , Black Dominic
Published: July 2023

Background

Hemp-derived delta-9 tetrahydrocannabinol (∆9 THC) products are freely available for sale across much of the USA, but the federal legislation allowing their sale places only minimal requirements on companies. Products must contain no more than 0.3% ∆9 THC by dry weight, but no limit is placed on overall dosage and there is no requirement that products are tested. However, some states—such as Colorado—specifically prohibit products created by “chemically modifying” a natural hemp component.

Methods

Fifty-three ∆9 THC products were ordered and submitted to InfiniteCAL laboratory for analysis. The lab analysis considered potency, the presence of impurities, and whether the ∆9 THC present was natural or converted from CBD. The presence of age verification, company-conducted testing, and warning labels was also considered.

Results

While 96.2% of products were under the legal ∆9 THC limit, 66.0% differed from their stated dosage by more than 10%, and although 84.9% provided a lab report to customers, 71.1% of these did not check for impurities. Additionally, 49% of products converted CBD to THC to achieve their levels, and only 15.1% performed age verification at checkout.

Conclusions

Despite some positive findings, the results show that hemp ∆9 THC companies offer inaccurately labeled products that contain more THC than would be allowed in adult-use states. This raises serious issues around consumer safety, and consent when consuming intoxicating products. Steps to boost accountability for companies must be considered by either the industry or lawmakers if intoxicating hemp products are to remain on the market safely.
Bridging online and offline dynamics of the face mask infodemic
Authors: Uyheng Joshua , Robertson Dawn C. , Carley Kathleen M.
Published: July 2023

Background

Online infodemics have represented a major obstacle to the offline success of public health interventions during the COVID-19 pandemic. Offline contexts have likewise fueled public susceptibility to online infodemics. We combine a large-scale dataset of Twitter conversations about face masks with high-performance machine learning tools to detect low-credibility information, bot activity, and stance toward face masks in online conversations. We match these digital analytics with offline data regarding mask-wearing and COVID-19 cases to investigate the bidirectional online-offline dynamics of the face mask infodemic in the United States.

Results

Online prevalence of anti-mask over pro-mask stance predicts decreased offline mask-wearing behavior and subsequently increased COVID-19 infections. These effects are partially influenced by low-credibility information and automated bot activity, which consistently feature greater anti-mask stance online. Despite their purported controversy, mask mandates generally decrease anti-mask stance online and increase mask-wearing offline, thus reducing future COVID-19 infections. Notable asymmetries are observed, however, between states run by Democratic and Republican governors: the latter tend to see higher levels of low-credibility information and anti-mask stance online, and thus lower mask-wearing and higher infection rates offline.

Conclusions

These findings contribute new insights around collective vulnerabilities to online infodemics and their links to evolving offline crises. We highlight the need to synergize and sustain targeted online campaigns from legitimate information sources alongside offline interventions in and beyond the pandemic.
Clonal architecture and evolutionary history of Waldenström's macroglobulinemia at the single-cell level
Authors: García-Sanz Ramón , García-Álvarez María , Medina Alejandro , Askari Elham , González-Calle Verónica , Casanova María , de la Torre-Loizaga Igor , Escalante-Barrigón Fernando , Bastos-Boente Miguel , Bárez Abelardo , Vidaña-Bedera Nerea , Alonso José María , Sarasquete María Eugenia , González Marcos , Chillón María Carmen , Alcoceba Miguel , Jiménez Cristina
Published: July 2023

To provide insight into the subclonal architecture and co-dependency patterns of the alterations in Waldenström's macroglobulinemia (WM), we performed single-cell mutational and protein profiling of eight patients. A custom panel was designed to screen for mutations and copy number alterations at the single-cell level in samples taken from patients at diagnosis (n=5) or at disease progression (n=3). Results showed that in asymptomatic WM at diagnosis, MYD88L265P was the predominant clonal alteration; other events, if present, were secondary and subclonal to MYD88L265P. In symptomatic WM, clonal diversity was more evident, uncovering combinations of alterations that synergized to promote clonal expansion and dominance. At disease progression, a dominant clone was observed, sometimes accompanied by other less complex minor clones, which could be consistent with a clonal selection process. Clonal diversity was also reduced, probably due to the effect of treatment. Finally, we combined protein expression with mutational analysis to map somatic genotype with the immunophenotype. Our findings provide a comprehensive view of the clonality of tumor populations in WM and how clonal complexity can evolve and impact disease progression.
Kinetic Analysis of Redox-active Aromatic Compounds Using Confinement Effects
Authors: Nakasone Kaiya , Katsuhara Kureo , Takimoto Daisuke
Published: July 2023

The kinetic analysis of electroactive molecules has contributed to developing electrode materials for energy storage systems. In this work, we studied the applicability of the confinement effect to evaluate the redox reaction kinetics for quinone- and anthraquinone-based molecules. The kinetics of the redox reactions corresponded well with previously reported theoretical calculation results, suggesting that this novel method can be used as a simple method to investigate the redox reaction kinetics of quinone- and anthraquinone-based molecules.
Self-Reported Signaling
Authors: Jungbauer Thomas , Waldman Michael
Published: July 2023

In many real-world settings, an action that affects the value of a product or service is self-reported rather than publicly observable. We investigate self-reporting when self-reports serve as a signal of sender productivity. In our model, a sender chooses an action and then sends a message concerning the action to multiple receivers. Receivers then bid for the sender’s service after deciding whether to audit the sender. We find that self-reporting can reverse the standard result in signaling models that there is overinvestment in the action and that the possibility of misrepresentation may in fact improve welfare given self-reported signaling. (JEL D82, D83, I23, I26, J24)
Decreasing Impatience
Authors: Chambers Christopher P. , Echenique Federico , Miller Alan D.
Published: July 2023

We characterize decreasing impatience, a common behavioral phenomenon in intertemporal choice. Discount factors that display decreasing impatience are characterized through a convexity axiom for investments at fixed interest rates. Then we show that they are equivalent to a geometric average of generalized quasi-hyperbolic discount rates. Finally, they emerge through parimutuel preference aggregation of exponential discount factors. (JEL D15, D61, D91)
Bargaining over Treatment Choice under Disagreement
Authors: Al-Najjar Nabil I. , Gary-Bobo Robert J.
Published: July 2023

A group of experts with different prior beliefs must choose a treatment. A dataset is made public and leads to revisions of beliefs. We propose a model where the experts’ disagreements are resolved through bargaining, using the Nash bargaining solution. Experts bargain after disclosure of the dataset. Bargaining may lead to an inefficient use of information in a strong sense: experts receive a lower payoff in every state and for any prior belief (i.e., inadmissibility). Bargaining exhibits underreaction to information as compared to the normative solution in which experts bargain ex ante on the procedure used to exploit the data. (JEL C78, D82, D83)
The impact of mismatch repair status and systemic inflammatory markers on radiological staging in colon cancer
Authors: Platt James R , Ansett Jennifer , Seligmann Jenny F , West Nicholas P , Tolan Damian J M
Published: July 2023

Objective:

Mismatch repair (MMR) deficient (dMMR) colon cancer (CC) is distinct from MMR proficient (pMMR) CC, yet the impact of MMR status on radiological staging is unclear. The purpose of this study was to investigate how MMR status impacts CC CT staging.

Methods:

We retrospectively compared CT staging accuracy between dMMR and pMMR CC patients undergoing curative resection. Accuracy was assessed as individual tumour (T)/nodal (N) stages and as dichotomous “statuses” (T1/2 vs T3/4; N0 vs N1/2). Patient characteristics were analysed for factors to support staging.

Results:

There was no significant difference in overall staging accuracy between the dMMR (44 patients) and pMMR (57 patients) groups. dMMR tumours with incorrect N stage/“status” were more likely to be overstaged than pMMR tumours (90% vs 59%; p = 0.023 for “N status”). Platelet count, CRP and neutrophil count (AUC 0.76 (p = 0.0078), 0.75 (p = 0.034) and 0.70 (p = 0.044), respectively) were associated with “N status” in dMMR tumours.

Conclusion:

Whilst overall staging accuracy was similar between groups, incorrectly N staged dMMR tumours were more likely to be overstaged than pMMR tumours, risking inappropriate surgical or neoadjuvant treatment. We describe novel relationships between several inflammatory markers and pathological “N status” in dMMR CC, which if integrated into routine practice may improve CT staging accuracy.

Advances in knowledge:

Compared to pMMR CC, dMMR CC is at significant risk of N overstaging. Platelet count, CRP and neutrophil count are higher in dMMR CC patients with nodal metastases than those without, and their role in refining clinical staging requires further investigation.
Interpretable artificial intelligence in radiology and radiation oncology
Authors: Cui Sunan , Traverso Alberto , Niraula Dipesh , Zou Jiaren , Luo Yi , Owen Dawn , El Naqa Issam , Wei Lise
Published: July 2023

Artificial intelligence has been introduced to clinical practice, especially radiology and radiation oncology, from image segmentation, diagnosis, treatment planning and prognosis. It is not only crucial to have an accurate artificial intelligence model, but also to understand the internal logic and gain the trust of the experts. This review is intended to provide some insights into core concepts of the interpretability, the state-of-the-art methods for understanding the machine learning models, the evaluation of these methods, identifying some challenges and limits of them, and gives some examples of medical applications.
Insights into acute mesenteric ischaemia: an up-to-date, evidence-based review from a mesenteric stroke centre unit
Authors: Garzelli Lorenzo , Ben Abdallah Iannis , Nuzzo Alexandre , Zappa Magaly , Corcos Olivier , Dioguardi Burgio Marco , Cazals-Hatem Dominique , Rautou Pierre-Emmanuel , Vilgrain Valérie , Calame Paul , Ronot Maxime
Published: July 2023

Radiologists play a central role in the diagnostic and prognostic evaluation of patients with acute mesenteric ischaemia (AMI). Unfortunately, more than half of AMI patients undergo imaging with no prior suspicion of AMI, making identifying this disease even more difficult. A confirmed diagnosis of AMI is ideally made with dynamic contrast-enhanced CT but the diagnosis may be made on portal-venous phase images in appropriate clinical settings. AMI is diagnosed on CT based on the identification of vascular impairment and bowel ischaemic injury with no other cause. Moreover, radiologists must evaluate the probability of bowel necrosis, which will influence the treatment options.

AMI is usually separated into different entities: arterial, venous, non-occlusive and ischaemic colitis. Arterial AMI can be occlusive or stenotic, the dominant causes being atherothrombosis, embolism and isolated superior mesenteric artery (SMA) dissection. The main finding in the bowel is decreased wall enhancement, and necrosis can be suspected when dilatation >25 mm is identified. Venous AMI is related to superior mesenteric vein (SMV) thrombosis as a result of a thrombophilic state (acquired or inherited), local injury (cancer, inflammation or trauma) or underlying SMV insufficiency. The dominant features in the bowel are hypoattenuating wall thickening with submucosal oedema. Decreased enhancement of the involved bowel suggests necrosis. Non-occlusive mesenteric ischaemia (NOMI) is related to impaired SMA flow following global hypoperfusion associated with low-flow states. There are numerous findings in the bowel characterised by diffuse extension. An absence of bowel enhancement and a thin bowel wall suggest necrosis in NOMI. Finally, ischaemic colitis is a sub-entity of arterial AMI and reflects localised colon ischaemia-reperfusion injury. The main CT finding is a thickened colon wall with fat stranding, which seems to be unrelated to SMA or inferior mesenteric artery lesions. A precise identification and description of vascular lesions, bowel involvement and features associated with transmural necrosis is needed to determine patient treatment and outcome.
Diffusion weighted imaging of extremity bone tumors—inter-reader analysis and incremental value over conventional MR imaging
Authors: Guirguis Mina , Gupta Anurag , Thakur Uma , Pezeshk Parham , Weatherall Paul , Sharan Gaurav , Xi Yin , Chhabra Avneesh
Published: July 2023

Objective:

To determine whether the addition of diffusion-weighted imaging (DWI) to conventional MRI improves diagnostic accuracy of bone tumor characterization with the hypothesis that the DWI has incremental value in the diagnosis of osseous tumors.

Methods:

In this multireader cross-sectional validation study, four musculoskeletal radiologists evaluated osseous tumors blinded to final diagnosis in two rounds—first without DWI or apparent diffusion coefficient (ADC) maps, then months later with these available. Each reader recorded a binary result as to whether the lesion is benign or malignant. Intraclass correlation (ICC) and Conger’s κ were used. Diagnostic performance measures including area under the receiver operating curve (AUC) were reported.

Results:

133 osseous tumors of the extremities (76 benign, 57 malignant) were tested. Blinded to DWI, average reader sensitivity, specificity, positive-predictive value, and negative-predictive value were 0.83, 0.92, 0.94, and 0.82, respectively. With DWI, the values were 0.85, 0.92, 0.94, and 0.83, respectively. Interreader agreement was good for both rounds (0.67 and 0.71, respectively, p-value > 0.05). Average reader confidence was 4.1 and 4.4, respectively (p-value < 0.001). ADC values and DWI/ADC ratios showed significant differences between benign and malignant tumors.

Conclusion:

DWI and ADC show statistically significantly different values of benign from malignant osseous tumors and mildly increased radiologist confidence with similar interreader reliability. However, given similar diagnostic accuracy, conventional MR imaging is adequate for bone tumor characterization and incremental value of DWI is limited.

Advances in knowledge:

This paper is the first of its kind to report the use of DWI/ADC ratio for the diagnosis of bone tumors.
Does the shape of the field-of-view influence the magnitude of artefacts from high-density materials in cone-beam computed tomography?
Authors: Cascante-Sequeira Deivi , Fontenele Rocharles Cavalcante , Martins Luciano Augusto Cano , Brasil Danieli Moura , Oliveira Matheus L , Freitas Deborah Queiroz , Haiter-Neto Francisco
Published: July 2023

Objective:

To compare cylindrical and convex triangular field-of-views (FOVs) concerning the magnitude of artefacts from high-density materials in cone-beam CT (CBCT).

Methods and materials:

Cylinders of amalgam, chromium-cobalt, titanium, and zirconia were individually placed in the anterior and posterior regions of a polymethylmethacrylate phantom and scanned using cylindrical and convex triangular FOVs of the Veraview X800 CBCT device. Using the Image J software, 15 square regions of interest (ROIs) were placed in the axial reconstruction around the middle level of the cylinder and at distances of 0.5, 1.0, and 1.5 cm from the centre of the cylinder. Mean grey value and standard deviation of each ROI were averaged for each distance and subtracted from the values of a control ROI to calculate the magnitude of the artefacts by the grey value mean difference (GVMD) and grey value standard deviation (GVSD). Multiway analysis of variance with Tukey post-hoc test with a significance level of 5% evaluated the effect of the shape of the FOV, position inside the FOV, high-density material, and the distance of the artefact from the material.

Results:

The convex triangular FOV increased the GVSD for all materials in the anterior and posterior regions at 0.5 cm compared to the cylindrical FOV (p < 0.0001). The convex triangular FOV showed greater GVMD for chromium-cobalt and zirconium in the anterior region and all materials in the posterior region at all distances (p < 0.0001).

Conclusion:

The FOV shape influences the magnitude of artefacts from high-density materials. The convex triangular FOV showed greater artefact magnitude with variability among the high-density materials, region in the FOV, and distance from the material.