bluuebunny/crossref_metadata_2025 huggingface dataset:
BSMM-Net: Multi-modal neural network based on bilateral symmetry for nasopharyngeal carcinoma segmentation
Authors: Zhou Haoyang , Li Haojiang , Chen Shuchao , Yang Shixin , Ruan Guangying , Liu Lizhi , Chen Hongbo
Published: January 2023

Introduction

Automatically and accurately delineating the primary nasopharyngeal carcinoma (NPC) tumors in head magnetic resonance imaging (MRI) images is crucial for patient staging and radiotherapy. Inspired by the bilateral symmetry of head and complementary information of different modalities, a multi-modal neural network named BSMM-Net is proposed for NPC segmentation.

Methods

First, a bilaterally symmetrical patch block (BSP) is used to crop the image and the bilaterally flipped image into patches. BSP can improve the precision of locating NPC lesions and is a simulation of radiologist locating the tumors with the bilateral difference of head in clinical practice. Second, modality-specific and multi-modal fusion features (MSMFFs) are extracted by the proposed MSMFF encoder to fully utilize the complementary information of T1- and T2-weighted MRI. The MSMFFs are then fed into the base decoder to aggregate representative features and precisely delineate the NPC. MSMFF is the output of MSMFF encoder blocks, which consist of six modality-specific networks and one multi-modal fusion network. Except T1 and T2, the other four modalities are generated from T1 and T2 by the BSP and DT modal generate block. Third, the MSMFF decoder with similar structure to the MSMFF encoder is deployed to supervise the encoder during training and assure the validity of the MSMFF from the encoder. Finally, experiments are conducted on the dataset of 7633 samples collected from 745 patients.

Results and discussion

The global DICE, precision, recall and IoU of the testing set are 0.82, 0.82, 0.86, and 0.72, respectively. The results show that the proposed model is better than the other state-of-the-art methods for NPC segmentation. In clinical diagnosis, the BSMM-Net can give precise delineation of NPC, which can be used to schedule the radiotherapy.
EEG Lempel-Ziv complexity varies with sleep stage, but does not seem to track dream experience
Authors: Aamodt Arnfinn , Sevenius Nilsen André , Markhus Rune , Kusztor Anikó , HasanzadehMoghadam Fatemeh , Kauppi Nils , Thürer Benjamin , Storm Johan Frederik , Juel Bjørn Erik
Published: January 2023

In a recent electroencephalography (EEG) sleep study inspired by complexity theories of consciousness, we found that multi-channel signal diversity progressively decreased from wakefulness to slow wave sleep, but failed to find any significant difference between dreaming and non-dreaming awakenings within the same sleep stage (NREM2). However, we did find that multi-channel Lempel-Ziv complexity (LZC) measured over the posterior cortex increased with more perceptual ratings of NREM2 dream experience along a thought-perceptual axis. In this follow-up study, we re-tested our previous findings, using a slightly different approach. Partial sleep-deprivation was followed by evening sleep experiments, with repeated awakenings and immediate dream reports. Participants reported whether they had been dreaming, and were asked to rate how diverse, vivid, perceptual, and thought-like the contents of their dreams were. High density (64 channel) EEG was recorded throughout the experiment, and mean single-channel LZC was calculated for each 30 s sleep epoch. LZC progressively decreased with depth of non-REM sleep. Surprisingly, estimated marginal mean LZC was slightly higher for NREM1 than for wakefulness, but the difference did not remain significant after adjusting for multiple comparisons. We found no significant difference in LZC between dream and non-dream awakenings, nor any significant relationship between LZC and subjective ratings of dream experience, within the same sleep stage (NREM2). The failure to reproduce our own previous finding of a positive correlation between posterior LZC and more perceptual dream experiences, or to find any other correlation between brain signal complexity and subjective experience within NREM2 sleep, raises the question of whether EEG LZC is really a reliable correlate of richness of experience as such, within the same sleep stage.
Understanding cingulotomy’s therapeutic effect in OCD through computer models
Authors: Sherif Mohamed A. , Fotros Aryandokht , Greenberg Benjamin D. , McLaughlin Nicole C. R.
Published: January 2023

Cingulotomy is therapeutic in OCD, but what are the possible mechanisms? Computer models that formalize cortical OCD abnormalities and anterior cingulate cortex (ACC) function can help answer this. At the neural dynamics level, cortical dynamics in OCD have been modeled using attractor networks, where activity patterns resistant to change denote the inability to switch to new patterns, which can reflect inflexible thinking patterns or behaviors. From that perspective, cingulotomy might reduce the influence of difficult-to-escape ACC attractor dynamics on other cortical areas. At the functional level, computer formulations based on model-free reinforcement learning (RL) have been used to describe the multitude of phenomena ACC is involved in, such as tracking the timing of expected outcomes and estimating the cost of exerting cognitive control and effort. Different elements of model-free RL models of ACC could be affected by the inflexible cortical dynamics, making it challenging to update their values. An agent can also use a world model, a representation of how the states of the world change, to plan its actions, through model-based RL. OCD has been hypothesized to be driven by reduced certainty of how the brain’s world model describes changes. Cingulotomy might improve such uncertainties about the world and one’s actions, making it possible to trust the outcomes of these actions more and thus reduce the urge to collect more sensory information in the form of compulsions. Connecting the neural dynamics models with the functional formulations can provide new ways of understanding the role of ACC in OCD, with potential therapeutic insights.
Investigating an alternative sustainable low-enriched uranium target for the manufacture of 99Mo using MCNP6.2 modelling with CINDER90
Authors: Raposio Robert , Braoudakis George , Rosenfeld Anatoly , Thorogood Gordon , Bedwell-Wilson Juniper
Published: January 2023

Introduction: Current fission-based methods of 99Mo production use targets that are based on high output without taking into consideration the amount of radioactive waste produced. We examine the idea of using a low enriched target (<20%) to reduce the amount of nuclear and chemical wastes produced by the manufacture of 99Mo via fission of uranium-based targets.

Methods: MCNP6.2 was used to model targets of 20%, 10%, 7%, 3%, and 1% enrichment for 99Mo output and sustainability.

Results and Discussion: The 1% enriched target at the lowest density of 0.2 g/cm3 of UO2 was found to have the highest sustainability score at 6 days irradiation but it had a low 99Mo output. On the other hand, the highest output target was found to be 20% enriched with a density of 8.0 g UO2/cm3 with an irradiation time of 20 days. Target security and safeguards concerns were modelled and found to be of minimal concern.
Protein restriction during lactation causes transgenerational metabolic dysfunction in adult rat offspring
Authors: Vargas Rodrigo , Martins Isabela Peixoto , Matiusso Camila Cristina Ianoni , Casagrande Raiana Aparecida , Zara Camila Benan , Huppes de Souza Anna Carolina , Horst William Pereira , Sieklicki Taina Cristine , Becker Tania Cristina Alexandrino , Lucredi Naiara Cristina , Comar Jurandir Fernando , Malta Ananda , Mathias Paulo Cezar de Freitas
Published: January 2023

Introduction

Protein restriction during lactation can induce metabolic dysfunctions and has a huge impact on the offspring’s phenotype later in its life. We tested whether the effects of a maternal low-protein diet (LP) in rats can be transmitted to the F2 generation and increase their vulnerability to dietary insults in adulthood.

Methods

Female Wistar rats (F0) were fed either a low-protein diet (LP; 4% protein) during the first 2 weeks of lactation or a normal-protein diet (NP; 23% protein). The female offspring (F1 generation) were maintained on a standard diet throughout the experiment. Once adulthood was reached, female F1 offspring from both groups (i.e., NP-F1 and LP-F1) were bred to proven males, outside the experiment, to produce the F2 generation. Male F2 offspring from both groups (NP-F2 and LP-F2 groups) received a standard diet until 60 days old, at which point they received either a normal fat (NF; 4.5% fat) or a high fat diet (HF; 35% fat) for 30 days.

Results

At 90 days old, LPNF-F2 offspring had increased lipogenesis and fasting insulinemia compared to NPNF-F2, without alteration in insulin sensitivity. HF diet caused increased gluconeogenesis and displayed glucose intolerance in LPHF-F2 offspring compared to LPNF-F2 offspring. Additionally, the HF diet led to damage to lipid metabolism (such as steatosis grade 3), higher body weight, fat pad stores, and hepatic lipid content.

Discussion

We concluded that an F0 maternal protein restricted diet during lactation can induce a transgenerational effect on glucose and liver metabolism in the F2 generation, making the offspring’s liver more vulnerable to nutritional injury later in life.
Anti-obesity effect of Angelica keiskei Jiaosu prepared by yeast fermentation on high-fat diet-fed mice
Authors: Fu Kunli , Gao Xiang , Hua Puyue , Huang Yuedi , Dong Ruitao , Wang Mingji , Li Qun , Li Zichao
Published: January 2023

In this study, an Angelica keiskei (A. keiskei) Jiaosu (FAK) was prepared by yeast fermentation to investigate its anti-obesity effect on high-fat diet (HFD)-fed mice. 70 SPF grade male C57BL/6J mice were randomly divided into 7 groups (n = 10): blank control group (N), high-fat model group (M), positive control group (Orl), unfermented control group (NF), high-dose intervention group (FH), medium-dose intervention group (FM), and low-dose intervention group (FL). The results showed that FAK intervention significantly reduced the body weight, Lee’s index and liver index of HFD-fed mice (P < 0.05). Compared with M group, the serum levels of triglyceride (TG), total cholesterol (TC), leptin and glucose (GLU) in FH group were remarkably decreased and that of interleukin-27 (IL-27) were increased (P < 0.05). The levels of TG, and TC in the liver of mice were also markedly decreased in the FH group (P < 0.05). HE staining results showed that the liver cells in the three intervention groups had less degeneration and fatty vacuoles in the cytoplasm, and the liver cords were orderly arranged compared with that of M group. Furthermore, FAK significantly inhibited epididymal adipose tissue cell expansion induced by HFD. FAK up-regulated the protein expression levels of p-AMPK and PPARα to promote lipolysis and down-regulated the expression of PPARγ to reduce lipid synthesis (P < 0.05). Additionally, the results of gut microbiota showed that after the intervention, a decrease trend of F/B value and Deferribacterota was noticed in the FH group compared with M group. At the genus level, FAK intervention significantly increased that of Ileiobacterium compared to the M group (p < 0.05). A rising trend of norank_f_Muribaculaceae, Lactobacillus, and Bifidobacterium were also observed in the HF group. Conclusively, these findings demonstrated that FAK intervention can effectively improve obesity in mice caused by HFD and the potential mechanisms was related to the regulation of serum levels of leptin and IL-27, lipogenesis and lipolysis in adipose tissue and gut microbiota composition.
The effects of L-carnitine supplementation on glycemic markers in adults: A systematic review and dose-response meta-analysis
Authors: Zamani Mohammad , Pahlavani Naseh , Nikbaf-Shandiz Mahlagha , Rasaei Niloufar , Ghaffarian-Ensaf Rasool , Asbaghi Omid , Shiraseb Farideh , Rastgoo Samira
Published: January 2023

Background and aims

Hyperglycemia and insulin resistance are concerns today worldwide. Recently, L-carnitine supplementation has been suggested as an effective adjunctive therapy in glycemic control. Therefore, it seems important to investigate its effect on glycemic markers.

Methods

PubMed, Scopus, Web of Science, and the Cochrane databases were searched in October 2022 for prospective studies on the effects of L-carnitine supplementation on glycemic markers. Inclusion criteria included adult participants and taking oral L-carnitine supplements for at least seven days. The pooled weighted mean difference (WMD) was calculated using a random-effects model.

Results

We included the 41 randomized controlled trials (RCTs) (n= 2900) with 44 effect sizes in this study. In the pooled analysis; L-carnitine supplementation had a significant effect on fasting blood glucose (FBG) (mg/dl) [WMD = −3.22 mg/dl; 95% CI, −5.21 to −1.23;p= 0.002;I2= 88.6%,p< 0.001], hemoglobin A1c (HbA1c) (%) [WMD = −0.27%; 95% CI, −0.47 to −0.07;p= 0.007;I2= 90.1%,p< 0.001] and homeostasis model assessment-estimate insulin resistance (HOMA-IR) [WMD = −0.73; 95% CI, −1.21 to −0.25;p= 0.003;I2= 98.2%,p< 0.001] in the intervention compared to the control group. L-carnitine supplementation had a reducing effect on baseline FBG ≥100 mg/dl, trial duration ≥12 weeks, intervention dose ≥2 g/day, participants with overweight and obesity (baseline BMI 25–29.9 and >30 kg/m2), and diabetic patients. Also, L-carnitine significantly affected insulin (pmol/l), HOMA-IR (%), and HbA1c (%) in trial duration ≥12 weeks, intervention dose ≥2 g/day, and participants with obesity (baseline BMI >30 kg/m2). It also had a reducing effect on HOMA-IR in diabetic patients, non-diabetic patients, and just diabetic patients for insulin, and HbA1c. There was a significant nonlinear relationship between the duration of intervention and changes in FBG, HbA1c, and HOMA-IR. In addition, there was a significant nonlinear relationship between dose (≥2 g/day) and changes in insulin, as well as a significant linear relationship between the duration (weeks) (coefficients = −16.45,p= 0.004) of intervention and changes in HbA1C.

Conclusions

L-carnitine could reduce the levels of FBG, HbA1c, and HOMA-IR.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier: CRD42022358692.
Effect of freezing-thawing on the quality changes of large yellow croaker treated by low-salt soaking during frozen storage
Authors: Bao Hongli , Zhang Jinsen , Li Mingao , Chen Yi , Mao Chunyan , Yang Jing , Gao Yuanpei , Deng Shanggui
Published: January 2023

Introduction

The production of the large yellow croaker has seasonal and regional characteristics, which is typically preserved on ice, possibly leading to its deterioration in a short time. Therefore, in this study, we focused on the effect of temperature fluctuation on the quality changes of the large yellow croaker during frozen storage.

Methods

In this experiment, the large yellow croaker was soaked in a low-salt solution, and physical and chemical properties, water-holding capacity, color, and protein characteristics of the muscle were investigated after repeated freeze–thaw (F–T) cycles and frozen storage.

Results and discussion

The results show the deterioration of muscle quality of large yellow croaker after low-salt treatment was lower than that of the salt-free soaking group. The salting treatment significantly (P < 0.05) enhanced the yield of large yellow croaker, which was 24.3% greater than the salt-free soaking group after 6 weeks of frozen storage. The microstructure of the salted muscle was more stable and maintained its cellular structure after F–T cycles and frozen storage. The b* value of the salt-free soaking group increased from b* value of the low-salt soaking group decreased from acceptable range. Sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) analysis indicates the content of 17 kDa peptide decreased in the low-salt soaking group, and the peptides at 21 and 24 kDa increased during frozen storage. The results of the present study provide guidance for the optimal processing, transport, and storage of large yellow croaker, but the effect of salting on lipid oxidation and protein oxidation requires further study.
Weight loss in children undergoing allogeneic hematopoietic stem cell transplantation within the first 100 days: Its influencing factors and impact on clinical outcomes
Authors: Yan Mei , Pan Jian , Huang Jie , Liu Changwei , Xia Xiaona , Zhu Ting , Wan Yuanyuan , Fang Yongjun , Tang Weibing
Published: January 2023

Purpose/Objective

This study aimed to evaluate the nutritional status of children subjected to allogeneic hematopoietic stem cell transplantation (alloHSCT) in the first 100 days. Objectives were to clarify the effect of weight loss on clinical outcomes, and to analyze factors influencing weight loss.

Methods

Eighty pediatric patients receiving alloHSCT were enrolled in the study. Body mass index (BMI) z-scores and weight for age (WFA) z-scores were collected. A multivariate regression model was set up to investigate factors affecting weight loss. Post-transplant clinical outcomes relative to weight loss on 100 days after transplantation were analyzed.

Results

At admission, eight patients (10%) were underweight, the number had increased to 23 (30.67%) by 100 days post-HSCT. On day + 100, only nutrition screening tool for childhood cancer (SCAN) scores ≥ 3 (OR: 4.474, 95% CI: 1.215, 16.472; P = 0.024) and acute graft versus host disease (aGVHD) (OR: 9.915, 95% CI: 3.302, 29.771; P < 0.001) were regarded as significant influencing factors of weight loss. The Weight loss ≥ 5% group was associated with longer hospital stays (P = 0.001), greater cost of inpatient treatment (P = 0.001), and a higher incidence of 100-day re-admission and intensive care unit (ICU) transfer (P = 0.03 and P = 0.033, respectively). Cumulative number of fever days (P = 0.023) and antibiotic use (P = 0.007) also increased significantly. The Weight loss ≥ 5% group had a significantly lower one-year overall survival rate compared with the Weight loss < 5% group (P = 0.015).

Conclusion

Pediatric patients’ nutritional status declined significantly after HSCT. Weight loss within the first 100 days influenced short-term clinical outcomes and one-year overall survival.
Psychological distress and quality of life in breast cancer survivors with taxane-induced peripheral neuropathy: A scoping review
Authors: Schwab Lauren , Visovsky Constance
Published: January 2023

Purpose

This review provides an assessment of psychological distress (depressive symptoms and anxiety symptoms) and the impact on quality of life in breast cancer survivors with chemotherapy-induced peripheral neuropathy induced by taxane-based chemotherapy.

Methods

The databases PubMed, CINAHL, Embase, and PsychInfo were searched for publications about psychological distress symptoms in breast cancer survivors with chemotherapy-induced peripheral neuropathy from taxane chemotherapy and the impact on quality of life.

Results

Only eight studies were identified that addressed psychological distress symptoms in BCS with CIPN treated with taxane chemotherapy and the impact of these symptoms on QOL. Of these studies, a majority reported increased symptoms of psychological distress (depressive symptoms and/or anxiety symptoms) in BCS with CIPN. Researchers found that the persistent nature of CIPN and severity of symptoms resulted in decreased QOL.

Conclusions

This review highlighted a notable lack of research on psychological distress (depressive symptoms and anxiety symptoms) in BCS with CIPN. Furthermore, there was a gap in knowledge in how this psychological distress impacts QOL in this population. Further research is needed to better understand the extent that BCS with CIPN experience symptoms of psychological distress and the impact on QOL. This research would enable researchers to develop interventions focused on decreasing and potentially preventing these symptoms in BCS with CIPN treated with taxane chemotherapy, thereby decreasing the impact on QOL.
Radiotherapy for keratoacanthoma of facial skin: A case report and review of literature
Authors: Jia Xiaojing , Ge Ying , Wang Hongyong , Ma Yan
Published: January 2023

Background

Keratoacanthoma (KA) is a benign tumor that arises from the infundibulum of hair follicles. However, some researchers believe that KA is a subtype of squamous cell carcinoma (SCC) or a borderline tumor. There are two types of KA: single-type and multiple-type. Surgical resection is the first-line treatment for KA. The treatment options for patients with large lesions who are not surgical candidates are limited. We present a case of single-type KA patients with basic diseases and large lesions that were untreatable surgically, but the lesions essentially disappeared after radiotherapy. No recurrences were discovered during the two-year follow-up.

Case Description

A 62-year-old male patient was admitted to the dermatology department of our hospital in June 2020 due to the discovery of a red papule on the right face two months prior, with occasional itching, which increased gradually. Pathological examination confirmed the diagnosis of KA. Due to the large lesions and underlying diseases, he was transferred to our radiotherapy department for radiotherapy after consultation. Since the surface of the lesion is uneven and close to the corner of the eye, we adopted intensity modulated radiation therapy (IMRT) at the beginning of radiotherapy. Following the reduction of the lesion, superficial electron beam and added a bolus with thickness of 5mm on the surface of the lesion was continued. The target dose: 42Gy/21 fractions (6MV X-ray, 22Gy; 2Gy/fraction; a total of 11 fractions, 6MeV electron beam, 20Gy; 2Gy/fraction; a total of 10 fractions). By the end of radiotherapy, the patient’s facial tumor was dry and subsided. The facial tumor subsided significantly two years after radiotherapy, and the damaged skin on the face recovered to a flat shape.

Conclusions

The treatment experience of this case shows that IMRT combined with superficial electron beam radiotherapy may be an effective treatment for single-type KA patients with basic diseases and large lesions that are not suitable for surgery, and it is worth further study.
Tissue mechanics modulate PCNP expression in oral squamous cell carcinomas with different differentiation
Authors: Zhang Leyang , Guo Dingcheng , Shen Junjie , Zheng Yayuan , Zhai Junkai , Li Ruiping , He Dengqi , Zhang Baoping
Published: January 2023

Background

PEST-containing nuclear protein (PCNP), a novel zinc finger protein, participates in cell cycle regulation. Previous studies have confirmed that PCNP plays a role in mediating cellular development and invasion in a variety of cancer types. However, the relationship between PCNP expression and the occurrence and development of oral squamous cell carcinoma (OSCC) requires further exploration. In this study, we used biological atomic force microscopy to examine the histomorphological and mechanical properties of OSCC to explore the relationship between PCNP expression and differentiation of OSCC.

Methods

Seventy-seven OSCC samples with varying degrees of differentiation were selected for hematoxylin and eosin staining, immunohistochemistry, and cellular mechanical measurement. The expression of PCNP and the mechanical properties such as stiffness and roughness of the tissue interface in OSCC samples were investigated. The Kaplan-Meier survival curve was utilized to assess the relationship of PCNP expression with patient survival.

Results

The level of PCNP was significantly higher in well-differentiated OSCC than in moderately and poorly differentiated OSCC (P < 0.001). High expression of PCNP was specifically associated with higher tumor differentiation, lack of lymph node metastasis, and lower tumor node metastasis stage (all P < 0.05). Patients with high PCNP expression had a higher survival rate than those with low PCNP expression. The average variation of stiffness within a single tissue ranged from 347 kPa to 539 kPa. The mean surface roughness of highly, moderately, and poorly differentiated OSCC and paraneoplastic tissues were 795.53 ± 47.2 nm, 598.37 ± 45.76 nm, 410.16 ± 38.44 nm, and 1010.94 ± 119.07 nm, respectively. Pearson correlation coefficient demonstrated a positive correlation between PCNP expression and tissue stiffness of OSCC (R = 0.86, P < 0.001).

Conclusion

The expression of PCNP was positively correlated with patient survival, tumor differentiation, and mechanical properties of tissue interfaces. PCNP is a potential biomarker for the early diagnosis and staging of OSCC. Furthermore, determination of the mechanical properties of the tissue interface could provide further useful information required for the detection and differentiation of OSCC.
MXRA8 is an immune-relative prognostic biomarker associated with metastasis and CD8+ T cell infiltration in colorectal cancer
Authors: Tan Lulu , Fu Daan , Liu Feng , Liu Jia , Zhang Yang , Li Xin , Gao Jinbo , Tao Kaixiong , Wang Guobin , Wang Lin , Wang Zheng
Published: January 2023

Background

Colorectal cancer (CRC) is the second most common cause of cancer-related deaths worldwide. Tumor metastasis and CD8+ T cell infiltration play a crucial role in CRC patient survival. It is important to determine the etiology and mechanism of the malignant progression of CRC to develop more effective treatment strategies.

Methods

We conducted weighted gene co‐expression network analysis (WGCNA) to explore vital modules of tumor metastasis and CD8+ T cell infiltration, then with hub gene selection and survival analysis. Multi-omics analysis is used to explore the expression pattern, immunity, and prognostic effect of MXRA8. The molecular and immune characteristics of MXRA8 are analyzed in independent cohorts, clinical specimens, and in vitro.

Results

MXRA8 expression was strongly correlated with tumor malignancy, metastasis, recurrence, and immunosuppressive microenvironment. Furthermore, MXRA8 expression predicts poor prognosis and is an independent prognostic factor for OS in CRC.

Conclusion

MXRA8 may be a potential immunotherapeutic and prognostic biomarker for CRC.
Prognosis of bronchial asthma in children with different pulmonary function phenotypes: A real-world retrospective observational study
Authors: Liu Lu , Ma Hui , Yuan Shuhua , Zhang Jing , Wu Jinhong , Dilimulati Muheremu , Wang Yahua , Shen Shiyu , Zhang Lei , Lin Jilei , Yin Yong
Published: January 2023

Objective

To follow up on the changes in pulmonary function phenotypes in children with asthma in the first year after diagnosis, and explore the risk factors of poor control in children with good treatment compliance.

Methods

Children who were diagnosed with asthma in the Respiratory Department of Shanghai Children's Medical Center from January 1, 2019 to December 31, 2020 and were re-examined every 3 months after diagnosis for 1 year were continuously included, regardless of gender. We collected the clinical data, analyzed clinical characteristics of the different pulmonary function phenotypes at baseline and explored risk factors of poor asthma control after 1 year of standardized treatment.

Results

A total of 142 children with asthma were included in this study, including 54 (38.0%) with normal pulmonary function phenotype (NPF), 75 (52.8%) with ventilation dysfunction phenotype (VD), and 13 (9.2%) with small airway dysfunction phenotype (SAD) in the baseline. Among them, there were statistically significant differences in all spirometry parameters, age, and course of disease before diagnosis (P < 0.05), and a negative correlation between age (r2 = −0.33, P < 0.001), course of disease before diagnosis (r2 = −0.23, P = 0.006) and FEV1/FVC. After 1-year follow-up, large airway function parameters and small airway function parameters were increased, fractional exhaled nitric oxide (FeNO) was decreased, the proportion of NPF was increased, the proportion of VD was decreased (P < 0.05), while there was no significant difference in the proportion of SAD. After 1 year of standardized treatment, 21 patients (14.8%) still had partly controlled or uncontrolled asthma. Our results showed that the more asthma attacks occurred within 1 year (OR = 6.249, 95% CI, 1.711–22.818, P = 0.006), the more times SAD presented at baseline and Assessment 1–4 (OR = 3.092, 95% CI, 1.222–7.825, P = 0.017), the higher the possibility of incomplete control of asthma.

Conclusion

About 15% of the children with good treatment compliance were still not completely controlled after 1 year of treatment, which is closely associated with persistent small airway dysfunction.
End-of-life decisions and practices as viewed by health professionals in pediatric critical care: A European survey study
Authors: Zanin Anna , Brierley Joe , Latour Jos M. , Gawronski Orsola
Published: January 2023

Background and Aim

End-of-Life (EOL) decision-making in paediatric critical care can be complex and heterogeneous, reflecting national culture and law as well as the relative resources provided for healthcare. This study aimed to identify similarities and differences in the experiences and attitudes of European paediatric intensive care doctors, nurses and allied health professionals about end-of-life decision-making and care.

Methods

This was a cross-sectional observational study in which we distributed an electronic survey to the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) members by email and social media. The survey had three sections: (i) 16 items about attitudes to EOL care, (ii) 14 items about EOL decisions, and (iii) 18 items about EOL care in practice. We used a 5-point Likert scale and performed descriptive statistical analysis.

Results

Overall, 198 questionnaires were completed by physicians (62%), nurses (34%) and allied health professionals (4%). Nurses reported less active involvement in decision-making processes than doctors (64% vs. 95%; p < 0.001). As viewed by the child and family, the child's expected future quality of life was recognised as one of the most critical considerations in EOL decision-making. Sub-analysis of Northern, Central and Southern European regions revealed differences in the optimal timing of EOL decisions. Most respondents (n = 179; 90%) supported discussing organ donation with parents during EOL planning. In the sub-region analysis, differences were observed in the provision of deep sedation and nutritional support during EOL care.

Conclusions

This study has shown similar attitudes and experiences of EOL care among paediatric critical care professionals within European regions, but differences persist between European regions. Nurses are less involved in EOL decision-making than physicians. Further research should identify the key cultural, religious, legal and resource differences underlying these discrepancies. We recommend multi-professional ethics education to improve EOL care in European Paediatric Intensive Care.
Choosing Wisely in pediatric healthcare: A narrative review
Authors: Trapani Sandra , Montemaggi Alessandra , Indolfi Giuseppe
Published: January 2023

Background

It has been estimated that 20% of the tests and therapies currently prescribed in North America are likely unnecessary, add no value, and may even cause harm. The Choosing Wisely (CW) campaign was launched in 2012 in the US and Canada to limit the overuse of medical procedures in adult and pediatric healthcare, to avoid overdiagnosis and overtreatment.

Methods

In this narrative review, we describe the birth and spread of the CW campaign all over the world, with emphasis on CW in pediatric healthcare.

Results

To date, CW has spread to more than 25 countries and 80 organizations, with 700 recommendations published. The awareness of medication overuse also made its way into pediatrics. One year after the launch of the CW campaign, the American Academy of Pediatrics and the pediatric section of the Society of Hospital Medicine provided the first recommendations specifically aimed at pediatricians. Thereafter, many European pediatric societies also became active in the CW campaign and published specific top-5 recommendations, although there is not yet a common set of CW recommendations in Europe.

Discussion

We reviewed the main pediatric CW recommendations in medical and surgical fields and discussed how the recommendations have been produced, published, and disseminated. We also analyzed whether and how the CW recommendations impacted pediatric medical practice. Furthermore, we highlighted the common obstacles in applying CW recommendations, such as pressure from patients and families, diagnostic uncertainty, and worries about legal problems. Finally, we highlighted the necessity to foster the CW culture, develop an implementation plan, and measure the results in terms of overuse decline.
Experience with clinical cerebral autoregulation testing in children hospitalized with traumatic brain injury: Translating research to bedside
Authors: Kunapaisal Thitikan , Moore Anne , Theard Marie A. , King Mary A. , Chesnut Randall M. , Vavilala Monica S. , Lele Abhijit V.
Published: January 2023

Objective

To report our institutional experience with implementing a clinical cerebral autoregulation testing order set with protocol in children hospitalized with traumatic brain injury (TBI).

Methods

After IRB approval, we examined clinical use, patient characteristics, feasibility, and safety of cerebral autoregulation testing in children aged <18 years between 2014 and 2021. A clinical order set with a protocol for cerebral autoregulation testing was introduced in 2018.

Results

25 (24 severe TBI and 1 mild TBI) children, median age 13 years [IQR 4.5; 15] and median admission GCS 3[IQR 3; 3.5]) underwent 61 cerebral autoregulation tests during the first 16 days after admission [IQR1.5; 7; range 0–16]. Testing was more common after implementation of the order set (n = 16, 64% after the order set vs. n = 9, 36% before the order set) and initiated during the first 2 days. During testing, patients were mechanically ventilated (n = 60, 98.4%), had invasive arterial blood pressure monitoring (n = 60, 98.4%), had intracranial pressure monitoring (n = 56, 90.3%), brain-tissue oxygenation monitoring (n = 56, 90.3%), and external ventricular drain (n = 13, 25.5%). Most patients received sedation and analgesia for intracranial pressure control (n = 52; 83.8%) and vasoactive support (n = 55, 90.2%) during testing. Cerebral autoregulation testing was completed in 82% (n = 50 tests); 11 tests were not completed [high intracranial pressure (n = 5), high blood pressure (n = 2), bradycardia (n = 2), low cerebral perfusion pressure (n = 1), or intolerance to blood pressure cuff inflation (n = 1)]. Impaired cerebral autoregulation on first assessment resulted in repeat testing (80% impaired vs. 23% intact, RR 2.93, 95% CI 1.06:8.08, p = 0.03). Seven out of 50 tests (14%) resulted in a change in cerebral hemodynamic targets.

Conclusion

Findings from this series of children with TBI indicate that: (1) Availability of clinical order set with protocol facilitated clinical cerebral autoregulation testing, (2) Clinicians ordered cerebral autoregulation tests in children with severe TBI receiving high therapeutic intensity and repeatedly with impaired status on the first test, (3) Clinical cerebral autoregulation testing is feasible and safe, and (4) Testing results led to change in hemodynamic targets in some patients.
IARS2-related disease manifesting as sideroblastic anemia and hypoparathyroidism: A case report
Authors: Gong Yan , Lan Xiao Ping , Guo Sheng
Published: January 2023

Background

IARS2 (EC6.1.5) is a mitochondrial isoleucine-tRNA synthetase. Despite the fact that only fewer than 30 patients have been reported in the literature, mitochondrial disorders caused by pathogenic variants in the IARS2 gene (OMIM: 616007) have a very broad and variable clinical phenotype spectrum. We present a child who has sideroblastic anemia and hypoparathyroidism as a result of a previously unreported mutation in the IARS2 gene.

Case presentation

A 14-year-old girl who had been anemic for 12 years was diagnosed with pure red cell aplasia (hemoglobin 42 g/L, reference range 110–160) at the age of 2. Her anemia was resistant to high-dose intravenous gamma globulin and cyclosporine therapy and required monthly blood transfusions to maintain normal hemoglobin levels. She developed cataracts at the age of 6 and was cured by phacoemulsification. At the age of 8, she visited the endocrine department, because of mental and physical retardation accompanied by repeated convulsions, and the antiepileptic treatment was ineffective. She was diagnosed with hypoparathyroidism. To control the convulsions, she was given calcitriol orally as well as large doses of calcium supplements. Due to severe growth and development delays, delayed sexual development, and hypokinesia at the age of 13.5Y, the parents agreed to a whole-exon gene sequencing test. IARS2 gene compound heterozygous variants c.2450G > A (p.Arg817His) and c.2511del (p.Leu838Phefs*69) were discovered. The girl was then diagnosed with IARS2-related disease and given a cocktail therapy of coenzyme Q10, vitamin B2, L-Carnitine and vitamin E. Although the child's clinical symptoms improved, she still experienced intermittent claudication and hip joint pain. The vitamin B6 was discontinued after three months due to its ineffectiveness in treating anemia. Because the child's ferritin levels remained elevated, she was also prescribed long-term oral deferiprone therapy.

Conclusion

Our findings broaden the clinical and genetic spectrum of IARS2-associated disease, and case summaries help raise clinical awareness of IARS2-associated disease and reduce under- and misdiagnosis.
Intelligence profiles and adaptive behaviors of high-functioning autism spectrum disorder and developmental speech and language disorders
Authors: Jin Wen-Yuan , Wu Ling-Ling , Hu Li-Fei , Li Wen-Hao , Song Chao , Wang Yan-Yan , Liu Xiao-Lin , Zhu Zhi-Wei
Published: January 2023

Objective

The present study was aimed at investigating the intelligence profiles and adaptive behaviors of children with high-functioning autism spectrum disorder (HFASD) and developmental speech and language disorders (DSLDs). We compared the similarities and differences of cognitive capabilities and adaptive functions and explored their correlations in the HFASD and DSLDs groups.

Methods

128 patients with HFASD, 111 patients with DSLDs and 114 typically developing (TD) children were enrolled into our study. Wechsler Intelligence Scale for Children-IV (WISC-IV) and Adaptive Behavior Assessment System-II (ABAS-II) were respectively applied to evaluate intelligence profiles and adaptive behaviors. Intelligence quotient (IQ) scores and adaptive functioning scores among the HFASD, DSLDs and TD groups were compared through one-way ANOVA. Pearson correlation coefficient was applied to examine the relationships between WISC indices and ABAS domains.

Results

Outcomes showed significantly poorer intelligence profiles and adaptive behaviors in HFASD and DSLDs groups. Both children with HFASD and DSLDs demonstrated impairments in verbal comprehension and executive functions. Processing speed and working memory were the predominant defects of children with HFASD and DSLDs in the field of executive functions, respectively. Whereas perceptual reasoning was a relative strength for them. Children with DSLDs had balanced scores of all the domains in ABAS-II; nevertheless, HFASD individuals demonstrated striking impairments in Social domain. Correlation analysis showed IQs of children with HFASD were positively correlated with all the domains and General Adaptive Composite (GAC) of ABAS-II. Additionally, IQs were positively correlated with Conceptual domain and GAC for children with DSLDs. Compared with DSLDs group, intelligence displayed stronger correlations with adaptive behaviors in HFASD group.

Conclusion

Our study expanded insights regarding intelligence profiles and adaptive behaviors of children with HFASD and DSLDs. Moreover, this study made breakthroughs in discovering positive correlations between IQs and adaptive functions in the two neurodevelopmental disorders.
Endoplasmic reticulum as a target in cardiovascular diseases: Is there a role for flavonoids?
Authors: Keylani Kimia , Arbab Mojeni Fariba , Khalaji Amirmohammad , Rasouli Asma , Aminzade Dlnya , Karimi Mohammad Amin , Sanaye Pantea Majma , Khajevand Nazanin , Nemayandeh Nasrin , Poudineh Mohadeseh , Azizabadi Farahani Mehdi , Esfandiari Mohammad Ali , Haghshoar Sepehr , Kheirandish Ali , Amouei Erfan , Abdi Amir , Azizinezhad Arash , Khani Afshin , Deravi Niloofar
Published: January 2023

Flavonoids are found in natural health products and plant-based foods. The flavonoid molecules contain a 15-carbon skeleton with the particular structural construction of subclasses. The most flavonoid’s critical subclasses with improved health properties are the catechins or flavonols (e.g., epigallocatechin 3-gallate from green tea), the flavones (e.g., apigenin from celery), the flavanones (e.g., naringenin from citrus), the flavanols (e.g., quercetin glycosides from berries, onion, and apples), the isoflavones (e.g., genistein from soya beans) and the anthocyanins (e.g., cyanidin-3-O-glucoside from berries). Scientific data conclusively demonstrates that frequent intake of efficient amounts of dietary flavonoids decreases chronic inflammation and the chance of oxidative stress expressing the pathogenesis of human diseases like cardiovascular diseases (CVDs). The endoplasmic reticulum (ER) is a critical organelle that plays a role in protein folding, post-transcriptional conversion, and transportation, which plays a critical part in maintaining cell homeostasis. Various stimuli can lead to the creation of unfolded or misfolded proteins in the endoplasmic reticulum and then arise in endoplasmic reticulum stress. Constant endoplasmic reticulum stress triggers unfolded protein response (UPR), which ultimately causes apoptosis. Research has shown that endoplasmic reticulum stress plays a critical part in the pathogenesis of several cardiovascular diseases, including diabetic cardiomyopathy, ischemic heart disease, heart failure, aortic aneurysm, and hypertension. Endoplasmic reticulum stress could be one of the crucial points in treating multiple cardiovascular diseases. In this review, we summarized findings on flavonoids’ effects on the endoplasmic reticulum and their role in the prevention and treatment of cardiovascular diseases.
Clinical study of lenvatinib in the treatment of hepatitis virus-related hepatocellular carcinoma and antiviral therapy
Authors: Li Xiaomi , Wang Jingyan , Ding Xiaoyan , Xu Yawen , Yu Minghua , Wu Hongxiao , Deng Na , Li Wei , Chen Jinglong
Published: January 2023

Background: Lenvatinib is recommended as a first-line tyrosine kinase inhibitor for advanced hepatocellular carcinoma (HCC) since 2017. The aim of this study was to compare the clinical action of lenvatinib in hepatitis B virus (HBV)-related HCC and hepatitis C virus (HCV)-related HCC.

Methods: A continuous cohort of advanced HCC was retrospectively enrolled. And the patients were divided into HBV-related HCC and HCV-related HCC based on previous history of hepatitis virus infection. Then propensity score matching (PSM) was conducted to compare objective response rate (ORR),disease control rate (DCR),progression-free survival (PFS),overall survival (OS) and safety between the two groups.

Results: A total of 203 eligible patients were included, with 72 HBV-related HCC and 36 HCV-related HCC after PSM. Both ORR (20.8% vs. 5.6%, P = .0759) and DCR (76.4% vs. 52.8%, P = .0232) were significantly higher in the HBV-related HCC than in the HCV-related HCC. Although no statistical differences in PFS (6.1 months vs. 3.3 months, P = .17) and OS (14.9 months vs. 17.7 months, P = .96) were observed between the two groups, there was a trend of difference in the PFS survival curve. On multivariate regression analysis of PFS, both HBV infection (HR, .54; 95% CI, .31–.95; P = .0332) and antiviral time >5 years (HR, .49; 95% CI, .26–.9; P = .0219) were identified as independent favorable factors, and AFP >200 ng/mL (HR, 1.88; 95% CI, 1.1–3.22; P = .0216) were found to be an independent adverse factor. In addition, compared with HCC who received the first dose of antiviral drugs less than 5 years, the patients who were administered those drugs over 5 years had a significantly favorable PFS (11.27 months vs. 3.87 months, P = .0011). Lenvatinib was well tolerated in all patients and the adverse events (AEs) were similar between the two groups.

Conclusion: It seemed that lenvatinib benefited more in HBV-related advanced HCC in delaying disease progression, compared to those with HCV-related advanced HCC.
Uterine fibroids — Causes, impact, treatment, and lens to the African perspective
Authors: Sefah Narvella , Ndebele Sithembinkosi , Prince Lillian , Korasare Elizabeth , Agbleke Michael , Nkansah Annabella , Thompson Humphrey , Al-Hendy Ayman , Agbleke Andrews Akwasi
Published: January 2023

Leiomyomas, or uterine fibroids as they are commonly known, are mostly seen in women of reproductive age. However, they can go undetected in most women, and approximately 25% of women show clinical symptoms. Although fibroids are a global burden impacting 80% of premenopausal women, they are more prevalent among Black women than among women of other races. Based on clinical diagnosis, the estimated cumulative incidence of fibroids in women ≤50 years old is significantly higher for black (>80%) versus white women (∼70%). The cause of leiomyomas is not clearly known, but studies have shown evidence of factors that drive the development or exacerbation of the disease. Evidence has linked risk factors such as lifestyle, age, environment, family history of uterine fibroids, and vitamin D deficiencies to an increased risk of uterine fibroids, which impact women of African descent at higher rates. Treatments may be invasive, such as hysterectomy and myomectomy, or non-invasive, such as hormonal or non-hormonal therapies. These treatments are costly and tend to burden women who have the disease. Sub-Saharan Africa is known to have the largest population of black women, yet the majority of uterine fibroid studies do not include populations from the continent. Furthermore, the prevalence of the disease on the continent is not well determined. To effectively treat the disease, its drivers need to be understood, especially with regard to racial preferences. This paper aims to review the existing literature and build a case for conducting future research on African women.