bluuebunny/crossref_metadata_2025 huggingface dataset:
Usefulness of Aortic Valve Calcification in Patients With Low-Flow Aortic Stenosis
Authors: Mogensen Nils Sofus Borg , Sanchez Dahl Jordi , Ali Mulham , Annabi Mohamed-Salah , Haujir Amal , Powers Andréanne , Carter-Storch Rasmus , Grenier-Delaney Jasmine , Møller Jacob Eifer , Øvrehus Kristian Altern , Pibarot Philippe , Clavel Marie-Annick
Published: January 2025

BACKGROUND:

Aortic valve calcification (AVC) has been shown to be a powerful assessment of aortic stenosis (AS) severity and a predictor of adverse outcomes. However, its accuracy in patients with low-flow AS has not yet been proven. The objective of the study was to assess the predictive value of AVC in patients with classical low-flow (CLF, that is, low-flow reduced left ventricular ejection fraction) or paradoxical low-flow (PLF, that is, low-flow preserved left ventricular ejection fraction) AS.

METHODS:

We prospectively included 641 patients, 319 (49.8%) with CLF-AS and 322 (50.2%) with PLF-AS, who underwent Doppler echocardiography and multidetector computed tomography. AVC ratio (AVCratio) was calculated as AVC divided by the sex-specific AVC threshold for AS severity; AVC score ≥2000 Agatston units in male patients and ≥1200 Agatston units in female patients. The primary end point of the study was all-cause mortality regardless of treatment.

RESULTS:

Sex-specific AVC thresholds identified AS severity correctly in 137 (87%) of the patients. During a median follow-up of 4.9 (4.3–5.9) years, there were 265 deaths. After comprehensive adjustment, AVCratio was associated with all-cause mortality in patients with CLF-AS (adjusted hazard ratio, 1.25 [95% CI, 1.01–1.56];
P
=0.046) and PLF-AS (adjusted hazard ratio, 1.51 [95% CI, 1.14–2.00];
P
=0.004). There was an interaction (
P
=0.001) between AVC and AS flow patterns (ie, CLF versus PLF) with regard to the prediction of mortality. The best AVCratio threshold to predict mortality was different in patients with CLF-AS (AVCratio ≥0.7) and PLF-AS (AVCratio ≥1). After a comprehensive analysis, AVCratio as a dichotomic variable was associated with all-cause mortality in all groups (
P
≤0.001). The addition of AVCratio to the models improved all models’ predictive value (all net reclassification index >18%; all
P
≤0.05).

CONCLUSIONS:

In patients with CLF-AS or PLF-AS, AVC is a major predictor of mortality. Thus, AVC should be used in low-flow patients to assess AS severity and stratify risk. Importantly, in patients with reduced left ventricular ejection fraction, a nonsevere AS (ie, AVC 70% of severe) could be associated with reduced survival.
NPA7: A Dual Receptor Activating Peptide That Inhibits Cardiac Oxidative Stress
Authors: Ma Xiaoyu , Malsawmzuali Joute Chawngvawr , Moroni Dante G. , Ma Xiao , Zheng Ye , Pan Shuchong , Wang Ying , Sangaralingham S. Jeson , Burnett John C.
Published: January 2025

BACKGROUND:

Cardiomyocyte oxidative stress significantly contributes to the progression of hypertension-induced heart failure, highlighting the need for targeted therapies. We developed a novel peptide, NPA7, that coactivates the GC-A (guanylyl cyclase A)/cGMP and MasR (Mas receptor)/cAMP pathway. This study aimed to test NPA7’s ability to inhibit oxidative stress by modulating the p62 (Sequestosome 1)-KEAP1 (Kelch-like ECH-associated protein 1)-NRF2 (nuclear factor erythroid 2-related factor 2) pathway in human cardiomyocytes (HCMs) and a rat model of hypertension.

METHODS:

Oxidative stress was induced in HCMs using H
2
O
2
with phosphate-buffered saline or NPA7 treatment. Intracellular reactive oxygen species levels were assessed via dihydroethidium staining. Western blotting analysis measured p62, KEAP1, and NRF2 protein levels, while GSH/GSSG (glutathione/glutathione disulfide) ratios and antioxidant gene expression were analyzed. HCMs were transfected with small interfering RNA targeting GC-A, MasR, or p62 before NPA7 and H
2
O
2
treatment. In vivo, spontaneously hypertensive rats received saline or NPA7, with normotensive Wistar Kyoto rats as control and cardiac oxidative stress, KEAP1 protein levels, NOX2 (NADPH oxidase 2), and p67 (NADPH oxidase subunit p67-phox) mRNA levels were measured.

RESULTS:

NPA7 reduced H
2
O
2
-induced reactive oxygen species levels and increased GSH/GSSG ratio in HCMs. Silencing GC-A (guanylyl cyclase A receptor) and MasR (Mas receptor) reversed NPA7’s effects. NPA7 activated the KEAP1-NRF2 pathway, enhancing NRF2’s antioxidant target gene expression. In p62 knockdown HCMs, NPA7-induced KEAP1 degradation and NRF2 activation were diminished. Reactive oxygen species levels were elevated in spontaneously hypertensive rat versusWistar Kyoto rats’ hearts, however, NPA7 treatment reduced myocardial reactive oxygen species, suppressed KEAP1 protein, and decreased NOX2 and p67 mRNA levels.

CONCLUSIONS:

NPA7 exhibits antioxidant properties in HCMs and spontaneously hypertensive rat hearts by targeting GC-A and MasR through the p62-KEAP1-NRF2 pathway, supporting a novel therapeutic approach against cardiovascular disease–related oxidative stress.
Normative trajectories of R1, R2*, and magnetic susceptibility in basal ganglia on healthy ageing
Authors: Chan Kwok-Shing , Zwiers Marcel P. , Jansen Michelle G. , Johansson Martin E. , Helmich Rick C. , Oosterman Joukje M. , Norris David G. , Beckmann Christian F. , Marques José P.
Published: January 2025

Quantitative MRI (qMRI) techniques, including R1, R2*, and magnetic susceptibility mapping, have emerged as promising tools for generating surrogate imaging markers of brain tissue microstructure, enabling non-invasive in vivo measurements associated with myelination and iron deposition. Gaining insights into how these quantitative measurements evolve throughout a normal lifespan can enhance our understanding of brain maturation processes and facilitate studies of disease-related microstructural changes by distinguishing pathological alterations from normal brain development. In this study, we established the normative trajectories of R1, R2*, and magnetic susceptibility in the basal ganglia at 3T. We used a healthy ageing cohort comprising 260 subjects with an evenly distributed age range (from 18 to 80 years) and sex ratio throughout adulthood. Utilising the non-parametric Gaussian Process Regression model to derive the normative trajectories, we found that R1 in these structures predominantly exhibits a quadratic shape over age, while R2* and magnetic susceptibility are primarily linear. We validated the normative trajectories of R2* and magnetic susceptibility using an independent cohort. This result reinforces existing findings on the association between age and qMRI. Additionally, we demonstrated that the spatial distributions of the qMRI parameters also change with age in the putamen and caudate nucleus. Finally, the utility of normative modelling of qMRI in the basal ganglia is validated using an independent cohort comprising both healthy participants and individuals with Parkinson’s disease, with comparable data acquisition protocols.
Peace and Harmony
Authors: Lee Kiwoon
Published: January 2025

In 1 Clement 20, addressing Corinthian Christians, Clement of Rome deliberately appealed to the Stoic topos of peace and harmony to navigate class conflicts. Viewed in the social and philosophical context of ancient Corinth, similarities in the conceptual background of this topos are observed. This study goes beyond the above assumption by recognizing recurrent echoes of the OT’s creation accounts and cosmic order in 1 Clement 20. Peace and harmony were likely associated with the attributes of—and believed to have emanated from—the biblical God. Thus, Clement advocated for unity by appealing to the cosmic order of God’s creation.
Hidden diversity in an ecologically specialized genus of Australian marsupials, the feather-tailed gliders, Acrobates (Diprotodontia, Acrobatidae)
Authors: APLIN KENNETH P. , ARMSTRONG KYLE N. , APLIN LUCY M. , JENKINS PAULA , INGLEBY SANDRA , DONNELLAN STEPHEN C.
Published: January 2025

The marsupial Family Acrobatidae includes the smallest gliding marsupial species in the monotypic Acrobates, found only in eastern Australia, and an equally small non-gliding species in another monotypic genus Distoechurus, found only in New Guinea. We applied molecular genetic analysis to Acrobates to assess the systematic significance of variation in superficial external characters of the tail and hindfoot (pes). Deep divergence in mitochondrial and nuclear genes demonstrated the broad sympatry of two species consistent with prior morphological diagnoses. Morphological assessment of museum vouchers showed that their distributions overlap extensively in New South Wales and Victoria and include locations where a range of biological research was conducted on the assumption of the presence of a single species. Many of these studies cannot be reassessed because neither vouchers nor tissue suitable for molecular genetic identification were collected. Intriguingly, acrobatids are the only marsupial group with internal ear discs, and the two species of Acrobates show demonstrable differences in the morphology of this structure, the biological significance of which needs to be established. Both species of Acrobates occur widely in the eucalypt forests of south-eastern Australia, which appear to be subject to a growing threat from bushfires likely aggravated by anthropogenic climate change.
Forcing Mechanisms of Strong Surface Winds in a Dust Storm–Prone, High-Latitude Proglacial Valley
Authors: Bellamy Daniel , Nadeau Daniel F. , King James
Published: January 2025

Proglacial valleys are important historical and contemporary sources of mineral dust emissions. These dust sources are situated within a complex mountainous terrain, which induce a series of superimposed meteorological phenomena. This paper assesses the forcing mechanisms of high wind speed (HWS) events in the dust storm–prone A’ą¨y Chu (Slims River) valley in southwest Yukon, Canada (60.96°N, 138.60°W). The period of 7 July 2021–30 September 2022 (≈15 months) is examined using surface meteorological stations distributed within and near the valley. A hierarchical indexing approach is applied, supported by high-resolution Weather Research and Forecasting (WRF) simulations, to identify dominant meteorological forcing mechanisms of strong wind events. Half (50.0%) of HWS events in the valley occur under high above-valley wind speeds. Little evidence was found that off-glacier winds drive HWS, despite frequent attribution of these winds to local dust emissions in the literature. A summertime valley wind system is likely responsible for persistent nocturnal HWS near the valley delta (61.00°N, 138.52°W), contributing to the 28% of summer HWS under distinctly calm aloft conditions. Efforts to constrain HWS characteristics from ambient conditions were not successful, partly confounded by adjacent valley wind systems. Ascertaining the configuration of phenomena responsible for high surface winds in these locations is key to yielding the predictive capacity of dust emissions from these rapidly deglaciating landscapes.

Significance Statement

Mineral dust emissions from high-latitude (>50°N) regions are poorly represented in current modeling approaches. Many dust sources are situated in a mountainous terrain, which heavily influences local wind systems. We investigated the drivers of strong surface winds in the A’ą¨y Chu valley (Canada) with a combination of surface observations and meteorological modeling. The relative importance of different meteorological systems is identified, indicating key phenomena to resolve in future efforts to simulate mineral dust emissions from this region and quantify contributions to the global dust budget.
Near Real-Time Measurement of Airborne Carbon Nanotubes with Metals Using Raman–Spark Emission Spectroscopy
Authors: Zheng Lina , Li Jialin , Huang Jing , Feng Wenting , Zhan Yuhan , Liu Dou
Published: January 2025

We present a near real-time measurement method that combines Raman and spark emission spectroscopy to quantitatively analyze the molecular structure of airborne single-walled carbon nanotubes (SWCNTs) and multi-walled carbon nanotubes (MWCNTs), as well as detect toxic metals within CNTs. A corona-based aerosol microconcentrator was used for airborne CNTs sampling to enhance the measurement accuracy and sensitivity. The intensity of the characteristic Raman bands of CNTs and atomic emission lines of metals exhibited a linear relationship with the analyte mass, yielding high coefficient R2 values. By carefully selecting appropriate signal peaks for calibration, we achieved a limit of detection (LOD) in terms of air concentration as low as 0.09 μg/m3 for SWCNT and 0.81 μg/m3 for MWCNT with a sampling time of 10 min. Additionally, our method exhibited excellent performance in measuring metals, with a mass LOD of 0.8–0.9 ng for Co and Ni and a mass LOD of 35.09 ng for Fe. The method performed well for the measurement of CNT and relevant metal composition with advantages of near real-time monitoring, low LOD, and portable use, making it a valuable tool for various applications in nanomaterial analysis.
Perspectives on psychosocial support services for unaccompanied asylum-seeking children and child victims of abuse in Türkiye
Authors: Bayyar Aliye Beyza , Daşbaş Serap
Published: January 2025

This article explores perspectives on psychosocial support services at Child Support Centers, one of the social service institutions in Türkiye. The research was conducted with 16 professionals providing a psychosocial support program to victims of abuse and unaccompanied asylum-seeking children. This program provides benefits to both professionals and children, facilitating tailored interventions based on individual needs. Furthermore, the psychosocial support process is influenced by factors such as working conditions, staff qualifications, in-service training, and legal regulations. The findings suggest the need for improved policies in child welfare, increased employment of social workers, and enhanced collaboration between social service organizations in Türkiye.
Gender disparities in adult patients undergoing emergency appendicectomy: A comparative analysis
Authors: Miller Gillian , Gall Lewis S , Macdonald Andrew , Khan Khurram Shahzad
Published: January 2025

Background

Emergency appendicectomy (EA) is a common procedure, yet few studies have focused on gender differences in these patients. This study aims to evaluate the demographics, preoperative investigations, intraoperative findings, and clinical outcomes between males and females undergoing EA.

Methods

A multicenter retrospective observational study was conducted across four hospitals involving patients who underwent EA between August 2018 and November 2025. Patients were identified through pathology records, and data were collected on demographics, preoperative blood tests, imaging, operative details, and clinical outcomes and results compared.

Results

1128 patients were included, with 57.5% being male. Males were younger (median age: 34 vs 40 years, P < .001). There was no significant difference in preoperative white cell or neutrophil counts, although males had lower C-reactive protein levels (median 72 vs 97, P < .001). Females were more likely to undergo pre-operative imaging, including ultrasound (20.7% vs 1.5%, P < .001) and CT scans (61.8% vs 54.9%, P = .020). Open surgery was more common in males (14% vs 6.5%, P < .001). No differences were observed in the severity of appendicitis, negative EA rates, hospital stay duration, postoperative complications, or 30-day readmission rates.

Conclusions

Although differences exist between genders in terms of age, imaging usage, and surgical approach, clinical outcomes are comparable.
Strain hardening and tensile deformation behaviour of two advanced high-strength steels with ferrite-bainite microstructure
Authors: Chatterjee Sudin , Chinara Manaswini , Prasad Akula Durga , Jayabalan Bhagyaraj , Mahashabde Vinay V. , Mukherjee Subrata
Published: January 2025

Two advanced high-strength steels (AHSSs) with varying percentages of bainite present in the microstructure were examined for their deformation behaviour under tensile loading. Despite having comparable yield strength (680–700 MPa) and tensile strength (775–780 MPa), the two steels behaved differently in terms of deformation and damage during tensile loading. The strengthening mechanism was governed by the combined effect of precipitates and the harder bainite phase. Also, the two steels’ strain-hardening behaviour differed. At the early stages of the deformation, the amount of harder bainite phase determined the strain hardening rate, however, in the later stages, the strain hardening rate became sluggish and gradual due to restricted mobility of the dislocations caused by the nano-precipitates. This phenomenon was further confirmed by the EBSD and KAM maps, revealing differences in grain misorientation resulting from the deformation. Overall, steel with a reduced volume fraction of bainite phase demonstrated a ductile fracture behaviour in contrast to the steel with a predominantly bainitic microstructure. In this case, the quasi-cleavage kind of fracture was discovered.
Effect of nitrogen content and magnesium-cerium treatment on inclusions in interstitial free steel
Authors: Jiang Yun-xuan , Hu Shao-yan , Wang De-yong , Chen Zhao-ping , Zhou Xing-zhi , Li Yong-kang , Wang Rui-zhi , Qu Tian-peng
Published: January 2025

The electric arc furnace process is beneficial for reducing carbon emission in the steelmaking industry. However, the excessive nitrogen content in electric arc furnace molten steel is unfavourable for producing high-grade interstitial free (IF) steel. In this work, the effect of nitrogen content on inclusions in IF steel and the Mg–Ce treatment modification performance were investigated through thermodynamic calculations and experimental characterisation. The results show that, as the nitrogen content in IF steel rises from 0.0025% to 0.0067%, the precipitation of TiN is promoted, leading to an increase in both the number density and the size of TiN inclusions. The average size of TiN increases from 2.61 to 4.31 μm. After Mg treatment in high-nitrogen IF steel, a significant increase in number density while a noticeable decrease in the size of TiN can be observed. After Ce treatment, the precipitation of TiN clusters embedded in large complex Ce-rich cores causes an increase in the number of large-sized inclusions, which weakens the modification effect. Moreover, after Mg–Ce combined treatment, the TiN clusters are no longer observed, inducing an obvious decrease in the average size of TiN to 2.95 μm. Results of the TiN inclusions statistics and disregistry calculations indicate that plenty of fine dispersed Mg-rich and Ce-rich inclusions can serve as the nuclei for the heterogeneous nucleation of TiN, thereby refining the inclusions.
Research on contact friction characteristics of SiCp/Al tool-chip under quasi-intermittent vibration assisted swing cutting
Authors: Yang Yang , Li Jinliang , Chen Yu , Sun Shuai , Zhai Shuaijie
Published: January 2025

In order to reduce the cutting force and tool wear during the processing of aluminum based silicon carbide composite materials, this study deeply explores the machining mechanism of quasi intermittent vibration assisted swing cutting of aluminum based silicon carbide composite materials. To this end, a tool-chip friction model was formulated to scrutinize the effects of cutting forces and chip formation under a spectrum of machining parameters. The findings indicate that the cutting force escalates with an increase in cutting depth and exhibits a trend of initial decrease followed by an increase with the rise in swing frequency. The tool swing characteristic of QVASC demonstrates superiority over orthogonal cutting (OC) in facilitating chip breakage. The experimental results show that when the cutting rate and vibration frequency are 10 m/min and 150 Hz, respectively, the length of the chips is the shortest. When the cutting depth and vibration frequency are 150 Hz, the cutting force is the smallest. The directional shifts in chip flow, instigated by the tool’s oscillation, induce horizontal bending of the chips, thereby easing their fragmentation and expediting chip removal, which in turn diminishes chip-tool interface friction. Moreover, as the cutting speed rises, the average length of chips tends to elongate. However, an increase in tool swing angle and frequency counteracts this trend, reducing the average chip length, with the frequency’s impact being notably pronounced. These insights provide direction for the application of SiCp/Al composite materials and the advancement of quasi intermittent vibration assisted swing cutting technology.
Investigating the Protective Role of Solasodine in Lipopolysaccharide-induced Acute Lung Injury in Rats
Authors: Lv Xiaoyan , He Yanlong , Zhang Yanhong
Published: January 2025

Background

Acute lung injury (ALI) is an acute inflammatory condition defined by the excessive generation of inflammatory chemicals in lung tissue. Solasodine, a glycoalkaloid isolated from Solanum species, has been proven to exhibit anti-inflammatory and anti-spermatogenic activities.

Purpose

The present study intended to explore the protective potential of Solasodine on lipopolysaccharide (LPS)-stimulated ALI in rat models.

Methods

The animals were assigned to four groups: Normal control, LPS-induced at 4 mg/kg, Solasodine alone 50 mg/kg, LPS + Solasodine 50 mg/kg. The lung tissue was examined to assess the activities of the lung wet/dry weight ratios, lung myeloperoxidase (MPO), nitric oxide (NO) activity, oxidative stress parameters malondialdehyde (MDA), 8-hydroxy-2′-deoxyguanosine (8-OHdG), and superoxide dismutase (SOD) along with the histopathological analysis were evaluated. In addition, lactate dehydrogenase (LDH) activity in the bronchoalveolar lavage fluid (BALF), levels of inflammatory cytokines interleukin (IL)-1β, tumor necrosis factor-alpha (TNF-α), IL-6, and neutrophil gelatinase-associated lipocalin (LCN-2) in BALF were determined.

Results

The results revealed that Solasodine treatment substantially lowered the wet/dry weight ratio, improved the histopathologic modifications, increased the SOD, and downregulated the levels of LDH, MPO, nitric oxide (NO), MDA, and 8-OHdG. Moreover, Solasodine treatment decreased the neutrophil infiltration and cytokines and protein levels in the BALF.

Conclusion

The current investigation suggested that Solasodine improved LPS-stimulated ALI owing to its anti-inflammatory and antioxidative activity in rats. This study’s nursing interventions involve vigilant monitoring, ethical treatment, supportive care, and accurate data collection. Vigilant monitoring detects distress, and ethical treatment minimizes suffering, supportive care includes oxygen therapy, and accurate data collection evaluates Solasodine efficacy.
Women’s Participation in Rural Development: A Case Study of the District Chakwal, Pakistan
Authors: Khan Sikandar , Ahmad Shakeel , Ur Rehman Altaf , Khan Mashal
Published: January 2025

In Pakistan, rural women play a crucial role in reducing food insecurity as food producers and processors. However, their participation in these activities constitutes only approximately 50% of the labour force. Rural women engage in agribusiness, animal rearing, poultry farming, and social relations but often face challenges due to limited resources and guidance. This results in losing lifetime opportunities for training, nutrition and Medicare. This study aimed to determine rural women’s involvement in rural development, specifically in Locale Chakwal, which comprises five tehsils: Kalar Kahar, Talagang, Chakwal, Chohasaidan Shah and Lawa. The data were collected through a semi-structured questionnaire. The results showed that most rural women were involved in yield-creation activities such as cutting, knitting, woolening and drying farming produce. In the domesticated animal part, women produce yogurt, draining and milk stockpiling. The study highlighted an empowering reaction against gender preference in fields such as education and training. Most women chose daily training for their skill improvement, focusing on training in harvesting activities, animal rearing, poultry production and drying leafy foods.
Effect of Probiotic Toothpaste on Enamel Mineralization and Streptococcus mutans Levels in Cleft Orthodontic Patients—A Randomized Clinical Trial
Authors: Murugesan Dinesh , Subramanian C. Siva , Kailasam Vignesh
Published: January 2025

Objective

To assess the effectiveness of probiotic and fluoride toothpaste on enamel mineralization and Streptococcus mutans levels in cleft lip and/or palate patients undergoing fixed orthodontic appliance therapy.

Design

A randomized comparative trial with a 1:1 allocation ratio.

Participants

Thirty-two patients with cleft lip and/or palate undergoing fixed orthodontic appliances were recruited.

Interventions

Cleft lip and/or palate patients undergoing fixed orthodontic appliances were randomized into Group 1 (probiotic toothpaste) or Group 2 (fluoride toothpaste). The toothpaste was given to the patient after oral prophylaxis. The patients were advised to use the toothpaste two times a day (morning and night) for a period of 4 weeks.

Main outcomes

Enamel mineral content was assessed before intervention (T0) and after 4 weeks of intervention (T1) using DIAGNOdent. Streptococcus mutans levels were assessed after 4 weeks of intervention (T1) for both the groups using real time-polymerization chain reaction (RT-PCR). Paired t-tests and t-tests were used for intragroup and intergroup comparisons, respectively. A P-value < .05 was considered statistically significant.

Results

Both the groups showed improvement in enamel mineral content after 4 weeks of intervention. Streptococcus mutans levels in the probiotic-containing toothpaste were lesser when compared to the fluoridated toothpaste group. No statistically significant difference was found between probiotic toothpaste and fluoridated toothpaste in both the assessed parameters.

Conclusions

Probiotic toothpaste is as effective as fluoride toothpaste in enamel remineralization. Probiotic toothpaste showed greater inhibitory effect on Streptococcus mutans than the fluoridated toothpaste.
Clinical Characteristics and Risk Factors of Patients with Lung Cancer Complicated with Pulmonary Embolism: A Case Control Study
Authors: Wang Pengfei , Liang Lei , Ma Kejing , Duan Wei
Published: January 2025

Purpose

The purpose of this study was to investigate the clinical characteristics and risk factors for patients with lung cancer complicated by pulmonary embolism and to provide a reference for the early clinical identification of these patients.

Methods

Eighty patients with lung cancer complicated with pulmonary embolism who were treated at Bethune Hospital of Shanxi from October 2018 to October 2025 were compared with 80 patients with lung cancer without pulmonary embolism. The clinical data of the two groups of patients were collected and analysed.

Results

Compared with that in patients in the LC group, the proportion of patients with pulmonary interstitial fibrosis in the LP group was significantly greater (p < 0.05). The incidence of dyspnoea in the LP group was significantly greater than that in the LC group (p < 0.05). Compared with that in the LC group, the proportion of pulmonary artery compression in the LP group was significantly greater, and the difference was statistically significant (p < 0.05). In terms of pathological type, the proportion of adenocarcinoma patients in the LP group was significantly greater than that in the LC group (p < 0.05). In terms of tumor stage, the proportion of patients with stage III/IV disease in the LP group was significantly greater than that in the LC group, while the proportion of patients with stage I/II disease was significantly lower than that in the LC group, and the difference was statistically significant (p < 0.05). The neutrophil [NEUT (%)], prothrombin time (PT), white blood cell (WBC), carcinoma embryonic antigen (CEA) and D-dimer (DD) levels were significantly greater in the LP group than in the LC group (p < 0.05). In terms of treatment, the proportion of patients receiving systemic chemotherapy in the LP group was significantly greater than that in the LC group (p < 0.05). Logistic regression analysis revealed that adenocarcinoma, systemic chemotherapy and tumor stage III-IV were independent risk factors for lung cancer complicated with pulmonary embolism.

Conclusion

(1) Tumor stage (III/IV), systemic chemotherapy, and adenocarcinoma were independent risk factors for pulmonary thromboembolism in patients with lung cancer. (2) In addition, patients with LP were more likely to have pulmonary interstitial fibrosis, dyspnoea, compression of the pulmonary artery by the tumor location, biological targeted therapy, and abnormal increases in D-dimer, WBC, NEUT (%), CEA and PT levels as laboratory indicators. (3) Pulmonary thromboembolism should be considered in lung cancer patients with a combination of the factors described above.
Pain-Related Responses in Preterm Babies Using Automated and Laser Heel-Lancing Devices
Authors: Lee Hea Jin , Kim Myoung Soo , Chung Mi Lim
Published: January 2025

Purpose: This study aimed to compare the pain-related behavioral and physiological responses and puncture-related characteristics between automated and laser lancets and examine the correlation between infants’ pain-related responses and facial expressions during heel lancing in a neonatal intensive care unit. Methods: Pain-related responses were assessed using the Neonatal Infant Pain Scale, heart rate, and oxygen saturation through pulse oximetry. Facial expressions were also analyzed using a facial recognition application. Puncture-related characteristics were assessed through puncture marks, number of punctures, and hemostasis. Results: There was a significantly higher puncture mark frequency at 3 min in the automated lancet group than in the laser lancet group. There were no interaction effects of time and group on pain-related behavioral response, heart rate, or oxygen saturation. There were significant positive correlations between the pain-related behavioral response and anger, disgust, fear, and sadness. Conclusion: The laser lancet had relatively good outcomes regarding puncture-related characteristics, although there was no significant difference in pain-related responses. A laser lancet is a novel option for preterm babies at risk of scar-related inflammation and coagulopathies.
Representing and organising the solo self-employed in Europe: The emergence of a ‘relational representation’ from the combination of prefigurative and contentious politics
Authors: Mezihorak Petr , Murgia Annalisa
Published: January 2025

Collective representation is traditionally associated with employees, while solo self-employed (SSE) workers, in both regulated and unregulated professions, are usually considered to be autonomous and therefore not in need of representation. However, in recent years, the SSE have increasingly represented their interests collectively, although often outside traditional representative organisations such as trade unions, employer organisations, and professional and business associations. By drawing on two case studies conducted within associations of unregulated SSE based in Germany and Italy, this article introduces the concept of ‘relational representation’. In particular, our findings show how a relational representation acts to support workers’ autonomy by promoting the building of relationships, and at the same time by mobilising both prefigurative and conflictual ways of doing politics, traditionally considered as alternatives. Drawing on feminist relational approaches to (inter)dependence and autonomy, the article discusses three organisational practices that allow for relational representation: engaging with welfare institutions on common professional conditions; redefining relations between representatives and represented; and promoting the exchange of experiences and interests among members.
A longitudinal cohort study demonstrating the beneficial effect of moderate consumption of green tea and coffee on the prevention of dementia: The JPHC Saku Mental Health Study
Authors: Koreki Akihiro , Nozaki Shoko , Shikimoto Ryo , Tsugane Shoichiro , Mimura Masaru , Sawada Norie
Published: January 2025

Background

While the preventive effects of green tea and coffee on cognitive decline have been demonstrated, their long-term effects on cognition remain unclear.

Objective

This study aims to investigate the effect of green tea and coffee consumption in middle age on the prevention of dementia.

Methods

This population-based cohort study included 1155 participants (aged 44–66 in 1995). Participants’ consumption of green tea and coffee was assessed using questionnaires in 1995 and 2000. Their cognitive levels were neuropsychologically evaluated in 2025–2015. Logistic regression analyses were conducted with significant cognitive decline (defined as multi-domain cognitive decline and more severe conditions) as the dependent variable. Stratified analyses were also conducted by sex and age.

Results

Individuals who consumed 2–3 cups of green tea daily had a significantly reduced risk of cognitive decline (OR = 0.56, 95%CI: 0.35–0.91) after adjusting potential confounders. However, this effect was not significant with consumption of 4 or more cups. This protective effect was particularly observed in males (OR = 0.38, 95%CI: 0.19–0.76). A significant risk reduction was also observed in individuals consuming one or more cups of coffee daily (OR = 0.54, 95%CI: 0.34–0.84) in the older subjects (median age [53 years old] and older in 1995) in the same fully adjusted model, but not in the entire sample.

Conclusions

Our findings suggest that moderate green tea consumption in midlife may have a beneficial effect on preventing dementia, particularly in males. The effects of coffee consumption may be more advantageous for older individuals.
Engaging guests for a greener tomorrow: Examining the role of hotel chatbots in encouraging pro-environmental behavior
Authors: Singh Deeksha , Kunja Sambashiva Rao
Published: January 2025

Over the past two decades, technology adoption has surged, with businesses leveraging innovations like chatbots to enhance customer experiences. Sustainability concerns have also escalated, particularly in the hospitality sector. Recognizing the importance of resource mindfulness and catering to digitally savvy, eco-conscious young consumers, there is a need to find a way to use technology to encourage pro-environmental behavior among hotel guests. Therefore, this study investigates how anthropomorphic chatbot concierges encourage willingness to partake in sustainable practices among young hotel guests. With a sample size of 346, the study confirms a positive and significant relationship between anthropomorphic chatbot concierge and the willingness of guests to partake in sustainable practices, which is mediated by hedonic motivation and positive experience. The findings contribute to the SEEK Model and value theory, offering practical insights for marketers to develop a sustainable competitive edge and cultivate an environmentally responsible brand image.
Recognition and management of inflammatory bowel disease
Authors: Ghosh S
Published: January 2025

Inflammatory bowel disease comprising of ulcerative colitis and Crohn's disease can no longer be considered to be diseases confined to the West. Genetic susceptibility, mucosal immune dysregulation and intestinal bacterial flora contribute to the pathogenesis, but the exact causes remain uncertain. The identification of Nod2 gene mutations associated with Crohn's disease points to defects in innate immune system that alter interaction with microbial agents. Early recognition is important to prevent morbidity and complications. This poses special challenge in countries where the incidence is lower than that in the West and infective diseases involving the intestinal tract is common. Management requires a multidisciplinary medical-surgical team effort and is focussed on disease modifying therapy rather than simply management of acute relapses. Corticosteroid therapy, though valuable, is not disease modifying and is associated with considerable side effects and morbidity. Specific targeted therapy using monoclonal antibodies has been a most important advance in recent years, but the cost of such therapy continues to be prohibitive.
Respiratory Medicine symposium
Authors: Gibbons MA
Published: January 2025

The Respiratory Medicine symposium considered many topics including the difficulties of managing functional breathlessness and breathlessness in pregnancy, pigeon fancier's lung, interventional bronchoscopy, inhalation therapy for COPD, pulmonary rehabilitation, and terminal care in non-malignant respiratory disease. The Robert W Philip Memorial Lecture focused on advances in the acute respiratory distress syndrome.
Herd-boy, Court Physician, MP, Spy: the life of Dr John Hutton of Dumfries
Authors: Howard JV
Published: January 2025

Dr John Hutton, a graduate of the Universities of Edinburgh and Padua, became the first Treasurer of the Royal College of Physicians of Edinburgh (1681–82), and Court Physician to King William III and Queen Mary (1688–1702). Later he was involved as a secret agent at the Court of Hanover, and was also MP for Dumfries Burghs (1710–12). He died in London, in November 1712, bequesting to the Presbytery of Dumfries a library of 1,500 volumes, including many medical books, much of which survives in New College Library, Edinburgh. An educational trust, established by Hutton for his native parish of Caerlaverock, continued till 1935.
Central vein stenosis in end stage renal failure patients
Authors: Koh KH , Tan C
Published: January 2025

Background: Central vein stenosis is a late complication of CVC. We assess the risk factors and treatment outcome.

Methods: A retrospective study on chronic haemodialysis patients in Sarawak, Malaysia in 2003.

Results: Out of 315 hemodialysis patients, 127 had CVC. Fifty percent (7/14) of patients with LIJC developed central vein stenosis compared with 0·9% (1/117) with RIJC (p<0·05). Seven out of 13 patients with left CVC and left AVF developed signs and symptoms of central vein stenosis in comparison to one out of 24 patients with right CVC and right AVF (p=0·001). Among the 14 patients with LIJC, those with central vein stenosis were older (p=0·028) and tended to have longer duration of catheterisation (p=0·142). Among the eight patients with central vein stenosis, four underwent venoplasty and stenting. All had symptoms improvement.

Conclusion: LIJC is associated with a high risk of central vein stenosis especially in the older patients. Venoplasty and stenting is a feasible treatment.
How does your vote count?
Authors: Welsby PD
Published: January 2025

It is common knowledge that voting procedures can affect the results of governmental elections. Few realise that voting procedures can affect the outcome of parochial small-scale committee decisions. Various voting procedures are available and the choice of voting procedure may be influenced by the outcome desired.
Forensic psychiatry experiences - a medical student visits New Zealand
Authors: Christie GA
Published: January 2025

This paper describes a medical student elective spent in asmall forensic psychiatry unit serving the south island of New Zealand. Patients seen in the unit or related prisons had often suffered severe past abus, psychopathic personalities were encountered, and alcohol and drug abuse, violence, and family disruption were common background factors. Treatment regimens were multidisciplinary, and community forms of care seemed to work well.
Valproate induced parkinsonism
Authors: Macphee GJA
Published: January 2025

This short report describes a case of drug induced parkinsonism associated with the use of sodium valproate therapy as a mood stabiliser. The clinical utility of FP-CIT SPECT scanning in the differential diagnosis of parkinsonism and tremor disorders is briefly reviewed. The importance of early recognition of valproate-induced parkinsonism is emphasised since this clinical syndrome is largely reversible after drug withdrawal.
Recent advances in the management of rheumatoid arthritis
Authors: Chee MM , Capell HA , Madhok R
Published: January 2025

A truly remarkable transformation in RA management has occurred over the past decade. Patient and physician expectation of treatment effect are now high, and management of inflammatory disease and co-morbidity is more readily tailored to individual patient needs. Therapy in rheumatoid arthritis encompasses symptomrelieving drugs (mainly NSAIDS) and DMARDS that retard progression of the disease. Increasingly, the aim of DMARD therapy is to achieve early and sustained suppression of disease activity. Where this can be achieved NSAIDS could potentially be discontinued. The rapid expansion of available therapies for RA over the past decade is exciting, but necessitates constant re-evaluation of treatment goals and toxicity profiles. It may be that the early use of DMARDS including anti-TNFa drugs will render NSAIDS and corticosteroids unnecessary. Early, sustained and intensive treatment will hopefully improve medium and long-term outcomes in RA. In this review we outline issues that have arisen with the use of NSAIDS and advances in the use of existing DMARDS. In addition, currently available biological agents and those in development are also discussed.
Stress and the heart
Authors: Boon N
Published: January 2025

The role of stress in the genesis of coronary heart disease has been difficult to resolve because stress is a nebulous concept that is difficult to define and virtually impossible to measure. Although there are links between psychosocial and emotional stress and cardiovascular disease there is little prospect of reducing coronary heart disease mortality by reducing stress. We should instead concentrate our efforts on identifyting, preventing, and eliminating the factors that create the underlying atheromatous coronary plaques that make us susceptible to the effects of stress.
Providing health services to rural and remote communities
Authors: Godden D
Published: January 2025

The provision of health services, including specialist medical services, to rural and remote communities may require a different approach to the increasingly sub-specialised, centralised and consumer-orientated systems prevailing in urban centres. The close links between health services and viability of communities introduces an additional political dimension to health planning in these settings. New models of care and new technologies will require specific training for rural settings. International experience must be used to mutual benefit in developing services of appropriate standard, which comply with local needs and are staffed by appropriately trained, supported and accredited clinicians.
Expedition medicine symposium 2005
Authors: Kelland N
Published: January 2025

This meeting, the first held on this subject by the College, aimed to address the medical challenges presented by the advent of ‘adventure tourism’, focusing on topics helpful for expedition medics.
Musculoskeletal pain
Authors: Littlejohn GO
Published: January 2025

Acute pain within the various components of the musculoskeletal system is a cardinal symptom of the pathophysiological processes involved with tissue damage, disease, or dysfunction. These disorders are generally wellcharacterised and management usually associated with good symptomatic and functional outcomes. Immediate activation of an inbuilt and hard-wired basic pain system serves a primary protective function to the host. Another system, perhaps best described as an advanced pain system, augments, amplifies, and extends the role of the pain system to other functions. Emotional distress has a potent effect on this process and drives a series of events that results in altered ‘downstream’ musculoskeletal symptoms and function. Under these circumstances chronic pain states may arise and may particularly involve the musculoskeletal tissues.

Fibromyalgia syndrome is used here as an example of a common chronic musculoskeletal pain syndrome, characterised by widespread pain and tenderness, in order to allow for discussion of the biopsychosocial inputs that must be addressed to provide the best clinical outcome. Emphasis is placed on understanding the nature of these problems, particularly to enhance reversibility and hence improve outcomes.
Acute coronary syndrome
Authors: Hogg KJ , Docherty A
Published: January 2025

The term ‘acute coronary syndrome’ encompasses STEMI,NSTEMI, and UA. The electrocardiogram identifies those with STEMI. An elevated troponin level measured at least 12 hours after the onset of pain distinguishes NSTEMI from UA. However, the separation of NSTEMI and UA is somewhat artificial, as the management of individual patients is based on their risk score, with troponin being only a small part of the equation. Patients at moderate to high risk of death, MI, or subsequent admission to hospital should be offered early coronary arteriography with a view to revascularisation. The CLARITY and COMMIT studies, when added to the CURE study, support the early use of clopidogrel in all patients with ACS, irrespective of age.
Inborn errors of metabolism in the newborn: clinical presentation and investigation
Authors: Fitzpatrick D
Published: January 2025

Inborn errors of metabolism are genetically determined interruptions of one (or several related) metabolic pathway(s). Clinical symptoms are caused by deficiency of the pathway product and/or toxicity resulting from the accumulation of an intermediary compound. Inborn errors of metabolism are mostly recessive disorders, with clinical symptoms rare in heterozygous individuals. The genetic defects involve homozygous (autosomal) or hemizygous (X-linked) mutations in genes encoding proteins with a single enzymatic function. However, interruptions in biochemical pathways may also result from mutations affecting the bioavailability of an enzymatic co-factor or disordered transport of the enzyme across intracellular membranes. In the latter two circumstances it is likely that more than one enzymatic process will be affected.

The five main modes of presentation of IEM in the neonatal period are acute intoxication, energy deficiency, organomegaly, profound central hypotonia, and malformations. The common diagnoses in each of these groups will be presented, with brief descriptions of the currently available options for diagnosis and therapy.
William Henderson (1810–72) and homeopathy in Edinburgh
Authors: Boyd DHA
Published: January 2025

William Henderson was appointed professor of general pathology at Edinburgh University and physician-in-ordinary to the ERI. He produced several papers on clinical and pathological aspects of aortic and heart disease and contributed to the differentiation of typhus and typhoid fevers. He became a homeopathist and was at the centre of a controversy surrounding the introduction of homeopathy to Edinburgh in the 1840s. This involved the Faculty of Medicine, the RCPE and medical societies as well as medical personalities, prominent among whom were Professor Sir James Y Simpson, Professor Sir Robert Christison and Professor James Syme. Many Scottish medical graduates were involved in the introduction of homeopathy to the British Isles. Glasgow is one of only four UK cities still to have a homeopathic hospital.
The case for an obstetric physician
Authors: Hadden DR
Published: January 2025

Obstetric medicine is a branch of general internal medicine which requires a defined training programme and a formal curriculum. There is still uncertainty among physicians about this specialty, and there is no recognised entry pathway through the UK Colleges of Physicians. Obstetricians have been more aware of the need for specific medical skills both before gestation, and during pregnancy, labour and the puerperium, and have introduced a training module in Maternal Medicine as an extension of obstetric training. There is now a demand from trainee physicians for an appropriate programme which bridges the artificial divide between internal medicine and pregnancy-related medicine. This demand has a long-established historical basis, but is now a contemporary problem which needs to be addressed.