bluuebunny/crossref_metadata_2025 huggingface dataset:
An insight into metastatic Leydig cell tumors: A case report
Authors: David Jerel , Chumbalkar Vaibhav , Chadha Juskaran
Published: July 2023

Sex cord-stromal tumors comprise approximately 5% of all testicular tumors, while the remainder are of germ cell origin. Leydig cell tumors are the most common subtype of testicular sex cord-stromal tumors and account for 1%–2% of all testicular tumors. Leydig cell tumors are mostly benign but approximately 5%–10% of them have malignant potential. The commonest metastatic sites are regional lymph nodes, lung, liver, and bones. Here, we report a case of late metastatic relapsed Leydig cell disease in a 73-year-old male. The goal of this care report was to better understand manifestation and management of patients with late relapsed Leydig cell tumors and low-volume disease. Patients with metastatic Leydig cell tumors (or sex cord-stromal tumors) have poor prognosis, and standard treatment recommendations do not exist. Surgical resection of metastasis and/or chemotherapy with bleomycin, etoposide, and cisplatin should be discussed with patients, as some were reported to have complete remission after these interventions. Although there are few literature studies and data to support ideal management, this case has shown that there may be utility for local radiation therapy in unresectable low-volume metastatic Leydig cell disease. A limitation in this report is that we will need long-term follow-up regarding this case. Given the rare occurrence of this malignancy, more data collection going forward will assist in the optimal management of future patients, given this diagnosis.
A Systematic Review of the Reporting Quality of Qualitative Research in Breast Plastic Surgery
Authors: Hircock Caroline , Leveille Cameron F , Chen Jeffrey , Lin Xue-Wei , Lansang Rafael P , Kim Patrick J , Huan Peter W , Gallo Lucas , Thoma Achilles
Published: July 2023

Background:Qualitative research incorporates patients’ voices into scientific literature. To date, there has been no formal review of qualitative research in plastic surgery. The primary objective of this study was to evaluate the reporting quality of “breast specific” plastic surgery qualitative research. Secondary objectives were to record study methodology and examine associations between reporting quality and publication/journal characteristics. Methods: MEDLINE, Embase, Psychinfo, and PubMed were searched to identify qualitative studies in breast plastic surgery. Findings were presented with descriptive analysis. Reporting quality was evaluated using the Standards for Reporting Qualitative Research (SRQR), a 21-item checklist. Results: Eighty studies were included. The median SRQR score was 17/21 (range: 6-21). The lowest reported SRQR items were qualitative approach (n = 29/80, 36%) and data collection method (n = 36/80, 45%). Nine (11%) studies described following a reporting guideline. Articles published in nursing journals had the highest average SRQR scores (18.4/21). There was no significant difference between studies published before or after the publication of SRQR ( P = .06). Eighty-six percent of studies focused on patient experiences with breast reconstruction (n = 69/80). Conclusions: The introduction of the SRQR has not led to significant improvement in the reporting of qualitative research. Rationale for methodology was frequently missing. We recommend that investigators conducting qualitative research in breast plastic surgery ensure they provide a rationale for their methodology and become familiar with the SRQR reporting guideline.
Reframing Part-Work Pedagogy: Three Portraits
Authors: Dillon Jonathan Edan
Published: July 2023

Part-work is a skill through which an individual performs and maintains one musical part while another part is performed at the same time. Rich and varied part-work experiences feature prominently in the musical lives of children. Despite this, elementary general music teachers often frame part-work as a skill needed in the short term to perform specific concert repertoire or as a skill needed in preparation for future participation in choirs, bands, and orchestras. In this article, three vignettes involving part-work in general music are juxtaposed with vignettes involving part-work beyond school settings. These narratives are offered in an effort to reframe part-work pedagogy as a means of enabling personally meaningful engagements with and through music. Practical considerations of this reframing are explored using Georgia Newlin’s teaching sequences for part-singing development as a foundation.
Management and outcome of COVID-19 in CTLA-4 insufficiency
Authors: Ochoa Sebastian , Abers Michael S. , Rosen Lindsey B. , Rump Amy , Howe Katherine , Lieberman Jay A. , Wright Benjamin L. , Suez Daniel , Krausz Máté , Grimbacher Bodo , Lionakis Michail S. , Uzel Gulbu
Published: July 2023

Despite the high incidence of COVID-19 worldwide, clinical experience with severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) in inborn errors of immunity remains limited. Recent studies have shown that patients with defects in type 1 interferon (IFN)-related pathways or those with autoantibodies against type 1 IFNs develop severe COVID-19. We reported the clinical course of 22 patients with CTLA-4 insufficiency and COVID-19 and retrospectively examined autoantibodies against type 1 IFNs at baseline. Data were obtained from the patient interviews and chart reviews. Screening for anti-IFN autoantibodies was performed using a multiplex particle-based assay. Student t test, Mann Whitney, analysis of variance, or χ2 tests were used where appropriate. Twenty-two patients aged from 8 months to 54 years, with genetically confirmed CLTA-4 insufficiency, developed COVID-19 from 2020 to 2022. The most common symptoms were fever, cough, and nasal congestion, and the median duration of illness was 7.5 days. Twenty patients (91%) developed mild COVID-19 and were treated as outpatients. Two patients were hospitalized because of COVID-19 pneumonia but did not require mechanical ventilation. Ten (45%) patients were vaccinated at the time of their first COVID-19 infection. Eleven patients received outpatient treatment with monoclonal antibodies against the SARS-CoV-2 spike protein. During the study period, 17 patients were vaccinated against SARS-CoV-2, with no severe vaccine-related adverse effects. Although median anti-S titers following vaccination or infection were lower in patients receiving immunoglobulin replacement therapy (IGRT) (349 IU/dL) than in those not receiving IGRT (2594 IU/dL; P = .15); 3 of 9 patients on IGRT developed titers >2000 IU/dL. All patients tested negative for autoantibodies against IFN-α, IFN-β, and IFN-ω at baseline. Most patients with CTLA-4 insufficiency and COVID-19 had nonsevere disease, lacked autoantibodies against type 1 IFNs, and tolerated messenger RNA vaccines with few adverse effects. Whether our findings can be extrapolated to patients receiving CTLA-4-targeting checkpoint inhibitors requires further studies.
Vibrio-Sequins - dPCR-traceable DNA standards for quantitative genomics of Vibrio spp
Authors: Flütsch Sabrina , Wiestner Fabian , Butticaz Lisa , Moor Dominik , Stölting Kai N.
Published: July 2023

Background

Vibrio spp. are a diverse group of ecologically important marine bacteria responsible for several foodborne outbreaks of gastroenteritis around the world. Their detection and characterization are moving away from conventional culture-based methods towards next generation sequencing (NGS)-based approaches. However, genomic methods are relative in nature and suffer from technical biases arising from library preparation and sequencing. Here, we introduce a quantitative NGS-based method that enables the quantitation of Vibrio spp. at the limit of quantification (LOQ) through artificial DNA standards and their absolute quantification via digital PCR (dPCR).

Results

We developed six DNA standards, called Vibrio-Sequins, together with optimized TaqMan assays for their quantification in individually sequenced DNA libraries via dPCR. To enable Vibrio-Sequin quantification, we validated three duplex dPCR methods to quantify the six targets. LOQs were ranging from 20 to 120 cp/µl for the six standards, whereas the limit of detection (LOD) was ~ 10 cp/µl for all six assays. Subsequently, a quantitative genomics approach was applied to quantify Vibrio-DNA in a pooled DNA mixture derived from several Vibrio species in a proof-of-concept study, demonstrating the increased power of our quantitative genomic pipeline through the coupling of NGS and dPCR.

Conclusions

We significantly advance existing quantitative (meta)genomic methods by ensuring metrological traceability of NGS-based DNA quantification. Our method represents a useful tool for future metagenomic studies aiming at quantifying microbial DNA in an absolute manner. The inclusion of dPCR into sequencing-based methods supports the development of statistical approaches for the estimation of measurement uncertainties (MU) for NGS, which is still in its infancy.
Effects of reminiscence therapy on quality of life and life satisfaction of the elderly in the community: a systematic review
Authors: Shin Eunyoung , Kim Myeongshin , Kim Seyoon , Sok Sohyune
Published: July 2023

Background

Reminiscence therapy is known as an effective intervention method for elderly with various health conditions. This study was to provide basic data for contributing to the spread and development of effective intervention by analyzing the characteristics and effects of reminiscence therapy applied to the elderly at home.

Methods

To select the article to be studied, literature published from January 2000 to January 2021 was searched through eight databases. A total of 897 articles were searched, and the collected papers were analyzed using the flow chart of Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). Of these, 6 articles suitable for the selection criteria were selected by reviewing titles and abstracts, excluding duplicate papers, using EndNote X9 and Excel 2013. The quality of literature was evaluated using the critical appraisal checklist of the Joanna Briggs Institute.

Results

For the characteristics of the selected literature, most of the literature published within the last 10 years was conducted, and the research design was conducted only in experimental research. The most common form of reminiscence therapy was group reminiscence, and the type was ‘simple reminiscence’. The intervention method of reminiscence therapy was provided in various ways, but ‘Sharing’ was mainly used, and the representative topic of recall was ‘Hometown’. Most of the intervention was performed less than 10 times and took about 60 min.

Conclusion

According to the results of this study, reminiscence therapy provided to the elderly living in the community was effective in improving their quality of life and life satisfaction. Therefore, it is suggested that reminiscence therapy can be an intervention method that is helpful for positive psychological factors and health promotion by improving the quality of life and life satisfaction of the elderly living in the community, and further, it is considered that the elderly can contribute to non-pharmacologically healthy aging in the community.
Association of blood neutrophil-lymphocyte ratio with short-term prognosis and severity of tuberculosis meningitis patients without HIV infection
Authors: Gu Zhihan , Liu Bofu , Yu Xiaomin , Cheng Tao , Han Tianyong , Tong Le , Cao Yu
Published: July 2023

Background

Predicting the short-term prognosis and severity of tuberculosis meningitis (TBM) patients without HIV infection can be challenging, and there have been no prior studies examining the neutrophil lymphocyte ratio (NLR) as a potential predictor of short-term prognosis or its relationship to TBM severity. We hypothesized that NLR might serve as an independent indicator of short-term prognostic significance and that there might be a correlation between NLR and severity. The aim of this study was to investigate the role of NLR as a predictor of short-term prognosis and its relationship to severity of tuberculosis meningitis patients without HIV infection.

Methods

We retrospectively collected data from patients diagnosed with TBM in the West China Hospital, Sichuan University, from the period between January 1st, 2018 and August 1st, 2019. Multivariable analysis was executed by the logistic regression model to verify the independence of the 28-day mortality, the discriminative power for predicting short-term prognosis was evaluated using a Receiver Operating Characteristic (ROC) curve, survival outcomes were analyzed using the Kaplan-Meier method and Pearson’s correlation analysis was performed to discuss correlation between NLR and the severity of TBM.

Results

We collected data from 231 TBM patients without HIV infection. 68 (29.4%) patients are classified as stage (I) 138(59.8%) patients are stage (II) 25(10.8%) patients are stage (III) 16(6.9%) patients died during the follow-up period of 28 days. By multiple logistic regression analyses, the NLR (OR = 1.065, 95% CI = 1.001–1.133, P = 0.045), peripheral neurological deficit (OR 7.335, 95% CI 1.964–27.385, P = 0 0.003) and hydrocephalus (OR 11.338, 95% CI 2.397–53.633, P = 0 0.002) are independent risk factors of 28-day mortality. The area under the ROC curve (AUC) for predicting short prognosis using NLR is 0.683 (95% CI 0.540–0.826, P = 0.015), the optimal cutoff value is 9.99(sensitivity: 56.3%, specificity: 80.9%). The Kaplan-Meier analysis demonstrated that patients with higher NLR(>9.99) had significantly worse survival outcomes(P<0.01).Pearson’s correlation analysis presents a significant positive correlation between the severity of TBM and NLR (r = 0.234, P<0.01).

Conclusions

NLR, peripheral neurological deficit, and hydrocephalus are independent risk factors of 28-day mortality, NLR can predict the short-term prognosis of TBM patients without HIV infection. NLR is also found to be significantly and positively correlated with the severity of TBM.
Impact of the first Gulf war on multiple sclerosis risk in Kuwait: a quasi-experimental study
Authors: Akhtar Saeed , Al-Hashel Jasem Y. , Alroughani Raed
Published: July 2023

Objective

It has been reasoned that stressful life events tend to alter immune function thereby increasing the susceptibility to autoimmune diseases including multiple sclerosis (MS). Using the database of Kuwait National MS Registry, this quasi-experimental study assessed the impact of the first Gulf War (Iraqi invasion of Kuwait in 1990) on MS risk in Kuwait.

Methods

MS incidence data from 1980 to 2019 were obtained from the Kuwait National MS Registry. Annual age-standardized incidence rates (ASIRs) (per 105 person-years) were computed using the World Standard Population as a reference. Interrupted time series analysis with the option of autoregressive order (1) was used to evaluate the impact of the first Gulf War on MS risk by treating 1990 as an intervention year.

Results

Estimated baseline annual ASIR (per 105 person-years) was 0.38 (95% CI: -1.02, 1.78; p = 0.587). MS ASIRs (per 105 person-years) tended to increase significantly every year prior to 1990 by 0.45 (ASIR per 105 person-years = 0.45; 95% CI: 0.15, 0.76; p = 0.005). During the first year of the first Gulf War, there seemed to be a non-significant increase (step change) in ASIRs (per 105 person-years) of MS (ASIR per 105 person-years = 0.85; 95% CI: − 5.16, 6.86; p = 0.775) followed by a non-significant increase in the annual trend in MS ASIRs per 105 person-years (relative to the preintervention trend i.e., the difference between the pre-first Gulf War versus the post-first Gulf War trends) by 0.65 (ASIR per 105 person-years = 0.65; 95% CI: − 0.22, 1.52; p = 0.138). However, a postestimation measure of the post-first Gulf War trend was statistically significant (ASIR per 105 person-years = 1.10; 95% CI: 0.40, 1.80; p = 0.003), which implies that the post-first Gulf War trend in the annual ASIRs (per 105 person-years) inclined to be the same as was the pre-first Gulf War (i.e., counterfactual of the pre-first Gulf War trend in annual ASIRs (per 105 person-years) as if no first Gulf War took place).The Durbin-Watson test statistic (d = 1.89) showed almost non-significant autocorrelations across the time series observations on ASIRs (per 105 person-years).

Conclusions

This study suggests that the first Gulf War was not significantly associated with the increasing trend in MS risk at population level in Kuwait neither with any short-term change nor with secular trend. Future studies may consider confirming the role of conflict-related stress or other stressful life events in potential exacerbation of MS risk along with unraveling biologically plausible mechanistic pathways.
Differentials and predictors of food insecurity among Federally Qualified Health Center target populations in Philadelphia: a cross-sectional study
Authors: Inguito Kai , Joa Brandon , Gardner James , Fung Eric N. , Layer Laura , Fritz Karen
Published: July 2023

Background

Over the past decade, the prevalence of food insecurity declined in the United States but curiously climbed in Philadelphia, Pennsylvania, a sizable metropolitan area where many households experience food insecurity and are dependent on programs like SNAP. Therefore, we aimed to determine the burden of food insecurity among populations near Philadelphia Federally Qualified Health Center (FQHC) clinic sites.

Methods

This cross-sectional study was conducted in North Philadelphia, a populous and impoverished section of Philadelphia with many zip codes reporting 30–45% or more of the population below the federal poverty line. Students and clinicians affiliated with a local FQHC conducted surveys on residents (n = 379) within 1-mile radiuses of three FQHC sites, using the Hunger Vital Sign™, a validated food security tool. Survey data were collected through door-to-door visits in the summer of 2019. We used simple, age-adjusted bivariable, and multivariable logistic regression models to predict food insecurity with independent variables, including age, sex, language preference, and BMI category.

Results

Food insecurity in North Philadelphia was much higher (36.9%) than previously reported in Philadelphia and nationwide. Food insecurity was inversely associated with age (AOR = 0.98, 95% CI: 0.97, 1.00), overweight (AOR = 0.58, 95% CI: 0.32, 1.06), and obesity (AOR = 0.60, 95% CI: 0.33, 1.09).

Conclusion

In North Philadelphia, the burden of food insecurity is higher than in the greater Philadelphia area, Pennsylvania state, and the rest of the nation and is predicted by age and BMI of residents. These findings demonstrate a need for more locally targeted research and interventions on food insecurity in impoverished urban settings.
The Skeletal Oncology Research Group Machine Learning Algorithm (SORG-MLA) for predicting prolonged postoperative opioid prescription after total knee arthroplasty: an international validation study using 3,495 patients from a Taiwanese cohort
Authors: Tsai Cheng-Chen , Huang Chuan-Ching , Lin Ching-Wei , Ogink Paul T. , Su Chih-Chi , Chen Shin-Fu , Yen Mao-Hsu , Verlaan Jorrit-Jan , Schwab Joseph H. , Wang Chen-Ti , Groot Olivier Q. , Hu Ming-Hsiao , Chiang Hongsen
Published: July 2023

Background

Preoperative prediction of prolonged postoperative opioid use (PPOU) after total knee arthroplasty (TKA) could identify high-risk patients for increased surveillance. The Skeletal Oncology Research Group machine learning algorithm (SORG-MLA) has been tested internally while lacking external support to assess its generalizability. The aims of this study were to externally validate this algorithm in an Asian cohort and to identify other potential independent factors for PPOU.

Methods

In a tertiary center in Taiwan, 3,495 patients receiving TKA from 2010–2018 were included. Baseline characteristics were compared between the external validation cohort and the original developmental cohorts. Discrimination (area under receiver operating characteristic curve [AUROC] and precision-recall curve [AUPRC]), calibration, overall performance (Brier score), and decision curve analysis (DCA) were applied to assess the model performance. A multivariable logistic regression was used to evaluate other potential prognostic factors.

Results

There were notable differences in baseline characteristics between the validation and the development cohort. Despite these variations, the SORG-MLA (https://sorg-apps.shinyapps.io/tjaopioid/) remained its good discriminatory ability (AUROC, 0.75; AUPRC, 0.34) and good overall performance (Brier score, 0.029; null model Brier score, 0.032). The algorithm could bring clinical benefit in DCA while somewhat overestimating the probability of prolonged opioid use. Preoperative acetaminophen use was an independent factor to predict PPOU (odds ratio, 2.05).

Conclusions

The SORG-MLA retained its discriminatory ability and good overall performance despite the different pharmaceutical regulations. The algorithm could be used to identify high-risk patients and tailor personalized prevention policy.
Does the postoperative quality of reduction, regardless of the surgical method used in treating a calcaneal fracture, influence patients’ functional outcomes?
Authors: Sayyed-Hosseinian Sayyed-Hadi , Shirazinia Matin , Arabi Hamid , Aghaee Monavar Afzal , Vahedi Ehsan , Bagheri Farshid
Published: July 2023

Background

The extensile lateral approach (ELA) and sinus tarsi approach (STA) are commonly utilized for surgically treating calcaneal fractures. This study compared the outcomes of ELA and STA in the management of calcaneal fractures and assessed the influence of postoperative quality of reduction on functional and pain scores.

Methods

The study included 68 adults with Sanders type-II and type-III calcaneal fractures who underwent either ELA or STA surgery. Pre- and postoperative radiographs and computed tomography scans were analyzed, and functional and pain scores were evaluated using the Manchester Oxford Foot Questionnaire (MOXFQ), American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and Visual Analogue Score (VAS) during follow-up visits.

Results

Out of the total patients, 50 underwent ELA surgery while 18 underwent STA surgery. The anatomic (excellent) reduction was achieved in 33 (48.5%) patients. There were no significant differences between the ELA and STA groups concerning functional scores, pain scores, the proportion of excellent reduction, and complications. Additionally, anatomic reduction, compared to near or non-anatomic (good, fair, or poor) reduction, demonstrated a decrease in MOXFQ (unstandardized β coefficient: -13.83, 95% CI: -25.47 to -2.19, p = 0.021), an increase in AOFAS (unstandardized β coefficient: 8.35, 95% CI: 0.31 to 16.38, p = 0.042), and a reduction in VAS pain (unstandardized β coefficient: -0.89, 95% CI: -1.93 to -0.16, p = 0.095) scores.

Conclusion

In conclusion, we found no significant differences regarding complications, excellent reduction, and functional scores between STA and ELA surgeries. Therefore, STA may be an effective alternative for the treatment of calcaneal fractures in Sanders type II and type III calcaneal fractures. Furthermore, the anatomic reduction of the posterior facet correlated with improved functional scores, emphasizing the importance of achieving it for restoring foot function regardless of surgery type or time between injury and surgery.
Impact of glycemic control on the progression of aortic stenosis: a single-center cohort study using a common data model
Authors: Hwang In-Chang , Kim Seok , Boo Dachung , Park Changhyun , Yoo Sooyoung , Yoon Yeonyee E. , Cho Goo-Yeong
Published: July 2023

Background

Diabetes mellitus (DM) is a well-established risk factor for the progression of degenerative aortic stenosis (AS). However, no study has investigated the impact of glycemic control on the rate of AS progression. We aimed to assess the association between the degree of glycemic control and the AS progression, using an electronic health record-based common data model (CDM).

Methods

We identified patients with mild AS (aortic valve [AV] maximal velocity [Vpeak] 2.0–3.0 m/sec) or moderate AS (Vpeak 3.0–4.0 m/sec) at baseline, and follow-up echocardiography performed at an interval of ≥ 6 months, using the CDM of a tertiary hospital database. Patients were divided into 3 groups: no DM (n = 1,027), well-controlled DM (mean glycated hemoglobin [HbA1c] < 7.0% during the study period; n = 193), and poorly controlled DM (mean HbA1c ≥ 7.0% during the study period; n = 144). The primary outcome was the AS progression rate, calculated as the annualized change in the Vpeak (△Vpeak/year).

Results

Among the total study population (n = 1,364), the median age was 74 (IQR 65–80) years, 47% were male, the median HbA1c was 6.1% (IQR 5.6–6.9), and the median Vpeak was 2.5 m/sec (IQR 2.2–2.9). During follow-up (median 18.4 months), 16.1% of the 1,031 patients with mild AS at baseline progressed to moderate AS, and 1.8% progressed to severe AS. Among the 333 patients with moderate AS, 36.3% progressed to severe AS. The mean HbA1c level during follow-up showed a positive relationship with the AS progression rate (β = 2.620; 95% confidence interval [CI] 0.732–4.507; p = 0.007); a 1%-unit increase in HbA1c was associated with a 27% higher risk of accelerated AS progression defined as △Vpeak/year values > 0.2 m/sec/year (adjusted OR = 1.267 per 1%-unit increase in HbA1c; 95% CI 1.106–1.453; p < 0.001), and HbA1c ≥ 7.0% was significantly associated with an accelerated AS progression (adjusted odds ratio = 1.524; 95% CI 1.010–2.285; p = 0.043). This association between the degree of glycemic control and AS progression rate was observed regardless of the baseline AS severity.

Conclusion

In patients with mild to moderate AS, the presence of DM, as well as the degree of glycemic control, is significantly associated with accelerated AS progression.
Psychometric properties of the arabic version of the maslach burnout inventory-human services survey (MBI-HSS) among lebanese dentists
Authors: Bassam Sanaa , Mohsen Heba , Barakat Zainab , Abou-Abbas Linda
Published: July 2023

Background

Dentists are at risk of burnout syndrome, which can have negative impacts on their work environment and productivity. Assessing burnout is crucial for maintaining the well-being and effectiveness of dentists in their profession. The present study aims to evaluate the psychometric properties of the Arabic version of the Maslach Burnout Inventory Human Services Survey (MBI-HSS) among dentists.

Methods

The original English version of the MBI-HSS was translated into Arabic, and then back-translated into English by experienced bilingual professionals. Lebanese dentists were asked to participate in the study between February and June 2019. Data collected included demographic information and items from the Arabic version of the MBI-HSS.

Results

A total of 441 people participated in the study, of whom 58.3% were men. The mean age of the sample was 39.6 years (SD = 12.8), with a range of 23 to 68 years old. Approximately 60% of dentists were specialists. Cronbach’s alphas were as follows: emotional exhaustion (alpha = 0.855), depersonalization (alpha = 0.823), and personal achievement (alpha = 0.667). The results of the test-retest reliability assessment demonstrated the strong reproducibility of the MBI-HSS [EE, ICC = 0.927 (0.845, 0.966), p-value < 0.0001; PA, ICC = 0.963 (0.921–0.983), p-value < 0.001; DP, ICC = 0.764 (0.497–0.889), p-value < 0.0001]. The exploratory factor analysis of the MBI-HSS yielded three psychometrically robust sub-domains representing dimensions of “emotional exhaustion,” “depersonalization,” and “personal achievement,” which explained 57.8% of the scale’s total variance. The confirmatory factor analysis revealed that the 15-item model (excluding items 4, 5, 12, 13, 16, 20, and 22) was the most fitting for the data.

Conclusions

The Arabic version of the MBI-HSS scale demonstrated good psychometric properties in Lebanese dentists. However, it would be important to conduct further research to confirm its reliability and validity in other Arab countries.
Examining the nexus between medical education and complexity: a systematic review to inform practice and research
Authors: Ogden Kathryn , Kilpatrick Sue , Elmer Shandell
Published: July 2023

Background

Medical education is a multifarious endeavour integrating a range of pedagogies and philosophies. Complexity as a science or theory (‘complexity’) signals a move away from a reductionist paradigm to one which appreciates that interactions in multi-component systems, such as healthcare systems, can result in adaptive and emergent outcomes. This examination of the nexus between medical education and complexity theory aims to discover ways that complexity theory can inform medical education and medical education research.

Methods

A structured literature review was conducted to examine the nexus between medical education and complexity; 5 databases were searched using relevant terms. Papers were included if they engaged fully with complexity as a science or theory and were significantly focused on medical education. All types of papers were included, including conceptual papers (e.g. opinion and theoretical discussions), case studies, program evaluations and empirical research. A narrative and thematic synthesis was undertaken to create a deep understanding of the use of complexity in medical education.

Results

Eighty-three papers were included; the majority were conceptual papers. The context and theoretical underpinnings of complexity as a relevant theory for medical education were identified. Bibliographic and temporal observations were noted regarding the entry of complexity into medical education. Complexity was relied upon as a theoretical framework for empirical studies covering a variety of elements within medical education including: knowledge and learning theories; curricular, program and faculty development; program evaluation and medical education research; assessment and admissions; professionalism and leadership; and learning for systems, about systems and in systems.

Discussion

There is a call for greater use of theory by medical educators. Complexity within medical education is established, although not widespread. Individualistic cultures of medicine and comfort with reductionist epistemologies challenges its introduction. However, complexity was found to be a useful theory across a range of areas by a limited number of authors and is increasingly used by medical educators and medical education researchers. This review has further conceptualized how complexity is being used to support medical education and medical education research.

Conclusion

This literature review can assist in understanding how complexity can be useful in medical educationalists' practice.
The novel properties of Kluyveromyces marxianus glucose sensor/receptor repressor pathway and the construction of glucose repression-released strains
Authors: Wang Lingya , Wang Anran , Wang Dongmei , Hong Jiong
Published: July 2023

Background

Glucose repression in yeast leads to the sequential or diauxic utilization of mixed sugars and reduces the co-utilization of glucose and xylose from lignocellulosic biomasses. Study of the glucose sensing pathway helps to construct glucose repression-released yeast strains and enhance the utilization of lignocellulosic biomasses.

Results

Herein, the glucose sensor/receptor repressor (SRR) pathway of Kluyveromyces marxianus which mainly consisted of KmSnf3, KmGrr1, KmMth1, and KmRgt1 was studied. The disruption of KmSNF3 led to a release of glucose repression, enhanced xylose consumption and did not result in deficient glucose utilization. Over-expression of glucose transporter gene restored the mild decrease of glucose utilization ability of Kmsnf3 strain to a similar level of the wildtype strain but did not restore glucose repression. Therefore, the repression on glucose transporter is parallel to glucose repression to xylose and other alternative carbon utilization. KmGRR1 disruption also released glucose repression and kept glucose utilization ability, although its xylose utilization ability was very weak with xylose as sole carbon source. The stable mutant of KmMth1-ΔT enabled the release of glucose repression irrespective that the genetic background was Kmsnf3, Kmmth1, or wildtype. Disruption of KmSNF1 in the Kmsnf3 strain or KmMTH1-ΔT overexpression in Kmsnf1 strain kept constitutive glucose repression, indicating that KmSNF1 was necessary to release the glucose repression in both SRR and Mig1-Hxk2 pathway. Finally, overexpression of KmMTH1-ΔT released the glucose repression to xylose utilization in S. cerevisiae.

Conclusion

The glucose repression-released K. marxianus strains constructed via a modified glucose SRR pathway did not lead to a deficiency in the utilization ability of sugar. The obtained thermotolerant, glucose repression-released, and xylose utilization-enhanced strains are good platforms for the construction of efficient lignocellulosic biomass utilization yeast strains.
Oral-microbiome-derived signatures enable non-invasive diagnosis of laryngeal cancers
Authors: Yu Shuting , Chen Junru , Zhao Yan , Yan Fangxu , Fan Yue , Xia Xin , Shan Guangliang , Zhang Peng , Chen Xingming
Published: July 2023

Background

Recent studies have uncovered that the microbiota in patients with head and neck cancers is significantly altered and may drive cancer development. However, there is limited data to explore the unique microbiota of laryngeal squamous cell carcinoma (LSCC), and little is known regarding whether the oral microbiota can be utilized as an early diagnostic biomarker.

Methods

Using 16S rRNA gene sequencing, we characterized the microbiome of oral rinse and tissue samples from 77 patients with LSCC and 76 control patients with vocal polyps, and then performed bioinformatic analyses to identify taxonomic groups associated with clinicopathologic features.

Results

Multiple bacterial genera exhibited significant differences in relative abundance when stratifying by histologic and tissue type. By exploiting the distinct microbial abundance and identifying the tumor-associated microbiota taxa between patients of LSCC and vocal polyps, we developed a predictive classifier by using rinse microbiota as key features for the diagnosis of LSCC with 85.7% accuracy.

Conclusion

This is the first evidence of taxonomical features based on the oral rinse microbiome that could diagnose LSCC. Our results revealed the oral rinse microbiome is an understudied source of clinical variation and represents a potential non-evasive biomarker of LSCC.
Glycyrrhiza polysaccharides inhibits PRRSV replication
Authors: Yang Youbing , Liu Yongjian , Lou Ran , Lei Ying , Li Gan , Xu Zhiqian , You Xiangbin
Published: July 2023

Glycyrrhiza polysaccharide (GCP) is a natural plant active polysaccharide extracted from traditional Chinese medicine licorice. In this research, we studied the antiviral activity of glycyrrhiza polysaccharide against porcine reproductive and respiratory syndrome virus (PRRSV), a virus of the Arteriviridae family, with a high rate of variation and has caused huge economic losses to the pig industry in various countries since its discovery. Our results show that GCP can inhibit PRRSV replication in a dose-dependent manner. Furthermore, GCP could inhibit the mRNA expression of receptor genes CD163 and NF-κB p65 and promote the mRNA expression of the SLA-7 gene. Because of these results, GCP can be used as a candidate drug to prevent and treat PRRS.
Statistical analysis of organelle movement using state-space models
Authors: Nishio Haruki , Hirano Satoyuki , Kodama Yutaka
Published: July 2023

Background

Organelle motility is essential for the correct cellular function of various eukaryotic cells. In plant cells, chloroplasts move towards the intracellular area irradiated by a weak light to maximise photosynthesis. To initiate this process, an unknown signal is transferred from the irradiated area to distant chloroplasts. Quantification of this chloroplast movement has been performed using visual estimations that are analyst-dependent and labour-intensive. Therefore, an objective and faster method is required.

Results

In this study, we developed the cellssm package of R (https://github.com/hnishio/cellssm.git), which is a user-friendly tool for state-space modelling to statistically analyse the directional movement of cells or organelles. Our method showed a high accuracy in estimating the start time of chloroplast movement in the liverwort Marchantia polymorpha over a short period. The tool indicated that chloroplast movement accelerates during transport to the irradiated area and that signal transfer speed is uneven within a cell. We also developed a method to estimate the common dynamics among multiple chloroplasts in each cell, which clarified different characteristics among cells.

Conclusions

We demonstrated that state-space modelling is a powerful method to understand organelle movement in eukaryotic cells. The cellssm package can be applied to various directional movements (both accumulation and avoidance) at cellular and subcellular levels to estimate the true transition of states behind the time-series data.
Upper extremity physical performance tests in female overhead athletes: a test–retest reliability study
Authors: Kardor Sara , Gorji Zahra , Ghotbi Nastaran , Attarbashi-Moghadam Behrouz , Shadmehr Azadeh , Gorji Mona
Published: July 2023

Objective

Despite the studies that have investigated the reliability of Upper Extremity Functional Tests(UEFTs), the reliability of Closed Kinetic Chain Upper Extremity Stability(CKCUES), Seated Medicine Ball Throw(SMBT), push-up(PU) and Unilateral Seated Shot Put(USSP) tests in overhead athletes has yet to be assessed. The objective of this study was to determine both the relative and absolute test–retest reliability of the four UEFTs in female overhead athletes.

Methods

Twenty-nine female overhead athletes (age: 26.6 ± 5.29 years) underwent the four UEFTs twice within a three- day interval. The upper limb stability was assessed through PU and CKCUES tests, while the power was assessed though SMBT and USSP tests. The Intraclass Correlation of Coefficient (ICC) was applied to assess the relative reliability. Absolute reliability was determined by calculating the Standard Error of Measurement (SEM) and the Minimal Detectable Change (MDC). Furthermore, Bland–Altman plots were used to detect the agreements between the two measurements.

Results

The relative reliability of PU, CKCUES, SMBT, and non-dominant arm USSP tests was excellent (ICC = 0.83, 0.80, 0.91, and 0.83, respectively). SEM was within a range of 1.69 to 1.72 for stability tests and a range of 13.61 to 52.12 for power (based on a 95% confidence interval). The MDC was 4.68 for PU and 4.75 for CKCUES test. At least four repetitions are needed to be considered a real improvement on PU and CKCUES tests. This value was 144.04, in SMBT and 59.03, 37.62 cm (dominant and non-dominant arm, respectively) in USSP tests, which represents the minimum change that must occur to be considered an athlete’s progression.

Conclusion

This study revealed that both the upper limb stability and power tests have acceptable relative and absolute intra-rater reliability in female overhead athletes. These can be considered as reliable tools in research and clinical settings.
Biomechanical effects of transverse connectors on total en bloc spondylectomy of the lumbar spine: a finite element analysis
Authors: Han Ye , Ren Xuehong , Liang Yijie , Ma Xiaoyong , Wang Xiaodong
Published: July 2023

Background

The influence of total en bloc spondylectomy (TES) on spinal stability is substantial, necessitating strong fixation to restore spinal stability. The transverse connector (TC) serves as a posterior spinal instrumentation that connects the left and right sides of the pedicle screw-rod system. Several studies have highlighted the potential of a TC in enhancing the stability of the fixed segments. However, contradictory results have suggested that a TC not only fails to improve the stability of the fixed segments but also might promote stress associated with internal fixation. To date, there is a lack of previous research investigating the biomechanical effects of a TC on TES. This study aimed to investigate the biomechanical effects of a TC on internal fixation during TES of the lumbar (L) spine.

Methods

A single-segment (L3 segment) TES was simulated using a comprehensive L spine finite element model. Five models were constructed based on the various positions of the TC, namely the intact model (L1-sacrum), the TES model without a TC, the TES model with a TC at L1–2, the TES model with a TC at L2–4, and the TES model with a TC at L4–5. Mechanical analysis of these distinct models was conducted using the Abaqus software to assess the variations in the biomechanics of the pedicle screw-rod system, titanium cage, and adjacent endplates.

Results

The stability of the surgical segments was found to be satisfactory across all models. Compared with the complete model, the internal fixation device exhibited the greatest constraint on overextension (95.2–95.6%), while showing the least limitation on left/right rotation (53.62–55.64%). The application of the TC had minimal effect on the stability of the fixed segments, resulting in a maximum reduction in segment mobility of 0.11° and a variation range of 3.29%. Regardless of the use of a TC, no significant changes in stress were observed for the titanium cage. In the model without the TC, the maximum von Mises stress (VMS) for the pedicle screw-rod system reached 136.9 MPa during anterior flexion. Upon the addition of a TC, the maximum VMS of the pedicle screw-rod system increased to varying degrees. The highest recorded VMS was 459.3 MPa, indicating a stress increase of 335.5%. Following the TC implantation, the stress on the adjacent endplate exhibited a partial reduction, with the maximum stress reduced by 27.6%.

Conclusion

The use of a TC in TES does not improve the stability of the fixed segments and instead might result in increased stress concentration within the internal fixation devices. Based on these findings, the routine utilisation of TC in TES is deemed unnecessary.
Phenotype and genotype heterogeneity of PLA2G6-associated neurodegeneration in a cohort of pediatric and adult patients
Authors: Dehnavi Ali Zare , Bemanalizadeh Maryam , Kahani Seyyed Mohammad , Ashrafi Mahmoud Reza , Rohani Mohammad , Toosi Mehran Beiraghi , Heidari Morteza , Hosseinpour Sareh , Amini Behnam , Zokaei Shaghayegh , Rezaei Zahra , Aryan Hajar , Amanat Man , Vahidnezhad Hassan , Mohammadi Pouria , Garshasbi Masoud , Tavasoli Ali Reza
Published: July 2023

Background

Phospholipase-associated neurodegeneration (PLAN) caused by mutations in the PLA2G6 gene is a rare neurodegenerative disorder that presents with four sub-groups. Infantile neuroaxonal dystrophy (INAD) and PLA2G6-related dystonia-parkinsonism are the main two subtypes. In this cohort, we reviewed clinical, imaging, and genetic features of 25 adult and pediatric patients harboring variants in the PLA2G6.

Methods

An extensive review of the patients’ data was carried out. Infantile Neuroaxonal Dystrophy Rating Scale (INAD-RS) was used for evaluating the severity and progression of INAD patients. Whole-exome sequencing was used to determine the disease's underlying etiology followed by co-segregation analysis using Sanger sequencing. In silico prediction analysis based on the ACMG recommendation was used to assess the pathogenicity of genetic variants. We aimed to survey a genotype-genotype correlation in PLA2G6 considering all reported disease-causing variants in addition to our patients using the HGMD database and the chi-square statistical approach.

Results

Eighteen cases of INAD and 7 cases of late-onset PLAN were enrolled. Among 18 patients with INAD, gross motor regression was the most common presenting symptom. Considering the INAD-RS total score, the mean rate of progression was 0.58 points per month of symptoms (Standard error 0.22, lower 95% − 1.10, and upper 95% − 0.15). Sixty percent of the maximum potential loss in the INAD-RS had occurred within 60 months of symptom onset in INAD patients. Among seven adult cases of PLAN, hypokinesia, tremor, ataxic gate, and cognitive impairment were the most frequent clinical features. Various brain imaging abnormalities were also observed in 26 imaging series of these patients with cerebellar atrophy being the most common finding in more than 50%. Twenty unique variants in 25 patients with PLAN were detected including nine novel variants. Altogether, 107 distinct disease-causing variants from 87 patient were analyzed to establish a genotype–phenotype correlation. The P value of the chi-square test did not indicate a significant relationship between age of disease onset and the distribution of reported variants on PLA2G6.

Conclusion

PLAN presents with a wide spectrum of clinical symptoms from infancy to adulthood. PLAN should be considered in adult patients with parkinsonism or cognition decline. Based on the current knowledge, it is not possible to foresee the age of disease onset based on the identified genotype.
Non-progressive breast carcinomas detected at mammography screening: a population study
Authors: Heggland Torunn , Vatten Lars Johan , Opdahl Signe , Weedon-Fekjær Harald
Published: July 2023

Background

Some breast carcinomas detected at screening, especially ductal carcinoma in situ, may have limited potential for progression to symptomatic disease. To determine non-progression is a challenge, but if all screening-detected breast tumors eventually reach a clinical stage, the cumulative incidence at a reasonably high age would be similar for women with or without screening, conditional on the women being alive.

Methods

Using high-quality population data with 24 years of follow-up from the gradually introduced BreastScreen Norway program, we studied whether all breast carcinomas detected at mammography screening 50–69 years of age would progress to clinical symptoms within 85 years of age. First, we estimated the incidence rates of breast carcinomas by age in scenarios with or without screening, based on an extended age-period-cohort incidence model. Next, we estimated the frequency of non-progressive tumors among screening-detected cases, by calculating the difference in the cumulative rate of breast carcinomas between the screening and non-screening scenarios at 85 years of age.

Results

Among women who attended BreastScreen Norway from the age of 50 to 69 years, we estimated that 1.1% of the participants were diagnosed with a breast carcinoma without the potential to progress to symptomatic disease by 85 years of age. This proportion of potentially non-progressive tumors corresponded to 15.7% [95% CI 3.3, 27.1] of breast carcinomas detected at screening.

Conclusions

Our findings suggest that nearly one in six breast carcinomas detected at screening may be non-progressive.
CimpleG: finding simple CpG methylation signatures
Authors: Maié Tiago , Schmidt Marco , Erz Myriam , Wagner Wolfgang , G. Costa Ivan
Published: July 2023

DNA methylation signatures are usually based on multivariate approaches that require hundreds of sites for predictions. Here, we propose a computational framework named CimpleG for the detection of small CpG methylation signatures used for cell-type classification and deconvolution. We show that CimpleG is both time efficient and performs as well as top performing methods for cell-type classification of blood cells and other somatic cells, while basing its prediction on a single DNA methylation site per cell type. Altogether, CimpleG provides a complete computational framework for the delineation of DNAm signatures and cellular deconvolution.