bluuebunny/crossref_metadata_2025 huggingface dataset:
“Revolutionary Youth” in Egypt: Interfaith Relations Since the 2011 Revolution
Authors: Kan Toby
Published: May 2023

Due to their important role as the “revolutionary youth” ( shabāb al-thawra) in the 2011 Egyptian revolution (known in part as the Arab Spring), they have attracted considerable attention from scholars. In the post-revolution era, discourse on the revolutionary youth has become prominent in Egypt. Compared to the social exclusion of the youth before 2011, it is noteworthy that the revolutionary youth emerged as the main focus of the interfaith relations between Muslims and Coptic Christians. Based on field research data, this article argues that since 2011, the “revolutionary youth” has become a new driving force of the solidarity movement among different sections of society, particularly interfaith harmony. By and large, the interfaith movement can be seen as an activist movement to maintain one’s ongoing revolutionary spirit by living differently. As a part of the global generation, Egyptian youth have been transformed by the revolution experience within the context of their historical–social location.
A Multicenter Assessment of Nurses’ Knowledge Regarding Pressure Ulcer Prevention in Intensive Care Units Utilizing the PUKAT 2.0
Authors: Guerrero Jefferson Garcia , Mohammed Heba , Pingue-Raguini Minerva , Cordero Rock Parreno , Aljarrah Imad
Published: May 2023

Introduction

Pressure ulcer (PU) care is pivotal in the practice of nurses working in intensive care units (ICUs). Therefore, nurses must possess adequate knowledge about the potential risks leading to the development of PUs, as well as managing complications that worsen patient conditions.

Objective

To evaluate the level of knowledge of ICU nurses concerning PU prevention in tertiary hospitals in Saudi Arabia.

Methods

In this cross-sectional study, the researchers recruited 320 ICU nurses from four tertiary hospitals using convenience sampling. Nurses’ knowledge regarding PU prevention was assessed using the revised and updated version of the Pressure Ulcer Knowledge Assessment Tool (PUKAT) 2.0. Data were collected between May and June 2022. The CROSS checklist was observed for reporting.

Results

The mean scores of nurses’ level of knowledge regarding PU prevention according to the themes of the revised and updated version of the PUKAT 2.0 were as follows—etiology: 62.81  ±  23.77; classification and observation: 50.86  ±  23.28; risk assessment: 31.19  ±  24.26; nutritious diet: 46.04  ±  25.96; prevention: 22.36  ±  12.41; and specific patient groups: 14.84  ±  22.88. Furthermore, the score for nurses’ overall level of knowledge of PU prevention was 39.55  ±  8.84 out of 100, interpreted as low based on the 60% cutoff; the minimum knowledge score was 0. Notably, knowledge of PU etiology, classification, observation, and specific patient groups differed based on the hospital of affiliation. Interestingly, gender was the only demographic characteristic based on which nurses’ knowledge regarding specific patient groups differed.

Conclusion

This study identified insufficient knowledge among ICU nurses regarding PU prevention, which can lead to complications among patients. Simulation scenarios related to PU prevention and management will be an effective way to help nurses gain appropriate knowledge that can be applied in clinical practice.
Has Trust in the European Parliament Polarized?
Authors: Bauer Paul C. , Morisi Davide
Published: May 2023

Scholars usually investigate how average levels of trust in institutions vary across countries and over time. Focusing on average levels, however, ignores distributional properties that might be equally relevant for institutional legitimacy and, more broadly, democratic stability. In this study, the authors investigate how the distribution of trust in the European Parliament has changed over time and across European Union member states. Drawing on pooled cross-sectional data from the European Social Survey for the period from 2002 to 2020, the authors find that confidence in the European Parliament has not only declined over time but also polarized as citizens have increasingly moved away from the “average citizen.” Furthermore, the authors find that trust has polarized, especially among the young versus the elderly and the employed versus the unemployed. These findings have implications for the legitimacy of European Union institutions.
‘We Were Not Earning Enough, So We Started This Job:’ Pathways to Navigate Sex Work in Kathmandu, Nepal
Authors: Karandikar Sharvari , Gezinski Lindsay B. , Casassa Kaitlin , Kaloga Marissa
Published: May 2023

This study explored the lived experiences of cisgender female sex workers (FSWs) in Kathmandu, Nepal, from human rights, political economy, poverty and structural oppression perspectives. Utilising the purposive snowball sampling method, qualitative interviews were conducted with 30 FSWs. The analysis involving holistic and provisional coding methods helped to identify three themes: (a) entering sex work through employer, (b) cycling in and out of sex work to supplement other income and (c) maintaining sex work through secrecy. These findings contain important implications for policy and practice promoting dignity of and right to self-determination by FSWs.
‘Out of the frying pan into the fire’: a qualitative study of the impact on masculinity for men living with advanced prostate cancer
Authors: Salifu Yakubu , Almack Kathryn , Caswell Glenys
Published: May 2023

Background:

Studies have highlighted how advanced prostate cancer causes biographical disruption and presents challenges to masculine identities for men. This article draws on a wider study that focused on the experiences of men living with advanced prostate cancer and their caregivers. Although men’s experience of advanced illness is not overlooked in the literature, only a small body of work has taken an in-depth look at men’s experiences with advanced prostate cancer and their caregivers in a non-Westernised cultural and social context.

Objective:

To explore how advanced prostate cancer impacts on men’s masculine identity from the perspective of patients and their caregivers.

Methods:

A qualitative study of men living with advanced prostate cancer ( n = 23) and family caregivers ( n = 23) in Ghana. We used the Consolidated Criteria for Reporting Qualitative Studies (COREQ) as the reporting guideline.

Results:

The findings from this study highlight profound challenges for most men to their masculine identities, from both the treatment and the symptoms of advanced prostate cancer within a non-Westernised, patriarchal society. Four main themes were developed. These were the impact on masculinity in terms of: (1) physical changes, (2) sexual ability, (3) socio-economic roles and (4) expressing emotions. Changes in physical appearance, feeling belittled, having no active sexual life and the inability to continue acting as provider and protector of the family made some men describe their situation as one of moving out of the ‘frying pan into the fire’.

Conclusion:

This study revealed the impact of advanced prostate cancer on masculine identity. These narratives add a new dimension to what is already known about the impacts on men’s masculine identities when dealing with advanced prostate cancer. This knowledge can help improve the care provided to men with advanced prostate cancer with emphasis on the cultures, beliefs and aspirations of these men and their caregivers.
Exploring underachieving students’ views of, and attitudes towards, mathematics across stage of schooling
Authors: Russo James , Kalogeropoulos Penelope , Roche Anne
Published: May 2023

Students enjoy mathematics less as they move through their schooling and this may be reflective of more negative attitudes towards learning mathematics in general; although not necessarily less valuing of mathematics as a discipline. However, little is known about how stage of schooling influences the relationship between viewing mathematics as problem solving and student attitudes towards mathematics. To address this gap, 123 Australian primary and secondary students identified by their teachers as underachieving in mathematics completed a questionnaire exploring their attitudes towards, and views of, mathematics. We found that although attitudes towards mathematics became more negative as year level increased, this was entirely driven by students enjoying mathematics less; neither their valuing of mathematics, nor their ability to cope with mathematics declined. Similarly, the extent to which students held a problem-solving view of mathematics was unrelated to stage of schooling. Interestingly, however, we also found that students who viewed mathematics as being fundamentally about problem solving were more likely to value mathematics as a discipline, and that this was particularly the case for secondary school students. We discuss how providing opportunities for secondary school students, including underachieving students, to engage with open-ended problem-solving tasks may lead to perceptions of mathematics as useful, purposeful, and important.
An Integrative Review of Project Portfolio Management Literature: Thematic Findings on Sustainability Mindset, Assessment, and Integration
Authors: Aghajani Masoud , Ruge Gesa , Jugdev Kam
Published: May 2023

Sustainability integration in project portfolio management helps shape strategic, organizational, and project-based contexts. The authors conducted a structured literature review from 2000 to 2021 and developed a novel integrative framework presenting a holistic view highlighting three substantive research themes: sustainability mindset, sustainability assessment, and sustainability integration in project portfolio processes. Noteworthy progress has been made at the strategic and portfolio levels toward framing a sustainability mindset (definition, values, and principles) and developing frameworks/tools for sustainability assessment and project portfolio selection. However, areas for more research include integrating sustainability into project portfolio processes, reporting, and organizational learning for portfolio improvement.
Advances in blood–brain barrier-crossing nanomedicine for anti-glioma
Authors: Liu Dongdong , Dai Xingliang , Tao Zhenchao , Zhou Hu , Hong Wenqing , Qian Haisheng , Cheng Hongwei , Wang Xianwen
Published: May 2023

Glioma is the most prevalent type of primary brain tumor, and glioblastoma multiforme (GBM) is the highest and most deadly type of primary central nervous system (CNS) tumor, affecting a significant number of patients each year, with a median overall survival of approximately 14.6 months after diagnosis. Despite intensive treatment, nearly all GBM patients experience recurrence, with a 5-year survival rate of about 5%. The protective BBB and high tumor heterogeneity prevent the effective delivery of drugs, resulting in the treatment failure of various drugs. The emergence of nanometer-scale diagnosis and treatment methods has provided new promising approaches to overcome these difficulties. Thus, our review focuses on the development of BBB-crossing nanomedicine-enhanced chemotherapy and combined therapy applications for glioma. Meanwhile, we also reviewed the strategies to overcome the blood–brain barrier. Additionally, we discuss recent achievements in the area of brain tumor treatment with nanomedicine and the rational design approach, which will offer recommendations for anti-GBM nanomedicine development.
Physiological and transcriptional mechanisms associated with cadmium stress tolerance in Hibiscus syriacus L.
Authors: Li Xiang , Liu Lanlan , Sun Shixian , Li Yanmei , Jia Lu , Ye Shili , Yu Yanxuan , Dossa Komivi , Luan Yunpeng
Published: May 2023

Background

Cadmium (Cd) pollution of soils is a global concern because its accumulation in plants generates severe growth retardation and health problems. Hibiscus syriacus is an ornamental plant that can tolerate various abiotic stresses, including Cd stress. Therefore, it is proposed as a plant material in Cd-polluted areas. However, the molecular mechanisms of H. syriacus tolerance to Cd are not yet understood.

Results

This study investigated the physiological and transcriptional response of “Hongxing”, a Cd2+-tolerant H. syriacus variety, grown on a substrate containing higher concentration of Cd (400 mg/kg). The Cd treatment induced only 28% of plant mortality, but a significant decrease in the chlorophyll content was observed. Malondialdehyde content and activity of the antioxidant enzymes catalase, peroxidase, and superoxide dismutase were significantly increased under Cd stress. Transcriptome analysis identified 29,921 differentially expressed genes (DEGs), including 16,729 down-regulated and 13,192 up-regulated genes, under Cd stress. Functional enrichment analyses assigned the DEGs mainly to plant hormone signal transduction, transport, nucleosome and DNA processes, mitogen-activated protein kinase signaling pathway, antioxidant process, fatty acid metabolism, and biosynthesis of secondary metabolites. Many MYB, EP2/ERF, NAC, WRKY family genes, and genes containing metal binding domains were up-regulated, implying that they are essential for the Cd-stress response in H. syriacus. The most induced genes were filtered out, providing valuable resources for future studies.

Conclusions

Our findings provide insights into the molecular responses to Cd stress in H. syriacus. Moreover, this study offers comprehensive and important resources for future studies toward improving the plant Cd tolerance and its valorization in phytoremediation.
Lymphomatoid granulomatosis with the central nervous system involvement as the main manifestation: a case report
Authors: Chen Dawei , Zhou Jing , Lu Weiwen , Lu Liuzhe , Chen Bo , Li Wenzhong
Published: May 2023

Background

Lymphomatoid granulomatosis (LyG) is a rare extralymphatic lymphoproliferative disease characterized by lymphocytic invasion into vascular walls and damage to blood vessels. The lungs are affected in 90% of LyG cases, followed by the skin, central nervous system (CNS), kidneys and liver.

Case presentation

Here we report a case of a young woman with LyG, with CNS involvement as the initial clinical manifestation. Computer tomography (CT) scans showed multiple nodular, patchy and flocculent high-density shadows in both lungs without mediastinal lymph node enlargement. Magnetic resonance imaging (MRI) scans showed multiple abnormal signal intensities in the right cerebellar hemisphere, frontal, parietal and temporal lobes, and dorsal brainstem, which became patchy and annular after enhancement. The post-operative pathological analysis of lesion samples confirmed the diagnosis of grade II LyG.

Conclusions

LyG should be concerned in young adults showing multiple radiological brain and lung lesions. Resection and postoperative medication of steroid hormones and IFN-α may be effective in the treatment of LyG.
The longitudinal effects of maternal parenting practices on children’s body mass index z-scores are lagged and differential
Authors: Kakinami Lisa , Danieles Prince Kevin , Hosseininasabnajar Fatemeh , Barnett Tracie A. , Henderson Mélanie , Van Hulst Andraea , Serbin Lisa A. , Stack Dale M. , Paradis Gilles
Published: May 2023

Background

The longitudinal relation between parenting practices and styles with children’s body mass index z-scores (zBMI) is poorly understood. Previous studies suggest the relationship may be complex, but small samples and short follow-ups diminish the strength of the evidence. The objectives of this study were to investigate whether the relationship is bidirectional, time-varying, and lagged using data from a large, representative birth cohort of Quebec children.

Methods

Data were from the Québec Longitudinal Study of Child Development (QLSCD), a prospective birth cohort (n = 1,602). The mothers’ interactions with their children (at ages 6, 8, 10, and 12 years) were utilized in factor analysis to identify three latent parenting practices (disciplinarian, lenient, and responsive). The parenting practices were analyzed with K-means clustering to identify the parenting styles. The temporal and bidirectional relationships were assessed in a cross-lagged path analysis using a structural equation modelling framework. Mixed models controlling for age, sex, income, mother’s education, and whether the participant was first-born were estimated. Missing data were handled with full information maximum likelihood.

Results

From the linear mixed models, greater lenient and responsive parenting practices were associated with higher zBMI (B = 0.03, p < 0.05) two years later. However, there was no evidence that the relationship was bidirectional nor that parenting style was predictive of children’s zBMI.

Conclusion

While mothers’ parenting practices were unaffected by their children’s zBMI, parental practices were predictive of future zBMI among their prepubertal children. More in-depth exploration of parenting practices and their potential impact on pediatric weight is needed.
Differences in the global exposure, mortality and disability of low bone mineral density between men and women: the underestimated burden in men
Authors: Zhu Binxiang , Hu Shian , Guo Jianfeng , Dong Zijian , Dong Yimin , Li Feng
Published: May 2023

Talking about osteoporosis, we tend to focus on post-menopause women who are at increased risk due to estrogen depletion, while less attention has been paid to the disease in men. Currently, there is a lack of understanding about the difference of osteoporosis incidence and burden by sex. In this study, we used data from the Global Burden of Disease Study 2019 (GBD 2019) to compare the difference in the prevalence and burden of low bone mineral density (LBMD) between men and women, by location, year, age and socio-demographic index. We found the prevalence of LBMD was higher in women than in men. However, the age standardized mortality rate was greatly higher in men than in women. Using disability-adjusted life year (DALY) to measure the burden, we also observed higher age standardized DALY rate in men. Using sociodemographic index (SDI) as the measure of social development level, we found that higher mortality and DALY rates were mainly seen in middle and high SDI countries. Falls were the leading cause for of deaths and disabilities in both men and women with LBMD, followed by transport injuries. Fall-related mortality was higher in women, while transport injuries caused more deaths and disabilities in men. Conclusively, more attention should be paid to osteoporosis in men, and related policies, clinical practices, and guidelines are in need to reduce the burden of LBMD and osteoporosis in men.
Chen’s penetrating-suture technique for pancreaticojejunostomy following pancreaticoduodenectomy
Authors: Zhang Lihong , Zhu Xuefeng , Zhu Yongsheng , Huang Jianjun , Tao Lide , Chen Yijun
Published: May 2023

Background

Postoperative pancreatic fistula (POPF) is the most serious complication and the main reason for morbidity and mortality after pancreaticoduodenectomy (PD). Currently, there exists no flawless pancreaticojejunal anastomosis approach. We presents a new approach called Chen’s penetrating-suture technique for pancreaticojejunostomy (PPJ), which involves end-to-side pancreaticojejunostomy by suture penetrating the full-thickness of the pancreas and jejunum, and evaluates its safety and efficacy.

Methods

To assess this new approach, between May 2006 and July 2018, 193 consecutive patients who accepted the new Chen’s Penetrating-Suture technique after a PD were enrolled in this study. Postoperative morbidity and mortality were evaluated.

Results

All cases recovered well after PD. The median operative time was 256 (range 208–352) min, with a median time of 12 (range 8–25) min for performing pancreaticojejunostomy. Postoperative morbidity was 19.7% (38/193) and mortality was zero. The POPF rate was 4.7% (9/193) for Grade A, 1.0% (2/193) for Grade B, and no Grade C cases and one urinary tract infection.

Conclusion

PPJ is a simple, safe, and reliable technique with ideal postoperative clinical results.
Acceptability of fully guided virtual implant planning software among dental undergraduate students
Authors: Shetty Shishir Ram , Murray Colin , Kawas Sausan Al , Jaser Sara , Talaat Wael , Madi Medhini , Kamath Vinayak , Manila Nisha , Shetty Raghavendra , Ajila Vidya
Published: May 2023

Background

Fully guided implant surgery as a technique is gaining popularity. It has been observed that use of surgical guides improves precision and predictability for dental implant placement. However, like any other newer technology, the acceptance of fully guided dental implant technology among users is based upon its perceived usability. This study aimed at evaluating the perception about using Virtual Implant Planning Software (VIPS) among undergraduate dental students at the university of Sharjah.

Methods

Ninety-Six dental surgery students from the University of Sharjah were included in the study. One week after the Virtual Implant Planning Software (Planmeca Romexis version 6.2 procedure, students were asked to complete a Combined technology acceptance model and the theory of planned behaviour (C-TAM TPB) questionnaire. Sixty-six students responded to the questionnaire.

Results

Cronbach’s alpha surpassed 0.7 for perceived usefulness, perceived ease of use, perceived behavioral control, and subjective norm. Attitude and behavioural intention reported Cronbach’s alpha values less than 0.7. Spearman’s correlation coefficient was significant for all the constructs. Perceived ease of use explained 49%, 33%, and 42% of the variance of perceived usefulness (R2 = 0.49), attitude (R2 = 0.33), and perceived behavioral control (R2 = 0.42) respectively. Perceived usefulness explained 25%, 18%, and 23% of the variance of attitude (R2 = 0.25), behavioral intention (R2 = 0.18), and perceived behavioral control (R2 = 0.23) respectively. Attitude accounted for 25%, 33%, and 29% of the variance of behavioral intention (R2 = 0.25), perceived behavioral control (R = 0.33), and subjective norm (R = 0.29) respectively.

Conclusion

The fully guided VIPS was acceptable by dental students specifically because of its usability. This makes VIPS a very effective tool for teaching implantology for dental students. VIPS also allows students to perform multiple repetitions of the implant planning procedure which enhances understanding and content retention.
Network pharmacological analysis of corosolic acid reveals P4HA2 inhibits hepatocellular carcinoma progression
Authors: Tang Fei-Feng , Liu Long , Tian Xiao-Ting , Li Ning , Peng Ying-Xiu , Qian Chun-Mei , Jia Ting-Ting , Liu Jing-Jin , Gao Wen-Hui , Xu Yan-Feng
Published: May 2023

Background

Corosolic acid is a pentacyclic triterpene acid with hypoglycemic, anti-inflammatory, and anti-cancer effects. However, its potential targets in hepatocellular carcinoma (HCC) are unknown, hindering clinical utilization.

Methods

Differentially expressed proteins of the Bel-7404 cell line were identified with tandem mass tag analysis and differentially expressed genes (DEGs) of an HCC TCGA dataset using bioinformatics. Gene functions and pathways were inferred using the DAVID database. Online databases were used to establish P4HA2 expression in HCC (GEPIA2) and its relationship with patient survival (UALCAN and The Human Protein Atlas), the association between P4HA2 expression and immune cell infiltration (TIMER2), and DNA methylation of the P4HA2 gene (MethSurv). Cell proliferation, cell cycle, and cell death were assessed with PI and SYTOX-Green staining, CCK-8, and colony formation assays. Protein expression levels were detected by Western blotting.

Results

A total of 44 differentially expressed proteins and 4498 DEGs were identified. Four genes whose proteins were also found in the differential protein profile but with opposing expressions were selected as candidate targets. The candidate gene prolyl 4-hydroxylase subunit alpha 2 (P4HA2) was recognized as the only potential target due to its high expression in public datasets, association with poor patient survival, and relation to immune cell infiltration in HCC tissues. Moreover, the DNA methylation status in 4 CpG islands of the P4HA2 gene correlated with a poor prognosis. Furthermore, corosolic acid treatment inhibited the proliferation of HCC cell lines Bel-7404 and HepG2 in a dose-dependent manner, caused G2/M phase cell cycle arrest, and promoted cell death. In addition, the treatment reduced P4HA2 protein levels.

Conclusion

Our results indicate that P4HA2 is a potential target of corosolic acid. Thus, they contribute to understanding molecular changes in HCC after corosolic acid treatment and facilitate finding new treatment regimens.
Multimodal-based machine learning strategy for accurate and non-invasive prediction of intramedullary glioma grade and mutation status of molecular markers: a retrospective study
Authors: Ma Chao , Wang Liyang , Song Dengpan , Gao Chuntian , Jing Linkai , Lu Yang , Liu Dongkang , Man Weitao , Yang Kaiyuan , Meng Zhe , Zhang Huifang , Xue Ping , Zhang Yupeng , Guo Fuyou , Wang Guihuai
Published: May 2023

Background

Determining the grade and molecular marker status of intramedullary gliomas is important for assessing treatment outcomes and prognosis. Invasive biopsy for pathology usually carries a high risk of tissue damage, especially to the spinal cord, and there are currently no non-invasive strategies to identify the pathological type of intramedullary gliomas. Therefore, this study aimed to develop a non-invasive machine learning model to assist doctors in identifying the intramedullary glioma grade and mutation status of molecular markers.

Methods

A total of 461 patients from two institutions were included, and their sagittal (SAG) and transverse (TRA) T2-weighted magnetic resonance imaging scans and clinical data were acquired preoperatively. We employed a transformer-based deep learning model to automatically segment lesions in the SAG and TRA phases and extract their radiomics features. Different feature representations were fed into the proposed neural networks and compared with those of other mainstream models.

Results

The dice similarity coefficients of the Swin transformer in the SAG and TRA phases were 0.8697 and 0.8738, respectively. The results demonstrated that the best performance was obtained in our proposed neural networks based on multimodal fusion (SAG-TRA-clinical) features. In the external validation cohort, the areas under the receiver operating characteristic curve for graded (WHO I–II or WHO III–IV), alpha thalassemia/mental retardation syndrome X-linked (ATRX) status, and tumor protein p53 (P53) status prediction tasks were 0.8431, 0.7622, and 0.7954, respectively.

Conclusions

This study reports a novel machine learning strategy that, for the first time, is based on multimodal features to predict the ATRX and P53 mutation status and grades of intramedullary gliomas. The generalized application of these models could non-invasively provide more tumor-specific pathological information for determining the treatment and prognosis of intramedullary gliomas.
Development and validation of sensitive BCR::ABL1 fusion gene quantitation using next-generation sequencing
Authors: Lee Hyeonah , Seo Jieun , Shin Saeam , Lee Seung-Tae , Choi Jong Rak
Published: May 2023

Background

BCR::ABL1 fusion has significant prognostic value and is screened for chronic myeloid leukemia (CML) disease monitoring as a part of routine molecular testing. To overcome the limitations of the current standard real-time quantitative polymerase chain reaction (RQ-PCR), we designed and validated a next-generation sequencing (NGS)-based assay to quantify BCR::ABL1 and ABL1 transcript copy numbers.

Methods

After PCR amplification of the target sequence, deep sequencing was performed using an Illumina Nextseq 550Dx sequencer and in-house–designed bioinformatics pipeline. The Next-generation Quantitative sequencing (NQ-seq) assay was validated for its analytical performance, including precision, linearity, and limit of detection, using serially diluted control materials. A comparison with conventional RQ-PCR was performed with 145 clinical samples from 77 patients.

Results

The limit of detection of the NQ-seq was the molecular response (MR) 5.6 [BCR::ABL1 0.00028% international scale (IS)]. The NQ-seq exhibited excellent precision and linear range from MR 2.0 to 5.0. The IS value from the NQ-seq was highly correlated with conventional RQ-PCR.

Conclusions

We conclude that the NQ-seq is an effective tool for monitoring BCR::ABL1 transcripts in CML patients with high sensitivity and reliability. Prospective assessment of the unselected large series is required to validate the clinical impact of this NGS-based monitoring strategy.
Agitation and aggression in people living with dementia and mild cognitive impairment in shared-housing arrangements – validation of a German version of the Cohen-Mansfield Agitation Inventory-Short Form (CMAI-SF)
Authors: Kratzer André , Scheel-Barteit Jennifer , Altona Janissa , Wolf-Ostermann Karin , Graessel Elmar , Donath Carolin
Published: May 2023

Background

The Cohen-Mansfield Agitation Inventory-Short Form (CMAI-SF) is a 14-item scale for assessing agitation and aggression, derived from the original 29-item CMAI, and completed by a proxy. Because the CMAI-SF has not yet been validated in German language, the aim of this study is to explore its construct validity.

Methods

Baseline data from a cluster-randomized trial to evaluate a non-pharmacological complex intervention for people living with dementia (PlwD) and mild cognitive impairment (MCI) were analyzed. The study sample consisted of 97 shared-housing arrangements (SHAs) in Germany, comprising N = 341 residents with mild to severe dementia and MCI. Trained nursing staff collected data by proxy-rating the CMAI-SF, Neuropsychiatric Inventory-Nursing Home Version (NPI-NH), and QUALIDEM. They also conducted the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA).

Results

In an exploratory factor analysis, three factors emerged: “aggressive behavior”, “verbally agitated behavior”, and “physically non-aggressive behavior”. The CMAI-SF total score showed good internal consistency (α = .85), and the factors themselves showed adequate internal consistency (α = .75/.76/.73). The CMAI-SF showed convergent validity with the NPI-NH agitation item (r = .66) and the NPI-NH “agitation & restless behavior” factor (r = .82). Discriminant validity was confirmed by a low (r = .28) correlation with the NPI-NH apathy item. Quality of life decreased significantly with agitation, as the CMAI-SF showed a moderate negative correlation with the QUALIDEM total score (r = -.35).

Conclusions

The 14-item CMAI-SF is a time-efficient, reliable, and valid assessment instrument. Three factors emerged that were similar to those already found in nursing home samples for the original CMAI and the CMAI-SF and in day care samples for the CMAI-SF. The findings provide preliminary evidence that the CMAI-SF can be used instead of the CMAI to reduce time, costs, and burden in future trials.

Trial registration

The DemWG study from which data were used to draft this manuscript was prospectively registered on 16 July 2019 at ISRCTN registry (ISRCTN89825211).
Domain-specific physical activity, sedentary behavior, subjective health, and health-related quality of life among older adults
Authors: Min Jihee , Chang Jae Seung , Kong In Deok
Published: May 2023

Purpose

This study aims to investigate the association between domain-specific physical activity (PA), sedentary behavior, subjective health perception, and health-related quality of life (HR-QoL) in Korean adults aged ≥ 65 years.

Methods

This cross-sectional study analyzed 6,004 older adults from the Korean National Health and Nutrition Examination Survey 2017–2020. PA and sedentary behavior were measured using a global PA questionnaire, and HR-QoL was assessed using the EuroQol-5 Dimension (EQ-5D, three-level version). Multiple logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) after adjusting for confounding parameters.

Results

Older adults who were physically active at work showed a negative association with subjectively good health and HR-QoL, whereas those physically active in transport or leisure time showed a positive association with subjectively good health and HR-QoL. Older adults highly engaged in sedentary behavior showed a worse perception of health and HR-QoL. Compared to high sedentary behavior and physical activity during leisure time or transport, the EQ-5D index was higher than that of their counterparts.

Conclusion

Both domain-specific PA and sedentary behavior were significantly associated with older adults’ perception of health and HR-QoL. Interventions are needed to improve HR-QoL by reducing sedentary behavior and encouraging physical activity in transportation or leisure time among adults aged 65 years and above.
Development and validation of explainable machine-learning models for carotid atherosclerosis early screening
Authors: Yun Ke , He Tao , Zhen Shi , Quan Meihui , Yang Xiaotao , Man Dongliang , Zhang Shuang , Wang Wei , Han Xiaoxu
Published: May 2023

Background

Carotid atherosclerosis (CAS), an important factor in the development of stroke, is a major public health concern. The aim of this study was to establish and validate machine learning (ML) models for early screening of CAS using routine health check-up indicators in northeast China.

Methods

A total of 69,601 health check-up records from the health examination center of the First Hospital of China Medical University (Shenyang, China) were collected between 2018 and 2019. For the 2019 records, 80% were assigned to the training set and 20% to the testing set. The 2018 records were used as the external validation dataset. Ten ML algorithms, including decision tree (DT), K-nearest neighbors (KNN), logistic regression (LR), naive Bayes (NB), random forest (RF), multiplayer perceptron (MLP), extreme gradient boosting machine (XGB), gradient boosting decision tree (GBDT), linear support vector machine (SVM-linear), and non-linear support vector machine (SVM-nonlinear), were used to construct CAS screening models. The area under the receiver operating characteristic curve (auROC) and precision-recall curve (auPR) were used as measures of model performance. The SHapley Additive exPlanations (SHAP) method was used to demonstrate the interpretability of the optimal model.

Results

A total of 6315 records of patients undergoing carotid ultrasonography were collected; of these, 1632, 407, and 1141 patients were diagnosed with CAS in the training, internal validation, and external validation datasets, respectively. The GBDT model achieved the highest performance metrics with auROC of 0.860 (95% CI 0.839–0.880) in the internal validation dataset and 0.851 (95% CI 0.837–0.863) in the external validation dataset. Individuals with diabetes or those over 65 years of age showed low negative predictive value. In the interpretability analysis, age was the most important factor influencing the performance of the GBDT model, followed by sex and non-high-density lipoprotein cholesterol.

Conclusions

The ML models developed could provide good performance for CAS identification using routine health check-up indicators and could hopefully be applied in scenarios without ethnic and geographic heterogeneity for CAS prevention.
Circular RNA circ0001955 promotes cervical cancer tumorigenesis and metastasis via the miR-188-3p/NCAPG2 axis
Authors: Wang Wei , Luo Haixia , Chang Jingjing , Yang Xin , Zhang Xiu , Zhang Qingmei , Li Yuanxing , Zhao Yueyang , Liu Jianbing , Zou Binbin , Hao Min
Published: May 2023

Background

Circular RNAs (circRNAs) are known to play a crucial role in a variety of malignancies. However, the precise role of circRNAs in cervical squamous cell carcinoma (CSCC) remains largely unknown.

Methods

The expression of circ0001955 was determined by real-time quantitative PCR and fluorescence in situ hybridization. To examine the effects of circ0001955 on CSCC metastasis and growth, functional experiments were conducted in vitro and in vivo. Mechanistically, nucleocytoplasmic separation, dual luciferase reporter assay, RNA antisense purification experiments, and rescue experiments were performed to confirm the interaction between circ0001955, miR-188-3p, and NCAPG2 in CSCC.

Results

Here, we demonstrated that a circRNA derived from the CSNK1G1 gene (circ0001955) is significantly upregulated in CSCC. The overexpression of circ0001955 promotes tumor proliferation and metastasis, whereas the knockdown of circ0001955 exerts the opposite effects. Mechanistically, circ0001955 competitively binds miR-188-3p and prevents miR-188-3p from reducing the levels of NCAPG2, activating the AKT/mTOR signaling pathway to induce epithelial mesenchymal transformation. Notably, the application of an inhibitor of mTOR significantly antagonized circ0001955-mediated CSCC tumorigenesis.

Conclusion

circ0001955 promotes CSCC tumorigenesis and metastasis via the miR-188-3p/NCAPG2 axis which would provide an opportunity to search new therapeutic targets for CSCC.

Graphical Abstract
Ideal vitamin D and handgrip strength counteracts the risk effect of APOE genotype on dementia: a population-based longitudinal study
Authors: Feng Jiangtao , Wang Qi , Zhang Yuan
Published: May 2023

Background

Higher vitamin D concentrations and grip strength contribute to lower individual-level risk of dementia, while apolipoprotein 4 (APOE e4) genotype carries increases dementia risk, but whether combination of ideal vitamin D and grip strength counteracts the risk effect of dementia related to APOE e4 genotype remains unclear. We aimed to investigate the interactions between vitamin D/grip strength and APOE e4 genotype and their association with dementia.

Methods

The UK Biobank cohort comprised 165,688 dementia-free participants (aged at least 60 years) for the dementia analysis. Dementia was ascertained using hospital inpatient, mortality, and self-reported data until 2021. Vitamin D and grip strength were collected at baseline and divided into tertiles. APOE genotype was coded as APOE e4 non-carries and APOE e4 carries. Data were analyzed using Cox proportional hazard models and restricted cubic regression splines, with adjusted for known confounders.

Results

Over the follow-up (median: 12.0 years), 3917 participants developed dementia. In women and men, respectively, compared with to the lowest tertile of vitamin D, the HRs (95% CIs) of dementia were lower in the middle [0.86 (0.76–0.97)/0.80 (0.72–0.90)] and the highest tertile [0.81 (0.72–0.90)/0.73 (0.66–0.81)]. Tertiles of grip strength showed similar patterns. In women and men, respectively, participants who had both highest tertile of vitamin D and grip strength was associated with a lower risk of dementia compared to those with both lowest tertile of these two exposures among APOE e4 genotype carries (HR = 0.56, 95% CI 0.42–0.76, and HR = 0.48, 95% CI 0.36–0.64) and APOE e4 genotype non-carries (HR = 0.56, 95% CI 0.38–0.81, and HR = 0.34, 95% CI 0.24–0.47). There were significant additive interactions between lower vitamin D/grip strength and APOE e4 genotype on dementia among women and men.

Conclusions

Higher vitamin D and grip strength were associated with a lower risk of dementia, and seemed to halve the adverse effects of APOE e4 genotype on dementia. Our findings suggested that vitamin D and grip strength may be imperative for estimating the risks of dementia, especially among APOE e4 genotype carries.
Serum levels of soluble urokinase plasminogen activator receptor in juvenile idiopathic arthritis: a single-center Swedish case-control study
Authors: Lewander Per , Wirestam Lina , Dahle Charlotte , Wetterö Jonas , Sjöwall Christopher
Published: May 2023

Objectives

Reliable biomarkers in the early stages of idiopathic arthritis (JIA) are scarce and the disease heterogeneity makes it clinically challenging to predict the risk of joint damage. Biomarkers with prognostic potential are warranted in order to individualize treatment and follow-up in JIA. The soluble urokinase plasminogen activator receptor (suPAR) has been reported as an easily measurable biomarker for prognosis and severity in several rheumatic diseases but it has never been studied in JIA.

Methods

Sera from 51 well-characterized patients with JIA and 50 age- and sex-matched control subjects were collected and stored for later analysis of suPAR. Patients were carefully followed clinically over 3 years and analysis of erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor (RF) and antibodies against cyclic citrullinated peptides (anti-CCP) were analyzed as part of clinical routine. Signs of joint erosions were evaluated by radiography.

Results

Overall, the levels of suPAR did not differ significantly between JIA patients and controls but those with polyarticular involvement showed higher suPAR (p = 0.013). In addition, elevated suPAR were associated with joint erosions (p = 0.026). Two RF/anti-CCP negative individuals with erosions showed high levels of suPAR.

Conclusions

We present new data on the biomarker suPAR in JIA. Our results indicate that, apart from RF and anti-CCP, analysis of suPAR could be of additional value in assessing the risk of erosions. Analysis of suPAR early could potentially guide treatment decision-making in JIA, but our observations should be confirmed in prospective studies.
Experimental hepatic encephalopathy causes early but sustained glial transcriptional changes
Authors: Claeys Wouter , Van Hoecke Lien , Lernout Hannah , De Nolf Clint , Van Imschoot Griet , Van Wonterghem Elien , Verhaege Daan , Castelein Jonas , Geerts Anja , Van Steenkiste Christophe , Vandenbroucke Roosmarijn E.
Published: May 2023

Hepatic encephalopathy (HE) is a common complication of liver cirrhosis, associated with high morbidity and mortality, for which no brain-targeted therapies exist at present. The interplay between hyperammonemia and inflammation is thought to drive HE development. As such, astrocytes, the most important ammonia-metabolizing cells in the brain, and microglia, the main immunomodulatory cells in the brain, have been heavily implicated in HE development. As insight into cellular perturbations driving brain pathology remains largely elusive, we aimed to investigate cell-type specific transcriptomic changes in the HE brain. In the recently established mouse bile duct ligation (BDL) model of HE, we performed RNA-Seq of sorted astrocytes and microglia at 14 and 28 days after induction. This revealed a marked transcriptional response in both cell types which was most pronounced in microglia. In both cell types, pathways related to inflammation and hypoxia, mechanisms commonly implicated in HE, were enriched. Additionally, astrocytes exhibited increased corticoid receptor and oxidative stress signaling, whereas microglial transcriptome changes were linked to immune cell attraction. Accordingly, both monocytes and neutrophils accumulated in the BDL mouse brain. Time-dependent changes were limited in both cell types, suggesting early establishment of a pathological phenotype. While HE is often considered a unique form of encephalopathy, astrocytic and microglial transcriptomes showed significant overlap with previously established gene expression signatures in other neuroinflammatory diseases like septic encephalopathy and stroke, suggesting common pathophysiological mechanisms. Our dataset identifies key molecular mechanisms involved in preclinical HE and provides a valuable resource for development of novel glial-directed therapeutic strategies.

Graphical Abstract
Comparison of different dose accumulation strategies to estimate organ doses after stereotactic magnetic resonance-guided adaptive radiotherapy
Authors: Regnery Sebastian , Leiner Lukas , Buchele Carolin , Hoegen Philipp , Sandrini Elisabetta , Held Thomas , Deng Maximilian , Eichkorn Tanja , Rippke Carolin , Renkamp C. Katharina , König Laila , Lang Kristin , Adeberg Sebastian , Debus Jürgen , Klüter Sebastian , Hörner-Rieber Juliane
Published: May 2023

Introduction

Re-irradiation is frequently performed in the era of precision oncology, but previous doses to organs-at-risk (OAR) must be assessed to avoid cumulative overdoses. Stereotactic magnetic resonance-guided online adaptive radiotherapy (SMART) enables highly precise ablation of tumors close to OAR. However, OAR doses may change considerably during adaptive treatment, which complicates potential re-irradiation. We aimed to compare the baseline plan with different dose accumulation techniques to inform re-irradiation.

Patients & methods

We analyzed 18 patients who received SMART to lung or liver tumors inside prospective databases. Cumulative doses were calculated inside the planning target volumes (PTV) and OAR for the adapted plans and theoretical non-adapted plans via (1) cumulative dose volume histograms (DVH sum plan) and (2) deformable image registration (DIR)-based dose accumulation to planning images (DIR sum plan). We compared cumulative dose parameters between the baseline plan, DVH sum plan and DIR sum plan using equivalent doses in 2 Gy fractions (EQD2).

Results

Individual patients presented relevant increases of near-maximum doses inside the proximal bronchial tree, spinal cord, heart and gastrointestinal OAR when comparing adaptive treatment to the baseline plans. The spinal cord near-maximum doses were significantly increased in the liver patients (D2% median: baseline 6.1 Gy, DIR sum 8.1 Gy, DVH sum 8.4 Gy, p = 0.04; D0.1 cm³ median: baseline 6.1 Gy, DIR sum 8.1 Gy, DVH sum 8.5 Gy, p = 0.04). Three OAR overdoses occurred during adaptive treatment (DIR sum: 1, DVH sum: 2), and four more intense OAR overdoses would have occurred during non-adaptive treatment (DIR sum: 4, DVH sum: 3). Adaptive treatment maintained similar PTV coverages to the baseline plans, while non-adaptive treatment yielded significantly worse PTV coverages in the lung (D95% median: baseline 86.4 Gy, DIR sum 82.4 Gy, DVH sum 82.2 Gy, p = 0.006) and liver patients (D95% median: baseline 87.4 Gy, DIR sum 82.1 Gy, DVH sum 81.1 Gy, p = 0.04).

Conclusion

OAR doses can increase during SMART, so that re-irradiation should be planned based on dose accumulations of the adapted plans instead of the baseline plan. Cumulative dose volume histograms represent a simple and conservative dose accumulation strategy.