bluuebunny/crossref_metadata_2025 huggingface dataset:
Cost-utility of behavioural activation for mitigating psychological impacts of COVID-19 on socially isolated older adults with depression and multiple long-term conditions compared with usual care: results from a pragmatic randomised controlled trial
Authors: Wang Han-I , Gilbody Simon , Littlewood Elizabeth , Baird Kalpita , Ekers David , McMillan Dean , Bailey Della , Chew-Graham Carolyn , Coventry Peter , Fairhurst Caroline , Hewitt Catherine , Parrott Steve
Published: January 2025

Background

Depression alongside multiple long-term conditions (MLTCs) in older adults poses a critical public health challenge, worsening physical and mental health and increasing healthcare costs. COVID-19 restrictions further exacerbated these impacts. Behavioural activation (BA) shows promise as a remote intervention for depression during isolation, but its cost-effectiveness for depressed, socially isolated older adults remains uncertain.

Objective

This study aimed to assess the cost-utility of BA versus usual care for older adults with depression and MLTCs during COVID-19 restrictions.

Methods

A randomised controlled trial recruited and randomised individuals aged 65 and over with depressive symptoms and MLTC (n=435) to either the BA intervention or usual care. Costs were measured from the perspective of the National Health Service and personal social services. Quality-adjusted life years (QALYs) were measured using the EQ-5D-3L at baseline, and 1, 3 and 12 months postrandomisation. Incremental cost-effectiveness ratios were calculated, with uncertainty addressed through non-parametric bootstrapping. Sensitivity analyses were conducted to assess the robustness of the primary analysis.

Findings

Primary analysis indicated that BA generated a small cost-saving (£62.34 per older adult; 95% CI: −£120.44 to £239.70) while QALY improvements remained unchanged (0.007; 95% CI −0.036 to 0.022) compared with usual care. The probability of BA being the preferred option is 0.71. Sensitivity analyses supported the primary analysis findings, confirming their robustness.

Conclusions and clinical implications

Compared with usual care, BA demonstrated a slight cost reduction while maintaining QALY improvement. The findings provide promise for BA interventions for older people with depression and MLTCs facing isolation.
Exploring pre-exposure prophylaxis (PrEP) modality preferences among black cisgender women attending family planning clinics in Chicago via a cross-sectional mixed-methods study
Authors: Johnson Amy K , Ott Emily , Friedman Eleanor E , Pandiani Agustina , Moore Amy , Alvarez Isa , Desmarais Catherine , Haider Sadia
Published: January 2025

Background

Despite pre-exposure prophylaxis (PrEP) demonstrated effectiveness, black cisgender women continue to be at an elevated risk for HIV acquisition and uptake of daily oral PrEP is low in this population in the USA. As advancements in PrEP delivery options continue, it is important to understand women’s acceptability of these additional options, specifically black cisgender women, in order to inform uptake and adherence among this population at increased need of HIV prevention options.

Setting

A cross-sectional survey among black cisgender women ages 13–45 (inclusive) attending women’s health clinics in Chicago, Illinois, USA, prior to the approval of cabotegravir long-acting injectable.

Methods

Descriptive statistics were used to describe the sample and bivariate analysis was used to detect differences between categorical and outcome variables using χ2test. Responses to open-ended questions were thematically coded to explore black cisgender women’s attitudes and preferences between the three methods of PrEP delivery including vaginal ring, long-acting injectable and a combined method that would prevent both pregnancy and HIV.

Results

In total, 211 cisgender women and adolescents responded to the survey. Both injections and combination pills were popular among participants, with 64.5% and 67.3% expressing interest in these forms of PrEP, respectively. The least popular method was the vaginal ring option, with 75.4% of respondents indicating that they would not consider using this modality. Overall, responses were not statistically different between the two surveys administered (χ2p values for injection PrEP method 0.66, combination PrEP method 0.93 and ring PrEP method 0.66) suggesting that the popularity of each method was not dependent on clinic location or the age of participants.

Conclusion

This research provides important insights into the preferences and attitudes of different PrEP modalities among black cisgender women. As different modalities continue to be approved for use among cisgender women, more research is needed to investigate the acceptability and preferences of these different modalities in order to improve uptake and adherence among this population.
Cluster randomised controlled trial on the effects of long-term home-based exercise for patients with chronic obstructive pulmonary disease with recent exacerbation: research protocol of theCOPDtoParisProject
Authors: Stoustrup Anna Lei , Thomsen Lars Pilegaard , Andreasen Jane , Palsson Thorvaldur S , Weinreich Ulla Møller
Published: January 2025

Background

Chronic obstructive pulmonary disease (COPD) is a highly prevalent respiratory disease associated with significant health decline and economic burdens. Pulmonary rehabilitation is an effective intervention, but securing adherence to exercise is difficult, particularly for frail and disabled patients, challenged by leaving their home. Home-based exercise is an emerging alternative for persons with COPD, but long-term adherence is unclear. This study aims to investigate the effects, experiences and acceptability of long-term home-based cycling for patients with COPD post exacerbation.

Methods and analyses

This cluster randomised controlled trial will recruit hospitalised patients with COPD following hospitalisation following exacerbation of COPD. Participants will be referred to acute rehabilitation for 8 weeks at discharge. After rehabilitation, participants are randomised in clusters of five into 1 year of home-based cycling with the goal of cycling from Aalborg to Paris, or into the control group, who will receive standard care. Data will be collected at baseline, postrehabilitation/intervention initiation, at 6 and 12 months. Primary outcome is physical performance, while secondary outcomes include daily activity levels, lung function, mobility, frailty, symptom severity, health-related quality of life, survival rates and readmissions. A qualitative substudy will uncover experiences from participants. Daily activity levels will be measured using leg-mounted triaxial accelerometers. Other parameters will be tested with physical tests, questionnaires and interviews. The study aims to include 50 patients, with 25 participants in each group. A cost-effectiveness analysis will assess the impact on disease prevention and hospitalisation.

Ethics and dissemination

This study, approved by The North Denmark Region Committee on Health Research Ethics (N-20230008) and compliant with the Helsinki Declaration, includes annual safety and progress reporting of potential adverse events. Results will be disseminated through peer-reviewed publications, conference presentations and community outreach to ensure accessibility to participants, healthcare professionals and the public.

Trial registration number

NCT06235502and Northern Jutland trial register (F2023-066).
Pan-tumor analysis to investigate the obesity paradox in immune checkpoint blockade
Authors: Alden Stephanie L , Charmsaz Soren , Li Howard L , Tsai Hua-Ling , Danilova Ludmila , Munjal Kabeer , Brancati Madelena , Warner Aanika , Howe Kathryn , Griffin Ervin , Nakazawa Mari , Thoburn Chris , Gizzi Jennifer , Hernandez Alexei , Gross Nicole E , Coyne Erin M , Hallab Elsa , Shin Sarah S , Durham Jennifer , Lipson Evan J , Ged Yasser , Baretti Marina , Hoffman-Censits Jean , Seiwert Tanguy Y , Guha Aditi , Bansal Sanjay , Tang Laura , Chandler G Scott , Mohindra Rajat , Garonce-Hediger Rachel , Jaffee Elizabeth M , Ho Won Jin , Kao Chester , Yarchoan Mark
Published: January 2025

Background

Obesity is a risk factor for developing cancer but is also associated with improved outcomes after treatment with immune checkpoint inhibitors (ICIs), a phenomenon called the obesity paradox. To interrogate mechanisms of divergent immune responses in obese and non-obese patients, we examined the relationship among obesity status, clinical responses, and immune profiles from a diverse, pan-tumor cohort of patients treated with ICI-based therapy.

Methods

From June 2021 to March 2023, we prospectively collected serial peripheral blood samples from patients with advanced or metastatic solid tumors who received ICI as standard of care at Johns Hopkins. Patients were stratified by obesity status at treatment initiation, with obesity defined as body mass index (BMI)≥30 at treatment initiation and BMI≥18.5 and <30 considered non-obese; underweight patients (BMI<18.5) were excluded. We evaluated the concentration of 37 cytokines and used cytometry by time of flight to characterize immune cell clusters and cell-surface expression markers at baseline and on-treatment.

Results

We enrolled 94 patients, of whom 30 (32%) were obese and 64 (68%) were non-obese. Compared with non-obese patients, obese patients had superior progression-free survival (HR: 0.44 (95% CI: 0.24 to 0.81), p=0.01) and overall survival (OS) (HR: 0.24 (95% CI: 0.07 to 0.80), p=0.02). Obese patients had lower serum IL-15 levels at treatment baseline and lower on-treatment levels of IL-6, IL-8, and IL-15. Low on-treatment IL-6 was associated with improved OS (HR: 0.27 (95% CI: 0.08 to 0.88), p=0.03), as was low on-treatment IL-8 (HR: 0.19 (95% CI: 0.05 to 0.70), p=0.01). Obese patients demonstrated lower levels of T effector cells with reduced expression of cytotoxicity markers and higher expression of exhaustion markers at baseline and on-treatment.

Conclusions

Obese and non-obese patients with cancer have divergent immunological responses to ICIs. Obesity is associated with reduced levels of certain inhibitory cytokines and higher expression of T-cell exhaustion markers. ICI-based therapy may more effectively reverse T-cell dysfunction in obese patients, potentially contributing to the paradoxically improved responses in this population.
Using the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) in a community setting: does it facilitate best interests decision-making?
Authors: Eli Karin , Bernstein Celia J , Harlock Jenny , Huxley Caroline J , Walsh Julia , Blanchard Hazel , Hawkes Claire A , Perkins Gavin D , Turner Chris , Griffiths Frances , Slowther Anne-Marie
Published: January 2025

In the UK, the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is a widely used process, designed to facilitate shared decision-making between a clinician and a patient or, if the patient lacks capacity to participate in the conversation, a person close to the patient. A key outcome of the ReSPECT process is a set of recommendations, recorded on the patient-held ReSPECT form, that reflect the conversation. In an emergency, these recommendations are intended to inform clinical decision-making, and thereby enable the attending clinician—usually a general practitioner (GP) or paramedic—to act in the patient’s best interests. This study is the first to explore the extent to which ReSPECT recommendations realise their goal of informing best interests decision-making in community contexts. Using a modified framework analysis approach, we triangulate interviews with patients and their relatives, GPs and nurses and care home staff. Our findings show that inconsistent practices around recording patient wishes, diverging interpretations of the meaning and authority of recommendations and different situational contexts may affect the interpretation and enactment of ReSPECT recommendations. Enacting ReSPECT recommendations in an emergency can be fraught with complexity, particularly when attending clinicians need to interpret recommendations that did not anticipate the current emergency. This may lead to decision-making that compromises the patient’s best interests. We suggest that recording patients’ values and preferences in greater detail on ReSPECT forms may help overcome this challenge, in providing attending clinicians with richer contextual information through which to interpret treatment recommendations.
Assessing ethics and law in medical schools: there is no single best answer
Authors: Moorlock Greg , Deans Zuzana , Trimble Michael
Published: January 2025

Medical ethics and law (MEL) have a well-established place in medical curricula within the UK, but appropriately assessing MEL in a medical school context can be extremely challenging. The Institute of Medical Ethics convened a working group focused on assessment in 2021, and in this article, we present a summary of the work undertaken by this group. We start by explaining the challenges presented by the assessment of MEL, highlighting the potentially demanding requirements set out by the General Medical Council in the UK. We then explore how MEL is currently assessed in UK medical schools. We go on to consider a number of different forms of assessment and their suitability for assessing ethics and law. Finally, we report the key recommendations from the working group and conclude that we are unconvinced that current approaches to assessing MEL are sufficient to robustly assess the General Medical Council’s learning outcomes.
Under-recognised neurocognitive deficits in adults and adolescents with tuberous sclerosis complex
Authors: Boisclair Mélissa , Blondeau Laury-Anne , Bouchard Florence , Drouin-Engler Rose-Marie , Li Jimmy , Bertrand Samuel , Zine-Eddine Fayçal , Létourneau-Guillon Laurent , Larochelle Catherine , Major Philippe , Boucher Olivier , Keezer Mark R
Published: January 2025

Background

Tuberous sclerosis complex (TSC) is a genetic disease characterised by the growth of benign tumours. The Tuberous sclerosis Associated Neuropsychiatric Disorders (TAND) Checklist is used to identify patient-reported neurocognitive deficits. Patients may, however, under-recognise mild cognitive impairment. We aimed to determine the frequency of abnormal scores on three objective tests of cognitive function in people with and without diagnosed intellectual disability and examine associations between scores on these tests with self-reported TAND Checklist symptoms.

Methods

We conducted a cross-sectional study where people with TSC (PwTSC; n=46) completed the TAND Checklist and three cognitive tests: Symbol Digit Modalities Test (SDMT), Montreal Cognitive Assessment test and Trail Making Test—Parts A and B. We examined associations between cognitive test scores and the TAND Checklist using Pearson’s correlations (95% CI). Receiver operating characteristics (ROC) curves were plotted to determine the screening accuracy of each measure in identifying physician-diagnosed neurocognitive disorders.

Results

There were minimal correlations between the cognitive test scores and the TAND Checklist. More than 20% of PwTSC reported no cognitive issues on the TAND Checklist but had abnormal performance on at least one cognitive test. The ROC curves demonstrated similar results, with areas under the curve of 0.93 (95% CI 0.79 to 1.00) for the SDMT but only 0.70 (95% CI 0.45 to 0.95) for the TAND Checklist.

Conclusion

Objective tests of cognitive function are useful in identifying unrecognised neurocognitive deficits in PwTSC. Deficits likely have multifactorial origins, including undiagnosed intellectual disability and the impact of chronic epilepsy.
Elevated serum neurofilament light chain levels in patients with neuropsychiatric systemic lupus erythematosus: a cross-sectional study
Authors: Balajková Veronika , Prokopcová Aneta , Elisak Martin , Mojžišová Hana , Pavelka Karel , Olejárová Marta
Published: January 2025

Background

The neurofilament light chain (NfL) in cerebrospinal fluid (CSF) and serum as a marker of neuronal damage may be a potential biomarker of neuropsychiatric involvement in SLE (NPSLE).

Methods

80 patients with SLE were included.

We obtained paired serum and CSF samples from 48 patients (NPSLE n=32, non-NPSLE n=16) and 31 controls. The serum and CSF levels of NfL were determined using ELISA.

Results

Patients with NPSLE demonstrated significantly higher levels of serum NfL compared with the non-NPSLE group (mean 31.68±36.63 pg/mL vs mean 16.75±12.48 pg/mL, respectively, p<0.05) and with controls (mean 10.74±4.36 pg/mL, p<0.01). Notably, CSF NfL concentrations in patients with NPSLE showed an upward trend (mean 1600±2852 pg/mL) in contrast to non-NPSLE patients (mean 393.4±191.9 pg/mL) and controls (mean 509.7±358.5 pg/mL). Furthermore, a positive correlation was observed between serum and CSF NfL levels in patients with NPSLE (R=0.8686, p<0.01). Elevated serum triacylglycerol concentrations, C reactive protein and organ damage were linked to increased serum (p=0.002; p<0.001; p=0.036) and CSF (p=0.008; p=0.007; p<0.001) NfL concentrations. In addition, we established a significant correlation between intrathecal NfL concentrations and interleukin-6 levels in the CSF of patients with NPSLE (R=0.5118, p<0.05).

Conclusion

The serum NfL levels may be a readily available marker of neuropsychiatric involvement in SLE.
Longitudinal associations of flare and damage accrual in patients with systemic lupus erythematosus
Authors: Kandane-Rathnayake Rangi , Milea Dominique , Louthrenoo Worawit , Hoi Alberta , Golder Vera , Cho Jiacai , Lateef Aisha , Luo Shue-Fen , Wu Yeong-Jian Jan , Hamijoyo Laniyati , Sockalingam Sargunan , Li Zhanguo , Navarra Sandra , Zamora Leonid , Harigai Masayoshi , Katsumata Yasuhiro , Chan Madelynn , Hao Yanjie , Zhang Zhuoli , O’Neill Sean , Goldblatt Fiona , Oon Shereen , Xu Xiaomeng , Navarro Rojas Aldo A , Bae Sang-Cheol , Lau Chak Sing , Nikpour Mandana , Morand Eric
Published: January 2025

Objective

To estimate the prevalence of organ damage (damage) and flare and to examine longitudinal associations between flares and subsequent damage accrual, in patients with systemic lupus erythematosus (SLE).

Methods

Patients enrolled in the Asia Pacific Lupus Collaboration cohort with ≥3 years of prospectively captured data were studied. Flares were assessed at routine visits, while damage ((Systemic Lupus International Collaborating Clinics/American College of Rheumatology) Damage Index) was assessed annually. Multivariable, multifailure survival analyses were carried out to quantify the association between flares and damage accrual.

Results

1556 patients with SLE with a median (IQR) of 5.7 (3.9, 7.0) years of follow-up were studied. 39.5% (n=614) of patients had damage at enrolment, and 31.9% (n=496) accrued damage during the study observation period. The incidence of damage accrual during observation was ~58/1000 person-years. Overall, 74.1% (n=1153) of patients experienced a flare of any severity (mild/moderate or severe) at least once; 56.9% (n=885) experienced recurrent (≥2) flares. The risk of subsequent damage accrual in patients who experienced mild-to-moderate flare, after controlling for confounders, was 32% greater than in patients without flares (adjusted HR) (95% CI 1.32 (1.17 to 1.72)). The risk of damage accrual was greater if patients had severe flares (HR (95% CI) 1.58 (1.18 to 2.11)). For each additional flare, the risk of damage accrual increased by 7% (HR (95% CI) 1.07 (1.02 to 1.13)).

Conclusions

Flares independently increased the risk of damage accrual. Prevention of flares should be considered a necessary goal of SLE disease management to minimise permanent damage.
Outcomes following immunosuppressive therapy withdrawal after complete renal response in proliferative lupus nephritis
Authors: Vidal-Montal Paola , Narváez Javier , Fulladosa Xavier , Mitjavila Francesca , Capdevila Olga , Torras Joan , Gomà Montserrat , Nolla Joan M
Published: January 2025

Objective

To investigate the rate and factors influencing renal relapse (RR) in proliferative lupus nephritis (LN) patients who discontinued immunosuppressive therapy (IST), as well as the long-term renal outcomes following RR.

Methods

Retrospective, single-centre study of biopsy-confirmed LN patients who had received IST for at least 36 months and maintained complete renal response (CRR) for a minimum of 12 months before therapy discontinuation.

Results

Of a total of 106 patients meeting the inclusion criteria, 76 with proliferative classes were selected for analysis. The median duration of IST prior to discontinuation was 83.5 months (IQR 25th–75th: 53.5–120). Relapse occurred in 29 patients (38.2%) at a median of 26.5 months (IQR 25th–75th: 9.25–63.5 months) following IST withdrawal. Relapses were classified as severe in 9 cases (31%) and moderate in 16 cases (55.2%). Renal rebiopsy was performed in 25 of these patients (86.2%), with 80% retaining the same histological class.

Discontinuation of IST at ≤34 years of age significantly increased the risk of RR (adjusted HR: 3.5). In contrast, an IST duration exceeding 48 months prior to discontinuation (HR: 0.26), maintaining CRR for at least 48 months (HR: 0.32), achieving complete remission per DORIS (definition of remission in systemic lupus erythematosus) criteria at IST withdrawal (HR: 0.21) and gradual IST tapering (HR: 0.09) were associated with a reduced risk of RR.

Following reintroduction of IST, 20 out of 29 patients (68.9%) achieved CRR, 5 (17.2%) achieved a partial response and 4 (13.8%) did not respond; of these, 3 patients (10.3%) progressed to end-stage renal disease.

Conclusions

Successful withdrawal of IST is possible in carefully selected patients with proliferative LN. If an RR occurs, most patients are able to remain in remission after resuming IST.
Pregnancy and cardiovascular outcomes among patients post Fontan surgery: a 25-year single-centre retrospective cohort study
Authors: Yehuda Daniel , Soudry Omri , Schwartz Eyal , Richter Ilan , Dadashev Alexander , Vig Shahar , Kolker Shimon , Houri Ohad , Hadar Eran , Kornowski Ran , Hirsch Rafael , Schamroth Pravda Nili
Published: January 2025

Introduction

Data on the characteristics and outcomes of pregnancy and among patients with Fontan physiology are limited. We aimed to evaluate the immediate and long-term outcomes among these patients who were followed at our centre.

Methods

We included adult patients who had undergone Fontan surgery for congenital heart disease and were pregnant between 1994 and 2021. We examined maternal and obstetric outcomes.

Results

In a cohort of 109 patients following Fontan procedure, 51 patients were women, and 19 patients (37%) had a pregnancy during the follow-up period, accounting for a total of 46 pregnancies. Intrauterine growth retardation of the fetus was common, observed in 23% of all pregnancies and 50% of live births. The main fetal complication was prematurity, observed in 43% of all pregnancies and 90% of live birth. The maternal complications included pre-eclampsia (one patient), placental detachment (one patient), acute heart failure exacerbation (one patient), arrhythmia (three atrial arrhythmias) and major peripartum haemorrhage (two patients), with no peripartum death.

Conclusions

Over one-third of women with Fontan physiology in our cohort had a documented pregnancy. Maternal and obstetric complications were common among these patients, and expanded long-term data is needed. Limitations, including small sample size and survival bias, may have underestimated the risk of adverse outcomes in this cohort.
Role and prognostic value of growth differentiation factor 15 in patient of heart failure with preserved ejection fraction: insights from the PURSUIT-HFpEF registry
Authors: Sakamoto Daisuke , Matsuoka Yuki , Nakatani Daisaku , Okada Katsuki , Sunaga Akihiro , Kida Hirota , Sato Taiki , Kitamura Tetsuhisa , Tamaki Shunsuke , Seo Masahiro , Yano Masamichi , Hayashi Takaharu , Nakagawa Akito , Nakagawa Yusuke , Yasumura Yoshio , Yamada Takahisa , Hikoso Shungo , Sotomi Yohei , Sakata Yasushi
Published: January 2025

Background

Growth differentiation factor 15 (GDF15) is a cytokine responding to oxidative stress and inflammation, and it regulates appetite and energy balance. The association between GDF15 and clinical factors and its prognostic value in elderly multimorbid patients with heart failure with preserved ejection fraction (HFpEF) have not been well unknown.

Methods

This exploratory analysis is part of the Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with preserved Ejection Fraction study (N=1231), an ongoing, prospective, multicentre observational study of acute decompensated HFpEF (UMIN000021831). A predefined subcohort of 212 patients underwent multi-biomarker testing. Of these, we analysed 181 patients with available GDF15 data. The primary endpoint was a composite of all-cause death and hospitalisation for HF.

Results

In this analysis population, the median age was 81 (75–85) years, with 48% male patients. GDF15 significantly correlated with cardiac burden, anaemia, renal dysfunction and inflammation. Notably, poor nutritional status was significantly associated with GDF15. GDF15 was linked to poor prognosis in this elderly multimorbid cohort with HFpEF (adjusted HR for log-transformed GDF15: 13.67, 95% CI: 2.78 to 67.22, p=0.001). Furthermore, GDF15 added significant incremental value to the MAGGIC risk score (net reclassification improvement=0.4955 (95% CI: 0.1367 to 0.8543), p=0.007; integrated discrimination improvement=0.0278 (95% CI: 0.0013 to 0.0543), p=0.040).

Conclusions

GDF15 was associated with anaemia, inflammation, renal dysfunction, cardiac burden and malnutrition. It demonstrated prognostic value in elderly multimorbid HFpEF patients, suggesting its potential role as a complementary marker for the prognostic risk assessment of HFpEF patients.

Trial registration number

UMIN-CTR ID: UMIN000021831.
Emergency interventions for cardiogenic shock due to decompensated aortic stenosis: a systematic review and meta-analysis
Authors: Kühne Stephanie Gladys , Patrignani Andrea , Elvinger Sebastien , Wein Bastian , Harmel Eva , Penev Damyan , Owais Tamer , Girdauskas Evaldas , Raake Philip W , Chiarito Mauro , Bongiovanni Dario
Published: January 2025

Background

Cardiogenic shock (CS) induced by severe aortic stenosis (AS) is a life-threatening condition with high mortality. Despite advancements in emergency interventions, the optimal treatment approach remains uncertain.

Aim

This study aimed to systematically review and analyse the existing evidence on outcomes of emergency transcatheter aortic valve implantation (eTAVI) and emergency balloon aortic valvuloplasty (eBAV) in CS patients.

Methods

A systematic literature review and meta-analysis was performed. The primary endpoint was mortality at 30 days. Secondary endpoints were in-hospital mortality, 1-year mortality, bleeding, major vascular complications, myocardial infarction, stroke, incidence of pacemaker implantation, acute kidney injury and aortic regurgitation.

Results

Seventeen studies were included, totalling 2811 patients. The analysis revealed a 30-day mortality pooled estimated rate for eTAVI of 19% (CI 0.17 - 0.20) and for eBAV 39% (CI 0.32 - 0.46). In-hospital mortality pooled estimated rates were 11% for eTAVI (CI 0.06 - 0.18) and for eBAV 40% (CI 0.28 - 0.54). One-year mortality pooled estimated rates for eTAVI were 29% (CI 0.20 - 0.40) and for eBAV 67% (CI 0.58 - 0.74). Pooled estimated rates of any bleeding were 12% for eTAVI (CI 0.06 - 0.20) and 15% for eBAV (CI 0.10 - 0.21). The rate of major vascular complications for eTAVI was 8% (CI 0.07 - 0.10) and 3% for eBAV (CI 0.0 - 0.23).

Conclusions

This meta-analysis indicates that mortality in CS due to AS remains high despite emergency interventional treatment. These findings offer critical insights for clinical decision-making optimising patient care in this critically ill population.
Novel use of ultrasound-guided high-intensity focused ultrasound (HIFU) may enable the neuroablation of the sacroiliac joint in a swine model: a feasibility study
Authors: Bulat Evgeny , Chaturvedi Rahul , Crowther Jason , Monette Sebastien , Gulati Amitabh
Published: January 2025

Background

Sacroiliac joint (SIJ) dysfunction accounts for the etiology of pain in 15%–30% of low back pain cases. Some patients with conservative treatment-refractory SIJ dysfunction undergo radiofrequency (RF) ablation of the SIJ for prolonged pain relief. This procedure involves placing up to 12 RF probes in what is an invasive, resource-intensive, and time-consuming process. High-intensity focused ultrasound is an alternative neuroablative technique that is non-invasive and potentially less cumbersome. MRI-guided high-intensity focused ultrasound (MRgHIFU) had previously been successfully applied to SIJ ablation in a swine model, and more recently had been trialed in humans. However, ultrasound-guided high-intensity focused ultrasound (USgHIFU) of the SIJ may be a more practical and rapid alternative to MRIgHIFU.

Methods

This was a prospective technology efficacy and safety study in a swine model. Three Yorkshire pigs underwent bilateral SIJ ablation using a proprietary USgHIFU prototype. Post procedure, treatment efficacy was assessed using clinical evaluation of pain and changes in ambulation, gross inspection of lumbosacral necropsy and pathology sections, and histology.

Results

Post anesthetic monitoring for 72 hours showed no signs of gait abnormalities or perceived pain in the swine models. Of the primary sacral spine targets, histological specimen review suggested successful lesioning of 37/54 sites (68.5%), specifically in the targeted areas that were visualized under ultrasound. Of the successful lesion zones, 22/37 (59.5%) included nerve lesions, 34/37 (91.9%) included muscle lesions, 34/37 (91.9%) included periosteum lesions, and 20/21 (95.2%) included bony lesions.

Conclusions

The preliminary study thus demonstrates that USgHIFU can create targeted contiguous strip lesions along the SIJ and lead to thermal necrosis of the posterior sacral network without causing additional neurological damage or damage to adjacent muscle tissue or bone outside of target areas.
Chinese stroke association guidelines on reperfusion therapy for acute ischaemic stroke 2024
Authors: Xiong Yunyun , Li Shuya , Wang Chunjuan , Sun Dapeng , Li Zixiao , Gu HongQiu , Jin Aoming , Dong Qiang , Liu Liping , Miao Zhongrong , Wang Yongjun
Published: January 2025

Background

Stroke remains a major global health challenge, with China experiencing a significant burden due to its high incidence and severe outcomes. Reperfusion therapies, such as intravenous thrombolysis and endovascular thrombectomy, have shown substantial benefits in improving early outcomes for ischaemic stroke. Recent clinical trials have validated the safety and efficacy of a broader range of thrombolytic agents and expanded the eligible patient populations for both intravenous thrombolysis and mechanical thrombectomy. This guideline aims to provide the latest evidence-based insights in the field of reperfusion therapy.

Methods

The Chinese Stroke Association (CSA) established a writing group to develop updated guidelines on reperfusion therapy for acute ischaemic stroke. A comprehensive search of MEDLINE (via PubMed) was conducted up to 30 September 2024. Experts in the field of stroke engaged in extensive discussions, both online and offline, to evaluate the latest evidence. Each recommendation was graded using the CSA’s class of recommendation and level of evidence in the Guideline Development Manual of the CSA.

Results

This guideline, reviewed and approved by the CSA Guidelines Writing Group, outlines the criteria for patient selection for thrombolysis and thrombectomy and summarises the latest evidence on various thrombolytic drug options to support decision-making in reperfusion therapy. Additionally, the guideline includes green channel flow charts for intravenous thrombolysis and mechanical thrombectomy, designed to assist clinicians in optimising their clinical decisions.

Conclusion

This guideline updates the latest advancements in the field of reperfusion therapy for acute ischaemic stroke. It is anticipated that future clinical research will further advance areas such as innovative thrombolytic agents, expanded indications for thrombolysis and mechanical thrombectomy.
Integrating smart city technologies for sustainable pavement infrastructure
Authors: Furtado Lara Sucupira , Bessa Iuri Sidney , Gurjão Nayara de Oliveira , Soares Jorge Barbosa
Published: January 2025

This article explores the connection between Smart City advancements and the development of materials and strategies for asphalt pavements. It highlights the synergy between Smart Cities and Industry 4.0 through current technological advancements using connectivity, artificial intelligence, and big data analysis. The relationships between Smart Cities and Industry 4.0 are examined with an emphasis on five major areas: (i) Internet of Things and integrated systems; (ii) robotics and additive manufacturing; (iii) augmented reality for modeling and simulations; (iv) data-driven analysis: big data, artificial intelligence; and (v) citizen participation. We also point to the importance of smart infrastructure, with the integration of nanomaterials and materials into the structure to reduce energy consumption, optimize resources, and assist automation in construction and maintenance strategies, contributing to the efficiency and longevity of pavement infrastructure. We conclude by envisioning how generative artificial intelligence is integrated into pavement research, opening new avenues for innovation.
No evidence of migration in a 4-year study of an at-risk migratory fish—the centenarian bigmouth buffalo (Ictiobus cyprinellus) of Saskatchewan
Authors: Bryshun Reid N. , Achtymichuk Gabrielle H. , Ferrari Maud C.O.
Published: January 2025

The bigmouth buffalo ( Ictiobus cyprinellus, Valenciennes 1844) is a long-lived freshwater fish native to North America that is listed as a species of special concern in its Saskatchewan-Nelson range. Little is known about their ecology and behavior, especially in the Saskatchewan Qu'Appelle River system where it faces multiple threats such as habitat fragmentation and competition with invasive species. In this study, we used acoustic telemetry to track the movements of 44 bigmouth buffalo throughout the Qu'Appelle River system in 2017–2019, and 2021, to monitor migration patterns from spring to fall and investigate if any of the five dams were impeding their ability to access either breeding or overwintering grounds. We found that bigmouth buffalo demonstrated minimal use of the river during this 4-year study, instead staying within the confines of a single lake year-round. Our results suggest that bigmouth buffalo in the Qu'Appelle River do not exhibit migratory behavior during nonflooding years. Considering their extended lifespan (>125 years), this could be attributed to their potential bet-hedging strategy for spawning primarily during flood years. The results indicate that bigmouth buffalo voluntarily remained within Buffalo Pound Lake throughout the study period. Whether this behavior was natural or was influenced by modifications to the system’s hydrology requires further investigation.
Production and decay of anticharmed pentaquark state with quark content $$\bar{c}sudd$$
Authors: Liu Shi-Dong , Wang Xiao-Yun , Liu Xiao-Hai , Li Gang
Published: January 2025

We use an effective Lagrangian approach to investigate the production of the anticharmed pentaquark state

$$P_{\bar{c}s}^{(*)-}$$

P

c

¯

s

(

∗
)
-

with the minimal quark content

$$\bar{c}sudd$$

c

¯

s
u
d
d

in the

$$\Lambda _b^0$$

Λ
b
0

decay. In our calculation, the

$$P_{\bar{c}s}^{(*)-}$$

P

c

¯

s

(

∗
)
-

is considered as the molecule state of the

$$nD_{s0(s1)}^{-}$$

n

D

s
0
(
s
1
)

-

in an S wave, and its production and decay occur via triangle loops at the hadron level. With the moderate model parameters, the computed results suggest that the branching fractions of

$$\Lambda _b^0\rightarrow P_{\bar{c}s}^{(*)-} D^+ $$

Λ
b
0

→

P

c

¯

s

(

∗
)
-

D
+

can reach approximately

$$10^{-4}$$

10

-
4

. The possible decay modes

$$ P_{\bar{c}s}^{(*)-} \rightarrow \Lambda D^{(*)-}$$

P

c

¯

s

(

∗
)
-

→
Λ

D

(

∗
)
-

and

$$ P_{\bar{c}s}^{(*)-} \rightarrow \Sigma D^{(*)-}$$

P

c

¯

s

(

∗
)
-

→
Σ

D

(

∗
)
-

are also investigated. It is hoped that these predictions could be helpful in searching for the anticharmed-strange pentaquark candidates in future LHCb experiments.
Effect of Climate-Related Disasters on Consumption: Theory and Evidence from Bangladesh
Authors: Roy Amit
Published: January 2025

As countries grapple with the aftermath of climate-related disasters, the disruptions they inflict on domestic consumption ripple through the fabric of income and price level shocks. The income shock emanates from the adverse effects of such disasters on economic agents, leading to both wage and asset income losses. On the other hand, the destruction of productive capacity and the disruption of supply chains by climatic disasters generate a price level shock. To delve deeper into these channels, this paper builds a novel climate economy model using nonlinear model predictive control. Moreover, using time-series analysis for Bangladesh, the study uncovers compelling evidence of the existence of income and price channels through which climatic disasters impact consumption where the price effect has appeared stronger than the income effect. The findings suggest that policymakers should simultaneously prioritize income-generating and price-supporting initiatives after climate-related disasters to achieve a rapid and sustainable consumption recovery to match or surpass the predisaster level.
The Impact of Micronutrient Training on High-Zinc Rice Demand Among Mothers: A Randomized Control Trial Study in Bangladesh
Authors: Valera Harold Glenn A. , Yamano Takashi , Puskur Ranjitha , Antonio Ronald Jeremy , Habib Muhammad Ashraful , Bashar M. D. Khairul , Pede Valerien O.
Published: January 2025

This paper measures the impact of a micronutrient training among women farmers with young children on the demand for zinc-enhanced varieties. We conducted a randomized control trial by providing micronutrient training in randomly selected villages in May–June 2017. These farmers were also given information on the biofortification of rice with zinc. One week after the training, we conducted a phone-based bidding for high-zinc rice seeds among trainees and their counterparts in control villages. More than 70% of the treated female farmers participated in the bidding for high-zinc rice seed, but only 23% of the women in the control group participated in the bidding. Female farmers who self-reported that they had input into most or all decisions on the use of income generated from rice bid a higher price than other female farmers. The results suggest the effectiveness of the micronutrient training, at least in a short period immediately after the training.
Berberine Inhibited SASP-Related Inflammation through RXRα/PPARγ/NEDD4 Pathway in Atherosclerosis
Authors: Zheng Yinghong , Kou Jiayuan , Gao Xi , Guo Jinxiang , Liu Qian , Ren Huiwen , Gao Tielei , Wang Qianbing , Zhao Yajie , Wang Yuqin , Li Hong , Yang Liming
Published: January 2025

The accumulation of aging cells significantly contributes to chronic inflammatory diseases such as atherosclerosis. Human carotid artery single-cell sequencing has shown that large numbers of aging foam cells are present in the plaques of human patients. Berberine (BBR) has been shown to inhibit cell senescence, however, the mechanisms involved in its treatment of atherosclerotic senescence have not yet been determined. Changes in plaque morphology and blood chemistry were observed in ApoE[Formula: see text] mice fed with a high-fat diet before and after BBR treatment. Inflammatory proteins linked to the senescence-associated secretory phenotypes (SASP) were detected in RAW264.7 and peritoneal macrophage-derived foam cells. Smart-seq analysis was used to explore the pathways associated with BBR therapy for atherosclerosis. Finally, the effect of lentivirus-mediated knockdown of RXRα in macrophages in plaques on atherosclerosis treatment with BBR was determined. We found that BBR reduced inflammation linked to SASP in atherosclerosis through the RXRα/PPARγ/NEDD4 signaling pathway. BBR increased GATA4 binding to p62, promoted ubiquitination, and inhibited SASP-associated protein production in RAW264.7 and peritoneal macrophage-derived foam cells. Mechanistically, according to the Smart-seq results, BBR activated RXRα and PPARγ, synergistically increased NEDD4 transcription levels, and promoted ubiquitination-mediated degradation of the GATA4/p62 complex. Additionally, the anti-aging impact of BBR on atherosclerosis was negated when macrophage-specific RXRα was knocked down using lentivirus (pLVCD68-shRNA RXRα) in ApoE[Formula: see text] mice. BBR activated PPARγ through RXRα-PPARγ immune complex in macrophage-derived foam cells, increased NEDD4 transcriptional activity, promoted ubiquitination of GATA4-p62 complex, and inhibited SASP-related inflammation. These findings suggest the potential of BBR as a novel approach to addressing SASP-associated inflammation in atherosclerosis.
Hedging for Balancing: Japan’s Foreign Policy in the 2010s–2020s
Authors: KOGA Kei
Published: January 2025

Since the 2000s, Japan has pursued a balancing strategy towards China by strengthening the US–Japan alliance. Nonetheless, the relative decline in the United States’ global strategic influence has compelled Japan to adopt a “security hedging” approach. Japan seeks to strengthen strategic relations with non-US security partners both within and beyond the Indo-Pacific region, diversifying the risks of diplomatic overdependence on the United States while continuing to fortify military cooperation with it.
Competing Regimes and Multiple Stakeholders: How China Hedges its Relations with Myanmar
Authors: HAN Enze
Published: January 2025

This article investigates China’s hedging strategy towards Myanmar following the military coup in 2021, characterised by competing regimes and numerous armed resistance groups. Given the volatile and uncertain political environment in Myanmar, Beijing’s strategy involves maintaining relationships with multiple stakeholders with not only the military junta but also various ethnic armed groups, and potentially the national unity government too.
Britain’s Indo-Pacific Security and Trade Policies: Continuity and Change Under the Labour Government
Authors: PURI Samir
Published: January 2025

The United Kingdom’s main motivation for its engagement in the Indo-Pacific is commercial, alongside its contributions to regional security. In July 2024, a Labour government replaced the Conservative government. While the United Kingdom’s commitment to the Indo-Pacific is expected to remain steadfast, managing the ongoing war in Europe and the expected impact of the incoming Trump presidency on transatlantic relations will challenge Labour for years to come. The United Kingdom’s long-term interests in the Indo-Pacific must now be managed alongside these more pressing concerns.
Significance of ∼1Ga granites from the South Delhi Fold Belt, NW India: Implications for paleogeographic reconstructions of Rodinia
Authors: Chatterjee Sadhana M. , Manna Anirban , Roy Alip , Sarkar Ayan Kumar , Das Subhrajyoti , Dutta Upama
Published: January 2025

In northwestern India, the South Delhi Fold Belt (SDFB) is a NE-SW trending Proterozoic fold belt. The Phulad Shear Zone (PSZ), characterised by mylonites, marks its western margin, formed around ∼820Ma in a ductile transpressional regime with a top-to-the-NNW reverse movement. Isolated reports of ∼1Ga granites within the SDFB correlate-in time with the Rodinia supercontinent assembly. These pink, foliated, equigranular granites, named Foliated pink granite, occur in a 6-12km wide, 200km long linear belt. Detailed investigations reveal synchronous deformation in both granites and PSZ mylonites. Geochemically, these granites are ferroan, calc-alkalic and dominantly metaluminous. Tectonic discrimination diagrams confirm A-type within-plate-granite characteristics, indicating emplacement in an extensional regime. U-Pb zircon dating of the granites yields a magmatic Concordia age of 970.7±2.9Ma, overprinted by a metamorphic age of 826.3±6.9Ma. This study documents similar magmatic and post-magmatic features across all ∼1Ga granites. Field, petrological, geochemical and geochronological data suggest Foliated pink granites originated from lower crustal melting during crustal thinning at ∼970Ma, followed by thrusting and deformation at 820-810Ma, coinciding with PSZ formation. Our study concludes that NW India lacks any geological evidence of Rodinia assembly, which is crucial for accurately reconstructing Rodinia's palaeogeography and understanding the role of India within Rodinia.
Negative-Weight Single-Source Shortest Paths in Near-Linear Time
Authors: Bernstein Aaron , Nanongkai Danupon , Wulff-Nilsen Christian
Published: January 2025

In the single-source shortest paths problem, the goal is to compute the shortest path tree from a designated source vertex in a weighted, directed graph. We present the first near-linear time algorithm for the problem that can also handle negative edge-weights; the runtime is

O
(
m

log
8

(
n
)

log
W
)

.

In contrast to all recent developments that rely on sophisticated continuous optimization methods and dynamic algorithms, our algorithm is simple: it requires only a simple graph decomposition and elementary combinatorial tools. In fact, ours is the first combinatorial algorithm for negative-weight single-source shortest paths to break through the classic

O
~

(
m

n

log
W
)

bound from over three decades ago (Gabow and Tarjan, SICOMP’89.)
Quantitative Study on the Performance of An Asynchronous Chain Model
Authors: Seol Jongho , Pu Cong , Park Nohpill
Published: January 2025

This paper presents a quantitative study on the performance of an asynchronous chain model [32] during its theoretical design stage. The asynchronous chain [32] in this study is asynchronous along with adaptively-sized blocks in a proactive manner, whereas the conventional chain controls the block posting in a strictly synchronous manner to the fixed-sized blocks. The model of the adaptive chain, with a rather “reactively” dynamic size of blocks as shown in [31], can be compared versus the proposed model which is asynchronous with a “proactively” dynamic size of the blocks. It is assumed in this paper that variable bulk arrivals (VBA) of transactions in Poisson distribution and asynchronous bulk posting (ABS) of transactions off a block potentially in different capacity in exponential time, referred to as VBAABS. Basic numerical simulations results have been reported in [32] primarily for feasibility validation purpose. In our earlier conference version [32] we have presented the work with focus on development and validation of the performance model in a quantitative manner with extensive numerical simulations to demonstrate the efficacy of the proposed asynchronous chain model, and in this paper we extend the work to also include substantially new works such as an extensive comparative study in performance versus other blockchain models such as the baseline chain model [30] (see Section 5.1) and the adaptive chain model [31] (5.2). Then, a summary by each chain model in consideration, is provided for clarity (5.3). Furthermore, a new simulation is conducted with a focus on the performance of microtransactions as a type of transactions to be commonly expected in the gaming decentralized applications to demonstrate the benefit from the proactive asynchrony of block postings (5.4). Lastly, the implementation results and analysis are shown based on the Ethereum open source as reported in [32].