bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding changes in pulmonary function and functional status in breast cancer patients after systemic chemotherapy and radiotherapy: a prospective study
Authors: Tuğral Alper , Arıbaş Zeynep , Akyol Murat , Bakar Yeşim
Published: February 2024

Background

Respiratory complications in breast cancer (BC) patients after chemotherapy (CT) and radiotherapy (RT) have been well acquainted and these complications should be investigated to prevent secondary problems and/or improve BC patients’ clinical outcomes. Therefore, this study aimed to assess the potential acute effect of systemic chemotherapy and radiotherapy on respiratory function and functional status of patients with breast cancer.

Methods

A total of 25 BC patients who were candidates for systemic chemotherapy and radiotherapy were recruited after oncological examination and included in this study. Respiratory function and functional status were assessed with the Pulmonary Function Test (PFT) and the Six-Minute Walk Test (6MWT), respectively. Patients were assessed before CT (c0), after CT (c1), and after RT (r1).

Results

25 BC patients were assessed in c0 and c1 while only 15 out of 25 patients (60%) were assessed in r1. The actual values of Forced vital capacity (FVC) (t = 2.338, p =.028), Forced expiratory volume in 1s (FEV1 (t = 2.708, p =.012), and the forced expiratory flow of between 25% and 75% of vital capacity (FEF25-75%) (t = 2.200, p =.038) were found significantly different after systemic CT. Inspiratory (MIP) and expiratory (MEP) muscle strength also did not show a significant change from c0 to c1. A significant effect of the type of surgery was found (Wilks’ lambda, F [1, 19] = 6.561, p =.019, ηp2 = 0.25) between c0 and c1 in actual FVC value. The main effect of time was found significant in FVC (F [2, 28] = 4.840, p =.016, ηp2 = 0.25) from c0 to r1. Pairwise comparisons with Bonferroni correction showed that there was a significant difference between c0 and r1 (p =.037).

Discussion

The present study showed decreased FVC and FEV1 actual values and percent predicted rates from baseline to the completion of treatment. Since the interactional effect of the type of surgery was significant, we suggest that clinical and demographic factors such as age should be considered when interpreting the early changes in PFT. In addition, the significant linear trend of decreasing in some specific outcomes in respiratory function also highlighted the need for continuous monitoring of potential respiratory problems in patients with BC from baseline to the completion of chemotherapy and radiotherapy.
The learning curve of the MS-TRAM/DIEP breast reconstruction by dual-trained breast surgeons
Authors: Li Shunrong , Zhang Songliang , Zhang Xiaolan , Yan Jingwen , Wang Shuai , Tan Luyuan , Rao Nanyan , Chen Kai , Zhu Liling
Published: February 2024

Background

Breast cancer surgeries involving MS-TRAM/DIEP breast reconstruction has traditionally been collaborative efforts between breast surgeons and plastic surgeons. However, in our institution, this procedure is performed by dual-trained breast surgeons who are proficient in both breast surgery and MS-TRAM/DIEP breast reconstruction. This study aims to provide insights into the learning curve associated with this surgical approach.

Materials and methods

We included eligible breast cancer patients who underwent MS-TRAM/DIEP breast reconstruction by dual-trained breast surgeons between 2015 and 2020 at our institution. We present the learning curve of this surgical approach, with a focus on determining factors affecting flap harvesting time, surgery time, and ischemic time. Additionally, we assessed the surgical complication rates.

Results

A total of 147 eligible patients were enrolled in this study. Notably, after 30 cases, a statistically significant reduction of 1.7 h in surgery time and 21 min in ischemic time was achieved, signifying the attainment of a plateau in the learning curve. And the major and minor complications were comparable between the early and after 30 cases.

Conclusion

This study explores the learning curve and feasibility experienced by dual-trained breast surgeons in performing MS-TRAM/DIEP breast reconstruction.

Trial registration

NCT05560633.
Impact of molar teeth distalization by clear aligners on maxillary alveolar bone thickness and root resorption: a three‑dimensional study
Authors: Al-Worafi Naseem Ali , Zheng Bowen , Al-Warafi Leena Ali , Alyafrusee Enas Senan , Alsomairi Majedh Abdo Ali , Liu Yi
Published: February 2024

Objective

This study aimed to evaluate the impact of molar teeth distalization movement by clear aligners on changes in the alveolar bone thickness and orthodontically induced inflammatory root resorption (OIIRR) in maxillary molars using conebeam computed tomography (CBCT).

Materials and methods

Three-dimensional CBCT scans of 35 adult patients (one hundred forty maxillary molars) with pre-designed selection criteria and a mean age of 24.4 ± 7.1 years were included. The measured parameters, including alveolar bone thickness for maxillary molars and root resorption (OIIRR), were analyzed using pre-and post-treatment CBCT (T0 and T1, respectively) with Invivo 6.0 software.

Result

Post-treatment, relevant statistically significant changes included deposition of bone in the average palatal surface of the 1st molars. The reduction of bone was seen in the average buccal surface of the first molars and both surfaces of the second molars. Regarding root length after treatment, the average maxillary 1st molar roots showed significant OIIRR (p < 0.001).

Conclusion

Clear aligner treatment could effectively reduce the incidence of alveolar bone thickness reduction and OIIRR in treating Class II malocclusions compared to conventional braces, as shown in previous studies. This research will aid in fully grasping the benefits of clear aligners.
Exploring the benefits of wild plants in dietary nutrition: investigating perspectives, choices, health impacts and sustainable practices
Authors: Anwar Tauseef , Qureshi Huma , Shahzadi Sumbal , Siddiqi Ejaz Hussain , Ali Hayssam M. , Abdelhamid Mohamed M. A. , Nazim Muhammad
Published: February 2024

Background

This ethnobotanical study in Dunyapur, District Lodhran, Pakistan, focuses on traditional medicinal knowledge, exploring 41 plants across 28 families. The research involves 496 informants from diverse backgrounds, including farmers, herbalists, housewives, teachers, and shopkeepers. The prevalence of herbs (68%) aligns with their accessibility and rapid regrowth, shaping the local medicinal landscape. The study investigates socio-demographic features, emphasizing the importance of considering the community's diverse perspectives.

Methods

The research employs quantitative ethnobotanical data analysis, introducing various indices like PPV, FUV, FIV, RFC, UV, and RI. The analysis of plant growth habits underscores the dominance of herbs, and the method of preparation evaluation identifies decoction as the most common (23%). Leaves (27%) are the most utilized plant part, and Resedaceae stands out with the highest FUV (0.38). FIV highlights the ecological and cultural significance of Poaceae, Boraginaceae, Fabaceae, and Solanaceae.

Results

The RFC values range from 0.016 to 0.032, with Cucumis melo having the highest value (0.032), indicating its frequent citation and cultural significance. The study reveals specific plants like Melia azedarach, Peganum harmala and Salvadora oleoides with high PR values for skin issues, reflecting their widespread acceptance and effectiveness. Oligomeris linifolia emerges with the highest UV (0.38), emphasizing its greater significance in local traditional practices. Leptadenia pyrotechnica records the highest RI (9.85), underlining its exceptional importance in the community's traditional pharmacopeia.

Conclusion

The findings offer a holistic understanding of ethnobotanical knowledge in Dunyapur, emphasizing the role of local contexts and ecological factors in shaping traditional plant uses. The study contributes valuable insights into the diverse practices within the community, laying the foundation for sustainable integration of traditional knowledge into broader healthcare frameworks.
Quality improvement project to reduce medicare 1-day write-offs due to inappropriate admission orders
Authors: Oke Olufolarin , Sullivan K. Michaela , Hom Jason , Svec David , Weng Yingjie , Shieh Lisa
Published: February 2024

Background

We identified that Stanford Health Care had a significant number of patients who after discharge are found by the utilization review committee not to meet Center for Mediare and Medicaid Services (CMS) 2-midnight benchmark for inpatient status. Some of the charges incurred during the care of these patients are written-off and known as Medicare 1-day write-offs. This study which aims to evaluate the use of a Best Practice Alert (BPA) feature on the electronic medical record, EPIC, to ensure appropriate designation of a patient’s hospitalization status as either inpatient or outpatient in accordance with Center for Medicare and Medicaid services (CMS) 2 midnight length of stay benchmark thereby reducing the number of associated write-offs.

Method

We incorporated a best practice alert (BPA) into the Epic Electronic Medical Record (EMR) that would prompt the discharging provider and the case manager to review the patients’ inpatient designation prior to discharge and change the patient’s designation to observation when deemed appropriate. Patients who met the inclusion criteria (Patients must have Medicare fee-for-service insurance, inpatient length of stay (LOS) less than 2 midnights, inpatient designation as hospitalization status at time of discharge, was hospitalized to an acute level of care and belonged to one of 37 listed hospital services at the time of signing of the discharge order) were randomized to have the BPA either silent or active over a three-month period from July 18, 2019, to October 18, 2019.

Result

A total of 88 patients were included in this study: 40 in the control arm and 48 in the intervention arm. In the intervention arm, 8 (8/48, 16.7%) had an inpatient status designation despite potentially meeting Medicare guidelines for an observation stay, comparing to 23 patients (23/40, 57.5%) patients in the control group (p = 0.001). The estimated number of write-offs in the control arm was 17 (73.9%, out of 23 inpatient patients) while in the intervention arm was 1 (12.5%, out of 8 inpatient patient) after accounting for patients who may have met inpatient criteria for other reasons based on case manager note review.

Conclusion

This is the first time to our knowledge that a BPA has been used in this manner to reduce the number of Medicare 1-day write-offs.
Effect of leadership styles on turnover intention among staff nurses in private hospitals: the moderating effect of perceived organizational support
Authors: Pattali Surabhila , Sankar Jayendira P. , Al Qahtani Haitham , Menon Nidhi , Faizal Shabana
Published: February 2024

Leadership styles have often been proven to support employees in performing their duties better and with more efficiency while enabling them to have extended organizational tenures. Staff nurses are an essential resource of hospitals to ensure proper administration and quality patient health care. The study aims to determine how transformational and authentic leadership styles affect the staff nurses’ turnover intention in private hospitals. In addition, it also finds the moderating effect of perceived organizational support. An explanatory quantitative research design with a cross-sectional investigation and a stratified sampling strategy was used for the study. Data from 296 nurses from the eight chosen private hospitals in the Kingdom of Bahrain were gathered using a questionnaire with 24 items. Smart-PLS was employed to conduct PLS-SEM (partial least squares structural equation modeling) to measure direct and indirect effects. The result indicates that transformational, authentic leadership styles and perceived organizational support significantly negatively affect nurses’ turnover intention. The study confirms the negative moderating effect of perceived organizational support between transformational leadership and turnover intention and the positive moderating effect of perceived organizational support between authentic leadership and turnover intention. Managers should concentrate on the leadership style to avoid its impact on turnover intention. By considering human resource practices such as communication and training strategies to cope with the negative effect of turnover intention, organizations can enhance employee engagement, improve job satisfaction, and foster a more stable and productive work environment. The present research revealed the adverse impact of turnover intention within hospitals by examining its association with leadership styles. The research made a significant contribution to the existing literature by delving into the impact of leadership styles on turnover intention, focusing on the moderating effect of perceived organizational support. The study’s findings shed light on the intricate relationship between leadership practices and employee turnover, providing valuable insights for both scholars and practitioners in the field. The study used a cross-sectional design to collect data and ensured the absence of standard method variance. The research enhanced the social dominance theory (SDT) by examining how perceived organizational support moderates the relationship between leadership styles and turnover intention.
Efficacy of virtual reality for pain relief in medical procedures: a systematic review and meta-analysis
Authors: Teh Jhia J. , Pascoe Dominic J. , Hafeji Safiya , Parchure Rohini , Koczoski Adam , Rimmer Michael P. , Khan Khalid S. , Al Wattar Bassel H.
Published: February 2024

Background

Effective pain control is crucial to optimise the success of medical procedures. Immersive virtual reality (VR) technology could offer an effective non-invasive, non-pharmacological option to distract patients and reduce their experience of pain. We aimed to evaluate the efficacy of Immersive virtual reality (VR) technology in reducing patient’s pain perception during various medical procedures by conducting a systematic review and meta-analysis.

Methods

We searched MEDLINE, EMBASE, CENTRAL, CINAHL, and SIGLE until December 2022 for all randomised clinical trials (RCT) evaluating any type of VR in patients undergoing any medical procedure. We conducted a random effect meta-analysis summarising standardised mean differences (SMD) with 95% confidence intervals (CI). We evaluated heterogeneity using I2 and explored it using subgroup and meta-regression analyses.

Results

In total, we included 92 RCTs (n = 7133 participants). There was a significant reduction in pain scores with VR across all medical procedures (n = 83, SMD − 0.78, 95% CI − 1.00 to − 0.57, I2 = 93%, p = < 0.01). Subgroup analysis showed varied reduction in pain scores across trial designs [crossover (n = 13, SMD − 0.86, 95% CI − 1.23 to − 0.49, I2 = 72%, p = < 0.01) vs parallel RCTs (n = 70, SMD − 0.77, 95% CI − 1.01 to − 0.52, I2 = 90%, p = < 0.01)]; participant age groups [paediatric (n = 43, SMD − 0.91, 95% CI − 1.26 to − 0.56, I2 = 87%, p = < 0.01) vs adults (n = 40, SMD − 0.66, 95% CI − 0.94 to − 0.39, I2 = 89%, p = < 0.01)] or procedures [venepuncture (n = 32, SMD − 0.99, 95% CI − 1.52 to − 0.46, I2 = 90%, p = < 0.01) vs childbirth (n = 7, SMD − 0.99, 95% CI − 1.59 to − 0.38, I2 = 88%, p = < 0.01) vs minimally invasive medical procedures (n = 25, SMD − 0.51, 95% CI − 0.79 to − 0.23, I2 = 85%, p = < 0.01) vs dressing changes in burn patients (n = 19, SMD − 0.8, 95% CI − 1.16 to − 0.45, I2 = 87%, p = < 0.01)]. We explored heterogeneity using meta-regression which showed no significant impact of different covariates including crossover trials (p = 0.53), minimally invasive procedures (p = 0.37), and among paediatric participants (p = 0.27). Cumulative meta-analysis showed no change in overall effect estimates with the additional RCTs since 2018.

Conclusions

Immersive VR technology offers effective pain control across various medical procedures, albeit statistical heterogeneity. Further research is needed to inform the safe adoption of this technology across different medical disciplines.
Icariin exerts anti-tumor activity by inducing autophagy via AMPK/mTOR/ULK1 pathway in triple-negative breast cancer
Authors: Zhao Mei , Xu Panling , Shi Wenjing , Wang Juan , Wang Ting , Li Ping
Published: February 2024

Background

Breast cancer is the most prevalent female tumor, of which triple-negative breast cancer (TNBC) accounts for about 15%. Characterized by its aggressive nature and limited treatment options, TNBC currently stands as a significant clinical challenge. This study aimed to investigate the effects of icariin (ICA) on TNBC and explore the underlying molecular mechanism.

Methods

Cell viability was assessed using CCK-8 assay, whereas the impact of ICA on cell proliferation was determined using colony formation assay and detection of proliferating cell nuclear antigen protein. Wound healing and transwell assays were used to evaluate the effects of ICA on cell migration and invasion, respectively. Flow cytometry was used to analyze cell cycle distribution and apoptosis. Transmission electron microscopy and monodansylcaverine staining were performed to detect the induction of autophagy, whereas molecular docking was conducted to predict the potential targets associated with autophagy. The in vivo anti-tumor effects of ICA were evaluated using a TNBC 4T1 xenograft mouse model. Protein expression levels were examined using immunoblotting and immunohistochemistry.

Results

In vitro, ICA effectively suppressed the viability, proliferation, migration, and invasion of TNBC cells and induced G0/G1 phase cell cycle arrest, apoptosis, and autophagy in TNBC cells by regulating the adenosine monophosphate-activated protein kinase (AMPK)/mammalian target of rapamycin (mTOR)/Unc-51-like kinase 1 (ULK1) signaling pathway. The knockdown of AMPK and inhibition of autophagy with 3-methyladenine reversed the effects of ICA, highlighting the importance of AMPK and autophagy in the anti-cancer mechanism of ICA. In vivo, ICA significantly inhibited TNBC growth, promoted autophagy, and regulated AMPK/mTOR/ULK1 pathway.

Conclusions

Our findings demonstrated that ICA exerts anti-cancer effects against TNBC and the associated molecular mechanisms. This study will help to facilitate further preclinical and clinical investigations for the treatment of TNBC.
ZNF460-mediated circRPPH1 promotes TNBC progression through ITGA5-induced FAK/PI3K/AKT activation in a ceRNA manner
Authors: Zhang Chuanpeng , Yu Ziyi , Yang Susu , Liu Yitao , Song Jiangni , Mao Juan , Li Minghui , Zhao Yi
Published: February 2024

Background

Circular RNAs are highly stable regulatory RNAs that have been increasingly associated with tumorigenesis and progression. However, the role of many circRNAs in triple-negative breast cancer (TNBC) and the related mechanisms have not been elucidated.

Methods

In this study, we screened circRNAs with significant expression differences in the RNA sequencing datasets of TNBC and normal breast tissues and then detected the expression level of circRPPH1 by qRT‒PCR. The biological role of circRPPH1 in TNBC was then verified by in vivo and in vitro experiments. Mechanistically, we verified the regulatory effects between circRPPH1 and ZNF460 and between circRPPH1 and miR-326 by chromatin immunoprecipitation (ChIP), fluorescence in situ hybridization assay, dual luciferase reporter gene assay and RNA pull-down assay. In addition, to determine the expression of associated proteins, we performed immunohistochemistry, immunofluorescence, and western blotting.

Results

The upregulation of circRPPH1 in TNBC was positively linked with a poor prognosis. Additionally, both in vivo and in vitro, circRPPH1 promoted the biologically malignant behavior of TNBC cells. Additionally, circRPPH1 may function as a molecular sponge for miR-326 to control integrin subunit alpha 5 (ITGA5) expression and activate the focal adhesion kinase (FAK)/PI3K/AKT pathway.

Conclusion

Our research showed that ZNF460 could promote circRPPH1 expression and that the circRPPH1/miR-326/ITGA5 axis could activate the FAK/PI3K/AKT pathway to promote the progression of TNBC. Therefore, circRPPH1 can be used as a therapeutic or diagnostic target for TNBC.
Early brain cognitive development in late preterm infants: an event-related potential and resting EEG study
Authors: Zhang Qinfen , Dong Xuan , Jin Wenjie , Fan Jiaojiao
Published: February 2024

Background

Late preterm infants (LPIs) are at risk of neurodevelopmental delay. Research on their cognitive development is helpful for early intervention and follow-up.

Methods

Event-related potential (ERP) and resting electroencephalography (RS-EEG) were used to study the brain cognitive function of LPIs in the early stage of life. The Gesell Developmental Scale (GDS) was used to track the neurodevelopmental status at the age of 1 year after correction, and to explore the neurophysiological indicators that could predict the outcome of cognitive development in the early stage.

Results

The results showed that mismatch response (MMR) amplitude, RS-EEG power spectrum and functional connectivity all suggested that LPIs were lagging behind. At the age of 1 year after correction, high-risk LPIs showed no significant delay in gross motor function, but lagged behind in fine motor function, language, personal social interaction and adaptability. The ROC curve was used to evaluate the predictive role of MMR amplitude in the brain cognitive development prognosis at 1 year, showing a sensitivity of 80.00% and a specificity of 90.57%. The area under the curve (AUC) was 0.788, with a P-value of 0.007.

Conclusions

Based on our findings we supposed that the cognitive function of LPI lags behind that of full-term infants in early life. Preterm birth and perinatal diseases or high risk factors affected brain cognitive function in LPIs. MMR amplitude can be used as an early predictor of brain cognitive development in LPIs.

Trial registration

This clinical trial is registered with the Chinese Clinical Trial Registry (ChiCTR). Trial registration number: ChiCTR2100041929. Date of registration: 2021-01-10. URL of the trial registry record: https://www.chictr.org.cn/.
Outpatient follow-up of tumour diseases through video-based value-oriented behavioural activation (ViVA): study protocol for a randomised controlled trial
Authors: Reder Maren , Hofheinz Christine , Melzner Lena , Prinz Gabriele , Kröger Christoph
Published: February 2024

Background

In Germany, approximately half a million people are diagnosed with cancer annually; this can be traumatic and lead to depression, anxiety, and adjustment disorders necessitating psycho-oncological intervention. Value-oriented behavioural activation, adopted from depression psychotherapy, aims to provide structured support to help patients adjust their personal values, goals, and activities within the context of their changed life situation. This trial aims to evaluate the effectiveness of video-based value-oriented behavioural activation against German S3-Guideline-compliant aftercare for cancer patients dealing with psychological distress.

Methods

This trial will use covariate-adaptive randomisation according to gender and type of tumour disease to assign participants to one of two study arms (value-oriented behavioural activation consisting of 12 manualised follow-up sessions delivered via video consultation vs. S3-Guideline-compliant aftercare comprising three supportive talks). Psychological strain, psychosocial distress, quality of life, work-related outcomes, fear of cancer recurrence, goal adjustment, satisfaction with the consultant-participant relationship, and rumination will be measured at baseline, twice during treatment, posttreatment, and at the 6-month follow-up. The target sample of 146 tumour patients experiencing high psychosocial distress will be recruited at the Rehazentrum Oberharz, Germany.

Discussion

This trial aims to test the effectiveness of value-oriented behavioural activation in aftercare for tumour patients, focusing on its capacity to reduce distress and the potential for long-term effects evaluated through a 6-month follow-up. The study’s possible challenges include enrolling a sufficient sample and ensuring adherence to treatment, mitigated through in-person recruitment and rigorous training of staff. If successful, the results will be of high public health relevance, especially for psychotherapeutic care in rural areas and among patients with limited mobility considering the video-based approach of the trial.

Trial registration

This study was registered at the German Clinical Trials Register: DRKS00031900 on Sep 19, 2023.
Implementation of type 1 diabetes genetic risk screening in children in diverse communities: the Virginia PrIMeD project
Authors: Guertin Kristin A. , Repaske David R. , Taylor Julia F. , Williams Eli S. , Onengut-Gumuscu Suna , Chen Wei-Min , Boggs Sarah R. , Yu Liping , Allen Luke , Botteon Lacey , Daniel Louis , Keating Katherine G. , Labergerie Mika K. , Lienhart Tyler S. , Gonzalez-Mejia Jorge A. , Starnowski Matt J. , Rich Stephen S.
Published: February 2024

Background

Population screening for risk of type 1 diabetes (T1D) has been proposed to identify those with islet autoimmunity (presence of islet autoantibodies). As islet autoantibodies can be transient, screening with a genetic risk score has been proposed as an entry into autoantibody testing.

Methods

Children were recruited from eight general pediatric and specialty clinics across Virginia with diverse community settings. Recruiters in each clinic obtained informed consent/assent, a medical history, and a saliva sample for DNA extraction in children with and without a history of T1D. A custom genotyping panel was used to define T1D genetic risk based upon associated SNPs in European- and African-genetic ancestry. Subjects at “high genetic risk” were offered a separate blood collection for screening four islet autoantibodies. A follow-up contact (email, mail, and telephone) in one half of the participants determined interest and occurrence of subsequent T1D.

Results

A total of 3818 children aged 2–16 years were recruited, with 14.2% (n = 542) having a “high genetic risk.” Of children with “high genetic risk” and without pre-existing T1D (n = 494), 7.0% (34/494) consented for autoantibody screening; 82.4% (28/34) who consented also completed the blood collection, and 7.1% (2/28) of them tested positive for multiple autoantibodies. Among children with pre-existing T1D (n = 91), 52% (n = 48) had a “high genetic risk.” In the sample of children with existing T1D, there was no relationship between genetic risk and age at T1D onset. A major factor in obtaining islet autoantibody testing was concern over SARS-CoV-2 exposure.

Conclusions

Minimally invasive saliva sampling implemented using a genetic risk score can identify children at genetic risk of T1D. Consent for autoantibody screening, however, was limited largely due to the SARS-CoV-2 pandemic and need for blood collection.
Impaired 24-h activity patterns are associated with an increased risk of Alzheimer’s disease, Parkinson’s disease, and cognitive decline
Authors: Winer Joseph R. , Lok Renske , Weed Lara , He Zihuai , Poston Kathleen L. , Mormino Elizabeth C. , Zeitzer Jamie M.
Published: February 2024

Background

Sleep-wake regulating circuits are affected during prodromal stages in the pathological progression of both Alzheimer’s disease (AD) and Parkinson’s disease (PD), and this disturbance can be measured passively using wearable devices. Our objective was to determine whether accelerometer-based measures of 24-h activity are associated with subsequent development of AD, PD, and cognitive decline.

Methods

This study obtained UK Biobank data from 82,829 individuals with wrist-worn accelerometer data aged 40 to 79 years with a mean (± SD) follow-up of 6.8 (± 0.9) years. Outcomes were accelerometer-derived measures of 24-h activity (derived by cosinor, nonparametric, and functional principal component methods), incident AD and PD diagnosis (obtained through hospitalization or primary care records), and prospective longitudinal cognitive testing.

Results

One hundred eighty-seven individuals progressed to AD and 265 to PD. Interdaily stability (a measure of regularity, hazard ratio [HR] per SD increase 1.25, 95% confidence interval [CI] 1.05–1.48), diurnal amplitude (HR 0.79, CI 0.65–0.96), mesor (mean activity; HR 0.77, CI 0.59–0.998), and activity during most active 10 h (HR 0.75, CI 0.61–0.94), were associated with risk of AD. Diurnal amplitude (HR 0.28, CI 0.23–0.34), mesor (HR 0.13, CI 0.10–0.16), activity during least active 5 h (HR 0.24, CI 0.08–0.69), and activity during most active 10 h (HR 0.20, CI 0.16–0.25) were associated with risk of PD. Several measures were additionally predictive of longitudinal cognitive test performance.

Conclusions

In this community-based longitudinal study, accelerometer-derived metrics were associated with elevated risk of AD, PD, and accelerated cognitive decline. These findings suggest 24-h rhythm integrity, as measured by affordable, non-invasive wearable devices, may serve as a scalable early marker of neurodegenerative disease.
‘Skip’ osteoporosis vertebral compression fractures caused by electrical injury: a case report and review of the literature
Authors: Jia Ruili , Sun Yanhao , Liu Chong , Liu Rui-chao , Long Yubin
Published: February 2024

Introduction

Electrical injuries rarely result in fractures, such as long bone fractures and spinal fractures. A few articles have reported osteoporosis vertebral compression fractures (OVCFs) caused by electrical injuries. Here, we present a rare case of 37-year-old male suffering from the 9th thoracic (T9) and 5th lumbar (L5) OVCFs after receiving a electric shock.

Case presentation

A 37-year-old Han male experienced an electric shock (480 V direct current) at the working time and felt immediately serious back pain. He did not fall and lose consciousness. X-ray and magnetic resonance imaging showed acute OVCFs, as well as dual-energy X-ray absorptiometry indicated osteoporosis. Normal laboratory tests can avoid secondary osteoporosis resulting from metabolic diseases and tumors. Finally, he was diagnosed with acute discontinuous OVCFs (T9 and L5). The patient denied having a history of back pain, whereas, he had a history of smoking, alcohol abuse, and congenital heart disease (tetralogy of Fallot) were associated with osteoporosis. Considering no local kyphosis and < 50% anterior body compression, we selected conservative treatment for this patient. At a 1-year and 3-year follow-up, the lateral thoracic and lumbar radiography demonstrated no instability of the spine, and the back pain has been relieved.

Conclusions

This rare case reminds us the importance of consulting a detailed medical history when we encounter young patients receiving electrical injuries. Discontinuously OVCFs must not be overlooked, even though we encounter a young man.
A fog-edge-enabled intrusion detection system for smart grids
Authors: Tariq Noshina , Alsirhani Amjad , Humayun Mamoona , Alserhani Faeiz , Shaheen Momina
Published: February 2024

The Smart Grid (SG) heavily depends on the Advanced Metering Infrastructure (AMI) technology, which has shown its vulnerability to intrusions. To effectively monitor and raise alarms in response to anomalous activities, the Intrusion Detection System (IDS) plays a crucial role. However, existing intrusion detection models are typically trained on cloud servers, which exposes user data to significant privacy risks and extends the time required for intrusion detection. Training a high-quality IDS using Artificial Intelligence (AI) technologies on a single entity becomes particularly challenging when dealing with vast amounts of distributed data across the network. To address these concerns, this paper presents a novel approach: a fog-edge-enabled Support Vector Machine (SVM)-based federated learning (FL) IDS for SGs. FL is an AI technique for training Edge devices. In this system, only learning parameters are shared with the global model, ensuring the utmost data privacy while enabling collaborative learning to develop a high-quality IDS model. The test and validation results obtained from this proposed model demonstrate its superiority over existing methods, achieving an impressive percentage improvement of 4.17% accuracy, 13.19% recall, 9.63% precision, 13.19% F1 score when evaluated using the NSL-KDD dataset. Furthermore, the model performed exceptionally well on the CICIDS2017 dataset, with improved accuracy, precision, recall, and F1 scores reaching 6.03%, 6.03%, 7.57%, and 7.08%, respectively. This novel approach enhances intrusion detection accuracy and safeguards user data and privacy in SG systems, making it a significant advancement in the field.
Prevalence, regional distribution, and trends of antimicrobial resistance among female outpatients with urine Klebsiella spp. isolates: a multicenter evaluation in the United States between 2011 and 2019
Authors: Kaye Keith S. , Gupta Vikas , Mulgirigama Aruni , Joshi Ashish V. , Ye Gang , Scangarella-Oman Nicole E. , Yu Kalvin , Mitrani-Gold Fanny S.
Published: February 2024

Background

Antimicrobial resistance research in uncomplicated urinary tract infection typically focuses on the main causative pathogen, Escherichia coli; however, little is known about the antimicrobial resistance burden of Klebsiella species, which can also cause uncomplicated urinary tract infections. This retrospective cohort study assessed the prevalence and geographic distribution of antimicrobial resistance among Klebsiella species and antimicrobial resistance trends for K. pneumoniae in the United States (2011–2019).

Methods

K. pneumoniae and K. oxytoca urine isolates (30-day, non-duplicate) among female outpatients (aged ≥ 12 years) with presumed uUTI at 304 centers in the United States were classified by resistance phenotype(s): not susceptible to nitrofurantoin, trimethoprim/sulfamethoxazole, or fluoroquinolone, extended-spectrum β-lactamase-positive/not susceptible; and multidrug-resistant based on ≥ 2 and ≥ 3 resistance phenotypes. Antimicrobial resistance prevalence by census division and age, as well as antimicrobial resistance trends over time for Klebsiella species, were assessed using generalized estimating equations.

Results

270,552 Klebsiella species isolates were evaluated (250,719 K. pneumoniae; 19,833 K. oxytoca). The most frequent resistance phenotypes in 2019 were nitrofurantoin not susceptible (Klebsiella species: 54.0%; K. pneumoniae: 57.3%; K. oxytoca: 15.1%) and trimethoprim/sulfamethoxazole not susceptible (Klebsiella species: 10.4%; K. pneumoniae: 10.6%; K. oxytoca: 8.6%). Extended-spectrum β-lactamase-positive/not susceptible prevalence was 5.4%, 5.3%, and 6.8%, respectively. K. pneumoniae resistance phenotype prevalence varied (p < 0.0001) geographically and by age, and increased over time (except for the nitrofurantoin not susceptible phenotype, which was stable and > 50% throughout).

Conclusions

There is a high antimicrobial resistance prevalence and increasing antimicrobial resistance trends among K. pneumoniae isolates from female outpatients in the United States with presumed uncomplicated urinary tract infection. Awareness of K. pneumoniae antimicrobial resistance helps to optimize empiric uncomplicated urinary tract infection treatment.
The effect of chelating agents on the Zn-phytoextraction potential of hemp and soil microbial activity
Authors: Kalousek Petr , Holátko Jiří , Schreiber Patrik , Pluháček Tomáš , Širůčková Lónová Kamila , Radziemska Maja , Tarkowski Petr , Vyhnánek Tomáš , Hammerschmiedt Tereza , Brtnický Martin
Published: February 2024

Background

Hemp (Cannabis sativa) is a crop with a wide range of uses, from the production of fiber and seeds to the secondary metabolites for medicinal purposes. In addition, it is characterized by high biomass yield and the ability to accumulate heavy metals, which makes this plant convenient for phytoremediation purposes. In this study, the effect of applying exogenous biodegradable chelating agents, citric acid (CA) and nitrilotriacetic acid (NTA), to zinc-contaminated soil on zinc (Zn) uptake by two industrial hemp varieties ‘Felina 32’ and ‘Monoica’ was studied. The effect of CA and NTA on available Zn in soils was investigated using an ‘in pot’ experiment under controlled conditions. The effect of both tested compounds on soil microbial activity was simultaneously evaluated.

Results

After the application of NTA at a concentration of 5 mmol L−1, a > threefold increased accumulation of Zn in the above-ground parts was recorded in the ‘Felina 32’ variety. In the ‘Monoica’ variety, the levels of Zn in the above-ground parts were increased > twofold. NTA affected the soil microbiome negatively, causing decreased enzyme activity (in ‘Monoica’ planted soil) and induced respiration (in ‘Monoica’ and especially in ‘Felina 32’ planted soil). On the other hand, CA application did not lead to significantly increased Zn levels in any of the studied hemp varieties. Together with CA’s negative effects on some soil enzymes, CA enhanced urease activity, dehydrogenase and several respiration types for the ‘Felina 32’ variety and exerted less detrimental effect on the soil microbiome. No toxic effects from increased Zn uptake and accumulation in experimental plants were detected, accounting for the unchanged physiological stress markers (levels of photosynthetic pigments and proline in leaves, chlorophyll fluorescence parameters) and selected growth traits of the above-ground organs and root system.

Conclusions

From the studied varieties, ‘Felina 32’ seems to be more suitable for Zn-phytoextraction because of its higher tolerance to increased Zn levels, higher biomass production and Zn accumulation capacity. Our results indicate the potential of using the ‘Felina 32’ variety in NTA-assisted Zn phytoextraction from contaminated soils.

Graphical Abstract
Pathological complete response of initially unresectable multiple liver metastases achieved using combined peptide receptor radionuclide therapy and somatostatin analogs following pancreatic neuroendocrine tumor resection: a case report
Authors: Umino Ryosuke , Nara Satoshi , Kobayashi Noritoshi , Mizui Takahiro , Takamoto Takeshi , Ban Daisuke , Esaki Minoru , Hiraoka Nobuyoshi , Shimada Kazuaki
Published: February 2024

Background

Peptide receptor radionuclide therapy (PRRT) serves as a novel and effective treatment option for somatostatin receptor-positive unresectable liver metastases of pancreatic neuroendocrine tumors (PNETs). However, there are few reported cases of surgical resection for initially unresectable liver metastases of PNET that were converted to resectable after PRRT. Here we report a case where PRRT and somatostatin analogs (SSAs) led to a pathological complete response of initially unresectable multiple liver metastases following PNET resection.

Case presentation

A 52-year-old man underwent pylorus-preserving pancreaticoduodenectomy for PNET at age 40 and subsequent hepatectomies for resectable liver metastases at 44 and 47 years of age. At age 48, a follow-up examination revealed unresectable multiple liver metastases, and PRRT with 177Lu-DOTATATE therapy was initiated. After four cycles of PRRT, most liver metastases diminished according to imaging studies, and the remaining two hepatic lesions continued to shrink with additional lanreotide. Conversion surgery for liver metastases was successfully performed, revealing no viable tumor cells in tissue specimens. Seventeen months after surgery, imaging showed no detectable residual tumor or recurrence. We present a review of the relevant literature that highlights the significance of our findings.

Conclusions

This rare case highlights the pathological complete response of initially unresectable multiple liver metastases achieved by PRRT and SSAs following PNET resection, suggesting their potential as a multimodality treatment option for unresectable PNET.
A systematic review of the challenges, emerging solutions and applications, and future directions of PET/MRI in Parkinson’s disease
Authors: Leung Isabella Hoi Kei , Strudwick Mark William
Published: February 2024

PET/MRI is a hybrid imaging modality that boasts the simultaneous acquisition of high-resolution anatomical data and metabolic information. Having these exceptional capabilities, it is often implicated in clinical research for diagnosing and grading, as well as tracking disease progression and response to interventions. Despite this, its low level of clinical widespread use is questioned. This is especially the case with Parkinson’s disease (PD), the fastest progressively disabling and neurodegenerative cause of death. To optimise the clinical applicability of PET/MRI for diagnosing, differentiating, and tracking PD progression, the emerging novel uses, and current challenges must be identified. This systematic review aimed to present the specific challenges of PET/MRI use in PD. Further, this review aimed to highlight the possible resolution of these challenges, the emerging applications and future direction of PET/MRI use in PD. EBSCOHost (indexing CINAHL Plus, PsycINFO) Ovid (Medline, EMBASE) PubMed, Web of Science, and Scopus from 2006 (the year of first integrated PET/MRI hybrid system) to 30 September 2022 were used to search for relevant primary articles. A total of 933 studies were retrieved and following the screening procedure, 18 peer-reviewed articles were included in this review. This present study is of great clinical relevance and significance, as it informs the reasoning behind hindered widespread clinical use of PET/MRI for PD. Despite this, the emerging applications of image reconstruction developed by PET/MRI research data to the use of fully automated systems show promising and desirable utility. Furthermore, many of the current challenges and limitations can be resolved by using much larger-sampled and longitudinal studies. Meanwhile, the development of new fast-binding tracers that have specific affinity to PD pathological processes is warranted.
Association of SLC30A8 rs13266634 gene polymorphism with type 2 diabetes mellitus (T2DM) in a population of Noakhali, Bangladesh: a case–control study
Authors: Mitu Farhana Siddiqi , Hossain Md. Murad , Das Shuvo Chandra , Islam Md. Mafizul , Barman Dhirendra Nath , Das Gupta Shipan
Published: February 2024

Background

Type 2 diabetes mellitus (T2DM) is considered to be a polygenic disorder that emerges as a result of complicated gene-environment interactions. Several investigations revealed that SLC30A8 rs13266634 polymorphism elevates T2DM risk. T2DM and hypertension (HTN) are often found to be coexist. Compared to normotensive non-diabetic controls, T2DM patients with HTN have a fourfold increased risk of cardiovascular disease (CVD). The average age of T2DM diagnosis is decreasing, and ‘early onset of T2DM’ in adolescents and young adults is an emerging worldwide health concern. The objective of this study was to examine the potential correlations of SLC30A8 rs13266634 polymorphism with T2DM and T2DM-related CVD and HTN as well as ‘early onset of T2DM’ in the Noakhali region.

Methods

This case–control study involved 163 T2DM patients and 75 healthy controls for analysis of SLC30A8-rs13266634 polymorphism. Genotyping of this polymorphism was performed using polymerase chain reaction-restriction fragment length polymorphism (PCR–RFLP) method. MedCalc and Gene Calc programs were used for statistical analysis.

Results

A statistically significant association of SLC30A8 rs13266634 (P < 0.05) with T2DM was found in dominant, over dominant and allele models. But this study found no evidence of a connection between SLC30A8-rs13266634 with CVD, HTN, or ‘early onset of T2DM’ in any models. Furthermore, T2DM patients had higher total cholesterol (TC) and triglyceride (TG) levels than non-diabetics individuals.

Conclusions

This study revealed a substantial association between the variation in SLC30A8-rs13266634 and the increased risk of developing T2DM within a sample of the Noakhali population in Bangladesh. However, no significant associations were observed between SLC30A8-rs13266634 and T2DM-related cardiovascular disease (CVD), hypertension (HTN), or the early onset of T2DM within this specific population.
Serum level of hepcidin in cirrhotic patients as a marker for hepatocellular carcinoma
Authors: Mohiedeen Khaled Mahmoud , Tahoon Mona Moustafa , Hanna Christina Samir Sadek , Abdel Aziz Mohamed Adel
Published: February 2024

Background

People all around the world are affected by primary liver cancers like hepatocellular carcinoma (HCC), which is usually associated with cirrhosis. Early HCC detection is crucial for better prognosis, but effective biomarkers are still needed. Hepcidin, a hormone-regulating iron homeostasis, has been implicated in liver diseases. In this study, blood hepcidin levels were evaluated in cirrhotic individuals as a possible biomarker for HCC.

Methods

There were three groups involved in this case-control study: cirrhotic patients with no HCC (group I), cirrhotic patients diagnosed with HCC (group II), and healthy controls (group III). Clinical and laboratory data, such as those from tests indicating the liver function, hepcidin levels, and imaging, were all analyzed using a number of statistical tests.

Results

When compared to those with cirrhosis, serum hepcidin levels were significantly lower in HCC patients, but there was no significant difference statistically between the two studies involved: cirrhotic groups and the controls. Serum alpha-fetoprotein (AFP) was also significantly greater in HCC patients.

Conclusions

The start and progression of liver diseases, such as HCC in cirrhotic people, appear to be influenced by hepcidin. It can be utilized as a potential HCC biomarker when cirrhotic liver is present, despite the fact that it cannot be used to diagnose cirrhosis by itself.
Usability of simplified audiometry and electrocardiogram during treatment of drug-resistant tuberculosis in Mozambique: a qualitative study
Authors: Nhassengo Pedroso , Zandamela Américo , Nhamuave Celina , Cassy Sheyla Rodrigues , Chiau Rogério , Mutaquiha Cláudia , Zindoga Pereira , Manhiça Ivan , Khosa Celso , Cowan James
Published: February 2024

Background

In 2021, there were approximately 450,000 cases of drug-resistant tuberculosis (DR-TB) worldwide. The treatment of DR-TB historically included expensive and toxic injectable drugs leading to adverse effects including ototoxicity and Electrocardiogram (ECG) abnormalities. This study described the perspectives of healthcare providers and people with DR-TB on the usability of simplified audiometry and ECG for monitoring treatment adverse effects.

Methods

A qualitative study was conducted in December 2019 across four provinces in Mozambique, namely Maputo, Gaza, Zambézia, and Nampula. Sixteen outpatient primary care health facilities equipped with simplified Audiometry and/or ECG devices (specifically, SHOEBOX Audiometer® and/or SmartHeart Pro ECG®) installed for at least 6 months before the study initiation were selected. The data was collected using in-depth interviews (IDI) and Focus Group Discussions (FGD) techniques. Interviews were audio-recorded, transcribed verbatim in Portuguese, coded, and analyzed using Nvivo 12 software®. We generated two themes and fit our results into a conceptual framework consisting of three domains in the implementation of technological innovations in health.

Results

A total of 16 healthcare providers and 91 people undergoing treatment for DR-TB were enrolled in the study. Most people with DR-TB had experienced audiometry testing and demonstrated a good understanding of the assessments. Conversely, while most healthcare providers demonstrated robust knowledge of the importance of both audiometry and ECG assessments, they were not confident in managing ECG devices and interpreting the results.

Conclusions

While healthcare providers demonstrated a consolidated understanding of the importance of audiometry, the limited number of devices and lack of training were constraints, impeding optimal usage and service delivery.