bluuebunny/crossref_metadata_2025 huggingface dataset:
Streets as experienced through the body, mind, and screen: The smartphone and the pedestrian's engagement with an urban public space
Authors: Lu Weixu
Published: September 2023

This study investigates the influence of smartphone use on the embodied experiences of pedestrians in urban public spaces. Participants in this study engaged in leisure walks in a bustling urban environment. The study employed a multi-sensory, multi-modal data collection approach, which incorporated mobile eye tracking, screen capture, think-aloud, and participant data review. Findings revealed dynamic relationships between the urban pedestrians’ embodied experiences (“streets as experienced through the body”), digital content (“streets on the screen”), and spatial knowledge (“streets in the mind”). The study explored the “unfolding” practice between multiple versions of the surrounding environment and sheds light on the complex interplay of cognitive, experiential, and digital inputs in shaping pedestrian actions. Moreover, the study uncovers the paradoxical effects of smartphone usage and introduces both serendipity and familiarity into the pedestrian's journey through public spaces. Further, the implications of this research highlight the need for mobile media studies to embrace “messy” and “noisy” data for a more comprehensive understanding of the interconnections between minds, bodies, places, and mobilities.
The facilitators and barriers of mHealth adoption and use among people with a low socio-economic position: A scoping review
Authors: Hengst Tessi M , Lechner Lilian , Dohmen Daan , Bolman Catherine AW
Published: September 2023

Background

Despite the fact that 95% of the global population has a mobile phone, the adoption of mHealth lags among people with a low socio-economic position (SEP). As they face health risks and many barriers in the traditional offline healthcare system, mHealth has an important role. Therefore, it is important to understand the factors that promote and impede mHealth adoption among people with a lower SEP.

Objective

The current study aims to provide an overview of what is known about the facilitators and barriers to the adoption and use of autonomous mHealth applications among people with low SEP.

Methods

A PRISMA scoping review in which the scientific databases PubMed, Web of Science, PsychInfo and SocINDEX were searched in the period of March 2017 to March 2022.

Results

Of the 1827 indexed papers, 13 papers were included in the review. In these papers, 30 factors have been identified as promoting or hindering the adoption of autonomous mHealth applications among low SEP people.

Conclusions

Thirty factors were found to facilitate or impede mHealth adoption among people with a low SEP, categorised into intrapersonal, interpersonal, community, ecological and app specific levels. Factors are assumed to be interrelated. The relationship between traditional (offline) care and digital care appeared to be of particular interest as the current study revealed that face-to-face contact is a prerequisite of mHealth adoption among people with low SEP. Therefore, a well-structured cosmopolitan system of stakeholders has been recommended.

Trial registration

This study was registered in OSF (https://doi.org/10.17605/OSF.IO/ATU9D).
Pre-training working memory/information processing capabilities and brain atrophy limit the improving effects of cognitive training
Authors: Esbrí Sónia Félix , Sebastián Tirado Alba , Zaragoza Mezquita Maria , Sanchis Segura Carla , Forn Cristina
Published: September 2023

Background

Computerized training in persons with multiple sclerosis (PwMS) seems to enhance working memory (WM)/information processing (IP), but factors associated with the efficacy of the treatment have not been sufficiently explored. Objective: To identify clinical and radiological characteristics associated with positive WM/IP training responses.

Methods

Radiological and neuropsychological assessments were carried out on a sample of 35 PwMs who were divided into “WM/IP-impaired” and “WM/IP-preserved.” All participants underwent adaptive n-back training for 10 days and were assessed post-training. Between-group differences (“WM/IP-impaired” vs. “WM/IP-preserved”) in training-induced cognitive improvement were assessed and exploratory correlational/ regression-based methods were employed to assess the relationship between cognitive improvement and clinical and radiological variables.

Results

All PwMS exhibited WM/IP benefits after training, but those with preserved WM/IP functions showed greater positive effects as well as transfer effects to other WM/IP tests when compared to the impaired group. Additional analyses revealed that positive response to treatment was associated with WM/IP baseline capabilities and greater gray matter volume (GMVOL) in relevant areas such as the thalamus.

Conclusions

Restorative cognitive training is suitable to improve cognition in PwMS but its effective outcome differs depending on the baseline WM/IP capabilities and GMVOL.
Years of play alter MRI measures of brain health in former Canadian Football League athletes: a pilot study
Authors: Doughty Mitchell , Danielli Ethan , Boshra Rober , Ruiter Kyle I. , Minuzzi Luciano , Connolly John F. , Noseworthy Michael D.
Published: September 2023

Introduction: Concussive and sub-concussive blows are commonly sustained during contact sports. Through a detailed neuroimaging analysis, this pilot study aimed to determine if a history of sport-related concussions exacerbated cognitive decline later in life. It was hypothesized that clinical health assessments and magnetic resonance imaging (MRI) techniques would provide insight into lasting health and well-being, structural, microstructural, and functional alterations caused by a history of concussive injuries. Materials and Methods: Twenty aging, retired Canadian Football League (rCFL) players (aged 56.9 ± 6.9) had clinical testing and MRI data acquired. Cortical thickness, voxel-wise diffusion tensor imaging (DTI), and Default Mode Network (DMN) connectivity data was collected for each subject and compared against healthy controls. Retired athlete age, playing position, and career length were also examined. Results: This study found widespread cortical thinning, significantly increased mean diffusivity, increased axial diffusivity, and both hyperactivity and hypoactivity within the DMN. Athlete age, position, and career length all influenced microstructural integrity. On average, retired athletes scored about 4 times greater depression-like and concussion-related symptoms and scored significantly lower in all health categories compared to healthy controls. Conclusions: These findings suggested that lasting signs of neurological injuries were present years after retiring from professional play.
Peripheral blood monocyte count and outcomes in patients with interstitial lung disease: a systematic review and meta-analysis
Authors: Min Bohyung , Grant-Orser Amanda , Johannson Kerri A.
Published: September 2023

Background

Peripheral blood monocyte counts have been associated with poor outcomes in interstitial lung disease (ILD). However, studies are limited by variable biomarker thresholds, analytic approaches and heterogenous populations. This systematic review and meta-analysis characterised the relationship between monocytes and clinical outcomes in ILD.

Methods

Electronic database searches were performed. Two reviewers screened abstracts and extracted data. Pooled estimates (hazard ratios (HRs)) of monocyte count thresholds were calculated for their association with mortality using ≥0.6×109and >0.9×109cells·L−1for unadjusted models and ≥0.95×109cells·L−1for adjusted models, using random effects, with heterogeneity and bias assessed. Disease progression associated with monocytes >0.9×109cells·L−1was also calculated.

Results

Of 3279 abstracts, 13 were included in the systematic review and eight in the meta-analysis. The pooled unadjusted HR for mortality for monocyte counts ≥0.6×109cells·L−1was 1.71 (95% CI 1.34–2.19, p<0.001, I2=0%) and for monocyte counts >0.90×109cells·L−1it was 2.44 (95% CI 1.53–3.87, p=0.0002, I2=52%). The pooled adjusted HR for mortality for monocyte counts ≥0.95×109cells·L−1was 1.93 (95% CI 1.24–3.01, p=0.0038 I2=69%). The pooled HR for disease progression associated with increased monocyte counts was 1.83 (95% CI 1.40–2.39, p<0.0001, I2=28%).

Conclusions

Peripheral blood monocyte counts were associated with an increased risk of mortality and disease progression in patients with ILD.
CRISPR applications in cancer diagnosis and treatment
Authors: Wang Mingxia , Chen Menghui , Wu Xia , Huang Xinbo , Yu Bo
Published: September 2023

Cancer remains a significant global health challenge, necessitating the exploration of novel and more precise therapeutic options beyond conventional treatments. In this regard, clustered regularly interspaced short palindromic repeats (CRISPR) systems have emerged as highly promising tools for clinical gene editing applications. The CRISPR family encompasses diverse CRISPR-associated (Cas) proteins that possess the ability to recognize specific target sequences. The initial CRISPR system consisted of the Cas9 protein and a single-guide RNA, which guide Cas9 to the desired target sequence, facilitating precise double-stranded cleavage. In addition to the traditional cis-cleavage activity, the more recently discovered Cas12 and Cas13 proteins exhibit trans-cleavage activity, which expands their potential applications in cancer diagnosis. In this review, we provide an overview of the functional characteristics of Cas9, Cas12, and Cas13. Furthermore, we highlight the latest advancements and applications of these CRISPR systems in cancer gene therapy and molecular diagnosis. We also emphasize the importance of understanding the strengths and limitations of each CRISPR system to maximize their clinical utility. By providing a comprehensive overview of the current state of CRISPR technology in cancer research, we aim to inspire further exploration and innovation in this rapidly evolving field.

Graphical abstract
The mitochondrial genome of the mountain wooly tapir, Tapirus pinchaque and a formal test of the effect of altitude on the adaptive evolution of mitochondrial protein coding genes in odd-toed ungulates
Authors: Gutiérrez Edgar G. , Ortega Jorge , Savoie Avery , Baeza J. Antonio
Published: September 2023

Background

The harsh conditions of high-altitude environments are known to drive the evolution of physiological and morphological traits in endothermic animals. These conditions are expected to result in the adaptive evolution of protein coding genes encoded in mitochondrial genomes that are vital for the oxidative phosphorylation pathway. In this study, we formally tested for signatures of adaptive evolution on mitochondrial protein coding genes in Tapirus pinchaque and other odd-toed ungulates inhabiting high-elevation environments.

Results

The AT-rich mitochondrial genome of T. pinchaque is 16,750 bp long. A phylomitogenomic analysis supports the monophyly of the genus Tapirus and families in the Perissodactyla. The ratio of non-synonymous to synonymous substitutions demonstrated that all mitochondrial genes undergo purifying selection in T. pinchaque and other odd ungulates living at high elevations. Over this negative background selection, Branch Models suggested that cox3 and nad6 might be undergoing stronger purifying selection than other mitochondrial protein coding genes. Furthermore, Site Models suggested that one and four sites in nad2 and nad5, respectively, could be experiencing positive selection. However, these results were supported by Likelihood Ratio Tests but not Bayesian Empirical Bayes posterior probabilities. Additional analyses (in DataMonkey) indicated a relaxation of selection strength in nad6, evidence of episodic diversifying selection in cob, and revealed episodic positive/diversifying selection signatures for two sites in nad1, and one site each in nad2 and nad4.

Conclusion

The mitochondrial genome of T. pinchaque is an important genomic resource for conservation of this species and this study contributes to the understanding of adaptive evolution of mitochondrial protein coding genes in odd-toed ungulates inhabiting high-altitude environments.
Integration of miRNA dynamics and drought tolerant QTLs in rice reveals the role of miR2919 in drought stress response
Authors: Kumar Deepesh , Ramkumar M. K. , Dutta Bipratip , Kumar Ajay , Pandey Rakesh , Jain Pradeep Kumar , Gaikwad Kishor , Mishra Dwijesh C. , Chaturvedi K. K. , Rai Anil , Solanke Amolkumar U. , Sevanthi Amitha Mithra
Published: September 2023

To combat drought stress in rice, a major threat to global food security, three major quantitative trait loci for ‘yield under drought stress’ (qDTYs) were successfully exploited in the last decade. However, their molecular basis still remains unknown. To understand the role of secondary regulation by miRNA in drought stress response and their relation, if any, with the three qDTYs, the miRNA dynamics under drought stress was studied at booting stage in two drought tolerant (Sahbaghi Dhan and Vandana) and one drought sensitive (IR 20) cultivars. In total, 53 known and 40 novel differentially expressed (DE) miRNAs were identified. The primary drought responsive miRNAs were Osa-MIR2919, Osa-MIR3979, Osa-MIR159f, Osa-MIR156k, Osa-MIR528, Osa-MIR530, Osa-MIR2091, Osa-MIR531a, Osa-MIR531b as well as three novel ones. Sixty-one target genes that corresponded to 11 known and 4 novel DE miRNAs were found to be co-localized with the three qDTYs, out of the 1746 target genes identified. We could validate miRNA-mRNA expression under drought for nine known and three novel miRNAs in eight different rice genotypes showing varying degree of tolerance. From our study, Osa-MIR2919, Osa-MIR3979, Osa-MIR528, Osa-MIR2091-5p and Chr01_11911S14Astr and their target genes LOC_Os01g72000, LOC_Os01g66890, LOC_Os01g57990, LOC_Os01g56780, LOC_Os01g72834, LOC_Os01g61880 and LOC_Os01g72780 were identified as the most promising candidates for drought tolerance at booting stage. Of these, Osa-MIR2919 with 19 target genes in the qDTYs is being reported for the first time. It acts as a negative regulator of drought stress tolerance by modulating the cytokinin and brassinosteroid signalling pathway.
The influence of muscle performance and fatigue on prognosis in patients with compensated liver disease
Authors: Ekerfors Ulrika , Simrén Magnus , Marschall Hanns-Ulrich , Demir Daghan , Josefsson Axel
Published: September 2023

Background

Poor muscle function is associated with a negative prognosis in advanced liver disease but the impact in compensated chronic liver disease is unknown. Similar prognostic uncertainty applies to fatigue. We aimed to assess the prognostic value of muscle performance and fatigue in a cohort of patients with compensated chronic liver disease.

Methods

We followed 241 patients with compensated chronic liver disease included in a study between 2010 and 2014. Subjects were 52 ± 15 years (mean ± SD; 134 females). All subjects performed four muscle function tests: “Timed Up and Go” test, walking speed, handgrip strength, and standing heel-rises. Fatigue was evaluated by fatigue impact scale. Follow up data was acquired through hospital records and registries.

Results

During follow up of 6.75 ± 1.4 years, 13 patients died (5.5%) and 11 (4.5%) patients underwent liver transplantation. A timed up and go over 10 s was not significantly associated with a lower survival (Kaplan-Meier, log rank test p = 0.132), or with transplant free survival (p = 0.543), Fig. 3. It was also not specifically associated with liver related causes of death (p = 0.597). The other physical functioning tests and fatigue were not significantly associated with mortality or transplant-free survival (p > 0.05 for all) except for maximal walking speed (2.2 vs. 1.9 m/s, p = 0.007).

Conclusions

Our study suggests that muscle function and fatigue are not key prognostic factors in compensated chronic liver disease. However, further confirmation in future studies is needed.
Is empiric proton pump inhibition in patients with symptoms of extraesophageal gastroesophageal reflux justified?
Authors: Fossmark Reidar , Ness-Jensen Eivind , Sørdal Øystein
Published: September 2023

Background

The prevalence of gastroesophageal reflux disease (GERD) has had a marked increase in Western countries with a paralleling interest in extraesophageal (EE) manifestations of GERD, including laryngopharyngeal reflux (LPR). There are considerable differences in clinical practice between gastroenterologists, otolaryngologists and pulmonologists.

Methods

In this narrative review we address some of these controversies concerning EE manifestations of GERD and LPR.

Results

It is disputed whether there is causal relationship between reflux and the numerous symptoms and conditions suggested to be EE manifestations of GERD. Similarly, the pathophysiology is uncertain and there are disagreements concerning diagnostic criteria. Consequently, it is challenging to provide evidence-based treatment recommendations. A significant number of patients are given a trial course with a proton pump inhibitor (PPI) for several months before symptoms are evaluated. In randomized controlled trials (RCTs) and meta-analyses of RCTs PPI treatment does not seem to be advantageous over placebo, and the evidence supporting that patients without verified GERD have any benefit of PPI treatment is negligible. There is a large increase in both over the counter and prescribed PPI use in several countries and a significant proportion of this use is without any symptomatic benefit for the patients. Whereas short-term treatment has few side effects, there is concern about side-effects after long-term use. Although empiric PPI treatment for suspected EE manifestations of GERD instead of prior esophageal 24-hour pH and impedance monitoring is included in several guidelines by various societies, this practice contributes to overtreatment with PPI.

Conclusion

We argue that the current knowledge suggests that diagnostic testing with pH and impedance monitoring rather than empiric PPI treatment should be chosen in a higher proportion of patients presenting with symptoms possibly attributable to EE reflux.
Immune responses of patients on maintenance hemodialysis after infection by SARS-CoV-2: a prospective observational cohort study
Authors: Bacharaki Dimitra , Karagiannis Minas , Giannakopoulos Panagiotis , Papachristou Evangelos , Divanis Dimitrios , Sardeli Aggeliki , Petrou Dimitra , Nikolopoulos Petros , Bratsiakou Adamantia , Zoi Vassiliki , Piliouras Nikitas , Damoraki Georgia , Liakopoulos Vassilios , Goumenos Dimitrios , Giamarellos-Bourboulis Evangelos J.
Published: September 2023

Background

Immune dysregulation in patients with acute COVID-19 under chronic hemodialysis (CHD) is fully not elucidated. The changes of mononuclear counts and mediators before and after HD and associations with final outcome were studied.

Method

In this prospective study, hospitalized patients with moderate-to-severe COVID-19 under CHD and matched comparators under HD were analyzed for their absolute counts of lymphoid cells and circulating inflammatory mediators. Blood samples were collected before start and at the end of the first HD session; dialysate samples were also collected.

Result

Fifty-nine patients with acute COVID-19 under CHD and 20 uninfected comparators under CHD were enrolled. Circulating concentrations of tumor necrosis factor-alpha (TNFα), interleukin (IL)-10, interferon-γ and platelet-derived growth factor-A were increased in patients. Concentrations of mediators did not differ before and after HD. Significant decreases of CD4-lymphocytes and CD19-lymphocytes were found in patients. The decrease of the expression of HLA-DR on CD14-monocytes was associated with unfavorable outcome (defined as WHO-CPS 6 or more by day 28); increased counts of CD19-lymphocytes were associated with better outcomes.

Conclusion

Patients under CHD develop an inflammatory reaction to SARS-CoV-2 characterized by increase of inflammatory mediators, decrease of circulating T-lymphocytes and decrease of the expression of HLA-DR on CD14-monocytes.
The effects of a Journey of the Brave Counseling Program on anxiety, well-being, and life adjustment in Taiwanese children
Authors: Tien Hsiu-Lan Shelley , Su Yi-Ning , Zhang Aizi , Kaichi Isana , Koshiba Takako , Okawa Sho , Urao Yuko , Shimizu Eiji
Published: September 2023

The purposes of the current study are two-fold. Study 1 aimed to examine the psychometric properties of the Spence Children’s Anxiety Scale (SCAS) in a Taiwanese sample. Study 2 aimed to explore the immediate and follow-up effects of Journey of the Brave Counseling Program (JBCP) on children’s’ anxiety, well-being, and life adjustment. A review and suggestions were provided for future research and practitioners in educational and counseling fields as reference. In Study 1, the pilot study included 150 to 200 children between ages 11 and 12 in Taoyuan City. In Study 2, we conducted a pretest-posttest nonequivalent groups quasi-experimental design. The participants in this stage were 16 children in an elementary school in Taoyuan City, between ages 11 and 12. After obtaining consent forms from the participants’ guardians, we randomly assigned these participants to an experimental group (N = 8) and a control group (N = 8). The experimental group received a 40-minute JBCP session weekly for ten weeks. The control group received a 40-minute career exploration small group counseling weekly for ten weeks. We administered the SCAS, Psychological Well-Being Scale, and School Life Adjustment Scale in the pretest, posttest, and follow-up test to measure change of anxiety, well-being, and life adjustment of the participants. In addition, the current study implemented some qualitative data, such as group progress notes, group member feedback questionnaires, and semi-structured interviews with participants’ homeroom teachers as supplementary data to clarify the effects of the JBCP. In Study 1, we found that the SCAS had a good validity and reliability for Taiwanese children. The results of Study 2 indicated that the JBCP had immediate and follow-up effects on the separation anxiety in the experimental group. With the pretest impact eliminated, the immediate and follow-up effects on overall anxiety in the experimental group were better than those on the control group. However, even though the immediate and follow-up effects of the JBCP on the experimental group were better than the control group but were not significant. Besides, the group member feedback questionnaires and participants’ homeroom teachers all indicated that the experimental group participants had positive attitude toward the JBCP, and they also positively improved their emotions and interpersonal relationships with others.
CASP3 gene expression and the role of caspase 3 in the pathogenesis of depressive disorders
Authors: Bliźniewska-Kowalska Katarzyna , Gałecki Piotr , Szemraj Janusz , Su Kuan-Pin , Chang Jane Pei-Chen , Gałecka Małgorzata
Published: September 2023

Background

The aim of our study was to evaluate the expression of the CASP3 gene at both mRNA and protein levels in patients with depressive disorders and to determine the impact of caspase 3 in the pathogenesis of depression;

Methods

A total of 290 subjects, including 190 depressed patients and 100 healthy controls, participated in the study. Socio-demographic and clinical data were collected, and the severity of depressive symptoms was assessed using the Hamilton Depression Rating Scale. Venous blood was collected and gene expression was evaluated using RT-PCR and ELISA at the mRNA and protein levels, respectively;

Results

The expression of the CASP3 gene was significantly lower in depressed patients compared to healthy controls at both the mRNA and protein levels. Additionally, a positive correlation was observed between CASP3 gene expression and disease duration as well as the number of depressive episodes;

Conclusions

Further studies are needed to investigate the role of caspase 3 in depressive disorders.
Application of clinical and CT imaging features in the evaluation of disease progression in patients with COVID-19
Authors: Wu Guobin , Zhu Yunya , Qiu Xingting , Yuan Xiaoliang , Mi Xiaojing , Zhou Rong
Published: September 2023

Background

The Corona Virus Disease 2019(COVID-19) pandemic has strained healthcare systems worldwide, necessitating the early prediction of patients requiring critical care. This study aimed to analyze the laboratory examination indicators, CT features, and prognostic risk factors in COVID-19 patients.

Methods

A retrospective study was conducted on 90 COVID-19 patients at the First Affiliated Hospital of Gannan Medical University between December 17, 2022, and March 17, 2023. Clinical data, laboratory examination results, and computed tomography (CT) imaging data were collected. Logistic multivariate regression analysis was performed to identify independent risk factors, and the predictive ability of each risk factor was assessed using the area under the receiver operating characteristic (ROC) curve.

Results

Multivariate logistic regression analysis revealed that comorbid diabetes (odds ratio [OR] = 526.875, 95%CI = 1.384-1960.84, P = 0.053), lymphocyte count reduction (OR = 8.773, 95%CI = 1.432–53.584, P = 0.064), elevated D-dimer level (OR = 362.426, 95%CI = 1.228-984.995, P = 0.023), and involvement of five lung lobes (OR = 0.926, 95%CI = 0.026–0.686, P = 0.025) were risk factors for progression to severe COVID-19. ROC curve analysis showed the highest predictive value for 5 lung lobes (AUC = 0.782). Oxygen saturation was positively correlated with normally aerated lung volume and the proportion of normally aerated lung volume (P < 0.05).

Conclusions

The study demonstrated that comorbid diabetes, lymphocyte count reduction, elevated D-dimer levels, and involvement of the five lung lobes are significant risk factors for severe COVID-19. In CT lung volume quantification, normal aerated lung volume and the proportion of normal aerated lung volume correlated with blood oxygen saturation.
Does mild flexion of the femoral prosthesis in total knee arthroplasty result in better early postoperative outcomes?
Authors: Zhou Hang , Wu Ze-Rui , Chen Xiang-Yang , Zhang Le-Shu , Zhang Jin-Cheng , Hidig Sakarie Mustafe , Feng Shuo , Yang Zhi
Published: September 2023

Background

The purpose of this study was to measure the femoral prosthesis flexion angle (FPFA) in total knee arthroplasty (TKA) using three-dimensional reconstruction, and to assess the differences in early clinical efficacy between patients with different degrees of flexion.

Methods

We conducted a prospective cohort study. From June 2019 to May 2021, 113 patients admitted for TKA due to osteoarthritis of the knee were selected. The patients’ postoperative knee joints were reconstructed in three dimensions according to postoperative three-dimensional computed tomography (CT) scans. The FPFA was measured, and the patients were divided into 4 groups: anterior extension group (FPFA < 0°), mildly flexed group (0° ≤ FPFA < 3°), moderately flexed group (3° ≤ FPFA < 6°) and excessively flexed group (6° ≤ FPFA). The differences in the Knee Society Score (KSS), knee Range of Motion (ROM), and visual analogue scale (VAS) scores were measured and compared between the four groups at each postoperative time point.

Results

Postoperative KSS, ROM, and VAS were significantly improved in all groups compared to the preoperative period. At 1 year postoperatively, the ROM was significantly greater in the mildly flexed group (123.46 ± 6.51°) than in the anterior extension group (116.93 ± 8.05°) and the excessively flexed group (118.76 ± 8.20°) (P < 0.05). The KSS was significantly higher in the mildly flexed group (162.68 ± 12.79) than in the other groups at 6 months postoperatively (P < 0.05). The higher KSS (174.17 ± 11.84) in the mildly flexed group was maintained until 1 year postoperatively, with a statistically significant difference (P < 0.05). No significant difference in VAS scores was observed between groups at each time point.

Conclusions

A femoral prosthesis flexion angle of 0–3° significantly improved postoperative knee mobility, and patients could obtain better Knee Society Scores after surgery, which facilitated the postoperative recovery of knee function.

Trial registration

ChiCTR2100051502, 2021/09/24.
Incidental parathyroidectomy during total thyroidectomy and functional parathyroid preservation: a retrospective cohort study
Authors: Melot Charlotte , Deniziaut Gabrielle , Menegaux Fabrice , Chereau Nathalie
Published: September 2023

Background

The published rate of incidental parathyroidectomy (IP) during thyroid surgery varies between 5.8% and 29%. The risk factors and clinical significance of postoperative transient hypocalcemia and permanent hypoparathyroidism are still debated. The aims of this study were to assess the clinical relevance of avoidable IP for transient hypocalcemia and permanent hypoparathyroidism, and to describe the risk factors for IP.

Methods

This retrospective cohort study included 1,537 patients who had a one-step total thyroidectomy in a high-volume endocrine surgery center between 2018 and 2019. Pathology reports were reviewed for incidentally removed parathyroid glands. Intrathyroidal parathyroid glands were excluded from the study. Demographic characteristics, potential risk factors, and postoperative calcium and PTH levels were compared between IP and control groups.

Results

Avoidable IP occurred in 234 (15.2%) patients. Patients with IP had a higher risk of transient hypocalcemia (17.9% vs. 11.5%, p = 0.006; odds ratio [OR] 1.68, 95% confidence interval [95% CI]1.16–2.45) and permanent hypoparathyroidism (4.7% vs. 1.6%, p = 0.002; OR 3.01, 95% CI 1.29–6.63) than patients without IP. Multivariate analysis showed that central lymph node dissection (CLND) and incidental removal of thymus tissue were independent risk factors for IP (OR 4.83, 95% CI 2.71–8.86, p < 0.001 and OR 1.72, 95% CI 1.02–2.82, p = 0.038).

Conclusions

Patients with IP were more likely to develop transient hypocalcemia and permanent hypoparathyroidism, indicating the clinical significance of avoidable IP for patients and the need for raising awareness among surgeons. Patients undergoing CLND are at a higher risk for IP, and should be adequately informed and treated. Any removal of thymus tissue should be avoided during CLND.
Evaluation of removal efficiency of capping materials used in pulp revascularization in vitro
Authors: Cebeci Gözde Yildiz , Almaz Merve Erkmen , Orhan Ekim Onur , Beklen Arzu
Published: September 2023

Background

This study aimed to evaluate the removal efficiency of different capping materials used in pulp revascularization (PR) in a failure scenario.

Methods

The apices of freshly extracted 30 maxillary incisors were cut to mimic the immature teeth; then, root canals were shaped up to #6 Peeso reamers. The regeneration steps of the American Association of Endodontists (AAE) were followed to simulate PR treatment in vitro. The canals were dressed with the Ciprofloxacin and Metronidazole medicament mixture for 2 weeks. Then capping material groups were created: BioDentine (BD), ProRootMTA (PMTA), and RetroMTA (RMTA) (n = 10). The sealed specimens were stored for 2 weeks at 37 ºC in phosphate-buffered saline then the samples were examined by micro-computed tomography (µ-CT) analysis. Set capping materials were retrieved using a specific cement removal kit by a single blind operator. The residue materials were examined again by µCT. Kruskal–Wallis and Mann–Whitney U tests sought the significance for residue volumes. One-way ANOVA and Tukey post hoc tests with the Bonferroni corrections sought significance for the duration (p = 0.05).

Results

In the first examined µCT data, the mean (SD) capping material volumes of the PMTA, BD, and RMTA were 6.447 µm3 (1.086), 8.771 µm3 (0.491), and 8.114 µm3 (2.447), respectively.

In the last examined µCT data, the median (IQR) residual volumes of the PMTA, BD, and RMTA were 0.051 µm3 (0.1), 0.313 µm3 (0.5), and 0.124 µm3 (0.1), respectively. A significant difference was found between BD and PMTA in the residual volumes (p < 0.05).

The mean (SD) durations of the retrieving procedures of PMTA, BD, and RMTA were 19.83 min (2.34), 19.24 (3.60), and 22.04 (1.68), respectively (p = 0.063).

Conclusions

Within the limitations of the presented study, it was concluded that the capping materials were largely removed from the root canals using a non-invasive approach. Nevertheless, this duration of the retrieving could be described as long.
Facilitators and barriers to optimal home blood pressure management in patients with hypertensive disorders of pregnancy in a tertiary care facility in Abuja, Nigeria: a qualitative research study
Authors: Mahmoud Zainab , Orji Adaego A. , Okoye Chukwuebuka F. , Ameh Friday O. , Jamro-Comer Erica , Isah Aliyu , Ekele Bissallah , Akaba Godwin , Ojji Dike B. , Huffman Mark D.
Published: September 2023

Background

Nigeria has one of the highest burdens of maternal deaths globally, and hypertensive disorders of pregnancy (HDP) are the leading cause of maternal morbidity and mortality in the country. There is a significant implementation gap in utilizing evidence-based practices for the management of HDP in Nigeria. This study evaluated facilitators and barriers to implementing a home blood pressure monitoring program to improve management of HDP.

Methods

From August 2022 to September 2022, we conducted 15 semi-structured, key informant interviews and 4 focus group discussions among patients, health care workers, and administrators at University of Abuja Teaching Hospital (UATH), a tertiary care centre in Nigeria. The study used the Consolidated Framework for Implementation Research to assess five domains: individual characteristics, inner and outer settings, intervention characteristics, and process of implementation. Audio files were transcribed, and data were analysed using a combination of inductive and deductive approaches. We also conducted 32 brief surveys on the participants to assess acceptability, appropriateness, and feasibility of a blood pressure monitoring program.

Results

The study sample consisted of healthcare workers (n=22) including specialists in cardiology, obstetrics and gynaecology, maternal-foetal medicine, nurses/midwives and resident doctors as well as patients (n=10). Mean (SD) age was 39.5 (10.9), and 78% were female. Participants identified facilitators including the perceived simplicity of home blood pressure monitoring program, high burden of HDP, and availability of a multi-disciplinary team of healthcare professionals with expertise in HDP management. Barriers identified were cost, limited knowledge of HDP amongst patients, limited transportation networks, inconsistent management protocols, and inadequate manpower and facilities. Survey results indicated that between 81% and 88% of participants reported that a blood pressure monitoring program would be acceptable, 56%-72% reported that it would be appropriate, and 47%-69% reported that it would be feasible.

Conclusion

This study identified facilitators and barriers while highlighting key implementation strategies to leverage and effectively address these respectively to enable successful implementation of a home blood pressure monitoring program. It also demonstrated that a home blood pressure monitoring program was considered acceptable, appropriate and feasible among respondents interviewed at UATH.
Strategies for deploying triple artemisinin-based combination therapy in the Greater Mekong Subregion
Authors: de Haan Freek , Amaratunga Chanaki , Thi Van Anh Cao , Orng Long Heng , Vonglokham Manithong , Quang Thieu Nguyen , Lek Dysoley , Boon Wouter P. C. , Dondorp Arjen M. , Moors Ellen H. M.
Published: September 2023

Background

This is a qualitative study to identify implementation challenges for deploying triple artemisinin-based combination therapy (TACT) in the Greater Mekong Subregion (GMS) of Southeast Asia and to explore strategies to overcome these challenges.

Methods

In-depth interviews were conducted in three countries that have repeatedly been confronted with ACT failures: Cambodia, Vietnam, and Lao PDR. Thirty-nine key stakeholders in the healthcare systems in these countries were interviewed. One participatory workshop was conducted in Cambodia, where scenarios for potential TACT deployment were discussed.

Results

The results section is organized around four strategic themes that emerged from the data: policy support, data and evidence, logistics and operation, and downstream engagement. The study revealed that countries in the GMS currently rely on ACT to eliminate Plasmodium falciparum malaria by 2025. TACT is, however, considered to be a useful backup strategy in case of future treatment failures and to prevent the re-establishment of malaria. The study showed that a major challenge ahead is to engage decision makers and healthcare providers into deploying TACT, given the low case incidence of falciparum malaria in the GMS. Interview respondents were also skeptical whether healthcare providers would be willing to engage in new therapies for a disease they hardly encounter anymore. Hence, elaborate information dissemination strategies were considered appropriate and these strategies should especially target village malaria workers. Respondents proposed several regulatory and programmatic strategies to anticipate the formation of TACT markets in the GMS. These strategies include early dossier submission to streamline regulatory procedures, early stakeholder engagement strategies to shorten implementation timelines, and inclusion of TACT as second-line therapy to accelerate their introduction in case they are urgently needed.

Conclusions

This paper presents a qualitative study to identify implementation challenges for deploying TACT in the GMS and to explore strategies to overcome these challenges. The findings could benefit researchers and decision makers in strategizing towards potential future deployment of TACT in the GMS to combat artemisinin and partner drug resistance.
Incidence of catastrophic health spending in Indonesia: insights from a Household Panel Study 2018–2019
Authors: Fattah Rifqi Abdul , Cheng Qinglu , Thabrany Hasbullah , Susilo Dwidjo , Satrya Aryana , Haemmerli Manon , Kosen Soewarta , Novitasari Danty , Puteri Gemala Chairunnisa , Adawiyah Eviati , Hayen Andrew , Gilson Lucy , Mills Anne , Tangcharoensathien Viroj , Jan Stephen , Asante Augustine , Wiseman Virginia
Published: September 2023

Background

Indonesia implemented one of the world’s largest single-payer national health insurance schemes (the Jaminan Kesehatan Nasional or JKN) in 2014. This study aims to assess the incidence of catastrophic health spending (CHS) and its determinants and trends between 2018 and 2019 by which time JKN enrolment coverage exceeded 80%.

Methods

This study analysed data collected from a two-round cross-sectional household survey conducted in ten provinces of Indonesia in February–April 2018 and August–October 2019. The incidence of CHS was defined as the proportion of households with out-of-pocket (OOP) health spending exceeding 10% of household consumption expenditure. Chi-squared tests were used to compare the incidences of CHS across subgroups for each household characteristic. Logistic regression models were used to investigate factors associated with incurring CHS and the trend over time. Sensitivity analyses assessing the incidence of CHS based on a higher threshold of 25% of total household expenditure were conducted.

Results

The overall incidence of CHS at the 10% threshold fell from 7.9% to 2018 to 4.4% in 2019. The logistic regression models showed that households with JKN membership experienced significantly lower incidence of CHS compared to households without insurance coverage in both years. The poorest households were more likely to incur CHS compared to households in other wealth quintiles. Other predictors of incurring CHS included living in rural areas and visiting private health facilities.

Conclusions

This study demonstrated that the overall incidence of CHS decreased in Indonesia between 2018 and 2019. OOP payments for health care and the risk of CHS still loom high among JKN members and among the lowest income households. More needs to be done to further contain OOP payments and further research is needed to investigate whether CHS pushes households below the poverty line.
Laparoscopic left hemihepatectomy guided by real-time indocyanine green fluorescence imaging using the arantius-first approach
Authors: Wang Jiaguo , Xu Jie , Lei Kai , You Ke , Liu Zuojin
Published: September 2023

Background and objective

Laparoscopic hepatectomy approaches, including major hepatectomy, were rapidly developed in the past decade. However, standard laparoscopic left hemihepatectomy (LLH) is still only performed in high-volume medical centres. In our series, we describe our technical details and surgical outcomes of LLH.

Methods

Thirty-nine patients who underwent LLH in our institute were enrolled in the study. Among these, 13 patients underwent LLH guided by real-time ICG fluorescence imaging using the Arantius-first approach (ICG-LLH group), and the other 26 underwent conventional LLH (conventional LLH group). Demographic characteristics and perioperative data were retrospectively collected and analysed. We compared the technical and postoperative short-term outcomes of the two groups.

Results

There were no significant differences in the demographic or clinicopathological characteristics of the patients in the two groups. ICG-LLH required significantly fewer pringle manoeuvres (1 vs. 3 times, p < 0.0001), had a shorter parenchyma dissection time (26 vs. 78 min, p < 0.001), and required fewer vessel clips (18 vs. 28, p < 0.001). Although there was no significant difference, the ICG-LLH group had less bile leakage (0 vs. 5, p = 0.09) and less blood loss (120 vs. 165, p = 0.119). There were no significant differences in the overall complication or R0 resection rates between the two groups.

Conclusion

Our data demonstrate that laparoscopic left hemihepatectomy guided by real-time ICG fluorescence imaging using the Arantius-first approach is safe and feasible in selected patients, thus improving the fluency of the surgical procedure and postoperative short-term outcomes.
RGS5 augments astrocyte activation and facilitates neuroinflammation via TNF signaling
Authors: Yin Shu , Ma Xin-yue , Sun Ying-feng , Yin Yan-qing , Long Ying , Zhao Chun-lai , Ma Jun-wei , Li Sen , Hu Yan , Li Ming-tao , Hu Gang , Zhou Jia-wei
Published: September 2023

Astrocytes contribute to chronic neuroinflammation in a variety of neurodegenerative diseases, including Parkinson's disease (PD), the most common movement disorder. However, the precise role of astrocytes in neuroinflammation remains incompletely understood. Herein, we show that regulator of G-protein signaling 5 (RGS5) promotes neurodegenerative process through augmenting astrocytic tumor necrosis factor receptor (TNFR) signaling. We found that selective ablation of Rgs5 in astrocytes caused an inhibition in the production of cytokines resulting in mitigated neuroinflammatory response and neuronal survival in animal models of PD, whereas overexpression of Rgs5 had the opposite effects. Mechanistically, RGS5 switched astrocytes from neuroprotective to pro-inflammatory property via binding to the receptor TNFR2. RGS5 also augmented TNFR signaling-mediated pro-inflammatory response by interacting with the receptor TNFR1. Moreover, interrupting RGS5/TNFR interaction by either RGS5 aa 1–108 or small molecular compounds feshurin and butein, suppressed astrocytic cytokine production. We showed that the transcription of astrocytic RGS5 was controlled by transcription factor early B cell factor 1 whose expression was reciprocally influenced by RGS5-modulated TNF signaling. Thus, our study indicates that beyond its traditional role in G-protein coupled receptor signaling, astrocytic RGS5 is a key modulator of TNF signaling circuit with resultant activation of astrocytes thereby contributing to chronic neuroinflammation. Blockade of the astrocytic RGS5/TNFR interaction is a potential therapeutic strategy for neuroinflammation-associated neurodegenerative diseases.
Theory-based correlates of cannabis use and intentions among US and Israeli adults: a mixed methods study
Authors: Cui Yuxian , LoParco Cassidy R. , Bar-Zeev Yael , Duan Zongshuan , Levine Hagai , Abroms Lorien C. , Wang Yan , Khayat Amal , Berg Carla J.
Published: September 2023

Background

In the US and Israel, non-medical (‘recreational’) cannabis use is illegal at the national level; however, use rates are high and decriminalization and legalization is spreading. Thus, theory-based intervention efforts, especially for youth prevention, are crucial.

Methods

This mixed-methods study of adults in the US (n = 1,128) and Israel (n = 1,094) analyzed: 1) cross-sectional survey data (Fall 2021) to identify theory-based correlates (risk perceptions, social norms) of past-month cannabis use, next-year use intentions, and intentions to use in the home or among children if non-medical cannabis was legal, using multivariable regression; and 2) qualitative interviews regarding perceptions of cannabis policies and use (US n = 40, Israel n = 44).

Results

16.7% reported past-month use; 70.5%, 56.3%, and 82.6% indicated “not at all likely” regarding next-year use and use in the home and among children if legal. Lower perceived risk and greater social norms were associated with past-month use, greater use intentions, and greater intentions to use in the home or among children. Past-month use was more prevalent among US (vs. Israeli) participants (22.0% vs. 11.2%); however, in multivariable regression controlling for past-month use, being from Israel was associated with greater use intentions (next-year; in the home/among children). Qualitative themes indicated: concerns about use (e.g., increasing use, health risks, driving-related risks) and legalization (e.g., impact on society/economy, marketing), and perceived benefits of use (e.g., medical) and legalization (e.g., access/safety, economic, individual rights).

Conclusions

Despite differences in cannabis perceptions and use across countries, perceived risk and social norms are relevant intervention targets regardless of sociopolitical context.