bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of pre-operative hypoxemia on the occurrence and outcomes of post-operative ARDS in Stanford type a aortic dissection patients
Authors: Teng Cai  , Fei Zhonghua , Liu Hongsheng , Liu Xinmei , Hu Zhansheng
Published: June 2023

Background

Pre-operative and post-operative hypoxemia are frequent complications of Stanford type A aortic dissection (AAD). This study explored the effect of pre-operative hypoxemia on the occurrence and outcome of post-operative acute respiratory distress syndrome (ARDS) in AAD.

Method

A total of 238 patients who underwent surgical treatment for AAD between 2016 and 2021 were enrolled. Logistic regression analysis was conducted to investigate the effect of pre-operative hypoxemia on post-operative simple hypoxemia and ARDS. Post-operative ARDS patients were divided into pre-operative normal oxygenation group and pre-operative hypoxemia group that were compared for clinical outcomes. Post-operative ARDS patients with pre-operative normal oxygenation were classified as the real ARDS group. Post-operative ARDS patients with pre-operative hypoxemia, post-operative simple hypoxemia, and post-operative normal oxygenation were classified as the non-ARDS group. Outcomes of real ARDS and non-ARDS groups were compared.

Result

Logistic regression analysis showed that pre-operative hypoxemia was positively associated with the risk of post-operative simple hypoxemia (odds ratios (OR) = 4.81, 95% confidence interval (CI): 1.67–13.81) and post-operative ARDS (OR = 8.514, 95% CI: 2.64–27.47) after adjusting for the confounders. The post-operative ARDS with pre-operative normal oxygenation group had significantly higher lactate, APACHEII score and longer mechanical ventilation time than the post-operative ARDS with pre-operative hypoxemia group (P < 0.05). Pre-operative the risk of death within 30 days after discharge was slightly higher in ARDS patients with pre-operative normal oxygenation than in ARDS patients with pre-operative hypoxemia, but there was no statistical difference(log-rank test, P = 0.051). The incidence of AKI and cerebral infarction, lactate, APACHEII score, mechanical ventilation time, intensive care unit and post-operative hospital stay, and mortality with 30 days after discharge were significantly higher in the real ARDS group than in the non-ARDS group (P < 0.05). After adjusting for confounding factors in the Cox survival analysis, the risk of death within 30 days after discharge was significantly higher in the real ARDS group than in the non-ARDS group (hazard ratio(HR): 4.633, 95% CI: 1.012–21.202, P < 0.05).

Conclusion

Preoperative hypoxemia is an independent risk factor for post-operative simple hypoxemia and ARDS. Post-operative ARDS with pre-operative normal oxygenation was the real ARDS, which was more severe and associated with a higher risk of death after surgery.
A framework for stakeholder engagement in the adoption of new anti-malarial treatments in Africa: a case study of Nigeria
Authors: Mokuolu Olugbenga Ayodeji , Bolarinwa Oladimeji Akeem , Opadiran Oluwatumobi Racheal , Ameen Hafsat Abolore , Dhorda Mehul , Cheah Phaik Yeong , Amaratunga Chanaki , de Haan Freek , Tindana Paulina , Dondorp Arjen M.
Published: June 2023

Background

Recent reports of artemisinin partial resistance from Rwanda and Uganda are worrisome and suggest a future policy change to adopt new anti-malarials. This is a case study on the evolution, adoption, and implementation of new anti-malarial treatment policies in Nigeria. The main objective is to provide perspectives to enhance the future uptake of new anti-malarials, with an emphasis on stakeholder engagement strategies.

Methods

This case study is based on an analysis of policy documents and stakeholders’ perspectives drawn from an empirical study conducted in Nigeria, 2019–2020. A mixed methods approach was adopted, including historical accounts, review of programme and policy documents, and 33 qualitative in-depth interviews and 6 focus group discussions.

Results

Based on policy documents reviewed, the adoption of artemisinin-based combination therapy (ACT) in Nigeria was swift due to political will, funding and support from global developmental partners. However, the implementation of ACT was met with resistance from suppliers, distributors, prescribers, and end-users, attributed to market dynamics, costs and inadequate stakeholder engagement. Deployment of ACT in Nigeria witnessed increased developmental partner support, robust data generation, ACT case-management strengthening and evidence on anti-malarial use in severe malaria and antenatal care management. A framework for effective stakeholder engagement for the future adoption of new anti-malarial treatment strategies was proposed. The framework covers the pathway from generating evidence on drug efficacy, safety and uptake; to making treatment accessible and affordable to end-users. It addresses which stakeholders to engage with and the content of engagement strategies with key stakeholders at different levels of the transition process.

Conclusion

Early and staged engagement of stakeholders from global bodies to community level end-users is critical to the successful adoption and uptake of new anti-malarial treatment policies. A framework for these engagements was proposed as a contribution to enhancing the uptake of future anti-malarial strategies.
Improvement studies for equitable and evidence-based innovation: an overview of the ‘IM-SEEN’ model
Authors: Allen Luke N. , Nkomazana Oathokwa , Mishra Sailesh Kumar , Gichangi Michael , Macleod David , Ramke Jacqueline , Bolster Nigel , Marques Ana Patricia , Rono Hilary , Burton Matthew , Kim Min , Ratshaa Bakgaki , Karanja Sarah , Ho-Foster Ari , Bastawrous Andrew
Published: June 2023

Background

Health inequalities are ubiquitous, and as countries seek to expand service coverage, they are at risk of exacerbating existing inequalities unless they adopt equity-focused approaches to service delivery.

Main text

Our team has developed an equity-focused continuous improvement model that reconciles prioritisation of disadvantaged groups with the expansion of service coverage. Our new approach is based on the foundations of routinely collecting sociodemographic data; identifying left-behind groups; engaging with these service users to elicit barriers and potential solutions; and then rigorously testing these solutions with pragmatic, embedded trials. This paper presents the rationale for the model, a holistic overview of how the different elements fit together, and potential applications. Future work will present findings as the model is operationalised in eye-health programmes in Botswana, India, Kenya, and Nepal.

Conclusion

There is a real paucity of approaches for operationalising equity. By bringing a series of steps together that force programme managers to focus on groups that are being left behind, we present a model that can be used in any service delivery setting to build equity into routine practice.
Integrative analysis of the gut microbiota and faecal and serum short-chain fatty acids and tryptophan metabolites in patients with cirrhosis and hepatic encephalopathy
Authors: Wang Qiang , Chen Chengxin , Zuo Shi , Cao Kun , Li Haiyang
Published: June 2023

Objective

The purpose of this study was to describe the changes in the gut microbiome of patients with cirrhosis and hepatic encephalopathy (HE), as well as quantify the variations in short-chain fatty acid (SCFA) and tryptophan metabolite levels in serum and faeces.

Methods

Fresh faeces and serum were collected from 20 healthy volunteers (NC group), 30 cirrhosis patients (Cir group), and 30 HE patients (HE group). Then, 16S rRNA sequencing and metabolite measurements were performed using the faeces. Gas chromatography‒mass spectrometry and ultrahigh-performance liquid chromatography-tandem mass spectrometry were used to measure SCFA and tryptophan levels, respectively. The results were analysed by SIMCA16.0.2 software. Differences in species were identified using MetaStat and t tests. The correlations among the levels of gut microbes and metabolites and clinical parameters were determined using Spearman correlation analysis.

Results

Patients with cirrhosis and HE had lower microbial species richness and diversity in faeces than healthy volunteers; these patients also had altered β-diversity. Serum valeric acid levels were significantly higher in the HE group than in the Cir group. Serum SCFA levels did not differ between the Cir and NC groups. Serum melatonin and 5-HTOL levels were significantly higher in the HE group than in the Cir group. The Cir and NC groups had significant differences in the levels of eight serum tryptophan metabolites. Furthermore, the levels of faecal SCFAs did not differ between the HE and Cir groups. Faecal IAA-Ala levels were significantly lower in the HE group than in the Cir group. There were significant differences in the levels of 6 faecal SCFAs and 7 faecal tryptophan metabolites between the Cir and NC groups. Certain gut microbes were associated with serum and faecal metabolites, and some metabolites were associated with certain clinical parameters.

Conclusion

Reduced microbial species richness and diversity were observed in patients with HE and cirrhosis. In both serum and faeces, the levels of different SCFAs and tryptophan metabolites showed varying patterns of change. In HE patients, the levels of some serum tryptophan metabolites, and not SCFAs, were correlated with liver function and systemic inflammation. Systemic inflammation in patients with cirrhosis was correlated with faecal acetic acid levels. In summary, this study identified metabolites important for HE and cirrhosis.
Characteristics of corticomuscular coupling during wheelchair Tai Chi in patients with spinal cord injury
Authors: Zu Yangmin , Luo Lina , Chen Xinpeng , Xie Haixia , Yang Chich-Haung Richard , Qi Yan , Niu Wenxin
Published: June 2023

Background

Wheelchair Tai Chi (WCTC) has been proved to have benefits for the brain and motor system of spinal cord injury (SCI) patients. However, the characteristics of corticomuscular coupling during WCTC are scarcely known. We aimed to investigate changes following SCI on corticomuscular coupling, and further compare the coupling characteristics of WCTC with aerobic exercise in SCI patients.

Methods

A total of 15 SCI patients and 25 healthy controls were recruited. The patients had to perform aerobic exercise and WCTC, while healthy controls needed to complete a set of WCTC. The participants accomplished the test following the tutorial video in a sitting position. The upper limb muscle activation was measured from upper trapezius, medial deltoid, biceps brachii and triceps brachii with surface electromyography. Cortical activity in the prefrontal cortex, premotor cortex, supplementary motor area and primary motor cortex was simultaneously collected by functional near-infrared spectroscopy. The functional connectivity, phase synchronization index and coherence values were then calculated and statistically analyzed.

Results

Compared to healthy controls, changes in functional connectivity and higher muscle activation were observed in the SCI group. There was no significant difference in phase synchronization between groups. Among patients, significantly higher coherence values between the left biceps brachii as well as the right triceps brachii and contralateral regions of interest were found during WCTC than during aerobic exercise.

Conclusion

The patients may compensate for the lack of corticomuscular coupling by enhancing muscle activation. This study demonstrated the potential and advantages of WCTC in eliciting corticomuscular coupling, which may optimize rehabilitation following SCI.
Structure of cellulose in birch phloem fibres in tension wood: an X-ray nanodiffraction study
Authors: Viljanen Mira , Muranen Sampo , Kinnunen Outi , Kalbfleisch Sebastian , Svedström Kirsi
Published: June 2023

Background

To gain a better understanding of bark layer structure and function, especially of the phloem fibres and their contribution to the posture control of trees, it is important to map the structural properties of these cells. The role of bark can also be linked to the reaction wood formation and properties which are essential when it comes to studying the questions related to tree growth. To offer new insights into the role of bark in the postural control of trees, we studied the micro- and nanoscale structures of the phloem and its nearest layers. This study is the first time, in which phloem fibres in trees have been extensively examined using X-ray diffraction (XRD).

We determined the orientation of cellulose microfibrils in phloem fibres of Silver birch saplings by using scanning synchrotron nanodiffraction. The samples consisted of phloem fibres extracted from tension, opposite and normal wood (TW, OW, NW).

Results

Using scanning XRD, we were able to obtain new information about the mean microfibril angle (MFA) in cellulose microfibrils in phloem fibres connected to reaction wood. A slight but consistent difference was detected in the average MFA values of phloem fibres between the TW and OW sides of the stem. Using scanning XRD, different contrast agents (intensity of the main cellulose reflection or calcium oxalate reflection, mean MFA value) were used to produce 2D images with 200 nm spatial resolution.

Conclusions

Based on our results, the tension wood formation in the stem might be related to the structure and properties of phloem fibres. Thus, our results suggest that the nanostructure of phloem fibres is involved in the postural control of trees containing tension and opposite wood.
Biological roles of A-to-I editing: implications in innate immunity, cell death, and cancer immunotherapy
Authors: Yuan Jing , Xu Li , Bao Hai-Juan , Wang Jie-lin , Zhao Yang , Chen Shuo
Published: June 2023

Adenosine-to-inosine (A-to-I) editing, a key RNA modification widely found in eukaryotes, is catalyzed by adenosine deaminases acting on RNA (ADARs). Such RNA editing destabilizes endogenous dsRNAs, which are subsequently recognized by the sensors of innate immune and other proteins as autologous dsRNAs. This prevents the activation of innate immunity and type I interferon-mediated responses, thereby reducing the downstream cell death induced by the activation of the innate immune sensing system. ADARs-mediated editing can also occur in mRNAs and non-coding RNAs (ncRNAs) in different species. In mRNAs, A-to-I editing may lead to missense mutations and the selective splicing of coding regions. Meanwhile, in ncRNAs, A-to-I editing may affect targeting and disrupt ncRNAs maturation, leading to anomalous cell proliferation, invasion, and responses to immunotherapy. This review highlights the biological functions of A-to-I editing, its role in regulating innate immunity and cell death, and its potential molecular significance in tumorigenesis and cancer targeted therapy and immunotherapy.
Prone position versus usual care in hypoxemic COVID-19 patients in medical wards: a randomised controlled trial
Authors: Nay Mai-Anh , Hindre Raphaël , Perrin Christophe , Clément Jérémy , Plantier Laurent , Sève Aymeric , Druelle Sylvie , Morrier Marine , Lainé Jean-Baptiste , Colombain Léa , Corvaisier Grégory , Bizien Nicolas , Pouget-Abadie Xavier , Bigot Adrien , Jamard Simon , Nyamankolly Elsa , Planquette Benjamin , Fossat Guillaume , Boulain Thierry
Published: June 2023

Background

Benefit of early awake prone positioning for COVID-19 patients hospitalised in medical wards and who need oxygen therapy remains to be demonstrated. The question was considered at the time of COVID-19 pandemic to avoid overloading the intensive care units. We aimed to determine whether prone position plus usual care could reduce the rate of non-invasive ventilation (NIV) or intubation or death as compared to usual care alone.

Methods

In this multicentre randomised clinical trial, 268 patients were randomly assigned to awake prone position plus usual care (N = 135) or usual care alone (N = 132). The primary outcome was the proportion of patients who underwent NIV or intubation or died within 28 days. Main secondary outcomes included the rates of NIV, of intubation or death, within 28 days.

Results

Median time spent each day in the prone position within 72 h of randomisation was 90 min (IQR 30–133). The proportion of NIV or intubation or death within 28 days was 14.1% (19/135) in the prone position group and 12.9% (17/132) in the usual care group [odds ratio adjusted for stratification (aOR) 0.43; 95% confidence interval (CI) 0.14–1.35]. The probability of intubation, or intubation or death (secondary outcomes) was lower in the prone position group than in the usual care group (aOR 0.11; 95% CI 0.01–0.89 and aOR 0.09; 95% CI 0.01–0.76, respectively) in the whole study population and in the prespecified subgroup of patients with SpO2 ≥ 95% on inclusion (aOR 0.11; 95% CI 0.01–0.90, and aOR 0.09; 95% CI 0.03–0.27, respectively).

Conclusions

Awake prone position plus usual care in COVID-19 patients in medical wards did not decrease the composite outcome of need for NIV or intubation or death.

Trial registration ClinicalTrials.gov Identifier: NCT04363463. Registered 27 April 2020.
Synthesis, antimicrobial and antioxidant activity of triazole, pyrazole containing thiazole derivatives and molecular docking studies on COVID-19
Authors: Matta Raghavender , Pochampally Jalapathi , Dhoddi Bala Narsimha , Bhookya Shankar , Bitla Sampath , Akkiraju Anjini Gayatri
Published: June 2023

New series of biologically active triazole and pyrazole compounds containing 2, 4-disubstituted thiazole analogues (12a-l) were synthesized from p-hydroxy benzaldehyde and phenyl hydrazine in excellent yields and purity. All the synthesized compounds were unambiguously identified based on their spectral data analyses (IR, 1H-NMR, 13C-NMR spectra, and HRMS). The final derivatives were evaluated for their in vitro anti-microbial activity after thorough purification. Among all the tested compounds, the compound 12e,12f and 12 kpossess the highest growth inhibitory activity at MIC values of4.8, 5.1and4.0 μg/ml respectively. The antioxidant properties of these compounds demonstrated and revealed remarkable activity compared to the standard antioxidant by using the DPPH free radical-scavenging assay. Moreover, molecular docking studies to evaluate the probable interactions with the catalytic domain of the gram-positiveS. aureustopoisomerase IV enzyme may provide new insights for developing these new hybrids as potential antimicrobial agents. The binding affinities of compounds12a-lwere ranging from − 10.0 to − 11.0 kcal/mol with topoisomerase IV enzyme and with COVID-19 main protease binding affinities are ranging from − 8.2 to − 9.3 kcal/mol. These docking studies reveal that the compounds12a-lcould be the best inhibitors for the novel SARS Cov-2 virus and have more future in discovery of potent drug candidates.
Amplicon sequencing allows differential quantification of closely related parasite species: an example from rodent Coccidia (Eimeria)
Authors: Ferreira Susana C. M. , Jarquín-Díaz Víctor Hugo , Heitlinger Emanuel
Published: June 2023

Background

Quantifying infection intensity is a common goal in parasitological studies. We have previously shown that the amount of parasite DNA in faecal samples can be a biologically meaningful measure of infection intensity, even if it does not agree well with complementary counts of transmission stages (oocysts in the case of Coccidia). Parasite DNA can be quantified at relatively high throughput using quantitative polymerase chain reaction (qPCR), but amplification needs a high specificity and does not simultaneously distinguish between parasite species. Counting of amplified sequence variants (ASVs) from high-throughput marker gene sequencing using a relatively universal primer pair has the potential to distinguish between closely related co-infecting taxa and to uncover the community diversity, thus being both more specific and more open-ended.

Methods

We here compare qPCR to the sequencing-based amplification using standard PCR and a microfluidics-based PCR to quantify the unicellular parasiteEimeriain experimentally infected mice. We use multiple amplicons to differentially quantifyEimeriaspp. in a natural house mouse population.

Results

We show that sequencing-based quantification has high accuracy. Using a combination of phylogenetic analysis and the co-occurrence network, we distinguish threeEimeriaspecies in naturally infected mice based on multiple marker regions and genes. We investigate geographical and host-related effects onEimeriaspp. community composition and find, as expected, prevalence to be largely explained by sampling locality (farm). Controlling for this effect, the novel approach allowed us to find body condition of mice to be negatively associated withEimeriaspp. abundance.

Conclusions

We conclude that amplicon sequencing provides the underused potential for species distinction and simultaneous quantification of parasites in faecal material. The method allowed us to detect a negative effect ofEimeriainfection on the body condition of mice in the natural environment.

Graphical Abstract
Advances in the allostery of angiotensin II type 1 receptor
Authors: Zhang Xi , Zhang Suli , Wang Meili , Chen Hao , Liu Huirong
Published: June 2023

Angiotensin II type 1 receptor (AT1R) is a promising therapeutic target for cardiovascular diseases. Compared with orthosteric ligands, allosteric modulators attract considerable attention for drug development due to their unique advantages of high selectivity and safety. However, no allosteric modulators of AT1R have been applied in clinical trials up to now. Except for the classical allosteric modulators of AT1R such as antibody, peptides and amino acids, cholesterol and biased allosteric modulators, there are non-classical allosteric modes including the ligand-independent allosteric mode, and allosteric mode of biased agonists and dimers. In addition, finding the allosteric pockets based on AT1R conformational change and interaction interface of dimers are the future of drug design. In this review, we summarize the different allosteric mode of AT1R, with a view to contribute to the development and utilization of drugs targeting AT1R allostery.
A multi-channel soft biometrics framework for seamless border crossings
Authors: Hassan Bilal , Sherazi Hafiz Husnain Raza , Ali Mubashir , Bashir Ali K.
Published: June 2023

As the number of passengers at border entry points such as airports and rail stations increases, so does the demand for seamless, secure, and fast biometric technologies for verification purposes. Although fingerprints are currently useful biometric technologies, they are intrusive and slow down the end-to-end verification process, increasing the chances of tampering. Emerging as an alternative technology, soft biometrics have proven successful for non-intrusive and rapid verification. Soft biometrics consists of a large set of features from three different modalities of the human body, including the face, body, and essential & auxiliary attachments. This paper proposes a multi-channel soft biometrics framework that leverages soft biometrics technology over traditional biometrics. The framework encapsulates four distinct components: ApparelNet, which verifies essential and auxiliary attachments; A-Net, which measures anthropometric soft biometrics; OneDetect, which predicts global soft biometrics; and RSFS, which develops a set of highly relevant and supportive soft biometrics for verification. The proposed framework addresses several critical limitations of existing biometrics technologies during the verification process at border entry points, such as intrusive behavior, response time, biometric tampering, and privacy issues. The proposed multi-channel soft biometrics framework has been evaluated using several benchmark datasets in the field, such as Front-view Gait (FVG), Pedestrian Attribute Recognition At Far Distance (PETA), and Multimedia and Vision (MMV) Pedestrian. Using heterogeneous datasets enables the testing of each framework component or channel against numerous constrained and unconstrained scenarios. The outcome of the envisioned multi-channel soft biometrics framework is presented based on distinct outcomes from each channel, but it remains focused on determining a single cumulative verification score for verification at border control. In addition, this multi-channel soft biometrics framework has extended applications in several fields, including crowd surveillance, the fashion industry, and e-learning.
Inhibition of monoamine oxidases by benzimidazole chalcone derivatives
Authors: Krishna Athulya , Lee Jiseong , Kumar Sunil , Sudevan Sachithra Thazhathuveedu , Uniyal Prerna , Pappachen Leena K. , Kim Hoon , Mathew Bijo
Published: June 2023

Ten benzimidazole chalcone derivatives were synthesized, and their monoamine oxidase (MAO) inhibitory activity was evaluated. Most compounds showed higher inhibitory activity against MAO-B than MAO-A. Compound BCH2 exhibited an IC50 value of 0.80 μM, thereby showing the most potent inhibition amongst all. In addition, BCH2 showed the highest MAO-B selectivity index (SI) with an SI value of 44.11 compared to MAO-A. Among the substituents, the halogen group showed the best MAO-B inhibition, and the ortho-position of the B ring showed better inhibitory activity than the para-site. In comparison with ortho-substituents, the inhibitory activity increased in the order, -Cl > -Br > -F > -H. BCH2 was found to be a competitive inhibitor of the enzyme with optimum inhibition kinetics, where Ki was found to be 0.25 ± 0.014 μM. In the reversibility experiment, BCH2 showed a recovery pattern after MAO-B inhibition, similar to that of lazabemide. Thus, BCH2 is a potent, reversible, and selective MAO-B inhibitor and has been suggested as a candidate for the treatment of neurological disorders.
Strategies for territorial tourism planning in natural protected areas (NPAs): Alto Mayo Protected Forest (BPAM), Peru
Authors: Nuñez-Torres Anghela , Arones-Huarcaya Aracelly , Yarasca-Aybar Cristian
Published: June 2023

The Alto Mayo Protected Forest (“Bosque de Protección Alto Mayo”, or BPAM for its Spanish acronym) is one of the largest natural protected areas (NPA) in Peru. The BPAM has several tourist attractions owing to its great biodiversity of ecosystems and species. However, the BPAM does not have an optimal offer of tourism services because of the lack of infrastructure articulated to the multiscalarity of its territory. The objective of this research is to propose integral strategies for permitted tourism uses of the BPAM, considering its plans and planning instruments oriented to the conservation of the ecosystem through sustainable projects. To diagnose the site and collect data, participatory workshops were held with local inhabitants and authorities involved in the administration of the BPAM. As a result, the BPAM was structured into five tourist zones to propose intervention strategies at three scales: territory, community, and architecture. At the territorial scale, a network of infrastructure and tourist circuits has been proposed. At the community scale, the suitability of each tourist zone was evaluated to propose activities classified as ecotourism, adventure, or rural. At the architectural scale, sustainable tourism equipment was configured through schematic strategies that considered the architectural object, connectors, and site. Finally, this study is synthesized as an example of an intervention instrument to promote sustainable tourism in NPAs with similar characteristics in the Peruvian Amazon.
Development of a digital training for social and emotional competences for medical assistants in vocational education and training in Germany
Authors: Peters Markus , Tschöpe Tanja , Konheiser Sebastian , Raecke Julia , Schnitzler Annalisa
Published: June 2023

This paper describes a digital training for social and emotional competences for prospective medical assistants (MAs) in Germany. Social and emotional competences (SEC) are necessary for the collaboration with colleagues as well as for the contact with clients, patients or customers. The German dual system of vocational education and training (VET) therefore considers them as essential parts of the profile of most training occupations. Nevertheless, few materials exist so far for the systematic training of these competences. In former studies three social and emotional competences have been identified as essential for MAs: emotion regulation, perspective coordination and communication strategies. At the same time development needs have been identified for all of them. To address these needs the three hours online training programme SECOTrain (Social and Emotional Competence Training) has been developed, which offers separate training sessions for all three competences. The aim of the paper is to depict how the fostering of social and emotional competences can be approached via a digital training, report our experiences with this endeavour and to discuss associated advantages as well as challenges and ways to deal with them. Digital formats offer new possibilities and chances for education and training, as they facilitate access to the content in a standardized and efficient way. An independent processing of trainings is made possible, regardless of time and teacher. At the same time, this comes along with a risk of overstraining some learners, as problems of understanding or motivation may occur. SECOTrain transfers pedagogical ideas into the context of digital learning to reduce these risks as much as possible. Each of the three training sessions follows the principles of the Cognitive Apprenticeship approach and is inspired by existing theories and trainings. Video sequences of typical critical interaction situations serve as material for explanation, application and reflection to support a strong practical orientation. Effects of the training will be evaluated in a pretest–posttest-follow-up experimental design. The paper presents goals and content as well as methods, pedagogical principles and theoretical foundation of SECOTrain. Furthermore, results of a small pilot study are presented and discussed with regard to further adjusting the training to the needs of the target group. At the end, an outline of the planned evaluation is given.
Astrocytic uptake of neuronal corpses promotes cell-to-cell spreading of tau pathology
Authors: Mothes Tobias , Portal Benjamin , Konstantinidis Evangelos , Eltom Khalid , Libard Sylwia , Streubel-Gallasch Linn , Ingelsson Martin , Rostami Jinar , Lindskog Maria , Erlandsson Anna
Published: June 2023

Tau deposits in astrocytes are frequently found in Alzheimer’s disease (AD) and other tauopathies. Since astrocytes do not express tau, the inclusions have been suggested to be of neuronal origin. However, the mechanisms behind their appearance and their relevance for disease progression remain unknown. Here we demonstrate, using a battery of experimental techniques that human astrocytes serve as an intermediator, promoting cell-to-cell spreading of pathological tau. Human astrocytes engulf and process, but fail to fully degrade dead neurons with tau pathology, as well as synthetic tau fibrils and tau aggregates isolated from AD brain tissue. Instead, the pathogenic tau is spread to nearby cells via secretion and tunneling nanotube mediated transfer. By performing co-culture experiments we could show that tau-containing astrocytes induce tau pathology in healthy human neurons directly. Furthermore, our results from a FRET based seeding assay, demonstrated that the tau proteoforms secreted by astrocytes have an exceptional seeding capacity, compared to the original tau species engulfed by the cells. Taken together, our study establishes a central role for astrocytes in mediating tau pathology, which could be of relevance for identifying novel treatment targets for AD and other tauopathies.
Risk and UCON-based access control model for healthcare big data
Authors: Jiang Rong , Chen Xue , Yu Yimin , Zhang Ying , Ding Weiping
Published: June 2023

The rapid development of healthcare big data has brought certain convenience to medical research and health management, but privacy protection of healthcare big data is an issue that must be considered in the process of data application. Access control is one of the methods for privacy protection, but traditional access control models cannot adapt to the dynamic, continuous, and real-time characteristics of healthcare big data scenarios. In this paper, we propose an access control model based on risk quantification and usage control (RQ-UCON). The model adds a risk quantification module to the traditional UCON model to achieve privacy protection of medical data. This module classifies risks into direct and indirect risks and quantifies them based on the physician's visit history. The model stores the quantified risk values as subject attributes. The RQ-UCON model uses an improved Exponentially Weighted Moving Average (EWMA) and penalty factors to predict risk value and to update the risk values of the subject attributes in real-time. The RQ-UCON model uses agglomerative hierarchical clustering to cluster the risk values of physicians within the department, resulting in risk intervals for each physician's operational behavior. Each risk interval is stored as a condition in the RQ-UCON model. Finally, according to the model whether the subject attributes meet the model conditions to determine whether the subject has the corresponding access rights, and according to the risk interval to grant the subject the corresponding access rights. Through the final experiment, it can be seen that the access control model proposed in this paper has a certain control on the excessive access behavior of doctors and has a certain limitation on the privacy leakage of healthcare big data.
Atrial fibrillation in cancer survivors – a systematic review and meta-analysis
Authors: Bao Yueyang , Lee John , Thakur Udit , Ramkumar Satish , Marwick Thomas H.
Published: June 2023

Background

Atrial fibrillation (AF) is a common cardiac complication during cancer treatment. It is unclear if cancer survivors have increased AF risk when compared to the population. AF screening is now recommended in patients ≥65 years, however there are no specific recommendations in the oncology population. We sought to compare the AF detection rate of cancer survivors compared to the general population.

Methods

We searched the Pubmed, Embase and Web of Science databases using search terms related to AF and cancer mapped to subject headings. We included English language studies, limited to adults > 18 years who were > 12 months post completion of cancer treatment. Using a random-effects model we calculated the overall AF detection rate. Meta-regression analysis was performed to assess for potential causes for study heterogeneity.

Results

Sixteen studies were included in the study. The combined AF detection rate amongst all the studies was 4.7% (95% C.I 4.0-5.4%), which equated to a combined annualised AF rate of 0.7% (95% C.I 0.1–0.98%). There was significant heterogeneity between studies (I2 = 99.8%, p < 0.001). In the breast cancer cohort (n = 6 studies), the combined annualised AF rate was 0.9% (95% C.I 0.1–2.3%), with significant heterogeneity (I2 = 99.9%, p < 0.001).

Conclusion

Whilst the results should be interpreted with caution due to study heterogeneity, AF rates in patients with cancer survival >12 months were not significantly increased compared to the general population.

Study Registration

Open Science Framework - DOI: https://doi.org/10.17605/OSF.IO/APSYG.
Magnitude of central obesity and associated factors among adult patients attending public health facilities in Adama town, Oromia region, Ethiopia, 2022
Authors: Getahun Mihiret Shawel , Deybasso Haji Aman , Komicha Meyrema Abdo , Gurara Abenet Menene
Published: June 2023

Background

Central obesity is excessive accumulation of fat around the abdomen, which is associated with the risk of coronary heart and cerebrovascular diseases. This study determined the magnitude of central obesity among adult patients using the waist-to-hip ratio, which has a superior capacity to measure the risk of developing non-communicable diseases compared to the body mass index used in previous studies in Ethiopia.

Methods

Institutional-based cross-sectional study was conducted among a sample of 480 adults from April 1 to May 30, 2022. A systematic random sampling technique was used to select the study participants. Data were collected by using interviewer-administered structured questionnaires and anthropometric measurements. The data were entered into EPI INFO version 7 and analyzed by Statistical Software for Social Science Version 25. The associations between independent and dependent variables were checked using bivariate and multivariate logistic regression analyses. Adjusted odds ratio and 95% confidence interval were used to measure the strengths of the association. Statistical significance was declared at a P value of less than 0.05.

Results

The magnitude of central obesity in this study was 40% (51.2% and 27.4% among females and males, respectively (95% CI 36–44%)). Being a female (AOR = 9.5, 95% CI 5.22–17.9), age range 35–44 (AOR = 7.0, 95% CI 2.9–16.7), 45–64 years (AOR = 10.1, 95% CI4.0–15.2), married (AOR = 2.5, 95% CI 1.3–4.7), high monthly income (AOR = 3.3, 95% CI 1.5–7.3), high consumption of milk and milk products (AOR = 0.3, 95% CI 0.1–0.6), family history of obesity (AOR = 1.8, 95% CI 1.1–3.2) were significantly associated with central obesity among the study participants.

Conclusion

The magnitude of central obesity was higher in the study area. Sex, age, marital status, monthly income, consumption of milk and milk products, and family history of obesity were independent determinants of central obesity. Therefore, it is important to raise awareness about central obesity through behavior change communication that targets the high-risk population.
Adipose Tissue Dysfunction in Polycystic Ovary Syndrome
Authors: Bril Fernando , Ezeh Uche , Amiri Mina , Hatoum Sana , Pace Lauren , Chen Yen-Hao , Bertrand Fred , Gower Barbara , Azziz Ricardo
Published: June 2023

Purpose

Polycystic ovary syndrome (PCOS) is a complex genetic trait and the most common endocrine disorder of women, clinically evident in 5% to 15% of reproductive-aged women globally, with associated cardiometabolic dysfunction. Adipose tissue (AT) dysfunction appears to play an important role in the pathophysiology of PCOS even in patients who do not have excess adiposity.

Methods

We undertook a systematic review concerning AT dysfunction in PCOS, and prioritized studies that assessed AT function directly. We also explored therapies that targeted AT dysfunction for the treatment of PCOS.

Results

Various mechanisms of AT dysfunction in PCOS were identified including dysregulation in storage capacity, hypoxia, and hyperplasia; impaired adipogenesis; impaired insulin signaling and glucose transport; dysregulated lipolysis and nonesterified free fatty acids (NEFAs) kinetics; adipokine and cytokine dysregulation and subacute inflammation; epigenetic dysregulation; and mitochondrial dysfunction and endoplasmic reticulum and oxidative stress. Decreased glucose transporter-4 expression and content in adipocytes, leading to decreased insulin-mediated glucose transport in AT, was a consistent abnormality despite no alterations in insulin binding or in IRS/PI3K/Akt signaling. Adiponectin secretion in response to cytokines/chemokines is affected in PCOS compared to controls. Interestingly, epigenetic modulation via DNA methylation and microRNA regulation appears to be important mechanisms underlying AT dysfunction in PCOS.

Conclusion

AT dysfunction, more than AT distribution and excess adiposity, contributes to the metabolic and inflammation abnormalities of PCOS. Nonetheless, many studies provided contradictory, unclear, or limited data, highlighting the urgent need for additional research in this important field.
Assessment of Neurodevelopment and Growth in Congenital Hypothyroidism: Serial 6-Year Follow-up Study of 408 Patients
Authors: Ha Eun Kyo , Kim Ju Hee , Cha Hye Ryeong , Lee Gi Chun , Shin Jeewon , Lee Eun , Lee Won Seok , Yoo Eun-Gyong , Jung Mo Kyung , Han Man Yong
Published: June 2023

Context

The link between congenital hypothyroidism (CH) and neurodevelopment is suggested, yet studies applying quantifiable measures are lacking. Moreover, socioeconomic disparities and subtle variation in timing of approach make the relationship difficult to detect.

Objective

To evaluate associations between CH and abnormalities in neurodevelopment and growth and determine the critical period for intervention.

Methods

We utilized a nationwide database to conduct a longitudinal analysis of 919 707 children. Exposure to CH was identified using claims-based data. The primary outcome of interest was suspected neurodevelopmental disorder, as measured using the Korean Ages & Stages Questionnaires (K-ASQ) administered annually from 9 to 72 months of age. Secondary outcomes were height and BMI z-scores. After randomly matching cases and controls at a 1:10 ratio, we employed inverse probability of treatment weighting and generalized estimating equation models for our analyses. We conducted subgroup analysis based on the age of treatment initiation.

Results

The prevalence of CH in our population was 0.05% (n = 408). Relative to the control group, the CH group had higher risk of suspected neurodevelopmental disorders (propensity score–weighted odds ratio: 4.52; 95% CI: 2.91, 7.02), and significantly increased risk in each of the 5 K-ASQ domains. No time interactions were noted at any rounds for the outcomes according to when the neurodevelopmental assessment was conducted (all P for interaction >.05). The CH group also had higher risk for low height-for-age z-score, but not for elevated BMI-for-age z-score. In subgroup analysis, delayed medication for CH correlated with worse neurodevelopmental outcomes.

Conclusion

The CH group had worse neurodevelopmental outcomes and reduced height-for-age z-score. Outcomes were worse when onset of treatment was increasingly delayed.
Comparison of Endocrinologists’ Physical Examination Documentation for In-person vs Video Telehealth Diabetes Visits
Authors: Arao Kevin A , Fincke B Graeme , Zupa Margaret F , Vimalananda Varsha G
Published: June 2023

Objective

Outpatient diabetes mellitus (DM) care over video telehealth (TH) requires modifications to how endocrinologists complete physical examinations (PEs). But there is little guidance on what PE components to include, which may incur wide variation in practice. We compared endocrinologists’ documentation of DM PE components for in-person (IP) vs TH visits.

Methods

Retrospective chart review of 200 notes for new patients with DM from 10 endocrinologists (10 IP and 10 TH visits each) in the Veterans Health Administration between April 1, 2020, and April 1, 2022. Notes were scored from 0 to 10 based on documentation of 10 standard PE components. We compared mean PE scores for IP vs TH across all clinicians using mixed effects models. Independent samples t-tests were used to compare both mean PE scores within clinician and mean scores for each PE component across clinicians for IP vs TH. We described virtual care-specific and foot assessment techniques.

Results

The overall mean (SE) PE score was higher for IP vs TH (8.3 [0.5] vs 2.2 [0.5]; P < .001). Every endocrinologist had higher PE scores for IP vs TH. Every PE component was more commonly documented for IP vs TH. Virtual care-specific techniques and foot assessment were rare.

Conclusions

Our study quantifies the degree to which Pes for TH were attenuated among a sample of endocrinologists, raising a flag that process improvements and research are needed for virtual Pes. Organizational support and training could help increase PE completion via TH. Research should examine reliability and accuracy of virtual PE, its value to clinical decision-making, and its impact on clinical outcomes.
Intermittent Fasting Sustainably Improves Glucose Tolerance in Normal Weight Male Mice Through Histone Hyperacetylation
Authors: Endo Sho , Uto Asuka , Miyashita Kazutoshi , Sato Masaaki , Inoue Hiroyuki , Fujii Kentaro , Hagiwara Aika , Ryuzaki Masaki , Oshida Takuma , Kinouchi Kenichiro , Itoh Hiroshi
Published: June 2023

To explore the mechanism by which intermittent fasting (IF) exerts prolonged effects after discontinuation, we examined mice that had been subjected to 4 cycles of fasting for 72 hours and ad libitum feeding for 96 hours per week (72hIF), followed by 4 weeks of ad libitum feeding, focusing on expression of genes for lipid metabolism in the skeletal muscle and histone acetylation in the promoter region. The 72hIF regimen resulted in metabolic remodeling, characterized by enhanced lipid utilization and mitochondrial activation in the muscle. This long-term IF (72hIF) caused stronger metabolic effects than alternate day fasting (24hIF) wherein fasting and refeeding are repeated every 24 hours. Upregulation of lipid oxidation genes and an increase in oxygen utilization were sustained even at 4 weeks after discontinuation of 72hIF, associated with histone hyperacetylation of the promoter region of uncoupling protein 3 (Ucp3) and carnitine palmitoyl transferase 1b (Cpt1b) genes. An increase in leucine owing to fasting-induced muscle degradation was suggested to lead to the histone acetylation. These findings support the previously unappreciated notion that sustainable promotion of histone acetylation in lipid oxidation genes of the muscle and adipose tissues during and after IF may contribute to sustained metabolic effects of IF.
Prevalence of Endocrine Manifestations and GIST in 108 Systematically Screened Patients With Neurofibromatosis Type 1
Authors: Dupuis Hippolyte , Chevalier Benjamin , Cardot-Bauters Catherine , Jannin Arnaud , Do Cao Christine , Ladsous Miriam , Cortet Christine , Merlen Emilie , Drouard Magali , Aubert Sébastien , Vidaud Dominique , Espiard Stéphanie , Vantyghem Marie-Christine
Published: June 2023

Context

In patients with neurofibromatosis type 1 (NF1), guidelines suggest screening for pheochromocytoma by metanephrine measurement and abdominal imaging, which may lead to the discovery of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) and their differential diagnosis, gastrointestinal stromal tumors (GISTs). Other endocrine manifestations such as follicular thyroid carcinoma and primary hyperparathyroidism have also been reported in a few cases.

Objective

This study aimed to describe prevalence and clinical presentation of these manifestations through systematic screening in a large cohort of patients.

Methods

In this monocentric retrospective study, 108 patients with NF1 were included and screened for endocrine manifestations and GISTs. Clinical, laboratory, molecular profile, pathology, and morphologic (abdominal computed tomography scan and/or magnetic resonance imaging) and functional imaging were collected.

Results

Twenty-four patients (22.2% of the cohort, 16 female, mean age 42.6 years) presented with pheochromocytomas that were unilateral in 65.5%, benign in 89.7%, and with a ganglioneural component in 20.7%. Three female patients (2.8% of the cohort, aged 42-63 years) presented with well-differentiated GEP-NETs, and 4 (3.7%) with GISTs. One patient had primary hyperparathyroidism, 1 patient had medullary microcarcinoma, and 16 patients had goiter, multinodular in 10 cases. There was no correlation between pheochromocytoma and other NF1 tumoral manifestations, nor correlations between pheochromocytoma and NF1 genotype, despite a familial clustering in one-third of patients.

Conclusion

The pheochromocytoma prevalence in this NF1 cohort was higher (>20%) than previously described, confirming the interest of systematic screening, especially in young women. The prevalence of GEP-NETs and GISTs was about 3%, respectively. No phenotype–genotype correlation was observed.