bluuebunny/crossref_metadata_2025 huggingface dataset:
UK policymaker and expert perspectives on the smoke-free generation policy: a qualitative study
Authors: Davies Nathan , Murray Rachael L , Langley Tessa , Morling Joanne , Bains Manpreet
Published: February 2025

Introduction

The UK smoke-free generation (SFG) proposal seeks to ban the sale of tobacco products to those born in or after 2009. There is substantial evidence for the benefits of raising the age of sale of tobacco but, despite several governments proposing SFG, the policy has faced significant challenge and has not been implemented at nation-state level. This study explores the context in which UK may be the first country to introduce SFG, identifies potential barriers and facilitators to SFG implementation and outlines possible approaches to SFG policy design.

Methods

We conducted 19 qualitative semistructured interviews with policymakers and health leaders in England, Scotland and Wales, including politicians, public health experts, academics, trading standards experts (responsible in UK for enforcing age restrictions on products), clinicians and civil society (charity sector) representatives. Data were analysed through Kingdon’s three policy streams (problem, policy and political) and organised using the framework approach.

Results

Participants conceptualised SFG as both addressing youth tobacco initiation and shifting societal norms. They agreed that all tobacco products should be included but had differing views on including e-cigarettes. Opinions on enforcement varied. Some believed minimal enforcement would suffice due to anticipated compliance, while others stressed the need for strong enforcement. All agreed enforcement should target retailers, not individuals. Politically, participants noted the rapid shift from advocates supporting Tobacco 21 to embracing SFG after government endorsement. Cohesive public health advocacy, maintaining cross-party support and public opinion and developing broader tobacco control policies were considerations for successful implementation.

Conclusions

Widespread support for SFG across expert, political and public opinion provides a strong foundation for its passing into law. UK public health actors swiftly took advantage of the opening of a tobacco control policy window. Those implementing SFG must carefully consider product coverage and its approach to enforcement.
Factors influencing the natural history of non-IgE-mediated gastrointestinal food allergies in paediatric age: a prospective multicentre cohort study
Authors: Carucci Laura , Nocerino Rita , Coppola Serena , Bedogni Giorgio , Capasso Pasqualina , Giglio Veronica , Berni Canani Roberto
Published: February 2025

Background

We aimed at identifying the factors influencing the natural history of non-IgE-mediated gastrointestinal food allergies (non-IgE-GIFA), a group of common paediatric conditions including food protein–induced: enteropathy (FPE), allergic proctocolitis (FPIAP), enterocolitis syndrome (FPIES), and motility disorders (FPIMD).

Methods

Prospective multicentre cohort study involving paediatric patients (both sexes, aged ≤14 y) with non-IgE-GIFA diagnosed and followed for 24 months at a Tertiary Centre for Paediatric Allergy, Gastroenterology and Nutrition. Anamnestic and clinical data were collected from all enrolled patients.

Results

123 non-IgE-GIFA patients were enrolled (56% male, median age (IQR) 150 (60–300) days): FPE (39%), FPIES (17%), FPIAP (16%) and FPIMD (28%). 42% of patients had multiple food allergies (FAs) at baseline, and 64% had a positive family history of allergy. Male sex (OR = 2.24, 95% CI 1.07 to 4.71) and every 1 month of diagnostic delay (OR=1.09, 95% CI 1.01 to 1.18) were positively associated with the occurrence of multiple FAs. At 24-month follow-up, 54% of patients acquired immune tolerance. This rate was higher in FPIAP (75%), when compared with FPIMD (62%), FPE (54%) and FPIES (24%). The odds of 24-month immune tolerance acquisition rate was lower in children with family history of allergy (OR=0.41, 95% CI 0.19 to 0.89) and in those with multiple FAs at baseline (OR=0.24, 95% CI 0.11 to 0.51). At 24-month follow-up, the rate of patients with allergic march was 0.46 (95% CI 0.38 to 0.55, n=57/123), without differences comparing the four phenotypes. The presence of multiple FAs at baseline was associated with an increased risk of developing allergic march (OR=2.22, 95% CI 1.07 to 4.61) at 24-month follow-up.

Conclusions

The results of the study suggest the potential role of modifiable and non-modifiable risk factors influencing the natural history of paediatric patients affected by non-IgE-GIFA.
Maternal knowledge, attitude and practice regarding commercial oral rehydration salt solution: experience from a diarrhoeal disease hospital in Bangladesh
Authors: Nuzhat Sharika , Islam Md Ridwan , Al Fidah Md Fuad , Islam Shoeb Bin , Rahman Md Mushfiqur , Paul Sneha , Nesa Mahfuz-Un , Chowdhury Devjani , Nabi Shayontan Fardin , Awn Awni Mokhtar Sallam Ali , Khan Liaquat Ali , Kawser Chowdhury Ali , Chisti Mohammod Jobayer , Ahmed Tahmeed
Published: February 2025

Background

Despite oral rehydration salt (ORS) solution being a life-saving medication, mothers of affected children often lack proper knowledge and exhibit improper practice of using ORS in sachets. We aimed to assess maternal knowledge, attitude and practice towards commercially available ORS and its use in treating under-5 children with diarrhoea.

Methods

The study was conducted at the Dhaka Hospital, Bangladesh. We included 350 mothers of under-5 children suffering from diarrhoea. Data were collected using a pretested questionnaire and modified Bloom’s cut-off was used to determine adequate knowledge (≥80%), positive attitude (≥90%) and proper practice (≥75%). Logistic regression models were developed after adjusting for confounding variables. Adjusted ORs (AORs) and their 95% CIs were reported.

Results

The prevalence of inadequate knowledge, negative attitude and improper practice was 88.0%, 59.1% and 72.5%, respectively. Participants with up to the higher secondary level of education had significantly higher odds of possessing adequate knowledge (AOR 7.47; 95% CI 2.76 to 20.12) and following proper practice (AOR 3.04; 95% CI 1.66 to 5.77). The majority (97.4%) reported being aware of the process of ORS preparation. Only 2.9% correctly knew all recommended steps. Approximately half (51.1%) knew the purpose of ORS use, and 24.6% believed that antibiotics are more helpful than ORS.

Conclusions

The findings of the study emphasise the need for substantial improvements to the existing health education program with a focus on parental education. Emphasis should be given to reading instruction on the sachet and promoting access to information via mass media outlets.
Association between the use of daily injury risk estimation feedback (I-REF) based on machine learning techniques and injuries in athletics (track and field): results of a prospective cohort study over an athletics season
Authors: Dandrieux Pierre-Eddy , Navarro Laurent , Blanco David , Ruffault Alexis , Ley Christophe , Bruneau Antoine , Iatropoulos Spyridon (Spyros) , Chapon Joris , Hollander Karsten , Edouard Pascal
Published: February 2025

Objective

To analyse the association between the level of use of injury risk estimation feedback (I-REF) provided to athletes and the injury burden during an athletics season.

Method

We conducted a prospective cohort study over a 38-week follow-up period on athletes competing at the French Federation of Athletics. Athletes completed daily questionnaires on their athletics activity, psychological state, sleep, self-reported level of I-REF use, and injuries. I-REF provided a daily estimation of the injury risk for the next day, ranging from 0% (no risk of injury) to 100% (maximum risk of injury). The primary outcome was the injury burden during the follow-up, defined as the number of days with injury per 1000 hours of athletics activity. A negative binomial regression model was used to analyse the association between self-reported I-REF use and the injury burden.

Results

Of the 897 athletes who met the inclusion criteria, 112 (38% women) were included in the analysis. The mean daily response rate of the follow-up was 37%±30%. The primary analysis found no significant association between the self-reported I-REF use and the injury burden (n=112,eβ: 0.992, 95% CI: 0.977 to 1.007; p=0.308). However, when considering athletes’ daily response rate in secondary analysis, for a response rate of at least 9%, we observed a significant association between the self-reported level of I-REF use and the injury burden (n=76,eβ: 0.981, 95% CI: 0.965 to 0.998; p=0.027).

Conclusions

Daily injury risk estimation feedback using machine learning was not associated with reducing injury burden.
Investigation of the effects of combined exercises and self-management education, with and without functional exercises, on pain and functional outcomes in patients with avascular necrosis of the femoral head: a protocol for a single-blind, randomised controlled trial with a parallel design and a 4 month follow-up
Authors: Gholami Zohreh , Faezi Seyedeh Tahereh , Mimar Raghad , Madreseh Elham
Published: February 2025

Non-traumatic avascular necrosis of the femoral head (AVNFH) is a progressive condition that often affects young individuals, leading to bone death and eventual collapse. This degeneration is causing pain and limited function in daily activities over time. This study will plan to enrol 53 male and female participants, aged 18–50 years, who have been diagnosed with AVNFH. Participants will be randomly assigned to one of two groups: (1) theExe+Functional group, which will receive 12 weeks of mixed therapeutic exercises combined with functional resistance exercises and self-management education and (2) thecontrol group, which will receive the same interventions but without functional exercises. TheExe+Functional groupwill engage in two times per week sessions of low-intensity resistance, and mobility exercises, along with a one time per week functional exercise session. Thecontrol groupwill have 3 weekly sessions of low-intensity exercises (resistance and mobility) without functional exercises. The primary outcomes of the study will be pain, measured using a Visual Analogue Scale (VAS) and functional pain, assessed using a Numeric Rating Scale (NRS). Secondary outcomes will include the Harris Hip Score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for hip osteoarthritis, the Timed Up and Go (TUG) test, the 30 s Chair Stand Test, active range of motion, muscle strength and the 10-metre walk test. Data will be collected at baseline (preintervention), postintervention at 12 weeks and at a 4 month follow-up. Trial registration number: IRCT20220510054814N2.
Novel method for risk stratifying suspected acute non-variceal upper GI bleeds using a blood-detection capsule: first UK hospital experience
Authors: D'Cunha Kamath Adnan , Friel Joseph Harry , Braddy-Green Cameron
Published: February 2025

Introduction

Acute upper gastrointestinal bleeding (AUGIB) remains a common presentation accounting for 0.1% of acute medical admissions. Current risk stratification to guide management is weighted on patient factors (eg, Glasgow-Blatchford Score, GBS, or Rockall Score, RS). With an increasingly comorbid population these scores may have less utility. We assess blood-detection capsules (BDC) to triage low-risk, non-variceal, AUGIB referrals.

Methods

A prospective service evaluation was performed at a district general hospital in East London. All AUGIB referrals received during the evaluation period were screened for suitability. The BDC was administered while participants wore an external receiver. If positive, participants underwent inpatient gastroscopy; if negative, they were managed as outpatients. Subsequent results, including complications and mortality, were recorded.

Results

21 referrals were screened during the evaluation period. 11 were excluded with the most common reasons being pacemaker incompatibility or haemodynamic instability. 10 participants with a median age of 76.5 years, Charlson Comorbidity Index of 5.5, GBS 9 and RS 4 were included. Six participants had a negative BDC. Four had a positive BDC; one non-bleeding duodenal ulcer, one oozing Roux-en-Y anastomotic ulcer and two normal examinations. The 90-day mortality was 0% and there were no adverse events among the participants.

Conclusion

Introduction of a BDC as a triage tool may reduce the need for inpatient gastroscopies, otherwise indicated by high GBS/RS. We propose patients with suspected non-variceal AUGIB and a negative BDC can be safely managed as outpatients, irrespective of GBS/RS. Larger cohort data is needed to assess the long-term benefit, cost-effectiveness and complication rates.
Panenteric capsule endoscopy in patients with melaena and a negative oesophagogastroduodenoscopy: a multi-centre real-world study
Authors: Yeo Jie Han , Choon Xin Yi , Seward Edward , McCartney Sara , Anderson Simon H C , Bloom Stuart , Willsmore James , Zissimopoulos Alexandra , Villa Miguela , Borrow Dean-Martin , Harrow Paul , Parisi Ioanna
Published: February 2025

Background

Gastrointestinal (GI) bleeding is a common event that can be life-threatening. Mussettoet aldemonstrated the feasibility of panenteric capsule endoscopy (PCE) in patients with melaena and a negative oesophagogastroduodenoscopy (OGD)—the bleeding source was identified in 80% of patients and colonoscopy was avoided in 50%. However, there are no large prospective trials and limited real-world data.

At two tertiary centres in the UK, we retrospectively evaluated the outcomes of patients who underwent an inpatient PCE following a negative OGD for suspected upper GI bleeding.

Methods

Capsule databases at each institution were reviewed from 2021 to 2024. The inclusion criteria were patients who had a suspected upper GI bleed (melaena and haemoglobin drop of >10 g/L) and underwent an inpatient PCE following a negative OGD. Data was extracted from the patient’s electronic health records.

Results

23 patients met the inclusion criteria. The mean age was 56 years. The median time from OGD to capsule ingestion was 4 days. The source of bleeding was identified by PCE in 70% of cases. A small bowel source was identified in 43%. PCE prevented unnecessary lower GI endoscopy in 70%. Capsule retention occurred in 1 patient and was managed conservatively. Rebleeding rates at 30 days, 6 months and 12 months were 9%, 4% and 0%.

Conclusion

PCE is an option for patients presenting with melaena and has a negative upper GI endoscopy. The findings from this study are promising with a diagnostic yield of 70%. Large, multi-centre randomised studies are required to further investigate this strategy.
Prognostic implications of iron deficiency in patients with atrial fibrillation, with and without chronic heart failure
Authors: Mohamed Abdullahi Ahmed , Christensen Daniel Mølager , Mohammad Milan , Torp-Pedersen Christian , Koeber Lars , Biering-Sørensen Tor , Hansen Morten Lock , Lamberts Morten , Binding Casper , Jensen Mads Hashiba , Elmegaard Mariam , Nouhravesh Nina , Holt Anders , Schou Morten , Gislason Gunnar
Published: February 2025

Background

Iron deficiency (ID) is common in patients with atrial fibrillation/flutter (AF), but its prognostic implications and optimal diagnostic criteria, particularly in those with and without heart failure (HF), remain unclear. This study assessed the associations between different ID definitions and clinical outcomes in patients with AF.

Methods

This Danish nationwide cohort study included 10 834 patients with AF who underwent iron studies between 2008 and 2019, stratified by HF status. ID was defined using four criteria: European Society of Cardiology (ESC) guidelines, ferritin <100 ng/mL, transferrin saturation (TSAT) <20% and serum iron ≤13 µmol/L. Associations between ID definitions and all-cause mortality, cardiovascular mortality and all-cause hospitalisation were evaluated using Cox regression models, adjusted for confounders.

Results

Prevalence of ID varied substantially across definitions, ranging from 36.2% to 62.7%. Over a median follow-up of 31 months, TSAT <20% was associated with increased all-cause and cardiovascular mortality in both HF (HR 1.25, 95% CI 1.14 to 1.37 and HR 1.31, 95% CI 1.14 to 1.49, respectively) and patients without HF (HR 1.39, 95% CI 1.18 to 1.64 and HR 1.54, 95% CI 1.18 to 2.00, respectively). Similarly, serum iron ≤13 µmol/L was associated with higher all-cause and cardiovascular mortality in HF (HR 1.44, 95% CI 1.31 to 1.58 and HR 1.42, 95% CI 1.24 to 1.63, respectively) and patients without HF (HR 1.67, 95% CI 1.41 to 1.97 and HR 1.46, 95% CI 1.13 to 1.89, respectively). ID defined by ESC guidelines or ferritin <100 ng/mL was not associated with mortality in either group but was linked to higher all-cause hospitalisation in patients with HF (HR 1.15, 95% CI 1.08 to 1.23 and HR 1.16, 95% CI 1.09 to 1.23, respectively).

Conclusions

ID defined by TSAT <20% or serum iron ≤13 µmol/L is associated with increased mortality in patients with AF, irrespective of HF status, highlighting these criteria as clinically relevant for risk stratification.
Effects of routine invasive management on reinfarction risk in older adults with frailty and non-ST-segment elevation myocardial infarction: a subanalysis of a randomised clinical trial
Authors: Sanchis Juan , Bueno Hector , Martí Sánchez David , Martinez-Selles Manuel , Díez Villanueva Pablo , Barrabes Jose A , Marín Francisco , Villa Adolfo , Sanmartin Fernandez Marcelo , Llibre Cinta , Sionis Alessandro , Elizaga Jaime , Alfonso Fernando , Nuñez Eduardo , Núñez Julio , Kunadian Vijay , Ariza-Solé Albert
Published: February 2025

Background

Clinical trials and meta-analyses indicate a reduced reinfarction risk with invasive management in older patients with non-ST-segment elevation myocardial infarction (NSTEMI). This study investigated whether similar benefits might be observed in frail patients.

Methods

The coMOrbilidades Síndrome Coronario Agudo - FRAIL (MOSCA-FRAIL) trial included 167 adults aged ≥70 years with frailty (Clinical Frailty Scale ≥4 points) and NSTEMI, who were randomised to invasive (n=84) or conservative (n=83) strategy during the index hospitalisation. The primary end point of this subanalysis was reinfarction, considering all-cause mortality as a competing event, at a 3-year median follow-up. The time to first reinfarction and all reinfarctions (first and recurrent) were considered. The substudy was not prespecified.

Results

The total number of deaths (93, 56%) exceeded that of first reinfarctions (32, 19%). Invasive treatment did not influence the reinfarction risk when accounting for death as a competing risk (subdistribution HR=0.87, 95% CI 0.54 to 1.40, p=0.56). An initially increased mortality risk with invasive management (significant between days 131 and 175) shifted to a lower mortality risk over time. A total of 45 reinfarctions (first and recurrent) were observed. The longitudinal trajectories corroborated that the invasive strategy did not reduce the risk of reinfarction over time (p=0.72). However, mortality followed a biphasic pattern, with higher mortality in the invasive group during the first 6 months and a reduction between 9 months and 3 years (p=0.05 for the entire time-dependent trajectory). The win ratio for the invasive strategy versus the conservative strategy was 1.08 (95% CI 0.72 to 1.63, p=0.70).

Conclusions

In older adults with frailty and NSTEMI, routine invasive management did not reduce the reinfarction risk at a 3-year follow-up. The high all-cause mortality associated with frailty may limit the impact of invasive management. Due to the limited sample size and risk for type II error, these findings should be considered hypothesis-generating.

Trial registration number

NCT03208153.
Onyx frontier DES in the setting of intracranial atherosclerotic disease: multicenter retrospective insights from early clinical experience
Authors: Davis Pierce , Sioutas Georgios , Reddy Chethan , Napole Alan , Jabarkheel Rashad , Scott Kyle , Kandregula Sandeep , Rahmani Redi , Choudhri Omar , Pukenas Bryan , Catapano Joshua S , Kan Peter , Grandhi Ramesh , Salah Walid K , Alaraj Ali , McGuire Laura Stone , Sheth Sunil A , Altschul David , Essibayi Muhammed Amir , Burkhardt Jan Karl , Srinivasan Visish M
Published: February 2025

Background

Intracranial atherosclerotic disease (ICAD) is a leading cause of stroke, often refractory to aggressive medical therapy. Recent advancements in drug-eluting stents (DES) show promise for improved efficacy in intracranial applications relative to traditional ICAD treatments.

Methods

We retrospectively collected all consecutive deployments of the Onyx Frontier [Medtronic, Santa Rosa, CA] stent in the setting of ICAD between August 2022 and August 2024 at six high-volume neuro-interventional centers across the US. Patients were included if their indication for stenting (eg, acute/recurrent stroke) was secondary to ICAD. Primary outcome was periprocedural stroke (<72 hours) and secondary outcomes included degree of pre- and post-stent vessel stenosis and National Institutes of Health Stroke Scale (NIHSS) scores at most recent follow-up. Secondary outcomes were assessed via paired t-tests.

Results

Among 55 patients that met our inclusion criteria, the mean age was 62, mean presentation NIHSS was 10, and 40% were female. A total of 62 devices were used. Most common occlusion locations included the middle cerebral and internal carotid arteries. The periprocedural stroke rate was 10.9%, with a mortality rate of 1.8%. Mean vessel stenosis significantly decreased from 84.90% pre-stent to 2.00% post-stent (P<0.05). Mean NIHSS score improved from 10.37 preoperatively to 3.23 at follow-up (p<0.05). Procedural failure did not occur, however complications occurred in 16.4% of cases.

Conclusion

Our findings suggest that stenting in this setting results in a lower periprocedural stroke rate than appreciated in historical trials such as SAMMPRIS and VISSIT. However, recent CASSISS and BASIS trials demonstrate far reduced periprocedural stroke rates in the context of submaximal angioplasty for ICAD. This, in conjunction with complication rate, suggest that the Onyx Frontier, while promising, may not offer a definitive solution to ICAD.
Flow-based simulation in transverse sinus stenosis pre- and post-stenting: pressure prediction accuracy, hemodynamic complexity, and relationship to pulsatile tinnitus
Authors: Stahl Janneck , Abou-Mrad Tatiana , Stone McGuire Laura , Janiga Gábor , Saalfeld Sylvia , Alaraj Ali , Berg Philipp
Published: February 2025

Background

The proximity of transverse sinus stenosis (TSS) to inner ear structures and the temporal bone makes it a substantial cause of pulsatile tinnitus (PT). Treatment typically involves venous sinus stenting. This study investigates the hemodynamic stressors in TSS patients with PT along the pulse-transmitting temporal bone area and evaluates its treatment effects.

Methods

Four patients with idiopathic intracranial hypertension, PT, and TSS, and four control patients were imaged using MR venography (MRV) and flat panel CT (FP-CT). Patient-specific blood flow simulations were conducted using boundary conditions based on quantitative MR angiography before and after VSS. Catheter-based trans-stenotic pressure gradient measurements were used to validate the simulation results.

Results

The prediction of pressure gradients was close to catheter-based measurements using FP-CT-based segmentations (absolute deviation of 0.35 mm Hg) and is superior to MRV-based reconstructions (absolute deviation of 6.9 mm Hg). In TSS patients, the sinus temporal bone contact areas revealed notably higher time-averaged wall shear stress by 47±22% and velocity values by 41±18% compared with the sinus brain side. The relative residence time decreased by 57±58%. After stenting, the hemodynamic parameters dropped at the temporal side and throughout the sigmoid sinus. Almost all control patient hemodynamics remained lower than post-interventional results.

Conclusion

Our simulations based on patient-specific flows highly predicts pressure gradients across the stenosis. Flow conditions in TSS reveal flow jet formation and high shear rates at the temporal bone, potentially causing sound transmission. The treatment reduces these stressors, demonstrating its targeted therapeutic effect.
Dural arteriovenous fistula research and management in China (DREAM-INI): initial characterization and patient cohort outcomes
Authors: Su Xin , Ma Yongjie , Song Zihao , Liu Huiwei , Zhang Chao , Pang Huishen , Chen Yiguang , Zhao Beichuan , Huang Mingyue , Sun Liyong , Hu Peng , Li Guilin , Hong Tao , Ye Ming , Zhang Hongqi , Zhang Peng
Published: February 2025

Background

Intracranial dural arteriovenous fistulas (DAVFs) are rare lesions, making it challenging to fully understand and improve their management. Globally, only two major large-scale studies have focused on DAVFs. This report outlines the design of the DREAM-INI (Dural arteriovenous fistula research and management in China) project and provides an overview of the 1101-patient cohort it includes.

Methods

Patient data were sourced from the DREAM-INI database, a retrospective, single-center observational study conducted from January 2001 to December 2022, encompassing a total of 1101 DAVF patients.

Results

The cohort consists of 367 patients diagnosed with Borden type I DAVFs, 172 patients with Borden type II fistulas, and 562 patients with Borden type III fistulas. 565 patients exhibited flow-related symptoms, 176 patients presented with intracranial hemorrhage, and 275 patients had non-hemorrhagic neurological deficits. A large proportion of patients (95.6%, 1053/1101) underwent treatment through endovascular embolization (83.7%, 922/1101), surgery (8.7%, 96/1101), or multimodal therapy (3.2%, 35/1101). The overall immediate angiographic cure rate was 85.2% (897/1053 treated cases), and the rate of treatment-related permanent neurological morbidity was 3.4% (45/1328 total procedures). The median duration from the final treatment to the last follow-up for DAVF was 39 months. The predictive factors for aggressive symptoms, initial angiographic cure, and complications in DAVFs have also been preliminarily explored.

Conclusions

With over 1100 patients, DREAM-INI represents a large and relatively well-documented registry of DAVF patient data in China and even globally. This database will enable numerous future studies, further advancing our understanding of this rare disease.
Finland’s New Children’s Hospital and resurgent charity in a Nordic post-welfare state
Authors: Alava Henni , Lindroos Janette , Pihlman Arvi
Published: February 2025

Finland’s New Children’s Hospital (NCH) opened in 2018 after a high-profile charity campaign. Through an analysis of the campaign, we illustrate how debates about children’s hospitals and charities are simultaneously shaped by universal debates over the ownership and funding of healthcare services, and by the particularities of historical context and local institutional arrangements. Such debates also draw from and contribute to shaping cultural repertoires, particularly shared beliefs and values concerning children, the state and charity. In Finland, the NCH marked a break from an established model of publicly funded hospitals, and a return to the pre-welfare state era when charities played a role in healthcare. The campaign thus generated substantial public debate, in which we identify three core claims: (1) Hospitals must be built with public funding and oversight. (2) Children are suffering because politicians have failed, and a new model is needed. (3) The NCH further strengthens Finland’s excellence in paediatric healthcare and promotes health technology exports. Over the course of the campaign, critique faded away, and the second and third lines of argument came to dominate public debate. Through a reflection on the historically changing relations between state, charity and children that shaped what we conceptualise as the NCH assemblage, we show how clichéd cultural tropes naturalised the political shift toward a post-welfare state that is embedded in the NCH campaign. As citizens without voter rights, children are exceptionally easy for politicians to sidestep when allocating funds. Yet, as what Sara Ahmed describes as ‘objects of feeling’, children are also exceptionally potent targets for charity, who, in the NCH case, came to serve as tools for the neoliberal disassembling and reassembling of healthcare services in Finland.
Purple urine bag syndrome: case series
Authors: Joseph Jewell , Sundararaj Jenifer Jeba , Shekinah Susan , Murali Shakila , Gladys Anitha , Kandaswamy Ramu
Published: February 2025

Purple urine bag syndrome is an uncommon condition that occurs in patients with long-standing indwelling urinary catheters, due to urinary tract infection (UTI) by bacteria producing sulfatase or phosphatase enzymes. This results in the formation of the pigments indigo (blue) and indirubin (red), together providing a purple appearance to urine. Management includes a change of catheter and appropriate antibiotics. Although prognosis is usually favourable, rare incidences of complications like Fournier’s gangrene have been reported.

We report three patients who developed purple urine bag syndrome: a man in his late 50s, a woman in her early 30s and a woman in her early 70s, who were on home-based care with regular home visits by the specialist palliative care team. None of them had any other signs or symptoms suggestive of UTIs. Their urinary catheters and collection bags were changed and proper catheter care was reinforced. All three patients were given antibiotics based on urine culture and sensitivity results. Following the same, urine colour reverted to normal in all patients and none of them had any recurrence.

We would like to underline the importance of identifying purple urine bag syndrome as an indicator of underlying UTI, especially in palliative care settings, where patients may not manifest the classical signs and symptoms of UTI. We also would like to highlight the importance of patient and caregiver education on proper catheter care for prevention.
Is NEWS2 the optimal evidence-based surveillance tool for all respiratory patients or does it just represent the beginning of an iterative development process?
Authors: Shaw Dominick , Fogarty Andrew W
Published: February 2025

Medical practice is built on the foundations of evidence-based medicine. Hence, the more common the clinical intervention, the more comprehensive the evidence on which that intervention should be based. Although the widespread adoption of a national early warning score in the UK has led to improvements in the delivery of care, it should be considered as providing a foundation that can be refined and developed, and there is still a need for critical reflection and evaluation of early warning scores, particularly for individuals with chronic respiratory disease, in order to optimise patient monitoring, predict deterioration and guide intervention.
Empowering recovery: a remote spirometry system and mobile app for monitoring and promoting pulmonary rehabilitation in patients with rib fracture
Authors: Liao Chien-An , Young Tai-Horng , Kuo Ling-wei , Fu Chih-Yuan , Chen Szu-An , Tee Yu-San , Kang Shih-Ching , Cheng Chi-Tung , Liao Chien-Hung
Published: February 2025

Background

Multiple rib fractures commonly result from blunt chest trauma. These fractures can lead to prolonged impairment in pulmonary function and often require long-term rehabilitation. This pilot study aimed to evaluate the feasibility of a remote spirometry device for continuous monitoring of lung function in patients with multiple rib fractures.

Methods

Between January 2021 and April 2021, we implemented a remote spirometry system for adult patients with multiple rib fractures and collected their clinical data. We used a Restart system to monitor the respiratory parameters of patients. This system included a wireless spirometer and a Healthy Lung mobile application. A portable spirometer was used to measure forced vital capacity (FVC), peak expiratory flow (PEF), and forced expiratory volume in 1 second.

Result

In total, 21 patients were included in this study. We categorized the participants into two age groups: those older and those younger than 65 years. No significant differences were observed between the two groups regarding demographic characteristics or device adoption rates. However, we observed that patients under 65 years demonstrated more remarkable improvement in pulmonary function than their older counterparts, with significant differences in FVC (110% vs 10%, p=0.032) and PEF (64.2% vs 11.9%, p=0.003).

Conclusion

The adoption of the remote spirometry device is similar between older and younger patients with rib fractures. However, the device improves pulmonary function more in patients in a younger age group. This tool may be effective as a real-time, continuous pulmonary function monitoring system for patients with multiple rib fractures.

Level of evidence

Level IV.
Simultaneous consolidation and remediation of copper contaminated sediments with vacuum electro-osmosis
Authors: Qi Wencheng , Shen Yang , Li Shaoyu , Chen Kaijia , Xu Junhong
Published: February 2025

Contaminated sediment treatment typically requires both dehydration and decontamination, which are normally investigated separately. By integrating vacuum electro-osmosis with electrokinetic remediation technologies, this study demonstrates the potential for simultaneous consolidation and remediation. A novel experiment system for vacuum electro-osmosis was developed to treat sediments with varying initial copper concentrations. The electrical characteristics indicated that both vacuum pressure and copper ions significantly affected the maintenance of electrical conductivity. Vacuum membrane compression increased effective potential by 5–6 V, and there was a clear positive correlation between initial currents and initial concentration of contaminants. The consolidation properties revealed that as contaminants and moisture were removed, the pores between soil particles increased, causing sudden subsidence in the middle area. Higher initial concentration contributed to higher ultimate drainage volumes, peaking at 1950.25 ml, and more evenly distributed settlement. Copper content measurements suggested that excessively low or high initial concentrations of copper diminished remediation effectiveness, with the highest anodic decontamination efficiency at 60%, albeit at the detriment of the cathode region. Copper fractions analysis revealed that weak acid-extractable and water-soluble fractions accounted for over 85% of total copper, predominantly influencing consolidation and remediation.
Contextualized Quaternion Embedding Towards Polysemy in Knowledge Graph for Link Prediction
Authors: Chen Jie , Wang Yinlong , Zhao Shu , Zhou Peng , Zhang Yanping
Published: February 2025

To meet the challenge of incompleteness within Knowledge Graphs, Knowledge Graph Embedding(KGE) has emerged as the fundamental methodology for predicting the missing link(Link Prediction), by mapping entities and relations as low-dimensional vectors in continuous space. However, current KGE models often struggle with the polysemy issue, where entities exhibit different semantic characteristics depending on the relations in which they participate. Such limitation stems from weak interactions between entities and their relation contexts, leading to low expressiveness in modeling complex structures and resulting in inaccurate predictions. To address this, we propose
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ernion
E
mbedding), a model that enhances the representation learning of entities across multiple semantic dimensions by leveraging quaternion rotation to capture diverse relational contexts. In specific, ConQuatE incorporates contextual cues from various connected relations to enrich the original entity representations. Notably, this is achieved through efficient vector transformations in quaternion space, without any extra information required other than original triples. Experimental results demonstrate that our model outperforms state-of-the-art models for Link Prediction on four widely-recognized datasets: FB15k-237, WN18RR, FB15k and WN18.
Bidirectional Directed Acyclic Graph Neural Network for Aspect-level Sentiment Classification
Authors: Xu Junjie , Xiao Luwei , Wu Anran , Ma Tianlong , Dong Daoguo , He Liang
Published: February 2025

To achieve outstanding aspect-level sentiment analysis (ASC), it is crucial to reduce the distance between aspect terms and opinion words. Recently, advanced methods in ASC use graph neural network (GNN)-based methods to leverage the syntactic dependency within the sentence, which can shorten the distance through syntactical dependencies. However, existing approaches that utilize GNNs have difficulty extracting long-distance relations in the dependency tree due to the over-smoothing problem resulting from stacking GNN layers, which limits their ability to detect remote relations. To solve this issue, we propose a Bidirectional Directed Acyclic Graph (BDAG) to reconstruct syntactic dependencies, and a Bidirectional Directed Acyclic Graph Neural Network (BDAGNN) to efficiently propagate multi-hop sentiment information. We also enhance the BDAG with affective commonsense knowledge from SenticNet for comprehensive sentiment classification. BDAGNN we proposed obtains partial state-of-the-art performance on four benchmark datasets, indicating the feasibility of encoding syntactic structure with BDAG.
AhR causes the release of proinflammatory cytokines and chemokines and airway epithelial barrier dysfunction in allergic rhinitis via upregulating SERPINB2
Authors: Lu Xinhong , Gao Gang , Jin Jiaxin , Huang Xiaobo , Lin Liwei , Qian Maohua , Shen Nimei
Published: February 2025

Introduction Allergic rhinitis (AR) remains a kind of nasal hypersensitivity illness with a considerable surge in incidence across the globe. Plasminogen activator inhibitor type 2 (SERPINB2) is an inflammatory mediator that can be also activated by aryl hydrocarbon receptor (AhR), a nuclear receptor that modulates the response to environmental stimuli. This work was devoted to the investigation into the role of SERPINB2 in AR and its relationship with AhR. Methods In human nasal epithelial cells (HNEpCs) stimulated with interleukin-4 (IL-4) or histamine, ELISA was adopted for quantifying proinflammatory cytokines and chemokines. Epithelial barrier function was assessed by transepithelial electrical resistance (TER). Western blot and immunofluorescence staining evaluated tight junction proteins. RT-qPCR and Western blot determined SERPINB2 and AhR expressions. Results The release of proinflammatory cytokines and chemokines was aggravated, TER value was reduced and the expressions of tight junction proteins were downregulated in HNEpCs when induced by IL-4 or histamine. SERPINB2 and AhR were both overexpressed and SERPINB2 depletion relieved inflammatory response and preserved epithelial barrier function in IL-4- or histamine-treated HNEpCs. Besides, AhR knockdown decreased SERPINB2 expression and SERPINB2 upregulation reverted the protective role of AhR silencing in the inflammatory response and epithelial barrier dysfunction in HNEpCs in response to IL-4 or histamine. Conclusion Collectively, AhR might activate SERPINB2 to exacerbate inflammation and airway epithelial barrier dysfunction in AR.
Early Complications After Mild to Moderate Ischemic Stroke and Impact on 3‐Month Outcome: The Multicenter Prospective Stroke Unit Plus Cohort Study
Authors: Sobesky Jan , Madai Vince Istvan , Zweynert Sarah , Malsch Carolin , Nabavi Darius Guenther , Audebert Heinrich J. , Kleinschnitz Christoph , Mackert Bruno Marcel , Schmitz Bettina , Wollenweber Frank Arne , Haeusler Karl Georg , Wellwood Ian , Wiedmann Silke , Endres Matthias , Dirnagl Ulrich , Meisel Andreas , Heuschmann Peter Ulrich
Published: February 2025

Background

Early stroke complications (ESCs) impair recovery and provide an important therapeutic target. Our multicenter prospective cohort study examined the prevalence and amount of poor outcomes attributable to ESCs.

Methods and Results

In patients with stroke, 16 ESCs were monitored by clinical assessment (“basic definition”) and by inclusion of laboratory values and clinical scales (“extended definition”). The association of complications with poor outcome (death or functional impairment: modified Rankin Scale score >3 or Barthel Index <60) at 3 months was analyzed using multiple logistic regression adjusted for stroke severity, age, and sex. Complications were stratified by their early treatment options, and average sequential population‐attributable fractions were estimated for treatable early complications. Of 1202 patients, outcome data were available for 1105 (91.9%; 43.0% women; mean age 68.3 years; baseline median National Institutes of Health Stroke Scale score on admission 3 points). Poor outcome was recorded for 100 patients (9.0%). By basic definition, recurrent stroke, fever, pneumonia, depression, urinary tract infection, and delirium were significantly associated with poor outcomes. The occurrence of 1 or more of these ESCs was associated with up to 19.6% of poor outcomes. By extended definition, urinary tract infection, depression, and delirium were significantly associated with poor outcomes. The occurrence of 1 or more of these ESCs was associated with up to 15.9% of poor outcomes.

Conclusions

In our cohort of patients with mild to moderate stroke, we identified a set of treatable ESCs with clinically relevant impact on outcome that may be targeted in future interventional trials.

Registration

URL:
https://www.bfarm.de
; Unique identifier: DRKS00004712.
One‐Year Functional Outcome of Patients After Surgery for Acute Stanford Type A Aortic Dissection
Authors: Yildiz Murat , Nucera Maria , Mosbahi Selim , Münker Kai , Kapkin Cem , Jungi Silvan , Siepe Matthias , Schoenhoff Florian
Published: February 2025

Background

Our aim was to report the functional outcome of Stanford type A aortic dissection (TAAD) after 1 year as well as morbidity and mortality.

Methods and Results

This is a retrospective analysis including 642 patients with TAAD from January 2005 to December 2021. Mean age at TAAD was 62 years (95% CI, 61–63), and 30% of the population were women. One year after surgery for TAAD, 75% of patients were living at home with New York Heart Association functional class I. No patients were observed with New York Heart Association functional class IV. Less than 2% resided in an assisted‐living facility. Eighty‐five percent of nonretired patients had returned to work. Two hundred twelve (33%) patients were retired after 1 year at a mean age of 73 years (95% CI, 72–74). Stroke (defined as any kind of neurological symptoms) occurred in 148 (23%) patients and was the cause of death in 33 patients. Of the remaining patients with stroke, 115 (30%) had no residual limitations 1 year after TAAD. The cross‐clamp time was significantly higher in patients with stroke (98 minutes [95% CI, 94.0–101.1] in patients without stroke versus 106 minutes [95% CI, 98.5–114.1] in patients with stroke;
P
=0.026). Sixty‐nine percent of patients with stroke lived at home, 28% lived at home with support, and 3% lived in an assisted‐living facility. One year after stroke, 77% of the patients achieved a modified Rankin Scale score ≤2, whereas no patient had a modified Rankin Scale score of 5. There was no significant correlation between sex and recovery rate (
P
=0.48). However, experiencing a stroke significantly increased the likelihood of residing in an assisted‐living facility or receiving support at home 1 year after TAAD (odds ratio, 9.46 [95% CI, 5.06–17.70];
P
<0.001). Thirty‐day mortality was 11.8%, and 92 patients (14%) died within the first year after TAAD. There was no significant sex difference in mortality (
P
=0.101).

Conclusions

One year after surgery for Stanford acute type A aortic dissection, almost 3 out of 4 patients lived unassisted at home. Stroke survivors have a favorable outcome, with the majority having mild or no residual neurological deficits at 1 year.
Fabry Cardiomyopathy: Myocardial Fibrosis, Inflammation, and Down‐Regulation of Mannose‐6‐Phosphate Receptors Cause Low Accessibility to Enzyme Replacement Therapy
Authors: Frustaci Andrea , Verardo Romina , Magnocavallo Michele , Frustaci Emanuela , Russo Matteo Antonio , Chimenti Cristina
Published: February 2025

Background

The clinical impact of enzyme replacement therapy on advanced Fabry disease cardiomyopathy appears to be limited. The pathologic mechanisms involved are still unclear.

Methods and Results

Ten male patients with advanced Fabry disease cardiomyopathy on enzyme replacement therapy, whose disease progressed from maximal wall thickness of 15.4±2.2 to 19.3±2.1 mm in 8.6±1.4 years of follow‐up, underwent left ventricular endomyocardial biopsy before and 4 hours after β‐agalsidase infusion (1 mg/kg). Comparative studies between pre‐ and postinfusion samples included the following: histology, electron microscopy and assessment of myocardial α‐galactosidase A activity; immunohistochemistry for α‐galactosidase A and semiquantitative evaluation (from 0 to 3) of its cardiomyocyte content; and ultrastructural immunogold analysis with anti‐α‐galactosidase A ab; and Western blot quantification of mannose‐6‐phosphate receptors. Controls were surgical biopsies from patients with mitral stenosis. Histologic and ultrastructural evaluation showed myocarditis in 7 of 10 patients, There was no removal of storage material while myocardial fibrosis was 9.8%±6.8% versus 3.8%±2.0% of controls. At ultrastructural immunogold analysis, myocardial α‐galactosidase A activity increased in postinfusion samples by overall 1.89‐fold. Alpha‐galactosidase A immunostaining in cardiomyocytes was absent at baseline in all patients and did not significantly improve in postinfusion samples. Immunogold particles increased by 1.33‐fold (17.6±3.6 preinfusion versus 21.5±5.9 postinfusion), remaining far from normal controls (86.9±6.6). Protein analysis showed mannose‐6‐phosphate receptors to be 81% lower than in a normal heart.

Conclusions

In spite of enzyme delivery to cardiac tissue, our study shows a low accessibility to enzyme replacement therapy of cardiomyocytes affected by advanced Fabry disease cardiomyopathy. It is sustained by myocardial fibrosis, inflammation, and severe down‐regulation of mannose‐6‐phosphate receptors.