bluuebunny/crossref_metadata_2025 huggingface dataset:
Anifrolumab in lupus nephritis: results from second-year extension of a randomised phase II trial
Authors: Jayne David , Rovin Brad , Mysler Eduardo , Furie Richard , Houssiau Frédéric , Trasieva Teodora , Knagenhjelm Jacob , Schwetje Erik , Tang Weifeng , Tummala Raj , Lindholm Catharina
Published: August 2023

Objective

To characterise the safety and efficacy of anifrolumab in active lupus nephritis (LN) through year 2 of the phase II randomised, double-blind Treatment of Uncontrolled Lupus via the Interferon Pathway (TULIP)-LN trial (NCT02547922) of 2 anifrolumab dosing regimens versus placebo.

Methods

Patients received intravenous anifrolumab 900 mg for the first 3 doses followed by 300 mg anifrolumab (intensified regimen (IR)), 300 mg anifrolumab (basic regimen (BR)) or placebo every 4 weeks throughout. To continue into Year 2, patients must have achieved at least partial renal response and a glucocorticoid tapering target.

Results

Of 147 randomised patients, 101 completed Year 1 study treatment; of these, 75 (74%) continued into Year 2 (anifrolumab IR: n=29, BR: n=23 and placebo: n=23). During Year 2, 72% of patients reported ≥1 adverse event (AE); serious AEs were reported in 6.9%, 8.7% and 8.7% of patients (anifrolumab IR, BR and placebo, respectively); 3 patients discontinued treatment due to an AE (anifrolumab IR: n=2 and placebo: n=1) and herpes zoster was reported in 2 patients (anifrolumab IR: n=1 and BR: n=1). The study was ongoing at the start of the pandemic, but no COVID-19 cases were reported. Of the 145 patients receiving treatment, more patients on the IR attained complete renal response at Week 104 compared with those on BR or placebo (27.3% vs 18.6% and 17.8%) and simultaneously achieved sustained glucocorticoid tapering (IR: 25.0%; BR: 18.6% and placebo: 17.8%). The improvements in estimated glomerular filtration rate were numerically larger in both anifrolumab groups versus placebo.

Conclusions

The safety and tolerability profile through Year 2 of TULIP-LN was generally consistent with Year 1, with promising efficacy results for the anifrolumab IR regimen. Collectively, the results support further investigation of an anifrolumab intensified dosing regimen in larger populations of patients with active proliferative LN.

Trial registration number

NCT02547922.
Understanding experiences of potential harm among MSM (cis and trans) using HIV self-testing in the SELPHI randomised controlled trial in England and Wales: a mixed-methods study
Authors: Witzel T Charles , Nicholls Emily Jay , McCabe Leanne , Weatherburn Peter , McCormack Sheena , Bonell Christopher , Gafos Mitzy , Lampe Fiona C , Speakman Andrew , Dunn David , Ward Denise , Phillips Andrew N , Pebody Roger , Gabriel Michelle M , Collaco-Moraes Yolanda , Rodger Alison J , Burns Fiona M
Published: August 2023

Background

The potential of HIV self-testing (HIVST) to cause harm is a concern hindering widespread implementation. The aim of this paper is to understand the relationship between HIVST and harm in SELPHI (An HIVSelf-testingPublicHealthIntervention), the largest randomised trial of HIVST in a high-income country to date.

Methods

10 111 cis and trans men who have sex with men (MSM) recruited online (geolocation social/sexual networking apps, social media), aged 16+, reporting previous anal intercourse and resident in England or Wales were first randomised 60/40 to baseline HIVST (baseline testing, BT) or not (no baseline testing, nBT) (randomisation A). BT participants reporting negative baseline test, sexual risk at 3 months and interest in further HIVST were randomised to three-monthly HIVST (repeat testing, RT) or not (no repeat testing, nRT) (randomisation B). All received an exit survey collecting data on harms (to relationships, well-being, false results or being pressured/persuaded to test). Nine participants reporting harm were interviewed in-depth about their experiences in an exploratory substudy; qualitative data were analysed narratively.

Results

Baseline: predominantly cis MSM, 90% white, 88% gay, 47% university educated and 7% current/former pre-exposure prophylaxis (PrEP) users. Final survey response rate was: nBT=26% (1056/4062), BT=45% (1674/3741), nRT=41% (471/1147), RT=50% (581/1161).

Harms were rare and reported by 4% (n=138/3691) in exit surveys, with an additional two false positive results captured in other study surveys. 1% reported harm to relationships and to well-being in BT, nRT and RT combined. In all arms combined, being pressured or persuaded to test was reported by 1% (n=54/3678) and false positive results in 0.7% (n=34/4665).

Qualitative analysis revealed harms arose from the kit itself (technological harms), the intervention (intervention harms) or from the social context of the participant (socially emergent harms). Intervention and socially emergent harms did not reduce HIVST acceptability, whereas technological harms did.

Discussion

HIVST harms were rare but strategies to link individuals experiencing harms with psychosocial support should be considered for HIVST scale-up.

Trial registration number

ISRCTN20312003.
Trends in the risk of heat stress to Canadian dairy cattle in a changing climate
Authors: VanderZaag Andrew , Riche Etienne Le , Qian Budong , Smith Ward , Baldé Hambaliou , Ouellet Veronique , Charbonneau Édith , Wright Tom , Gordon Rob
Published: August 2023

Canada's climate is warming faster than the global average, but the warming is unevenly distributed. This study analyzes historical and future climate change in dairy-producing regions across Canada to better understand how Canada's dairy cows are affected. Historical changes (i.e., 1960–2019) were assessed using temperature and humidity data from 29 weather stations across the country. The temperature–humidity index (THI) was used as an indicator of dairy cattle at risk of heat stress, and three THI metrics evaluated the frequency, severity, and duration of potential heat stress. Future scenarios were investigated using five global climate models to project daily THI under three Shared Socioeconomic Pathways (SSPs). Projections were grouped into three time periods (2020–2049, 2040–2069, and 2060–2089). Historical climate trends show an increase in temperature, humidity, and THI exceedance in most west coast and eastern Canada locations, affecting 84% of the national dairy herd. Future scenarios project that 90% of the national herd will experience a large increase in the frequency, severity, and duration of THI exceedance under all but the most optimistic SSP. These findings highlight the need for Canadian dairy farmers to consider heat-stress adaptation strategies.
Photocatalytic splitting of water on g-C3N4-based single-atom Pt catalysts with stable “sandwich” structure: a combined first principles and semi-empirical investigation
Authors: Yang Cheng , Yan Jinren , Wu Jiang , Li Rujie , Liu Qingju
Published: August 2023

Solar-to-hydrogen energy conversion is a promising strategy to solve environmental pollution and energy crisis by utilizing photocatalytic water splitting. In this work, a “sandwich” structure of g-C3N4-based single-atom platinum (Pt) catalyst for photocatalytic water splitting is proposed and investigated using a combined first principles and semi-empirical study method. The calculation results indicate that, without any co-catalyst, the photogenerated holes in the valence band of BL-g-C3N4 cannot oxidize H2O to O2, and its oxygen evolution reaction (OER) performance is not better than that of the pristine monolayer g-C3N4. Significantly, the photogenerated holes in the valence band of the “sandwich”-structured photocatalyst g-C3N4–Pt1–g-C3N4 can oxidize H2O to O2 without any co-catalyst. That is, the OER performance of g-C3N4–Pt1–g-C3N4 is better than that of the pristine g-C3N4 and the pristine bilayer-g-C3N4 (BL-g-C3N4). However, it can be found that the introduction of single Pt atom confinement in the BL-g-C3N4 cannot effectively reduce hydrogen evolution reaction (HER) energy barrier or improve the hydrogen evolution kinetics of BL-g-C3N4. In other words, the introduction of the confined single Pt atom in the BL-g-C3N4 not only fails to improve HER performance of BL-g-C3N4, but deteriorates HER catalytic performance of BL-g-C3N4. These findings provide some theoretical insights for engineers to prepare photocatalysts with higher activity and stability.
Detrital geochronology of the Cunningham Lake formation: an overlap succession linking Cache Creek terrane to Stikinia at ∼205 Ma
Authors: Milidragovic D. , Ootes L. , Zagorevski A. , Cleven N. , Wall C.J. , Luo Y. , Friedman R.M.
Published: August 2023

Detrital zircon from three coarse-grained marine siliciclastic rocks was analyzed for U–Pb, Lu–Hf, and trace element compositions to constrain the timing of deposition and sediment provenance of the Cunningham Lake formation (formerly siliciclastic unit of the Sitlika assemblage) in north-central British Columbia. This strategy tests previously proposed sedimentary linkages between the Cache Creek terrane and the westerly rocks of the Stikine terrane. All three samples indicate maximum depositional ages at ca. 205–202 Ma (Rhaetian). The samples contain a predominant ca. 225–215 Ma detrital population, sourced from proximal contemporaneous volcanic arcs, and minor Permian to Middle Triassic and Carboniferous arc-derived detrital populations. The absence of Precambrian grains is consistent with the strongly suprachondritic zircon compositions (εHf(t) = +7 to +20), and indicates exclusively juvenile sources for the Cunningham Lake formation. Late Triassic sources of zircon are not known in the Cache Creek terrane and, except within western Stikine terrane, are uncommon among the Intermontane terranes that amalgamated with the Cache Creek terrane during Late Triassic–Early Jurassic. The Stikine suite (ca. 230–214 Ma) and coeval volcanic rocks in western Stikinia are the most probable sources of Late Triassic detritus for the Cunningham Lake formation. Stikinia’s Paleozoic basement is the probable source of Carboniferous detrital zircon. Volcanic arc–backarc complexes in the Cache Creek terrane are the most likely sources of Permian to Middle Triassic detritus in the Intermontane terranes. Accordingly, the siliciclastic rocks of the Cunningham Lake formation represent an overlap sedimentary succession that links Stikinia to the Cache Creek terrane by the latest Triassic.
Morphological evidence for the extension of the Zabargad Transform Fault Zone to the Saudi Arabian Red Sea margin
Authors: Petrovic Alexander , Panara Yuri , Vahrenkamp Volker
Published: August 2023

The fault locations and orientation of the Zabargad Transform Fault Zone, also called the Zabargad Fracture Zone (ZFZ), have previously only been delineated by satellite-based geophysical data, causing intense debate over the last few decades. Newly recognized geomorphological features identified in bathymetric and LiDAR data from the NE Red Sea margin present the first ground evidence for the northern extent of the ZFZ. The features are aligned over 84 km, starting from the Mabahiss Deep, near the spreading axis, and continuing to the shallow Saudi Arabian shelf along the northern termination of the Al Wajh carbonate platform. Analysis of the seafloor morphology reveals three geomorphic terrains: (1) a deeply incised canyon feeding into the Mabahiss Deep, which is characterized by dozens of amphitheatre-shaped scarps; (2) a 22 km wide head-scarp that follows the edge of the Al Wajh platform; and (3) multiple fault scars and graben-like structures on the shallow shelf. We interpret these morphological features as deformation indicators associated with the deformation processes in the ZFZ and postulate that they represent the northern end of the ZFZ. In addition, the fault zone delineates the NW margin of the Al Wajh carbonate platform and most likely continues to shape it. This paper gives new insights into the interaction between fracture zones and continental margins and their role in the morphogenesis of the seafloor.
Tissue Biology: In Search of a New Paradigm
Authors: Adler Miri , Chavan Arun R. , Medzhitov Ruslan
Published: August 2023

Animal tissues are made up of multiple cell types that are increasingly well-characterized, yet our understanding of the core principles that govern tissue organization is still incomplete. This is in part because many observable tissue characteristics, such as cellular composition and spatial patterns, are emergent properties, and as such, they cannot be explained through the knowledge of individual cells alone. Here we propose a complex systems theory perspective to address this fundamental gap in our understanding of tissue biology. We introduce the concept of cell categories, which is based on cell relations rather than cell identity. Based on these notions we then discuss common principles of tissue modularity, introducing compositional, structural, and functional tissue modules. Cell diversity and cell relations provide a basis for a new perspective on the underlying principles of tissue organization in health and disease.
Albumin and fibrinogen synthesis rates in advanced chronic liver disease
Authors: Amouzandeh Mariam , Sundström Anna , Wahlin Staffan , Wernerman Jan , Rooyackers Olav , Norberg Åke
Published: August 2023

Albumin and fibrinogen synthesis were positively correlated, but the high variation indicates that these are probably influenced by different mechanisms. There might be a limited metabolic reserve for the liver to increase both albumin and fibrinogen synthesis in response to longstanding inflammation in CLD and fibrinogen seems to be prioritized.
Profit Coordination and Optimization of Agricultural Product Brand Promotion Lead by Farmer Cooperative Organizations
Authors: Guo Fangfang , Lai Ivan Ka Wai , Zhang Tao , Zhong Yaoguang
Published: August 2023

In the e-commerce supply chain of agricultural products, there are three parties: farmer cooperative organizations, e-commerce platforms, and consumers. This study aims to investigate how to coordinate farmer cooperative organizations and e-commerce platforms to maximize the overall profits of the supply chains of agricultural products. Based on the Stackelberg game theory, this paper constructs a two-level supply chain decision-making model led by farmers’ cooperatives and followed by e-commerce platforms. It discusses two supply chain decision-making models (decentralized and centralized) with decision variables (selling price and promotion effort). The results show that the overall profit of the supply chain under centralized decision making is higher than the overall profit under decentralized decision making. In order to achieve the coordination of agricultural product sales price and brand promotion efforts and achieve win-win cooperation, this paper puts forward two coordination schemes: (1) coordinating revenue sharing, cost sharing, and wholesale price discounts and (2) coordinating the wholesale price. These two contract coordination schemes are verified by example analysis. Finally, the following strategies are recommended, including strengthening the investment in brand promotion and contract management.
Transnasal Endoscopic Treatment of Tension Pneumocephalus Caused by Posttraumatic or Iatrogenic Ethmoidal Damage
Authors: Latif Omer Goran , Maurizi Riccardo , Francavilla Beatrice , Rekawt Hama Rashid Kareem , Velletrani Gianluca , Salah Hasan Mustafa , Marzocchella Giulia , Gubari Mohammed Ibrahim Mohialdeen , Di Girolamo Stefano
Published: August 2023

Background. Tension pneumocephalus is a neurosurgical emergency caused by progressive accumulation of air in the intracranial spaces mediated by a valve mechanism. Tension pneumocephalus usually presents with headaches, reduced consciousness, and even death. One of the most common causes is an ethmoidal defect resulted by nasal surgery or facial traumas. Methods. A literature review about tension pneumocephalus resulting from ethmoidal damages was performed. Surgery strategies included decompression by frontal burr holes and multilayer repair of the ethmoidal defect. In this paper, an endoscopic technique that exploits the ethmoidal defect to decompress the intracranial spaces and to resolve tension pneumocephalus with fewer complications and shorter hospitalization in comparison to frontal craniotomy is proposed. Conclusion. The proposed endonasal endoscopic technique could be effectively used as a first-line treatment for symptomatic tension pneumocephalus caused by posttraumatic or iatrogenic ethmoidal defect.
SARS-CoV-2 Prediction Strategy Based on Classification Algorithms from a Full Blood Examination
Authors: Choukhan C. F. , Lasri I. , El Hatimi R. , Lemnaouar M. R. , Esghir M.
Published: August 2023

A fast and efficient diagnosis of serious infectious diseases, such as the recent SARS-CoV-2, is necessary in order to curb both the spread of existing variants and the emergence of new ones. In this regard and recognizing the shortcomings of the reverse transcription-polymerase chain reaction (RT-PCR) and rapid diagnostic test (RDT), strategic planning in the public health system is required. In particular, helping researchers develop a more accurate diagnosis means to distinguish patients with symptoms with COVID-19 from other common infections is what is needed. The aim of this study was to train and optimize the support vector machine (SVM) and K-nearest neighbors (KNN) classifiers to rapidly identify SARS-CoV-2 (positive/negative) patients through a simple complete blood test without any prior knowledge of the patient’s health state or symptoms. After applying both models to a sample of patients at Israelita Albert Einstein at São Paulo, Brazil (solely for two examined groups of patients’ data: “regular ward” and “not admitted to the hospital”), it was found that both provided early and accurate detection, based only on a selected blood profile via the statistical test of dependence (ANOVA test). The best performance was achieved by the improved SVM technique on nonhospitalized patients, with precision, recall, accuracy, and AUC values reaching 94%, 96%, 95%, and 99%, respectively, which supports the potential of this innovative strategy to significantly improve initial screening.
The Relationship between Trait Impulsivity and Everyday Executive Functions among Patients with Type 2 Diabetes Mellitus: The Mediating Effect of Negative Emotions
Authors: Liu Na , Heng Chun-Ni , Cui Yi , Li Ling , Guo Yan-Xue , Liu Qin , Cao Bao-Hua , Wu Di , Zhang Yin-Ling
Published: August 2023

Background. In recent years, the incidence of type 2 diabetes mellitus (T2DM) has dramatically increased, imposing a heavy financial burden on society and individuals. The most cost-effective way to control diabetes is diabetes self-management, which depends on patients’ executive functions (EFs). However, the level of EFs among patients with T2DM varies greatly. In addition to diabetes-related factors contributing to a decline in EFs, trait impulsivity as a relatively stable personality trait may explicate individual differences in EFs. The objective of this study was to verify the mediating effect of negative emotions on the relationship between trait impulsivity and EFs among patients with T2DM in China. Methods. A total of 305 patients with T2DM were enrolled consecutively from the endocrinology departments of three tertiary hospitals in China using convenience sampling. The participants completed the Sociodemographic Questionnaire, Mini-Mental State Examination (MMSE), Barratt Impulsiveness Scale-Brief (BIS-Brief), Depression Anxiety and Stress Scales with 21 items (DASS-21), and Behavior Rating Inventory of Executive Function-Adult (BRIEF-A) version. A structural equation modeling was used to verify the mediating effect of negative emotions on the relationship between trait impulsivity and EFs. Results. A total of 32.46% of the participants experienced at least one aspect of daily EF decline. The mediating effect of trait impulsivity on the Behavioral Regulation Index (BRI) of EFs through negative emotions was significant, accounting for 29.57% of the total effect. The mediating effect of trait impulsivity on the Metacognitive Index (MI) of EFs through negative emotions was significant, accounting for 31.67% of the total effect. Conclusions. Trait impulsivity can positively predict EF decline, which can be alleviated by improving the negative emotions of patients with T2DM. Future research exploring interventions to improve the EFs of patients with T2DM should therefore consider their trait impulsivity and negative emotions.
Path Planning of Ant Colony Algorithm Based on Decision Tree in the Context of COVID-19
Authors: Shao Yi , Deng Xuefeng , Feng Lingqing
Published: August 2023

Reasonable planning of travel routes can keep people away from crowded areas and reduce the probability of contracting the COVID-19. In view of the characteristics related to virus infection and human flow density, it can overcome the shortcomings of using the same pheromone initial value and slow initial convergence in route planning of ant colony optimization (ACO) algorithm. In this paper, the decision tree algorithm is used to divide the human flow density into three levels: high risk, medium risk, and low risk; and different pheromone volatility coefficients are set to change the distribution of pheromone concentration. The experimental results show that the improved ACO algorithm could help to reduce the likehood of passing through the medium-risk areas and the high-risk areas, which is reduced to less than 1%. This scheme provides an efficient route planning method for epidemic prevention and control that can be applied in the daily prevention of COVID-19 in universities.
Supplementary Figure S8 from Natural Killer Cell Activation by Ubiquitin-specific Protease 6 Mediates Tumor Suppression in Ewing Sarcoma
Authors: Jain Kanika , Henrich Ian C. , Quick Laura , Young Robert , Mondal Shreya , Oliveira Andre M. , Blobel Gerd A. , Chou Margaret M.
Published: August 2023

Gating strategy for immune lineages in abscopal response experiment
Supplementary Figure S4 from Natural Killer Cell Activation by Ubiquitin-specific Protease 6 Mediates Tumor Suppression in Ewing Sarcoma
Authors: Jain Kanika , Henrich Ian C. , Quick Laura , Young Robert , Mondal Shreya , Oliveira Andre M. , Blobel Gerd A. , Chou Margaret M.
Published: August 2023

RT-qPCR of surface markers induced by USP6
Supplementary Figure S1 from Natural Killer Cell Activation by Ubiquitin-specific Protease 6 Mediates Tumor Suppression in Ewing Sarcoma
Authors: Jain Kanika , Henrich Ian C. , Quick Laura , Young Robert , Mondal Shreya , Oliveira Andre M. , Blobel Gerd A. , Chou Margaret M.
Published: August 2023

NK depletion confirmation
FIGURE 6 from Natural Killer Cell Activation by Ubiquitin-specific Protease 6 Mediates Tumor Suppression in Ewing Sarcoma
Authors: Jain Kanika , Henrich Ian C. , Quick Laura , Young Robert , Mondal Shreya , Oliveira Andre M. , Blobel Gerd A. , Chou Margaret M.
Published: August 2023

Intratumoral USP6 expression induces systemic activation of NK and myeloid cells. RAG2−/− mice were xenografted with USP6/A673 and treated with or without dox, or not xenografted (Control, Ctrl). PB was collected approximately 3 weeks later, and subjected to flow cytometry. Abundance, early/late activation, proliferative potential, and cytotoxic activity were assessed using the indicated markers in the entire NK population (NK1.1+/NKp46+; A), and in NK cell subpopulations as defined by levels of CD27 and CD11b (B; see also Supplementary Fig. S6 for definition of subsets). C, Abundance of myeloid populations (among the CD11b+/CD45+ cells) as defined by the indicated markers (Ctrl n = 4, −dox n = 6, +dox n = 9).
Phase Separation in Kidney Diseases: Autosomal Dominant Polycystic Kidney Disease and Beyond
Authors: Zhang Lirong , Liu Zhiheng , Lu Yumei , Nie Jing , Chen Yupeng
Published: August 2023

Background: The formation of biomolecular condensates via phase separation has emerged as a fundamental principle underlying the spatiotemporal coordination of biological activities in cells. Aberrant biomolecular condensates often directly regulate key cellular process involved in the pathogenesis of human diseases, including kidney diseases. Summary: In this review, we summarize the physiological roles of phase separation and methodologies for phase separation studies. Taking autosomal dominant polycystic kidney disease as an example, we discuss recent advances toward elucidating the multiple mechanisms involved in kidney pathology arising from aberrant phase separation. We suggest that dysregulation of phase separation contributes to the pathogenesis of other important kidney diseases, including kidney injury and fibrosis. Key Messages: Phase separation provides a useful new concept to understand the mechanisms underlying kidney disease development. Targeting aberrant phase-separated condensates offers new therapeutic avenues for combating kidney diseases.
Diplomats as Skilful Bricoleurs of the Digital Age: EU Foreign Policy Communications from the COREU to WhatsApp
Authors: Bicchi Federica , Lovato Marianna
Published: August 2023

The article analyses how and to what effect diplomats navigate a landscape in which the physical and the digital have become inextricably intertwined, with emphasis on written communications in the European Union (EU) foreign policy system from the 1970s to the present. Putting International Relations literature into dialogue with Management Studies (particularly media richness theory and sense-making), it looks at how diplomats work their way through different forms of digital written communications. It addresses the effects of diplomacy’s digitalisation in terms of time, space and confidentiality. Digital tools have hastened diplomacy’s tempo and affected security considerations, while they have had mixed effects in terms of centre–periphery relations in diplomatic conversations, particularly for gender and wealth. The EU foreign policy system exemplifies these dynamics, from the spectacular rise of the COREU system to its decline in favour of faster, easier-to-use technologies such as e-mail and texting.
Early Prediction and HRCT Evaluation of Post Covid-19 Related Lung Fibrosis
Authors: Rahman Md. Tanzilur , Nahar Nishat Un , Ibrahim Md. , Islam Iftadul , Bhowmik Bishwajit , Shirin Mahbuba , Khan Md. Mizanur Rahman , Akkas Nafisa , Molla Md. Maruf Ahmed
Published: August 2023

Background:

Early detection of post-COVID-19-related lung fibrosis is very important for the early introduction of treatment and to minimize morbidity and mortality. The aim of this study is the early detection and evaluation of post-COVID-19 fibrosis by high-resolution computed tomography (HRCT).

Methods:

This prospective study included 115 patients irrespective of age and sex, who tested positive for the SARS-CoV-2 by nasopharyngeal swab (RT PCR), admitted to the Dhaka North City Corporation (DNCC) dedicated COVID-19 hospital, Dhaka, and discharged after recovery. Patients went through a chest HRCT scan at least once during their hospital stay and another scan during follow-up after hospital discharge and 8 to 12 weeks of negative RT-PCR report.

Result:

Among 100 patients 23 patients had >50% of total lung involvement by visual assessment. Thirty-three patients had 25% to 50% of total lung volume involvement. Twenty-seven patients had less than 25% of total lung involvement, whereas 17 patients had no visual fibrotic change on the follow-up HRCT scan. A statistical association was found between age, gender, smoking, and severe form of lung fibrosis ( P < .05). Patients with mild CT severity score (⩽8) had a very good prognosis. Patients who were admitted to the hospital for more than 15 days were more prone to developing moderate and severe forms of fibrosis. Patients who received at least 2 doses of the COVID-19 vaccine had less severe forms of fibrosis as well as more cases of complete radiological recovery. On the HRCT scan, most of the patients had bilateral, peripheral (68%), and predominant mid & lower lobar parenchymal involvement.

Conclusion:

Early detection and HRCT evaluation of post-COVID-19 related lung fibrosis is very crucial for early management and introduction of anti-fibrotic drugs.
Risk factors for hypokalemia and its association with postoperative recovery in patients scheduled for radical gastrectomy: a retrospective study
Authors: Yang Min , Li Qian , Zhou Yan , Zhu Yun-Qing , Cui Yu-Xuan , Chen Yu , Zhou Xiao-Kai , He Ming-Feng
Published: August 2023

Background

Hypokalemia is common in patients of various operations, especially gastrointestinal surgery, which seriously affects the safety and enhanced recovery after surgery. Our study aims to explore the risk factors of preoperative hypokalemia of radical gastrectomy for gastric cancer and analyze its impact on postoperative recovery.

Methods

A total of 122 patients scheduled for radical gastrectomy from September, 2022 to December, 2022 were retrospectively analyzed. According to the serum potassium level before skin incision, patients were divided into hypokalemia group (n = 64) and normokalemia group (n = 58). Factors including age, gender, BMI, ASA classification, glutamic pyruvic transaminase (ALT), glutamic oxaloacetic transaminase (AST), creatinine, blood urea nitrogen (BUN), albumin, hypertension history, whether taking calcium channel blockers, β-receptor blockers, angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor antagonist (ARB), thiazide diuretics and other drugs, anemia history, diabetes mellitus history, inability to eat or intestinal obstruction, vomiting, diarrhea, hypokalemia on admission and whether under cooperation with clinical nurse specialist were compared between groups. Univariate logistic regression analysis was used to determine risk factors for hypokalemia with p < 0.2 included as a cutoff. Multivariate logistic regression was used to analyze the influencing factors of preoperative hypokalemia for the indicators with differences. A receiver operating characteristic (ROC) curve was used to evaluate the efficacy of the regression model. Primary exhaust time and defecation time after surgery were compared between the two groups.

Results

The use of ACEI or ARB [OR 0.08, 95% CI (0.01 to 0.58), p = 0.012] and thiazide diuretics [OR 8.31, 95% CI (1.31 to 52.68), p = 0.025], inability to eat for more than 3 days or intestinal obstruction [OR 17.96, 95% CI (2.16 to 149.43), p = 0.008], diarrhea for more than 48 h [OR 6.21, 95% CI (1.18 to 32.61), p = 0.031] and hypokalemia on admission [OR 8.97, 95% CI (1.05 to 77.04), p = 0.046] were independent influencing factors of hypokalemia before skin incision. Primary postoperative exhaust time and defecation time was significantly longer in the hypokalemia group than in the normokalemia group, no matter after laparoscopic radical gastrectomy (p = 0.044, p = 0.045, respectively) or open radical gastrectomy (p = 0.033, p = 0.019, respectively).

Conclusion

Early attention and management of serum potassium in patients undergoing radical gastrectomy can better reduce perioperative adverse reactions and promote recovery of gastrointestinal function.
Building a predictive model of low birth weight in low- and middle-income countries: a prospective cohort study
Authors: Patterson Jackie K. , Thorsten Vanessa R. , Eggleston Barry , Nolen Tracy , Lokangaka Adrien , Tshefu Antoinette , Goudar Shivaprasad S. , Derman Richard J. , Chomba Elwyn , Carlo Waldemar A. , Mazariegos Manolo , Krebs Nancy F. , Saleem Sarah , Goldenberg Robert L. , Patel Archana , Hibberd Patricia L. , Esamai Fabian , Liechty Edward A. , Haque Rashidul , Petri Bill , Koso-Thomas Marion , McClure Elizabeth M. , Bose Carl L. , Bauserman Melissa
Published: August 2023

Background

Low birth weight (LBW, < 2500 g) infants are at significant risk for death and disability. Improving outcomes for LBW infants requires access to advanced neonatal care, which is a limited resource in low- and middle-income countries (LMICs). Predictive modeling might be useful in LMICs to identify mothers at high-risk of delivering a LBW infant to facilitate referral to centers capable of treating these infants.

Methods

We developed predictive models for LBW using the NICHD Global Network for Women’s and Children’s Health Research Maternal and Newborn Health Registry. This registry enrolled pregnant women from research sites in the Democratic Republic of the Congo, Zambia, Kenya, Guatemala, India (2 sites: Belagavi, Nagpur), Pakistan, and Bangladesh between January 2017 – December 2020. We tested five predictive models: decision tree, random forest, logistic regression, K-nearest neighbor and support vector machine.

Results

We report a rate of LBW of 13.8% among the eight Global Network sites from 2017–2020, with a range of 3.8% (Kenya) and approximately 20% (in each Asian site). Of the five models tested, the logistic regression model performed best with an area under the curve of 0.72, an accuracy of 61% and a recall of 72%. All of the top performing models identified clinical site, maternal weight, hypertensive disorders, severe antepartum hemorrhage and antenatal care as key variables in predicting LBW.

Conclusions

Predictive modeling can identify women at high risk for delivering a LBW infant with good sensitivity using clinical variables available prior to delivery in LMICs. Such modeling is the first step in the development of a clinical decision support tool to assist providers in decision-making regarding referral of these women prior to delivery. Consistent referral of women at high-risk for delivering a LBW infant could have extensive public health consequences in LMICs by directing limited resources for advanced neonatal care to the infants at highest risk.
Factors associated with the intention of pregnant women to give birth with epidural analgesia: a cross-sectional study
Authors: Van Leugenhaege Luka , Degraeve Julie , Jacquemyn Yves , Mestdagh Eveline , Kuipers Yvonne J.
Published: August 2023

Background

In Belgium most women receive epidural analgesia during labour. Although, it offers satisfactory pain relief during labour, the risk on a series of adverse advents has been reported. The objective of this study was to determine factors associated with the intention of pregnant women, anticipating a vaginal birth, of requesting epidural analgesia during labour.

Methods

A cross-sectional study, using an online self-report questionnaire was performed, including socio-demographic and personal details. Associated factors were examined with the HEXACO-60 questionnaire, the Mental Health Inventory-5, the Tilburg Pregnancy Distress Scale and the Labour Pain Relief Attitude Questionnaire for pregnant women. The level of intention to request epidural analgesia was based on two questions: Do you intend to ask for epidural analgesia (1) at the start of your labour; (2) at some point during labour? Data were collected predominantly during the second and third trimester of pregnancy. Descriptive analysis and a multiple linear regression analysis were performed.

Results

949 nulliparous (45.9%) and multiparous (54.1%) pregnant women, living in Flanders (Dutch-speaking part of Belgium) anticipating a vaginal birth completed the questionnaires. Birth-related anxiety (ß 0.096, p < 0.001), the attitude that because of the impact of pregnancy on the body, asking for pain relief is normal (ß 0.397, p < 0.001) and feeling more self-confident during labour when having pain relief (ß 0.034, p < 0.001) show a significant positive relationship with the intention for intrapartum epidural analgesia. The length of the gestational period (ß − 0.056, p 0.015), having a midwife as the primary care giver during pregnancy (ß − 0.048, p 0.044), and considering the partner in decision-making about pain relief (ß − 0.112, p < 0.001) show a significant negative relationship with the intention level of epidural analgesia. The explained variability by the multiple regression model is 54%.

Conclusions

A discussion during pregnancy about the underlying reason for epidural analgesia allows maternity care providers and partners to support women with pain management that is in line with women’s preferences. Because women’s intentions vary during the gestational period, pain relief should be an issue of conversation throughout pregnancy.
Predictors of pregnancy stress and psychological birth trauma in women undergoing vaginal delivery: a cross-sectional study in China
Authors: Ma Dongmei , Sun Shiwen , Qian Jialu , Wang Man , Gu Huimin , Lou Jingjing , Yu Xiaoyan
Published: August 2023

Background

Psychological birth trauma exhibits a high incidence worldwide, resulting in a wide range of negative impacts on mothers, infants, couples, families and society at large through the maternal-centered ripple effect. However, there is currently limited research on psychological birth trauma in China. Social support and pregnancy stress are important influencing factors of psychological birth trauma. Consequently, this study aimed to explore predictors of pregnancy stress and psychological birth trauma in women undergoing vaginal delivery in China.

Methods

This cross-sectional study was performed at a single medical center between December 2021 and May 2022 in Hangzhou, China. Participants were selected using a convenience sampling technique. A total of 351 postpartum women within one week after vaginal delivery were included. Questionnaires were used to collect sociodemographic and obstetric characteristics and scores on the Pregnancy Stress Rating Scale (PSRS), City Birth Trauma Scale (City BiTS), Social Support Rating Scale (SSRS) and Family Adaptation Partnership Growth Affection and Resolve index (Family APGAR). Both univariate analysis and multiple linear regression analysis were conducted to assess predictors of pregnancy stress and psychological birth trauma.

Results

The median (IQR) of PSRS and City BiTS scores were 10.00 (14.00) and 3.00 (9.00), respectively. The incidence of postpartum posttraumatic stress disorder was 4.0% (14/351). Parity, social support, family support and level of education were predictors of pregnancy stress. Delivery complications, psychological traumatic event, pregnancy stress and family support were predictors of psychological birth trauma (P < 0.05).

Conclusion

Pregnancy stress is related to social support, family support and some sociodemographic and obstetric characteristics. Psychological birth trauma is correlated with delivery complications, psychological traumatic event, pregnancy stress and family support. Consequently, enhancing social support, especially family support, for pregnant women as a means of reducing pregnancy stress can effectively prevent psychological birth trauma.
Navigating young minds: reliability and validity of the Greek version of kiddie – schedule for affective disorders and schizophrenia – present and lifetime DSM-5 version (K-SADS-PL-GR-5)
Authors: Kolaitis Gerasimos , Zaravinos-Tsakos Foivos , Rokas Ioannis-Marios , Syros Ioannis , Tsakali Antonia , Belivanaki Maria , Giannakopoulos Georgios
Published: August 2023

Background

The Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL) is one of the most popular semi-structured psychiatric interviews for children and adolescents. Its latest DSM-5 version (K-SADS-PL DSM-5) has only recently been adapted and validated in various languages. In the present study, we aimed to investigate the reliability and validity of the Greek version of the K-SADS-PL DSM-5.

Methods

A total of 137 patients consecutively referred for admission, aged 7–17, were included. The K-SADS-PL DSM-IV was translated and adapted to correspond to DSM-5 categories. Convergent and divergent validity were assessed against two self-report rating scales, Children’s Depression Inventory (CDI) and Screen for Child Anxiety Related Emotional Disorders (SCARED). Inter-rater reliability was calculated exclusively for instances where a diagnosis involved three or more patients.

Results

Our findings revealed good to excellent inter-rater reliability and good to excellent consensual validity across most psychiatric diagnoses, except for panic disorder. Diagnostic efficiency, measured by sensitivity, specificity, positive and negative predictive values, consistently showed high specificity and negative predictive validity across all diagnostic categories.

Conclusions

These findings support the applicability of the Greek version of the K-SADS-PL DSM-5 as a reliable and valid diagnostic tool in Greek-speaking populations.
Association between dietary carotenoids intake and chronic constipation in American men and women adults: a cross-sectional study
Authors: Wang Jiangnan , Kong Wanru , Liu Min , Wang Yuping , Zheng Ya , Zhou Yongning
Published: August 2023

Background

Dietary carotenoids have been proven to improve intestinal disorders like inflammatory bowel disease and colon cancer, yet little is known about the link between dietary carotenoids and constipation. This study aims to examine the relationship between dietary carotenoids intake and constipation, using data from the National Health and Nutrition Examination Survey (NHANES) 2005–2010.

Methods

A total of 11,722 participants were enrolled. Chronic constipation was defined as type 1 (separate hard lumps, like nuts) and type 2 (sausage-like, but lumpy) in the Bristol stool form scale (BSFS). Carotenoids intake was obtained from the average of two 24-hour dietary recall questionnaires (if only one 24-hour was available, we used it) and divided into quartiles (Q). The prevalence of constipation was calculated across men and women individuals. The relationship between dietary carotenoids intake and constipation in men and women was assessed with weighted logistic regression and smoothed curve fitting after adjusting confounders, with results displayed as weighted odds ratio (OR) with 95% confidence intervals (95% CI). The model was further stratified by age, race, and HEI 2015 scores (with median as cutoff) among men and women.

Results

The total weighted prevalence of chronic constipation in this study was 8.08%, 11.11% in women and 5.18% in men. After multivariable adjustment, compared with the lowest intake, participants with the highest dietary lycopene intake (ORQ4 vs. Q1= 0.55, 95% CI: 0.36–0.84, p for trend = 0.01) and total lycopene intake (ORQ4 vs. Q1 = 0.52, 95% CI: 0.34–0.80, p for trend = 0.01) were negatively associated with the risk of chronic constipation in men, whereas increased dietary α-carotene intake reduced the risk of chronic constipation in women (ORQ4 vs. Q1 = 0.69, 95% CI: 0.48–0.98, p for trend = 0.04). Smoothing curve fitting further supported these results and provided evidence of dose-response effects. No association was found between other types of carotenoids and chronic constipation in men and women.

Conclusions

Increasing lycopene intake may improve bowel function in men while increased α-carotene intake may reduce the risk of chronic constipation in women. Further studies are essential to explore the role that the intake of carotenoids plays in chronic constipation.
How to coach student professional development during times of challenges and uncertainties
Authors: van Ede Annelies E. , Claessen Roy J. M. , van Gils Merel , Gorgels Wim J. M. J. , Reuzel Rob P. B. , Smeets Annemieke G. J. M. , van Gurp Petra J. M.
Published: August 2023

Background

What we teach our (bio)medical students today may differ from the future context under which they will operate as health professionals. This shifting and highly demanding profession requires that we equip these students with adaptive competencies for their future careers. We aimed to develop a framework to promote and facilitate professional development from day one, guided by self-awareness and self-directed learning.

Approach

Based on self-directed, transformative and experiential learning, patient involvement and teamwork, we developed a 3-year longitudinal personal-professional development (LPPD) program in the (bio)medical sciences undergraduate curriculum to stimulate self-driven professional development in a variable context. Through group meetings and individual coach consultations, students address topics such as self-awareness, self-directed and lifelong learning, collaboration, well-being and resilience. To drive learning students receive extensive narrative feedback on an essay assignment.

Evaluation

Experiences and outcomes were evaluated with questionnaires and in-depth interviews. Students and coaches value personal and professional development in a safe learning environment that encourages self-exploration, diversity and connection. Over time, students show more self-awareness and self-directedness and increasingly apply trained skills, resulting in professional identity formation. Students need more clarification to understand the concept of assessment as learning.

Implications

With the generic content of a longitudinal program embedded in a meaningful environment, the personal and professional development of students can be facilitated and stimulated to face future challenges. When translating to other curricula, we suggest considering the complexity of professional development and the time expenditure needed for students to explore, experiment and practice. An early start and thorough integration are recommended.
Shared decision making for anticoagulation reduces anxiety and improves adherence in patients with atrial fibrillation
Authors: Chiu Hsiao-Hui , Chang Shih-Lin , Cheng Hao-Min , Chao Tze-Fan , Lin Yenn-Jiang , Lo Li-Wei , Hu Yu-Feng , Chung Fa-Po , Liao Jo-Nan , Tuan Ta-Chuan , Lin Chin-Yu , Chang Ting-Yung , Kuo Ling , Liu Chih-Min , Tsai Yung-Nan , Huang Yu-Ting , Chang Yuh-Lih , Wung Ju-Chieh , Chen Shih-Ann
Published: August 2023

Background

Treatment with oral anticoagulants (OACs) could prevent stroke in atrial fibrillation (AF), but side effects developed due to OACs may cause patients anxiety during decision making. This study aimed to investigate whether shared decision making (SDM) reduces anxiety and improves adherence to stroke prevention measures in patients with AF.

Methods

A one-group pretest–posttest design using a questionnaire survey was applied at the outpatient cardiology clinic between July 2019 until September 2020. A Patient Decision Aid (PDA) tool was used for the completion of the questionnaire survey after health education and counseling. Ten questions were included for patients’ recognition of SDM, and a 5-point scoring method was used, where “very much” was scored as 5 points, and “totally not” was scored as 1 point.

Results

Fifty-two patients with AF were enrolled. In terms of patients’ recognition of SDM, points of more than 4.17 out of 5 were noted, indicating recognition above the level of “very much.” The patients’ anxiety scores before SDM were 3.56 (1.2), with a decrease of 0.64 points (p < 0.001) to 2.92 (1.3) after SDM. After SDM, the number of patients who decided to take OAC increased from 76.9% to 88.5%, and the 15.4% answering “unclear” decreased to 1.9% (p = 0.006). The patients’ anxiety levels after SDM were associated with gender (p = 0.025).

Conclusions

The approach using SDM enhanced our understanding of the pros and cons of OAC treatment and, in patients with AF, decreased anxiety about therapeutic decisions and increased willingness to accept treatment options.