bluuebunny/crossref_metadata_2025 huggingface dataset:
Environmental Drivers of Antimicrobial Resistance in Low and Middle-Income Countries: The Impacts of a Changing World
Authors: Nashwan Abdulqadir J , Shah Hussain Haider , Hussain Tooba , Rauf Sameer Abdul , Ahmed Sirwan Khalid
Published: April 2024

This letter highlights the impact of environmental drivers on antimicrobial resistance (AMR) in low and middle-income countries (LMICs) and highlights the need for a comprehensive approach to address this global health threat. Key factors, such as agricultural practices, wastewater treatment, and pollution, contribute to the development and spread of resistant pathogens. Utilizing the One Health approach, the paper emphasizes the importance of promoting responsible antimicrobial use, strengthening public health systems, investing in innovative research, and raising public awareness. By understanding and addressing these environmental drivers, we can work toward safeguarding global health and ensuring a sustainable future.
The impact of educational and medical systems on autistic children from multilingual American homes: A systematic review
Authors: Kim Hyejung , Baker Diana , Kim Sunyoung , Liu Cong , Cook Kelley
Published: April 2024

Research has demonstrated that multilingual exposure does not inherently impede language development or academic achievement in autistic children. Nevertheless, autistic students who are multilingual learners may experience unique challenges in the United States, where systemic barriers constrain both the diagnosis and the delivery of education. This review synthesizes 46 US-based studies to assess how educational and, to a lesser extent, medical systems are (or are not) prepared to offer adequate support to autistic individuals from multilingual families. Results reveal varied patterns of systemic inequity faced by multilingual children on the autism spectrum, elucidating the issues of disproportionality as well as unequal access to educational and medical resources. While the majority of studies emphasize the benefits of multilingual environments for autistic students, a persistent trend in favor of monolingual instructional strategies remains. Despite this, emerging publications present experimental evidence that drawing on students’ first languages can bolster academic and behavioral performance and strengthen executive functioning.

Lay Abstract

Research has found that autistic children can navigate multilingual schools and communities without harming their language skills or school success. However, they may encounter specific challenges within the United States, where educational and healthcare systems are insufficiently equipped to meet their needs. This review examined 46 US-based studies on the topic and findings reveal persistent deficit-based ideas about multilingualism and autism (e.g., professionals recommending that autistic students only speak and learn in English) accompanied by patterns of unequal identification of autism among multilingual children. These findings highlight issues of disproportionality and inadequate access to educational and healthcare resources. However, recent studies indicate that incorporating a child’s native language in education not only enhances learning and behavioral outcomes but also boosts cognitive functions like problem-solving and planning. Taken as a whole, current research suggests that intentionally addressing linguistic diversity will allow educational and medical systems to better serve autistic children.
Typhoon- and temperature-induced responses of a cable-stayed bridge
Authors: Jing Qiang , Shan Yushi , Zhang Lu , Yan Yu , Xia Zili , Xia Yong
Published: April 2024

Long-span bridges are subjected to wind and temperature actions. Wind action is generally the governing load of long-span bridges in design, while temperature action is also significant. Accurate separation of typhoon- and temperature-induced responses is thus necessary for in-depth investigation of their effects and comprehensive evaluation of structural performance. This paper separates the temperature- and typhoon-induced responses of the Qingzhou Bridge by using a unified global analysis approach. The field-monitored meteorological data and structural responses collected from the structural health monitoring system installed on the bridge are analyzed in detail, with emphasis on the comparison of those during typhoon Higos (Signal No. 9) and a typical sunny day after the typhoon. Results show that the quasi-static variation of displacement and stress responses are higher on a typical sunny day than those during the typhoon period, which is out of intuition. Through the unified analysis, the temperature-induced responses are calculated, and the typhoon-induced responses can be separated. The temperature- and typhoon-induced longitudinal displacement, mid-span deflection, and stress of the girder are compared. The temperature-induced response accounts for a large part of the total quasi-static recording either on a typical sunny day or during the typhoon period, whereas typhoon caused significant dynamic responses. The typhoon-induced quasi-static and dynamic responses are also in good agreement with the wind tunnel test results. This case study demonstrates the effectiveness of the unified global analysis in separating the temperature effect.
Complications and Efficacies of Surgical Versus Transcatheter Closure for Pediatric Ostium Secundum Atrial Septal Defect: A Meta-Analysis
Authors: de Liyis Bryan Gervais , Kosasih Anastasya Maria , Jagannatha Gusti Ngurah Prana , Dewangga Made Satria Yudha
Published: April 2024

Introduction:

The optimal approach for pediatric ostium secundum atrial septal defect (ASD) closure remains uncertain. This study aims to assess complications and efficacies of surgical and transcatheter closures.

Methods:

Systematic search in Medline, Cochrane, and EMBASE databases identified cohort studies until July 2023. Complications, length of hospital stay, and efficacy outcomes were evaluated. Subgroup analyses considered ethnicity, ASD size, age, and rim deficiency involvement.

Results:

Fourteen cohort studies involving 9695 patients were comprehensively analyzed. Regarding complications, the pediatric patients in the surgery group exhibited higher occurrences of cardiac arrhythmia (odds ratio [OR]: 1.87, 95% confidence interval [CI]: 1.22–2.87, p=0.004), pericardial effusion (OR: 14.80, 95% CI: 6.97–31.43, p<0.00001), and pulmonary complications (OR: 2.58, 95% CI: 1.73–3.85, p<0.00001) compared with those in the transcatheter group. However, no significant difference in fever incidence was observed (OR: 2.57, 95% CI: 0.90–7.34, p=0.08). Furthermore, length of hospital stay was notably shorter in the pediatric transcatheter group (mean difference [MD]: 4.00, 95% CI: 1.71–6.29, p=0.0006). Regarding efficacies, both groups demonstrated similar rates of successful closure (OR: 1.97, 95% CI: 0.56–6.92, p=0.29) and residual shunting (OR: 0.55, 95% CI: 0.17–1.77, p=0.31) in the pediatric cohort. Subgroup analyses revealed that surgical residual shunting was notably lower in the European pediatric population (OR: 0.18, 95% CI: 0.07–0.45, p=0.0002), in cases with ASD size exceeding 15 mm (OR: 0.19, 95% CI: 0.08–0.49, p=0.0006), and in pediatric patients younger than 8 years (OR: 0.33, 95% CI: 0.12–0.92, p=0.03). Interestingly, residual shunting involving complex ASD with rim deficiency was more pronounced in the surgery group (OR: 2.66, 95% CI: 1.33–5.32, p=0.006).

Conclusions:

Both surgical and transcatheter closures are equally effective, with transcatheter closure showing significantly fewer complications.

Clinical Impact

This meta-analysis offers pivotal insights for clinicians grappling with the optimal approach to pediatric ostium secundum ASD closure. The observed higher incidence of cardiac arrhythmias, pericardial effusions, and pulmonary complications in surgical closures underscores the challenges associated with this modality. In contrast, transcatheter closure, with its comparable efficacy and shorter hospital stays, emerges as an appealing and less invasive alternative. These findings equip clinicians with evidence to make informed decisions, optimizing patient outcomes. Subgroup analyses further refine recommendations, emphasizing tailored considerations for European pediatric patients, larger ASDs, and those under 8 years old, ultimately fostering personalized and improved care strategies.
Simulation-based evaluation of effects of fabric structure on thermal conductivity of various 2D woven composites
Authors: Alghamdi Abdulrahman
Published: April 2024

The thermal conductivities of woven composites are strongly affected by the anisotropic properties of the reinforcing fibers, and thus by the fabric structure. In this study, the thermal conductivity of 2D woven composites was investigated by optimizing the fabric structures to enhance the through-thickness and in-plane thermal conductivities. Multiscale finite element models were developed to simulate the thermal behavior of various 2D fabric structures and evaluate their thermal performance under varying conditions, focusing on the effects of fiber tow undulation, dry-zone porosity, and matrix-rich zones. Fabric architectures were selected based on common 2D weavings of composites. The results showed that the tow undulation substantially enhanced the through-thickness conductivity and mitigated the impact of porosity. In addition, a higher tow anisotropy increased the effect of undulation. Moreover, the plain-weave fabric structures exhibited the highest through-thickness and in-plane thermal conductivities among the evaluated 2D woven fabrics in porous composites. Finally, the matrix-rich zones showed a stronger effect on the through-thickness than on the in-plane thermal conductivity of the 2D woven composites.
A Collaborative Conservation Perspective: Ensuring Preservation, Access, and Safety in Exhibits
Authors: Herrmann Jennifer , Kim Dong Eun
Published: April 2024

Ensuring preservation, access and safety in exhibits relies heavily on collaboration. This paper describes some examples of ways conservators and scientists at the National Archives collaborate with archivists, collection managers, and exhibit staff in preparation for exhibitions to support NARA’s mission of public access to high-value federal government records.
Do uncontrolled processes contribute to evaluative learning? Insights from a new two-US process dissociation procedure and ambivalence measures
Authors: Béna Jérémy , Lacassagne Doris , Corneille Olivier
Published: April 2024

The contribution of uncontrolled processes to evaluative learning has been examined in evaluative conditioning procedures by comparing evaluations of conditioned stimuli between tasks or within tasks but between learning instruction conditions. In the present research, we introduced a new procedure that keeps both tasks and instructions constant. In addition, we introduced ambivalence measures to address this uncontrollability question. The new procedure involves forming an impression of conditioned stimuli based on their pairing with one unconditioned stimulus while attending but discarding the influence of another unconditioned stimulus holding the same (congruent trials) versus a different (incongruent trials) valence. When the to-be-used and to-be-discarded unconditioned stimuli share the same (vs. a different) valence, controlled and uncontrolled processes should support the same (vs. opposite) responses. We used this approach in two preregistered experiments ( Ntotal = 467) using dichotomous evaluative classifications (Experiments 1 and 2), evaluative ratings, and two measures of attitudinal ambivalence: mouse trajectories and felt ambivalence (Experiment 2). While we failed to find evidence for uncontrolled processes in evaluative classification frequencies separately in Experiments 1 and 2, analyses of aggregated classification frequencies across Experiments 1 and 2 suggested a small contribution of uncontrolled processes. In addition, we found larger felt ambivalence for incongruent than congruent trials. Overall, the present findings are mixed but support the possibility of a contribution of uncontrolled processes to evaluative learning, even when control is applied to a focal stimulus and additional influences come from a to-be-disregarded stimulus.
Nothing Changed, Nothing Gained? Emotional Responses towards European Integration in the Memoirs of Polish Farmers
Authors: Radowska-Lisak Mirosława , Kowalska Magdalena
Published: April 2024

Accession to the European Union (EU) aroused diverse emotions in public debate among citizens, but the everyday experience of being an EU member is much more difficult to narrate than by relating to two contrasting views for and against European integration. The situation becomes more complicated if we analyse the emotional responses of Polish farmers, for whom joining the EU has been one more change in the last two centuries: the fall of feudalism, the agricultural reform after the Second World War, and the post-1989 political transformation. We aim to analyse personal narratives while observing how feelings about the EU have become embedded in everyday life experience narratives and how they are expressed and managed in a socio-cultural context. The presence of contradictory views was expected, as was the appearance of a combination of emotions and indifference, and, finally, the use of emotions as resistance. Based on the analysis of 55 memoirs from 1918 to 2018, we have determined the possible types of the integration experience; firstly, Poland’s accession to the EU meant change and was associated mainly with positive emotions, secondly, with negative emotions, thirdly, it meant change, and was associated with ambiguous emotions; and lastly, it did not mean a change. We noted not only the contrasting positions e.g. hope and fear but also the mixture of emotions and various paths of resistance that included demonstrating the inadequacy of the master narrative to personal experience or neutralising it but also filling the intermediary space between two opposite views and finding a way out from this opposition to the higher level of division and thus narrating non-change. It is the sense of personal dignity and permanence that negates the perception of accession as a change.
People in a Biodiverse Region Experienced Varying Types and Timing of Conflict With Multiple Wildlife Species
Authors: Buchholtz Erin
Published: April 2024

Background & Research Aims: Understanding how people and wildlife coexist is crucial to informing conservation and management of biodiverse areas, supporting both wildlife conservation and human well-being. Yet, most studies of human-wildlife conflict and coexistence focus on a limited number of wildlife species. Methods: This study characterizes patterns of reported human-wildlife conflict in the Okavango region of Botswana based on records for all species from the Botswana Department of Wildlife and National Parks (2008 – 2016). Results: The reported incidents implicated a diverse range of wildlife species in conflict. The patterns indicated that for conflicts like crop and property damage, only a few main species were implicated, while livestock damage reports had more diversity of conflict species. Additionally, people in this region faced wildlife challenges throughout the year. Conclusion & Implications for Conservation: Having such variable types and timing of conflict, and from diverse species, may make it particularly difficult for people to mitigate costs and prevent further conflicts.
The Moderating Role of HIV Stigma on the Relationship between Perceived Social Support and Antiretroviral Therapy Adherence Self-Efficacy among Adult PLHIV in South Africa
Authors: Luthuli Muziwandile Qiniso , John-Langba Johannes
Published: April 2024

Background

People living with human immune deficiency virus (PLHIV) grapple with distinct challenges, including HIV stigma which affects their antiretroviral therapy (ART) adherence self-efficacy. This study investigates the interaction of HIV stigma and perceived social support on ART adherence self-efficacy among adult PLHIV in South Africa.

Methods

This study utilized a cross-sectional design that involved 201 participants selected using time location sampling at a tertiary health facility in Durban.

Results

HIV stigma was significantly and negatively associated with self-efficacy (β = −7.860, t = −4.654, p = .001), with variations across different stigma levels (β = −5.844, t = −4.003, p = .001). Social support was significantly and positively associated with self-efficacy at lower HIV stigma levels (β = 7.440, t = 3.887, p = .001), in contrast to higher levels (β = −2.825, t = 1.400, p = .163).

Conclusion

Social support significantly influences ART adherence self-efficacy, particularly at lower levels of HIV stigma, but the effect of support weakens as stigma intensifies.
An indirect comparison of acalabrutinib with and without obinutuzumab vs zanubrutinib in treatment-naive CLL
Authors: Kittai Adam S. , Allan John N. , James Dan , Bridge Helen , Miranda Miguel , Yong Alan S. M. , Fam Fady , Roos Jack , Shetty Vikram , Skarbnik Alan , Davids Matthew S.
Published: April 2024

The efficacy and safety of acalabrutinib plus obinutuzumab and acalabrutinib monotherapy vs zanubrutinib in patients with treatment-naive chronic lymphocytic leukemia/small lymphocytic lymphoma without del(17p) were compared using an unanchored matching-adjusted indirect comparison. Individual patient-level data from ELEVATE-TN (acalabrutinib plus obinutuzumab, n = 162; acalabrutinib monotherapy, n = 163) were weighted to match published aggregate baseline data from SEQUOIA cohort 1, which excluded patients with del(17p) (zanubrutinib, n = 241), using variables that were prognostic/predictive of investigator-assessed progression-free survival (INV-PFS) in an exploratory Cox regression analysis of ELEVATE-TN. After matching, INV-PFS was longer with acalabrutinib plus obinutuzumab (hazard ratio [HR], 0.41; 95% confidence interval [CI], 0.23-0.74) and comparable with acalabrutinib monotherapy (HR, 0.91; 95% CI, 0.53-1.56) vs zanubrutinib. Acalabrutinib monotherapy had significantly lower odds of any grade hypertension vs zanubrutinib (odds ratio [OR], 0.44; 95% CI, 0.20-0.99), whereas acalabrutinib plus obinutuzumab had significantly higher odds of neutropenia (OR, 2.19; 95% CI, 1.33-3.60) and arthralgia (OR, 2.33; 95% CI, 1.37-3.96) vs zanubrutinib. No other significant differences in safety were observed. In summary, acalabrutinib plus obinutuzumab had longer INV-PFS with increased odds of neutropenia and arthralgia than zanubrutinib, whereas acalabrutinib monotherapy had similar INV-PFS with lower odds of any grade hypertension. These trials were registered at www.ClinicalTrials.gov as #NCT02475681 and #NCT03336333.
Changes in physical activity, sedentary behaviour and sleep following pulmonary rehabilitation: a systematic review and network meta-analysis
Authors: Manifield James , Chaudhry Yousuf , Singh Sally J. , Ward Thomas J.C. , Whelan Maxine E. , Orme Mark W.
Published: April 2024

Background:

The variety of innovations to traditional centre-based pulmonary rehabilitation (CBPR), including different modes of delivery and adjuncts, are likely to lead to differential responses in physical activity, sedentary behaviour and sleep.

Objectives:

To examine the relative effectiveness of different pulmonary rehabilitation-based interventions on physical activity, sedentary behaviour and sleep.

Methods:

Randomised trials in chronic respiratory disease involving pulmonary rehabilitation-based interventions were systematically searched for. Network meta-analyses compared interventions for changes in physical activity, sedentary behaviour and sleep in COPD.

Results:

46 studies were included, and analyses were performed on most common outcomes: steps per day (k=24), time spent in moderate-to-vigorous physical activity (MVPA; k=12) and sedentary time (k=8). There were insufficient data on sleep outcomes (k=3). CBPR resulted in greater steps per day and MVPA and reduced sedentary time compared to usual care. CBPR+physical activity promotion resulted in greater increases in steps per day compared to both usual care and CBPR, with greater increases in MVPA and reductions in sedentary time compared to usual care, but not CBPR. Home-based pulmonary rehabilitation resulted in greater increases in steps per day and decreases in sedentary time compared to usual care. Compared to usual care, CBPR+physical activity promotion was the only intervention where the lower 95% confidence interval for steps per day surpassed the minimal important difference. No pulmonary rehabilitation-related intervention resulted in greater increases in MVPA or reductions in sedentary time compared to CBPR.

Conclusion:

The addition of physical activity promotion to pulmonary rehabilitation improves volume of physical activity, but not intensity, compared to CBPR. High risk of bias and low certainty of evidence suggests that these results should be viewed with caution.
Comparative transcriptome analysis provides molecular insights into heterosis of waterlogging tolerance in Chrysanthemum indicum
Authors: Su Jiangshuo , Zhao Limin , Yang Yingnan , Yang Yang , Zhang Xuefeng , Guan Zhiyong , Fang Weimin , Chen Fadi , Zhang Fei
Published: April 2024

Background

Heterosis breeding is one of the most important breeding methods for chrysanthemum. To date, the genetic mechanisms of heterosis for waterlogging tolerance in chrysanthemum are still unclear. This study aims to analyze the expression profiles and potential heterosis-related genes of two hybrid lines and their parents with extreme differences in waterlogging tolerance under control and waterlogging stress conditions by RNA-seq.

Results

A population of 140 F1 progeny derived from Chrysanthemum indicum (Nanchang) (waterlogging-tolerant) and Chrysanthemum indicum (Nanjing) (waterlogging-sensitive) was used to characterize the extent of genetic variation in terms of seven waterlogging tolerance-related traits across two years. Lines 98 and 95, respectively displaying positive and negative overdominance heterosis for the waterlogging tolerance traits together with their parents under control and waterlogging stress conditions, were used for RNA-seq. In consequence, the maximal number of differentially expressed genes (DEGs) occurred in line 98. Gene ontology (GO) enrichment analysis revealed multiple stress-related biological processes for the common up-regulated genes. Line 98 had a significant increase in non-additive genes under waterlogging stress, with transgressive up-regulation and paternal-expression dominant patterns being the major gene expression profiles. Further, GO analysis identified 55 and 95 transgressive up-regulation genes that overlapped with the up-regulated genes shared by two parents in terms of responses to stress and stimulus, respectively. 6,640 genes in total displaying maternal-expression dominance patterns were observed in line 95. In addition, 16 key candidate genes, including SAP12, DOX1, and ERF017 which might be of significant importance for the formation of waterlogging tolerance heterosis in line 98, were highlighted.

Conclusion

The current study provides a comprehensive overview of the root transcriptomes among F1 hybrids and their parents under waterlogging stress. These findings lay the foundation for further studies on molecular mechanisms underlying chrysanthemum heterosis on waterlogging tolerance.
High-throughput diagnostic markers for foliar fungal disease resistance and high oleic acid content in groundnut
Authors: Pandey Manish K. , Gangurde Sunil S. , Shasidhar Yaduru , Sharma Vinay , Kale Sandip M. , Khan Aamir W. , Shah Priya , Joshi Pushpesh , Bhat Ramesh S. , Janila Pasupuleti , Bera Sandip K. , Varshney Rajeev K.
Published: April 2024

Background

Foliar diseases namely late leaf spot (LLS) and leaf rust (LR) reduce yield and deteriorate fodder quality in groundnut. Also the high oleic acid content has emerged as one of the most important traits for industries and consumers due to its increased shelf life and health benefits.

Results

Genetic mapping combined with pooled sequencing approaches identified candidate resistance genes (LLSR1 and LLSR2 for LLS and LR1 for LR) for both foliar fungal diseases. The LLS-A02 locus housed LLSR1 gene for LLS resistance, while, LLS-A03 housed LLSR2 and LR1 genes for LLS and LR resistance, respectively. A total of 49 KASPs markers were developed from the genomic regions of important disease resistance genes, such as NBS-LRR, purple acid phosphatase, pentatricopeptide repeat-containing protein, and serine/threonine-protein phosphatase. Among the 49 KASP markers, 41 KASPs were validated successfully on a validation panel of contrasting germplasm and breeding lines. Of the 41 validated KASPs, 39 KASPs were designed for rust and LLS resistance, while two KASPs were developed using fatty acid desaturase (FAD) genes to control high oleic acid levels. These validated KASP markers have been extensively used by various groundnut breeding programs across the world which led to development of thousands of advanced breeding lines and few of them also released for commercial cultivation.

Conclusion

In this study, high-throughput and cost-effective KASP assays were developed, validated and successfully deployed to improve the resistance against foliar fungal diseases and oleic acid in groundnut. So far deployment of allele-specific and KASP diagnostic markers facilitated development and release of two rust- and LLS-resistant varieties and five high-oleic acid groundnut varieties in India. These validated markers provide opportunities for routine deployment in groundnut breeding programs.
The association between C-reactive protein and coronary artery calcification: a systematic review and meta-analysis
Authors: Tajani Amirhossein , Sadeghi Masoumeh , Omidkhoda Navid , Mohammadpour Amir Hooshang , Samadi Sara , Jomehzadeh Vahid
Published: April 2024

Background

While coronary artery calcification (CAC) is recognized as a reliable marker for coronary atherosclerosis, the relationship between the concentration of C-reactive protein (CRP) and the incidence and progression of CAC remains controversial.

Method

PubMed, Embase, Web of Science, and Scopus were systematically searched to identify relevant observational studies until October 2023. The methodological quality of the included studies was evaluated using the Newcastle-Ottawa Scale (NOS). A random-effects meta-analysis was employed to calculate pooled odd ratios (OR) and corresponding 95% confidence intervals, considering heterogeneity among the studies.

Results

Out of the 2545 records, 42 cross-sectional and 9 cohort studies were included in the systematic review. The meta-analysis on 12 eligible cross-sectional studies revealed no significant association between CAC and CRP [pooled OR: 1.03 (1.00, 1.06)]. Additionally, an insignificant association was found between CAC and CRP through meta-analysis on three eligible cohort studies [pooled OR: 1.05 (0.95, 1.15)] with no considerable heterogeneity across studies. Sensitivity analyses indicated that the meta-analysis models were robust. There was no evidence of publication bias.

Conclusion

Based on the meta-analysis findings, elevated levels of CRP did not emerge as a valuable prognostic maker for CAC incidence and progression prediction.
Adult vasovagal syncope with abdominal pain diagnosed by head-up tilt combined with transcranial doppler: a preliminary study
Authors: Wang Jingyi , Li Hua , Huang Xuming , Hu Huoyou , Lian Baorong , Zhang Daxue , Wu Jiarui , Cao Liming
Published: April 2024

Background

Syncope is a common condition that increases the risk of injury and reduces the quality of life. Abdominal pain as a precursor to vasovagal syncope (VVS) in adults is rarely reported and is often misdiagnosed.​.

Methods

We present three adult patients with VVS and presyncopal abdominal pain diagnosed by synchronous multimodal detection (transcranial Doppler [TCD] with head-up tilt [HUT]) and discuss the relevant literature.

Results

Case 1: A 52-year-old man presented with recurrent decreased consciousness preceded by six months of abdominal pain. Physical examinations were unremarkable. Dynamic electrocardiography, echocardiography, head and neck computed tomography angiography, magnetic resonance imaging (MRI), and video electroencephalogram showed no abnormalities. Case 2: A 57-year-old woman presented with recurrent syncope for 30 + years, accompanied by abdominal pain. Physical examination, electroencephalography, and MRI showed no abnormalities. Echocardiography showed large right-to-left shunts. Case 3: A 30-year-old woman presented with recurrent syncope for 10 + years, with abdominal pain as a precursor. Physical examination, laboratory analysis, head computed tomography, electrocardiography, and echocardiography showed no abnormalities. Syncope secondary to abdominal pain was reproduced during HUT. Further, HUT revealed vasovagal syncope, and synchronous TCD showed decreased cerebral blood flow; the final diagnosis was VVS in all cases.

Conclusions

Abdominal pain may be a precursor of VVS in adults, and our findings enrich the clinical phenotypic spectrum of VVS. Prompt recognition of syncopal precursors is important to prevent incidents and assist in treatment decision-making. Abdominal pain in VVS may be a sign of sympathetic overdrive. Synchronous multimodal detection can help in diagnosing VVS and understanding hemodynamic mechanisms.
The structure–function relationship between multifocal pupil perimetry and retinal nerve fibre layer in glaucoma
Authors: Carle Corinne F. , Chain Allan Y. H. , Kolic Maria , Maddess Ted
Published: April 2024

Background

Multifocal pupillographic objective perimetry (mfPOP) is a novel method for assessing functional change in diseases like glaucoma. Previous research has suggested that, in contrast to the pretectally-mediated melanopsin response of intrinsically photosensitive retinal ganglion cells, mfPOP responses to transient onset stimuli involve the extrastriate cortex, and thus the main visual pathway. We therefore investigate the correlation between peripapillary retinal nerve fibre layer (pRNFL) thickness and glaucomatous visual field changes detected using mfPOP. Parallel analyses are undertaken using white on white standard automated perimetry (SAP) for comparison.

Methods

Twenty-five glaucoma patients and 24 normal subjects were tested using SAP, 3 mfPOP variants, and optical coherence tomography (OCT). Arcuate clusters of the SAP and mfPOP deviations were weighted according to their contribution to published arcuate divisions of the retinal nerve fibre layer. Structure–function correlation coefficients (r) were computed between pRNFL clock-hour sector thickness measurements, and the local visual field sensitivities from both SAP and mfPOP.

Results

The strongest correlation was observed in the superior-superotemporal disc sector in patients with worst eye SAP MD < -12 dB: r = 0.93 for the mfPOP LumBal test (p < 0.001). Correlations across all disc-sectors were strongest in these same patients in both SAP and mfPOP: SAP r = 0.54, mfPOP LumBal r = 0.55 (p < 0.001). In patients with SAP MD ≥ -6 dB in both eyes, SAP correlations across all sectors were higher than mfPOP; mfPOP correlations however, were higher than SAP in more advanced disease, and in normal subjects.

Conclusions

For both methods the largest correlations with pRNFL thickness corresponded to the inferior nasal field of more severely damaged eyes. Head-to-head comparison of mfPOP and SAP showed similar structure–function relationships. This agrees with our recent reports that mfPOP primarily stimulates the cortical drive to the pupils.
Effects of antidepressant on FKBP51 mRNA expression and neuroendocrine hormones in patients with panic disorder
Authors: Zou Zhili , Huang Yulan , Maes Michael , Wang Jinyu , He Ying , Min Wenjiao , Zhou Bo
Published: April 2024

Objective

The purpose of this study was to investigate the effects of escitalopram on the peripheral expression of hypothalamic-pituitary-adrenal (HPA) axis-related genes (FKBP51,HSP90,NR3C1andPOMC) and HPA-axis hormones in patients with panic disorder (PD).

Methods

Seventy-seven patients with PD were treated with escitalopram for 12 weeks. All participants were assessed for the severity of panic symptoms using the Panic Disorder Severity Scale (PDSS). The expression of HPA-axis genes was measured using real-time quantitative fluorescent PCR, and ACTH and cortisol levels were measured using chemiluminescence at baseline and after 12 weeks of treatment.

Results

At baseline, patients with PD had elevated levels of ACTH and cortisol, andFKBP51expression in comparison to healthy controls (allp < 0.01). Correlation analysis revealed thatFKBP51expression levels were significantly positively related to cortisol levels and the severity of PD (allp < 0.01). Furthermore, baseline ACTH and cortisol levels, andFKBP51expression levels were significantly reduced after 12 weeks of treatment, and the change in the PDSS score from baseline to post-treatment was significantly and positively related to the change in cortisol (p < 0.01).

Conclusions

The results suggest that PD may be associated with elevated levels of ACTH and cortisol, andFKBP51expression, and that all three biomarkers are substantially decreased in patients who have received escitalopram treatment.
A systematic review of the association between history of sexually transmitted infections and subsequent condom use in adolescents
Authors: Tremblay Frédérique , Courtemanche Yohann , Bélanger Richard E. , Turcotte-Tremblay Anne-Marie
Published: April 2024

Sexually transmitted infections (STIs) are common among adolescents. According to the Health Belief Model, cues to action influence preventive behaviors. Cues to action can include health experiences such as being diagnosed with an STI. The impact of a history of STIs on subsequent condom use among adolescents remains largely unexamined, despite high rates of recurrence and their health impacts. This project aimed to systematically review the literature on the association between curable STIs and subsequent condom use among adolescents. The systematic review, reported following PRISMA guidelines, was conducted using the Joanna Briggs Institute method. Eligible studies, in the form of cohort studies, case-control studies, or cross-sectional studies, targeted adolescents aged 10 to 24, with or without a history of curable STIs; the outcome was subsequent condom use. MEDLINE (Ovid), Embase (Elsevier), and Web of Science were searched from January 2012 to December 2022 with the assistance of an information specialist. Two reviewers independently selected articles and extracted data. Risk of bias analysis was performed using ROBINS-E. The review explores results, with tables, based on population characteristics, exposure, and outcome, and addresses the influence of gender, ethnicity, and age. Of 3088 articles identified, seven studies were retained. Almost all the studies focused on African-American, Nigerian, or Rwandan adolescents, and several included only girls. Among girls, a history of STI increased subsequent condom use in combination with other contraceptive methods (n = 4). Among boys and older adolescents of both genders, a history of STI was associated with a decrease in condom use (n = 3). No study distinguished between different STIs. While all the studies (n = 7) presented a high risk of bias, six did not present a threat to conclusion validity. All the studies indicated that a history of STI could influence subsequent protective behaviors, possibly by acting as a cue to action, as posited by the Health Belief Model. This information enhances our understanding of factors leading to the adoption of preventive health measures among adolescents and could apply to other infectious experiences.

Registration The protocol is registered in PROSPERO (CRD42023397443).
Prevalence and correlates of sleep disturbance among adolescents in the eastern seaboard of China
Authors: Yang Haidong , Luan Lingshu , Xu Jiuli , Xu Xingran , Tang Xiaowei , Zhang Xiaobin
Published: April 2024

Background

Sleep disturbances are serious public health issues that warrant increased attention, especially in adolescents. The aim of this study was to investigate the prevalence and factors associated with sleep disorders among urban adolescents in China.

Methods

This study utilized an online survey to assess the demographic characteristics and mental health status of secondary school students in Lianyungang City. The Patient Health Questionnaire-9 (PHQ-9) was used to evaluate sleep disturbances in adolescents. The seven-item Generalized Anxiety Disorder (GAD-7) assessed anxiety symptoms, and the Perceived Social Support Scale (PSSS) was used to measure perceived social support.

Results

Among 3443 adolescents, the prevalence of sleep disorders were 10.8%, with significantly higher proportions of sleep disorders (13.7% VS 8.3%, P < 0.001) among female adolescents when compared to males. Binary regression analysis revealed that anxiety symptoms (OR = 1.305, 95% CI: 1.269–1.342, P < 0.001) was risk factor for sleep disturbances, and significant other support (OR = 0.944, 95% CI: 0.896–0.994, P = 0.028) and good annual household income (OR = 0.616, 95% CI: 0.394–0.963, P = 0.034) were protective factors. Furthermore, multinomial logistic regression analysis showed that age, sex, and anxiety symptoms were associated with an elevated risk of experiencing more frequent sleep disturbances (all P < 0.05).

Conclusions

We have found that 10.8% of adolescents experience sleep disorders, and it is evident that various factors can influence healthy sleeping. These results underscore the significance of addressing these factors to enhance sleep health among this population.
Application of double plate fixation combined with Masquelet technique for large segmental bone defects of distal tibia: a retrospective study and literature review
Authors: Wang Zhaohui , Zou Chengyou , Zhan Xiaohuan , Li Xianhui , Ghen Guocai , Gao Junqing
Published: April 2024

Background

There is no effective consensus on the choice of internal fixation method for the Masquelet technique in the treatment of large segmental bone defects of the distal tibia. Thus, the study aimed to investigate the outcomes of the Masquelet technique combined with double plate fixation in the treatment of large segmental bone defects.

Methods

This was a retrospective study involving 21 patients with large segmental bone defects of the distal tibia who were treated between June 2017 and June 2020. The length of bone defect ranged from 6.0 cm to 11 cm (mean, 8.19 cm). In the first stage of treatment, following complete debridement, a cement spacer was placed to induce membrane formation. In the second stage, double plate fixation and autologous cancellous bone grafting were employed for bone reconstruction. Each patient’s full weight-bearing time, bone healing time, and Iowa ankle score were recorded, and the occurrence of any complications was noted.

Results

All patients were followed up for 16 to 26 months (mean, 19.48 months). The group mean full weight-bearing time and bone healing time after bone grafting were 2.41 (± 0.37) months and 6.29 (± 0.66) months, respectively. During the treatment, one patient had a wound infection on the medial side of the leg, so the medial plate was removed. The wound completely healed after debridement without any recurrence. After extraction of iliac bone for grafting, one patient had a severe iliac bone defect, which was managed by filling the gap with a cement spacer. Most patients reported mild pain in the left bone extraction area after surgery. The postoperative Iowa ankle score range was 84–94 (P < 0.05). In this cohort, 15 cases were rated as “excellent”, and 6 cases as “good” on the Iowa ankle scoring system.

Conclusion

The Masquelet technique combined with double plate fixation is a safe and effective method for the treatment of large segmental bone defects of the distal tibia.
Effects of solid lipid nanocarrier containing methyl urolithin A by coating folate-bound chitosan and evaluation of its anti-cancer activity
Authors: Al-Fatlawi Ilham Naeem Abd Ali , Pouresmaeil Vahid , Davoodi-Dehaghani Fatemeh , Pouresmaeil Aida , Akhtari Ali , Tabrizi Masoud Homayouni
Published: April 2024

Background

Nanotechnology-based drug delivery systems have received much attention over the past decade. In the present study, we synthesized Methyl Urolithin A-loaded solid lipid nanoparticles decorated with the folic acid-linked chitosan layer called MuSCF-NPs and investigated their effects on cancer cells.

Methods

MuSCF-NPs were prepared using a high-pressure homogenization method and characterized using FTIR, FESEM, DLS, and zeta potential methods. Drug encapsulation was assessed by spectrophotometry and its cytotoxic effect on various cancer cells (MDA-MB231, MCF-7, PANC, AGS, and HepG2) by the MTT method. Antioxidant activity was assessed by the ABTS and DPPH methods, followed by expression of genes involved in oxidative stress and apoptosis by qPCR and flow cytometry.

Results

The results showed the formation of monodisperse and stable round nanoparticles with a size of 84.8 nm. The drug loading efficiency in MuSCF-NPs was reported to be 88.6%. MuSCF-NPs exhibited selective cytotoxicity against MDA-MB231 cells (IC50 = 40 μg/mL). Molecular analysis showed a significant increase in the expression of Caspases 3, 8, and 9, indicating that apoptosis was occurring in the treated cells. Moreover, flow cytometry results showed that the treated cells were arrested in his SubG1 phase, confirming the pro-apoptotic effect of the nanoparticles. The results indicate a high antioxidant effect of the nanoparticles with IC50 values ​​of 45 μg/mL and 1500 μg/mL against ABTS and DPPH, respectively. The reduction of catalase gene expression confirmed the pro-oxidant effect of nanoparticles in cancer cells treated at concentrations of 20 and 40 μg/mL.

Conclusions

Therefore, our findings suggest that the MuSCF-NPs are suitable candidates, especially for breast cancer preclinical studies.
Procedural skills workshops for primary care physicians in Israel: a comprehensive analysis
Authors: Rosenblum Omer , Yehoshua Ilan , Adler Limor , Liran Ori
Published: April 2024

Background

Some of the most common complaints addressed by primary care physicians (PCPs) require manual procedures, such as lacerations repair, abscesses drainage, ingrown toenails removal, dry needling for myofascial pain syndrome, and Epley maneuver for treating benign paroxysmal positional vertigo (BPPV). The aim of this study was to describe the procedural skills workshops program for PCPs implemented in Maccabi Healthcare Services and to investigate how many PCPs have participated and used the skills since the program’s inception in 2017.

Methods

In this observational study, we followed all participants in courses from 2017 to 2021. We extracted all procedures performed during these years by PCPs who learned the skill in MHS.

Results

During the study period, 620 PCPs participated in workshops for dry needling, soft-tissue and joint injections, BPPV treatment, minor surgical procedures, and spirometry. Most procedures performed were dry needling (average annual number 3,537) and minor surgical procedures (average annual number 361). The average annual use per physician was highest for dry needling (annual average use per physician who used the learned skill was 50.9), followed by soft tissue and joint injections (16.8), minor surgical procedures (14.8), and BPPV treatment (7.5).

Conclusion

procedural skills workshops may expand PCPs’ therapeutic arsenal, thus empowering PCPs and providing more comprehensive care for patients. Some manual skills, such as dry needling, soft tissue injections, and the Epley maneuver, were more likely to be used by participants than other skills, such as spirometry and soft tissue injections.
Medical students’ AI literacy and attitudes towards AI: a cross-sectional two-center study using pre-validated assessment instruments
Authors: Laupichler Matthias Carl , Aster Alexandra , Meyerheim Marcel , Raupach Tobias , Mergen Marvin
Published: April 2024

Background

Artificial intelligence (AI) is becoming increasingly important in healthcare. It is therefore crucial that today’s medical students have certain basic AI skills that enable them to use AI applications successfully. These basic skills are often referred to as “AI literacy”. Previous research projects that aimed to investigate medical students’ AI literacy and attitudes towards AI have not used reliable and validated assessment instruments.

Methods

We used two validated self-assessment scales to measure AI literacy (31 Likert-type items) and attitudes towards AI (5 Likert-type items) at two German medical schools. The scales were distributed to the medical students through an online questionnaire. The final sample consisted of a total of 377 medical students. We conducted a confirmatory factor analysis and calculated the internal consistency of the scales to check whether the scales were sufficiently reliable to be used in our sample. In addition, we calculated t-tests to determine group differences and Pearson’s and Kendall’s correlation coefficients to examine associations between individual variables.

Results

The model fit and internal consistency of the scales were satisfactory. Within the concept of AI literacy, we found that medical students at both medical schools rated their technical understanding of AI significantly lower (MMS1 = 2.85 and MMS2 = 2.50) than their ability to critically appraise (MMS1 = 4.99 and MMS2 = 4.83) or practically use AI (MMS1 = 4.52 and MMS2 = 4.32), which reveals a discrepancy of skills. In addition, female medical students rated their overall AI literacy significantly lower than male medical students, t(217.96) = -3.65, p <.001. Students in both samples seemed to be more accepting of AI than fearful of the technology, t(745.42) = 11.72, p <.001. Furthermore, we discovered a strong positive correlation between AI literacy and positive attitudes towards AI and a weak negative correlation between AI literacy and negative attitudes. Finally, we found that prior AI education and interest in AI is positively correlated with medical students’ AI literacy.

Conclusions

Courses to increase the AI literacy of medical students should focus more on technical aspects. There also appears to be a correlation between AI literacy and attitudes towards AI, which should be considered when planning AI courses.