bluuebunny/crossref_metadata_2025 huggingface dataset:
Customized Denonvilliers' Fascia Excision: An Advanced total Mesorectal Excision Technique for Anteriorly Located Rectal Cancer
Authors: Bae Sung Uk , Varela Cristopher , Nassr Manar , Kim Nam Kyu
Published: February 2023

BACKGROUND:

The role of Denonvilliers' fascia in achieving a negative circumferential resection margin during anterior total mesorectal excision has been controversial. Opinion on whether to dissect in the anterior or posterior surgical plane varies among researchers.

IMPACT OF INNOVATION:

We performed total mesorectal excision with selective en bloc resection of Denonvilliers' fascia based on preoperative magnetic resonance imaging staging, preoperative clinical tumor stage, and tumor level in selected patients with anterior rectal tumors adherent to Denonvilliers' fascia.

TECHNOLOGY MATERIALS AND METHODS:

Between March and August 2021, 5 patients who underwent robotic (n = 4) and laparoscopic (n = 1) total mesorectal excision for anteriorly located low rectal adenocarcinomas after neoadjuvant chemoradiotherapy were enrolled in this study. Transabdominal total mesorectal excision dissection is performed by changing to a plane anterior to Denonvilliers' fascia, with partial or total excision tailored to the tumor level and depth of invasion as a further step in circumferential resection margin clearing. Customized excision of Denonvilliers' fascia was performed by dissecting through the extramesorectal plane. This anterior plane permits resection of Denonvilliers' fascia, exposing the prostate and seminal vesicles.

PRELIMINARY RESULTS:

Two tumors were located at the seminal vesicle level and 3 were found at the prostate level. The mean distance from the anal verge to the distal margin of the tumor was 4.8 ± 0.9 cm. Denonvilliers' fascia was preserved in one patient and partially excised in four. Customized Denonvilliers' fascia excision was performed in 3 robotic ultra-low anterior resections with coloanal anastomosis, one laparoscopic ultralow anterior resection with coloanal anastomosis, and one robot-assisted abdominoperineal resection. The circumferential resection margins in all patients were negative.

CONCLUSIONS AND FUTURE DIRECTIONS:

Anterior dissection in front of Denonvilliers' fascia can be selectively performed during total mesorectal excision based on preoperative planning, tumor location, and clinical tumor stage. Preoperative magnetic resonance imaging and magnified operative views in minimally invasive platforms provide access to more precise surgical planes for clear circumferential resection, achieving optimal functional outcomes and oncological safety.
A Randomized, Single-Center, Double-Blinded, Split-Body Clinical Trial of Poly-l-Lactic Acid for the Treatment of Cellulite of the Buttocks and Thighs
Authors: Almukhtar Rawaa M. , Wood Emily S. , Loyal Jameson , Hartman Nina , Fabi Sabrina G.
Published: February 2023

BACKGROUND

More than 90% of women report concerns of cellulite on their skin. Poly-l lactic acid (PLLA-SCA) is a biocompatible, semipermanent, synthetic filler that induces neocollagenesis.

OBJECTIVE

To investigate the safety and efficacy of PLLA-SCA for the treatment of cellulite of the buttock and thigh regions.

METHODS

This was a prospective, single-center, double-blinded, split-body, clinical trial of 20 women with slight to moderate skin laxity of the buttocks and/or thighs contributing to mild-to-moderate cellulite. Each subject’s buttocks and thighs were randomized to receive injections with up to 2 vials of PLLA-SCA or the equivalent volume of bacteriostatic water per treatment area. Subjects received at total of 3 treatments 4 weeks apart and were followed for 330 days.

RESULTS

Treatment of the buttocks with PLLA-SCA resulted in significant reduction of depression depth, improvement in the morphological appearance of the skin, improvement in the grade of skin laxity, and overall improvement in cellulite appearance. Treated thighs showed reduction in the depth and number of depressions and an improvement in overall cellulite appearance. No significant procedure side effects were found.

CONCLUSION

Poly-l lactic acid offers an effective and safe method for treating cellulite of the buttocks and thighs.
Potential of Mesalazine Therapeutic Drug Monitoring by Measuring Fecal Excretion in Patients With Ulcerative Colitis
Authors: van de Meeberg Maartje M. , Verheij Elwin R. , Fidder Herma H. , Bouma Gerd , Huitema Alwin D.R. , Oldenburg Bas
Published: February 2023

Background:

Therapeutic drug monitoring of mesalazine (5-ASA) in patients with ulcerative colitis is unavailable. Mucosal 5-ASA concentrations are assumed to be higher during remission, but biopsy is not practical. Therefore, we investigated the feasibility of measuring mesalazine levels in feces. To explore the potential role of fecal mesalazine measurements in therapeutic drug monitoring, we compared the dry fecal concentration and daily fecal excretion of 5-ASA and its metabolite N-acetyl-5-ASA in patients with ulcerative colitis with active and quiescent disease.

Methods:

Adults with ulcerative colitis on oral mesalazine and scheduled for colonoscopy were eligible for inclusion in this cross-sectional study. Stool and urine samples were collected for 48 and 24 hours, respectively, and rectal biopsies were performed. (N-acetyl-)5-ASA was measured using mass spectrometry. Biochemically active disease was defined as a fecal calprotectin level above 100 mcg/g and endoscopically active disease as any activity following the endoscopic Mayo score (≥1).

Results:

Approximately 28 patients were included in the study. Daily fecal excretion of (N-acetyl-)5-ASA did not differ between patients with (n = 13) and without (n = 15) endoscopically active disease [median 572 mg/d versus 597 mg/d (P = 0.86) for 5-ASA and 572 mg/d versus 554 mg/d (P = 0.86) for N-acetyl-5-ASA]. The same applied to the fecal concentration [median 9.7 mcg/mg dry weight versus 10.3 (P = 0.53) and 12.0 versus 9.9 (P = 0.89)]. The results were comparable when the biochemical disease activity definition was used. The mucosal concentrations and urinary excretion of (N-acetyl-)5-ASA did not differentiate between quiescent and active activity.

Conclusions:

Fecal (N-acetyl-)5-ASA measurements do not correlate with disease activity, which renders it an unsuitable tool for therapeutic drug monitoring of mesalazine.
The evolving knowledge on primary hemostasis in patients with cirrhosis: A comprehensive review
Authors: Zanetto Alberto , Campello Elena , Senzolo Marco , Simioni Paolo
Published: February 2023

Patients with cirrhosis develop complex alterations in primary hemostasis that include both hypocoagulable and hypercoagulable features. This includes thrombocytopenia, multiple alterations of platelet function, and increased plasma levels of von Willebrand factor. Contrary to the historical view that platelet dysfunction in cirrhosis might be responsible for an increased bleeding tendency, the current theory posits a rebalanced hemostasis in patients with cirrhosis. Severe thrombocytopenia is not indicative of the bleeding risk in patients undergoing invasive procedures and does not dictate per se the need for pre-procedural prophylaxis. A more comprehensive and individualized risk assessment should combine hemostatic impairment, the severity of decompensation and systemic inflammation, and the presence of additional factors that may impair platelet function, such as acute kidney injury and bacterial infections. Although there are multiple, complex alterations of platelet function in cirrhosis, their net effect is not yet fully understood. More investigations evaluating the association between alterations of platelet function and bleeding/thrombosis may improve risk stratification in patients with decompensated cirrhosis. Besides hemostasis, the assessment of von Willebrand factor Ag and ADP-induced, whole-blood platelet aggregation normalized by platelet count (VITRO score and PLT ratio) are promising biomarkers to predict the risk of hepatic decompensation and survival in both compensated and decompensated patients. Further investigations into the in vivo interplay between platelets, circulating blood elements, and endothelial cells may help advance our understanding of cirrhotic coagulopathy. Here, we review the complex changes in platelets and primary hemostasis in cirrhosis and their potential clinical implications.
Radiological and Dosimetric Evaluation of Biomaterial Composite Phantoms with High Energy Photons and Electrons
Authors: Samson Damilola Oluwafemi , Aziz Mohd Zahri Abdul , Shukri Ahmad , Mat Jafri Mohd Zubir , Hashim Rokiah , Zuber Siti Hajar , Hashikin Nurul Ab. Aziz , Rabba James Anthony , Samson Peter Ayoola , Yusof Mohd Fahmi Mohd
Published: February 2023

The current study was undertaken to investigate the radiological and dosimetric parameters of natural product-based composite (SPI/NaOH/IA-PAE/Rhizophora spp.) phantoms. The radiological properties of the phantoms were measured at different gamma energies from Compton scatter of photons through angles of 0, 30, 45, 60, 75, and 90 degrees. Ionization chamber (IC) and Gafchromic EBT3 film dosimeters were employed to evaluate the dosimetric characteristics for photons (6–10 MV) and electrons (6–15 MeV). Radiological property results of the composite phantoms were consistent with good quality compared to those of solid water phantoms and theoretical values of water. Photon beam quality index of the SPI15 phantom with p-values of 0.071 and 0.073 exhibited insignificant changes. In addition, good agreement was found between PDD curves measured with IC and Gafchromic EBT3 film for both photons and electrons. The computed therapeutic and half-value depth ranges matched within the limits and are similar to those of water and solid water phantoms. Therefore, the radiological and dosimetric parameters of the studied composite phantom permit its use in the selection of convenient tissue- and water-equivalent phantom material for medical applications.
Impact of a Caffeine Restriction Policy on Inpatients With Schizophrenia
Authors: Lagreula Juliette , Ferraiolo Mattia , De Timary Philippe , Delatte Benoit , Elens Laure , Hermans Emmanuel , Dalleur Olivia
Published: February 2023

Background/Purpose

Caffeine is the most commonly used psychostimulant worldwide. Although its large intake is suspected to worsen psychotic symptoms because of increasing dopamine neurotransmission, schizophrenic patients are heavier caffeine consumers than the general population. This study aims to assess the impact of a caffeine restriction policy in a psychiatric hospital on patient psychopathology, hospitalization characteristics, and psychotropic prescribing patterns.

Methods

It is a retrospective cross-sectional study based on electronic health records of a psychiatric hospital in the French-speaking area of Belgium. Two different periods were compared, the first (n = 142), in 2017, when caffeine was available in the institution and the second (n = 119), between November 2018 and November 2019 after the restriction of access to caffeine was implemented. Adult inpatients with schizophrenia or schizoaffective disorder admitted for an acute hospitalization were included. Antipsychotic exposure, benzodiazepine daily dose, Global Assessment of Functioning scores, length of hospital stay, and some other factors were tested for their potential association with the decaffeinated period.

Results

After adjusting for potential confounders, reduced caffeine availability inside the hospital was significantly associated with higher Global Assessment of Functioning scores at discharge (adjusted odds ratio [aOR] = 2.86, 95% confidence interval [CI] = 1.77–4.62) and shorter hospital stays (aOR = 0.68, 95% CI = 0.47–0.99) but was not associated with change in antipsychotic exposure at discharge (aOR = 1.04, 95% CI = 0.64–1.7) or benzodiazepine daily dose (aOR = 0.89, 95% CI = 0.61–1.29).

Conclusions

Limiting access to caffeine in psychiatric hospitals is a simple and inexpensive intervention that should be promoted, especially for patients with schizophrenia.
Outcomes of sexagenarian living liver donors in Korea: A multicenter study
Authors: Kim Jong Man , Joo Dong Jin , Hong Suk Kyun , You Young Kyoung , Hwang Shin , Ryu Je Ho , Kim Doo Jin , Yu Hee Chul , Nah Yang Won , Kim Myoung Soo
Published: February 2023

The safety of elderly living liver donors and recipient outcomes are always of concern. In the present study, the effects of age in 2 donor groups, a 60+years old group and a 50–59 years old group (referred to as the 60s and 50s donor groups, respectively), on living donor liver transplantation were compared regarding donor safety and recipient outcomes. We retrospectively identified 209 patients 50 years and above of age at 9 centers from 2005 to 2017 in Korea. The 60s donor group represented 10% (n=21) of donor patients. One case in each group was a left liver graft, respectively, and the others were right liver grafts. Postoperative complications were more common in the 60s donor group, but the proportion of Clavien-Dindo grade III in the 60s donor group did not differ from that in the 50s donor group. In-hospital mortality did not occur among donors, and donor mortality was not reported during the observation period. Postoperative total bilirubin and hospitalization in recipients of the 60s donor group were higher and longer than in recipients of the 50s donor group, respectively. Although the cumulative overall survival of the recipients in the 60s donor group was significantly lower than that of the 50s donor group, a difference was not observed in graft survival. Multivariate analysis showed that increased living liver donors age, the coexistence of HCC, and increased intraoperative blood loss during the recipient operation were important predisposing factors for patient death.

Present study suggests that highly selected elderly living donors (≥60 y) can safely donate with similar recipient graft survival rates though the recipient overall patient survival is inferior compared to the 50s donor group.
Analysis of systolic and diastolic blood pressure variability in frail, pre-frail, and non-frail elderly patients: The relationship between frailty syndrome and blood pressure variability in the elderly
Authors: Gu Yan , Wan Ying , Ren Jue-Hui , Zhao Yi , Wang Yan , Shen Jun-Hua
Published: February 2023

Frailty can change the prognosis and treatment approach of chronic diseases. We, therefore, conducted this study to explore the relationship between frailty syndrome and blood pressure variability in the elderly. The clinical data of 150 elderly patients with debilitating syndrome admitted to the neurology department of our hospital from May 2021 to May 2022 were selected, and they were grouped according to Fried debilitation scale and divided into 50 cases each in the debilitation group, pre-debilitation group, and no-debilitation group. The general data, co-morbidities, medications, and biochemical indexes were collected. The 24-hour ambulatory blood pressure monitoring was performed in each group, and the mean systolic blood pressure, diastolic blood pressure, nocturnal systolic load value, and diastolic load value were analyzed to determine the relationship between blood pressure variability and senile frailty. Serum albumin (ALB) and high-density lipoprotein were significantly lower in the debilitated and pre-debilitated groups than in the non-debilitated group (P < .05). Multivariate logistic regression analysis revealed that age (odds ratio [OR]: 3.910, 95% confidence intervals [CI]: 2.021–5.402) was a risk factor for frailty in the elderly, and serum ALB (OR: 0.656, 95% CI: 0.110–0.960) and HDL (OR: 0.581, 95% CI: 0.237–0.944) were protective factors for frailty in the elderly. Age, type of medication taken, co-morbidities, serum ALB, and HDL are influencing factors of debilitating syndrome. Serum ALB and HDL are protective factors against debilitating syndrome in the elderly. Age is an independent risk factor of debilitation in the elderly and increased fluctuation of blood pressure in the elderly can increase their risk of developing debilitating syndrome.
Efficacy of laparoscopic inguinal hernia in day surgery mode and inpatient surgery mode in China: A meta-analysis
Authors: Zhong Yang , He Miao , Liu Zhi , Chen Jian Yu , Lv Xiao Jiang , Liu Mao , Wen Ai Ping , Qin Long , Li Jian Shui
Published: February 2023

Background:

In China, laparoscopic inguinal hernia repair (LIHR) under the day surgery mode (DSM) has developed rapidly as an important surgical method for inguinal hernia repair, and it has unique advantages in many aspects. Compared with inpatient surgery mode (ISM), there are some differences in intraoperative and postoperative related indicators, hospitalization costs, and patient satisfaction. Many studies have shown that LIHR in DSM can significantly shorten hospital stay, effectively reduce hospitalization costs, and improve patient satisfaction. Accordingly, this study aimed to compare the differences in intraoperative and postoperative related indicators, hospitalization costs, and patient satisfaction of LIHR between DSM and ISM in China.

Methods:

The PubMed/Medline, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Wan Fang databases were searched for randomized controlled trials, cohort studies from the establishment of the database to July 1, 2022. Odds ratio (OR), mean difference, standardized mean difference (SMD), and 95% confidence interval were selected as the effect scale indices for the evaluation of the difference in hospitalization costs, hospital stay, operation time, recovery time, complications, and patient satisfaction. All of these were compared using RevMan 5.3 Software (The Cochrane Collaboration, Copenhagen, Denmark).

Results:

Nine studies involving 1176 patients, 590 in the DSM group and 586 in the ISM group, were included. The hospital stay (d) (SMD = −7.27, 95% confidence interval, CI: −8.68 to −5.87, P 
< .001), hospitalization costs (SMD = −7.89, 95% CI: −10.25 to −5.53, P 
< .001) in DSM group were significantly lower than the ISM group. Additionally, the patient dissatisfaction (OR = 0.05, 95% CI: 0.01–0.17, P < .001) in DSM group was significantly lower than the ISM group. Nevertheless, no significant differences were found in the operation time (minute) (mean difference = −0.32, 95% CI: −1.78 to 1.14, P = .67), recovery time (h) (SMD = −3.27, 95% CI: −6.95 to 0.41, P 
= .08), and postoperative complications (OR = 0.80, 95% CI: 0.47–1.36, P = .41) between the 2 groups.

Conclusion:

In China, compared with ISM, LIHR under DSM can significantly shorten hospital stay, greatly reduce hospitalization costs, and significantly improve patient satisfaction. There were no significant differences in operation time, recovery time and postoperative complications.
Multiple cholesterol granulomas of the breast: A case report and review of the literature
Authors: Jin Menglei , Wu Qiang , Miao Bingliang , Jin Jing , Gao Chenyi , Xu Xiaoming , Luo Yingbo , Chen Zhigang
Published: February 2023

Rationale:

Cholesterol granuloma of the breast is a rare disease defined as chronic reactive inflammation of cholesterol crystals and foreign body giant cells. This disease can mimic breast cancer in the clinic as painless palpable hard nodules, and imaging shows irregular hypoechoic nodules with unclear boundaries. Therefore, the uncommon lesions can be easily misdiagnosed as breast cancer. Meanwhile, it can be easily neglected by clinicians because of poor understanding.

Patient concerns:

In this report, we present a rare case of multiple cholesterol granulomas of the breast, which was analyzed retrospectively and combined with all 11 relevant available studies in the last 50 years.

Interventions:

The patient had undergone multiple breast imaging inspections for breast nodules and had the local resection of nodules.

Diagnoses:

The patient was confirmed to have a final diagnosis of benign cholesterol granulomas but was initially considered as breast cancer.

Outcomes:

The patient did not complain of discomfort after surgery, and ultrasound reexamination 5 months after surgery showed no recurrence.

Lessons:

By retrospective analysis, dynamic contrast-enhanced magnetic resonance imaging and core needle biopsy can synergistically help clinicians distinguish it from other breast disease. To raise awareness of such a rare disease and reduce related misdiagnoses, we summarize the characteristics of cholesterol granulomas and recommend appropriate novel diagnosis and treatment regimens for patients with cholesterol granulomas.
Coordinated Patient Care via Mobile Phone–Based Telemedicine in Secondary Stroke Prevention
Authors: Li Dong-Mei , Lu Xiao-Ying , Yang Peng-Fei , Zheng Jing , Hu Huan-Huan , Zhou Yu , Zhang Ling-Juan , Liu Jian-Min
Published: February 2023

Background:

To prevent recurrent stroke, patients need to follow evidence-based practices following discharge; however, adherence to these practices is suboptimal.

Purpose:

To evaluate whether a smartphone mobile application can improve medication adherence and stroke awareness in secondary stroke prevention.

Methods:

A retrospective study design was used. Patients with ischemic stroke registered in a database between August 2018 and January 2019 were enrolled. Propensity score matching was used to match patients managed with the mobile application compared with regular practice in a 1:2 ratio.

Results:

Sixty-five patients were paired with 123 controls. Three-month medication adherence was 93.8% in the application group versus 82.9% in the control group (P = .036). Patients in the application group were more likely to know stroke warning signs (P = .003) and when to call an ambulance for stroke symptoms (87.7% vs 72.4%, P = .016).

Conclusions:

Using a mobile application may increase medication adherence and stroke awareness in secondary stroke prevention.
Improved Brain Tumor Conspicuity at 3 T Using Dark Blood, Fat-Suppressed, Dixon Unbalanced T1 Relaxation-Enhanced Steady-State MRI
Authors: Edelman Robert R. , Walker Matthew , Ankenbrandt William J. , Leloudas Nondas , Pang Jianing , Bailes Julian , Bobustic George , Koktzoglou Ioannis
Published: February 2023

Objectives

Contrast-enhanced magnetic resonance imaging (MRI) is the cornerstone for brain tumor diagnosis and treatment planning. We have developed a novel dual-echo volumetric dark blood pulse sequence called Dixon unbalanced T1 relaxation-enhanced steady-state (uT1RESS) that improves the visibility of contrast-enhancing lesions while suppressing the tissue signals from blood vessels and fat. The purpose of this study was to test the hypothesis that Dixon uT1RESS would significantly improve the conspicuity of brain tumors compared with magnetization-prepared rapid gradient echo (MPRAGE), as well as to determine potential limitations of the technique.

Materials and Methods

This retrospective study was approved by the hospital institutional review board. Forty-seven adult patients undergoing an MRI scan for a brain tumor indication were included. Contrast-enhanced MRI of the brain was performed at 3 T using both MPRAGE and Dixon uT1RESS. To control for any impact of contrast agent washout during the scan procedure, Dixon uT1RESS was acquired in approximately half the subjects immediately after MPRAGE, and in the other half immediately before MPRAGE. Image quality, artifacts, and lesion detection were scored by 3 readers, whereas lesion apparent signal-to-noise ratio and lesion-to-background Weber contrast were calculated from region-of-interest measurements.

Results

Image quality was not rated significantly different between MPRAGE and Dixon uT1RESS, whereas motion artifacts were slightly worse with Dixon uT1RESS. Comparing Dixon uT1RESS with MPRAGE, the respective values for mean lesion apparent signal-to-noise ratio were not significantly different (199.31 ± 99.05 vs 203.81 ± 110.23). Compared with MPRAGE, Dixon uT1RESS significantly increased the tumor-to-brain contrast (1.60 ± 1.18 vs 0.61 ± 0.47 when Dixon uT1RESS was acquired before MPRAGE and 1.94 ± 0.97 vs 0.82 ± 0.55 when Dixon uT1RESS was acquired after MPRAGE). In patients with metastatic disease, Dixon uT1RESS detected at least 1 enhancing brain lesion that was missed by MPRAGE on average in 24.7% of patients, whereas Dixon uT1RESS did not miss any lesions that were demonstrated by MPRAGE. Dixon uT1RESS better detected vascular and dural invasion in a small number of patients.

Conclusions

In conclusion, brain tumors were significantly more conspicuous at 3 T using Dixon uT1RESS compared with MPRAGE, with an approximately 2.5-fold improvement in lesion-to-background contrast irrespective of sequence order. It outperformed MPRAGE for the detection of brain metastases, dural or vascular involvement. These results suggest that Dixon uT1RESS could prove to be a useful adjunct or alternative to existing neuroimaging techniques for the postcontrast evaluation of intracranial tumors.
Severe Postictal Confusion After Electroconvulsive Therapy
Authors: Schuur Gijsbert , Verdijk Joey P.A.J. , ten Doesschate Freek , van Wingen Guido A. , van Waarde Jeroen A.
Published: February 2023

Objectives

Severe postictal confusion (sPIC) is an important but poorly investigated adverse effect of electroconvulsive therapy (ECT). In this retrospective study, prevalence of sPIC and potential risk factors were explored.

Methods

Medical charts of 295 ECT patients (mean ± SD age, 57 ± 15 years; male, 36%) were scrutinized for occurrence of sPIC, as well as demographic, clinical, and treatment characteristics. Patients showing sPIC were compared with patients who did not, using univariate statistics. Multivariate analyses with a split-sample validation procedure were used to assess whether predictive models could be developed using independent data sets.

Results

O 295 patients, 74 (25.1%) showed sPIC. All patients showing sPIC needed extra medication, 9% (n = 7) required physically restraints, and 5% (n = 4) had to be secluded. Univariate analyses showed several trends: patients with sPIC were more often males (P = 0.05), had more often history of cerebrovascular incident (P = 0.02), did not use concomitant selective serotonin reuptake inhibitors (P = 0.01), received higher median dosage of succinylcholine (P = 0.02), and received pretreatment with flumazenil more often (P = 0.07), but these associations did not remain significant after correction for multiple comparisons. Multiple logistic regression analysis did not result in a model that could predict sPIC in the holdout data set.

Conclusions

In this retrospective naturalistic study in 295 ECT patients, the prevalence of sPIC appeared to be 25%. Patients showing sPIC were characterized by male sex, history of cerebrovascular incident, use of higher-dose succinylcholine, and pretreatment with flumazenil. However, multivariate analysis revealed no significant model to predict sPIC in independent data.
Genomic sentinel surveillance: Salmonella Paratyphi B outbreak in travellers coinciding with a mass gathering in Iraq
Authors: Chattaway Marie Anne , Shersby Natasha , Katwa Parisha , Adair Kyle , Painset Anais , Godbole Gauri
Published: February 2023

Salmonella

Paratyphi B infections in England are the least common imported typhoidal infection but can still cause invasive disease. Sentinel surveillance at the reference laboratory detected an outbreak from Iraq due to reported travel history, enabling enhanced PCR testing for a quick diagnosis.
Vitamin B12 in pregnancy and its relationship with maternal BMI and gestational DM
Authors: Muzaffar Rameesha , Khursheed Jameeha , Yousaf Anum
Published: February 2023

Introduction

Gestational diabetes mellitus (GDM) is one of the most prevalent complications of pregnancy. In a joint statement released in 2018, the International Federation of Obstetrics and Gynecology (FIGO) and the International Diabetes Federation (IDF) stated that high blood glucose levels during pregnancy have an impact on maternal, newborn, and child health and may contribute to the global burden of type 2 diabetes mellitus and cardiovascular metabolic disorders in the short and long term.

Objectives

The basic aim of the study is to analyze vitamin B12 in pregnancy and its relationship with maternal BMI and gestational DM.

Material and methods

This cross-sectional study was conducted in THQ Hospital Deepalpur, Pakistan during March 2021 to August 2021. Record gathered from 118 hospitals with the total number of 364 women stated for the study coordinator. As per database record, 11% (41 women) were excluded due to initial trimester spontaneous abortion as well as type 2 diabetes diagnosed in 16; 4% and follow up loss 2; 1%.

Results

Maternal outcomes in pregnant women with type 1 diabetes and those without the disease were evaluated in this study. No maternal mortality occurred within 30 days of delivery in 630 pregnancies with type 1 diabetes. However, pregnant women with type 1 diabetes were usually at a much higher risk of developing adverse maternal events during their pregnancy than women without type 1 diabetes, even after adjusting for age and infant sex or age, infant sex, place of residence, income level, occupation, calendar year, and Charlson comorbidity index.

Conclusion

It is concluded type 1 diabetes remains a significant disease threatening pregnant women and their offspring. Clinicians should be aware of this clinical situation.
The impact of prolonged walking on fasting plasma glucose in type 2 diabetes: A Randomised controlled crossover study
Authors: Niwaha Anxious J. , Rodgers Lauren R. , Hattersley Andrew T. , Andrews Robert C , Shields Beverley M. , Nyirenda Moffat J. , Jones Angus G.
Published: February 2023

Aims

In many low-income countries, fasting glucose is the primary measure of glycaemic control used for treatment titration, as HbA1c is often unavailable or unaffordable. Many patients in these countries walk long distances to the clinic, but the impact of walking on fasting glucose in type 2 diabetes is unknown. We aimed to determine whether this prolonged walking affects the reliability of fasting plasma glucose as a measure of glycaemic control.

Methods

In a randomised crossover trial, the change in glucose from baseline in the fasting state was compared between walking on a treadmill at a predetermined speed of 4.5 km/hour for 1 hour and not walking (resting) in people with type 2 diabetes. The pre-specified primary outcome was glucose at 1 and 2 hours.

Results

45 participants were enrolled and all completed both visits. 21/45 (46.7%) were female, and the median age was 51. Glucose during and after walking was similar to glucose while at rest; glucose difference (walking minus rest) was -0.15 (95% CI: -0.55, 0.26) and -0.10 (95% CI: - 0.50, 0.31) mmol/L at 1 and 2 hours respectively, p>0.4 for both).

Conclusions

Fasting plasma glucose is not meaningfully affected by prolonged walking in participants with type 2 diabetes; therefore, the reliability of fasting glucose for monitoring glycaemic burden is unlikely to be altered in patients who walk to the clinic.

Research in context

What is already known about this subject?

Fasting glucose is widely used to assess glycaemic control in people living with diabetes in low income countries, as HbA1c and home glucose monitoring are unaffordable. In these settings people living with diabetes will often walk long distances to receive healthcare.

Little is known on the impact of walking on fasting glucose in people living with diabetes.

What is the key question?

Is fasting plasma glucose measure affected by a single bout of exercise such as walking in individuals with type 2 diabetes (T2D)?

What are the new findings?

There was no significant change in fasting glucose at the end of the walking exercise.

There was no meaningful change in fasting glucose observed at any point up to 3 hours after commencing exercise.

How might this impact on clinical practice in the foreseeable future?

Fasting plasma glucose is not meaningfully affected by prolonged walking in participants with type 2 diabetes; therefore, the reliability of fasting glucose for monitoring glycaemic burden is unlikely to be altered in patients who walk to the clinic.
Machine Learning-based prediction of Early Neurological Deterioration after Thrombolysis in Acute Ischemic Stroke
Authors: Gao Yuan , Zong Ce , Liu Hongbing , Zhang Ke , Yang Hongxun , Wang Anran , Wang Yunchao , Li Yapeng , Liu Kai , Li Yusheng , Yang Jing , Song Bo , Xu Yuming
Published: February 2023

Background

Early neurological deterioration (END) after thrombolysis in acute ischemic stroke (AIS) cannot be ignored. Our aim is to establish an interpretable machine learning (ML) prediction model for clinical practice.

Methods

Patients in this study were enrolled from a prospective, multi-center, web-based registry database. Demographic information, treatment information and laboratory tests were collected. END was defined as an increase of ⩾2 points in total National Institutes of Health Stroke Scale (NIHSS) score within 24 hours after thrombolysis. Eight ML models were trained in the training set (70%) and the tuned models were evaluated in the test set (30%) by calculating the area under the curve (AUC), sensitivity, specificity, accuracy, and F1 scores. Calibration curves were plotted and brier scores were calculated. The SHapley Additive exPlanations (SHAP) analysis and web application were developed for interpretation and practice.

Results

A total of 1956 patients were included in the analysis. Of these, 305 patients (15.6%) experienced END. We used logistic regression to identify six important variables: hemoglobin, white blood cell count, the ratio of lymphocytes to monocytes (LMR), thrombin time, onset to treatment time, and prothrombin time. In the test set, the results showed that the Extreme gradient boosting (XGB) model (AUC 0.754, accuracy 0.722, sensitivity 0.723, specificity 0.720, F1 score 0.451) exhibited relatively good performance. Calibration curves showed good agreement between the predicted and true probabilities of the XGB (brier score=0.016) model. We further developed a web application based on it by entering the values of the variables (https://ce-bit123-ml-app1-13tuat.streamlit.app/).

Conclusions

Through the identification of critical features and ML algorithms, we developed a web application to help clinicians identify high-risk of END after thrombolysis in AIS patients more quickly, easily and accurately as well as making timely clinical decisions.
Isolation may select for earlier and higher peak viral load but shorter duration in SARS-CoV-2 evolution
Authors: Sunagawa Junya , Kim Kwang Su , Park Hyeongki , Komorizono Ryo , Choi Sooyoun , Torres Lucia Ramirez , Woo Joohyeon , Jeong Yong Dam , Hart William S , Thompson Robin N. , Aihara Kazuyuki , Iwami Shingo , Yamaguchi Ryo
Published: February 2023

During the COVID-19 pandemic, human behavior change as a result of nonpharmaceutical interventions such as isolation may have induced directional selection for viral evolution. By combining previously published empirical clinical data analysis and multi-level mathematical modeling, we found that the SARS-CoV-2 variants selected for as the virus evolved from the pre-Alpha to the Delta variant had earlier and higher infectious periods but a shorter duration of infection. Selection for increased transmissibility shapes the viral load dynamics, and the isolation measure is likely to be a driver of these evolutionary transitions. In addition, we showed that a decreased incubation period and an increased proportion of asymptomatic infection were also positively selected for as SARS-CoV-2 mutated to the extent that people did not isolate. We demonstrated that the Omicron variants evolved in these ways to adapt to human behavior. The quantitative information and predictions we present here can guide future responses in the potential arms race between pandemic interventions and viral evolution.
Cytosolic retention of the mitochondrial protease HtrA2 during mitochondrial protein import stress (MPIS) triggers the DELE1-HRI pathway
Authors: Bi Paul Y. , Killackey Samuel A. , Schweizer Linus , Arnoult Damien , Philpott Dana J. , Girardin Stephen E.
Published: February 2023

Mitochondrial stress inducers, such as the proton ionophore carbonyl cyanide m-chlorophenyl hydrazone (CCCP) and the ATPase pump inhibitor oligomycin, trigger the DELE1-HRI branch of the integrated stress response (ISR) pathway. Previous studies performed using epitope-tagged forms of DELE1 showed that these stresses induced the accumulation of a cleaved form of DELE1, DELE1-S, which stimulates HRI. Here, we report that mitochondrial protein import stress (MPIS) is an overarching stress that triggers the DELE1-HRI pathway, and that endogenous DELE1 could be cleaved into two forms, DELE1-S and DELE1-VS, the latter accumulating only upon non- depolarizing MPIS. We further showed that DELE1 specifically senses MPIS triggered by the inhibition of the TIM23 complex at the inner mitochondrial membrane (IMM). While MPIS can also cause mitophagy induction through engagement of the NLRX1-RRBP1 pathway, we observed that DELE1-HRI and NLRX1-RRBP1 signaling were engaged independently upon MPIS. Surprisingly, our results suggest that in our cellular model the mitochondrial protease OMA1 was dispensable for DELE1 cleavage upon MPIS. Instead, we identified a key role for another mitochondrial protease, HtrA2, in mediating the cleavage of DELE1 into DELE1-S and DELE1- VS. Our data further suggest that DELE1 is likely cleaved into DELE1-S by HtrA2 in the cytosol, while the DELE1-VS form might be generated during halted translocation of the protein into mitochondria. Together, this study identifies MPIS as the overarching stress detected by DELE1 and identifies HtrA2 as a critical protease involved in DELE1 processing.
A discursive exploration of gender in primary textbooks of English in Pakistan
Authors: Dar Shazia Riaz , Bano Sobia
Published: February 2023

Purpose

This study intends to unveil the imbalance in gender portrayal, reflected in English textbooks, used at the primary level in the four provinces of Pakistan.

Design/methodology/approach

Within the framework of feminist critical discourse analysis (FCDA), this paper aims to explore the ways in which gender stereotypes and ideologies are inculcated through the discursive schemes in the selected textbooks. The methodology adopted is to connect the linguistic features in the texts (the Micro) to the social factors (the Macro). The analysis has been done on two levels: on the first level, the content analysis was employed to quantify the gender representation in the textbook. On the second level, the discourse analysis was carried out to view gender stereotypes in the wide spectrum of social norms.

Findings

The results of this study reveal a significant disproportion and imbalance in gender representation in the four books. They clearly show that the textbooks in Pakistan contribute to the socialization of children in a very traditional and stereotypical way. The findings of the study recommend extensive awareness at societal level in general, and particular reforms in the education sector for a step toward a progressive and prosperous society.

Originality/value

The current paper is innovative as it demystifies how gendered ideologies are ingrained in the curriculum, used for English language teaching in a developing country like Pakistan. It fosters the value addition in existing research since it investigated the gender disparity systematically by employing quantitative content and qualitative FCDA.
Do all brand CSR initiatives make consumers happy? The role of CSR-brand (mis)fit and sense of relatedness
Authors: Gilal Faheem Gul , Gilal Naeem Gul , Martinez Luis F. , Gilal Rukhsana Gul
Published: February 2023

Purpose

This paper aims to explore whether brand corporate social responsibility (CSR) initiatives increase consumers’ happiness via a mediating mechanism of emotional brand attachment and to examine how brand CSR’s effect may be moderated by CSR fit (e.g. CSR-brand fit vs misfit) and sense of relatedness (e.g. low vs high).

Design/methodology/approach

A series of six studies (including the one that is available online), combining field and experimental data, were conducted to test the hypothesized relationships.

Findings

Results support the hypothesis that brand CSR initiatives make consumers happy by increasing their attachment to the brand (Studies 1 and 2). This effect is strengthened both directly and indirectly through emotional attachment when brands engage in CSR fit activities (Study 3), but it is weakened when brands engage in CSR misfit activities (Study 4). Furthermore, the effect is more pronounced when brands choose CSR activities that have a high sense of relatedness, and it is eliminated when brands use CSR activities with a low sense of relatedness (Study 5). Finally, the results indicate that when brand CSR programs make consumers happy, they become more likely to purchase, spread positive word of mouth and pay a premium (Study 6).

Originality/value

This research has several major implications for business-to-consumer companies that are unsure about the value of brand CSR initiatives, want to make consumers happy but are unsure which CSR strategies to focus on and/or have decided to launch CSR initiatives but lack guidance on the specific strategies relevant to their desired performance outcomes.
Competition–banking stability: the moderating role of government intervention quality in North African countries
Authors: Basty Nadia , Ghazouani Ines
Published: February 2023

Purpose

This study investigates how bank competition affects financial stability and whether government intervention contributes to shaping this relationship in North African countries.

Design/methodology/approach

A review of the literature on the subject was conducted, combined with an empirical analysis that used a two-step system generalized method of moments (GMM) and a sample of 45 banks operating in North African countries over the period 2005–2019.

Findings

The findings reveal a quadratic relationship between competition and banking stability in North African countries. Competition–stability view and competition–fragility view could be applied at the same time for North African banks. Additionally, in this context, results highlight a negative impact of government intervention on financial stability in a competitive financial sector. North African banks operating in a high government intervention quality environment tend to engage in high-risk investments. Robustness checks with alternative measures of competition and banking stability also show consistent results.

Originality/value

To the authors’ knowledge, this is the first time that the North African context has been explored to determine the role of the quality of government intervention in the relationship between competition and banking system fragility. This paper seeks to cover the shadow field in existing literature through further new information. Thus, it contributes to the emerging market banking literature by showing that both high and low levels of competition can improve financial stability in North African countries. Moreover, it expands its contribution by displaying the moderator effect of intervention quality on the bank competition–stability relationship.
Interrogating the environmental accountability of foreign oil and gas companies in Basra, Iraq: a stakeholder theory perspective
Authors: Morrison Leanne J. , Alshamari Alia , Finau Glenn
Published: February 2023

Purpose

This paper aims to interrogate the accountabilities of the foreign companies which have directly invested in the Iraqi oil and gas industry.

Design/methodology/approach

Using both qualitative and quantitative methodologies, the authors first map the stakeholder accountabilities (qualitative) of foreign oil and gas companies and second, the authors seek to demonstrate quantitatively – through structural break tests and publicly available sustainability reports – whether these companies have accounted for their environmental and social impacts both to Iraqi people and to the global community.

Findings

The authors find that the Western democratic values embedded in stakeholder theory, in terms of sustainability, do not hold the same meaning in cultural contexts where conceptions and application of Western democratic values are deeply problematic. This paper identifies a crucial problem in the global oil supply chain and problematises the application of traditional theoretical approaches in the context of the Iraqi oil and gas industry.

Practical implications

Implications of this study include the refocus of attention onto the local and global environmental impacts of the Iraqi oil and gas industry by foreign direct investments. Such a refocus highlights the reasons and ways that decision makers should accommodate these less salient stakeholders.

Originality/value

The primary contribution is the critique of the lack of environmental accountability of foreign direct investment companies in the Iraqi oil and gas industry. The authors also make theoretical and methodological contributions via the problematisation of the cultural bias inherent in traditional stakeholder theories, and by introducing a quantitative method to evaluate the accountabilities of companies.
Numerical study on influence of inclination and sinusoidal heating on magneto-convection in an inclined lid-driven cavity
Authors: Sivanandam Sivasankaran , Marimuthu Bhuvaneswari
Published: February 2023

Purpose

The numerical analysis is to scrutinize the collective effect of convective current along with the thermal energy transport in an inclined lid-driven square chamber with sine curve based temperature at the lower wall in the existence of unchanging external magnetic field. Insulation has been placed on the left and right of the box to increase the effective space volume of the shell. The thermal condition at ceiling wall is kept lower than the one on the floor.

Design/methodology/approach

The finite volume method employs to discretize (non-dimensional) system of equations govern the model. The heat transfer rate is measured by adjusting various variables, such as the Richardson number Hartmann number, inclination of an enclosure.

Findings

The flow behavior of enclosure convection is more highly influenced within the natural convection when enclosure inclination varies as well as magnetic field strength. The overall heat transfer rate decreases due to increase in both the Hartmann number as well as Richardson number.

Practical implications

The results of the present study are very useful to the cooling of electronic equipments.

Social implications

The study model is useful to the thermal science community and modelling field.

Originality/value

This research is a novel work on mixed convection flow in an inclined chamber with sinusoidal heat source.