bluuebunny/crossref_metadata_2025 huggingface dataset:
THE EFFECT OF HEAT-TREATMENT ON THE MECHANICAL PROPERTIES OF EXPANDED GLASS PARTICLE/A356 SYNTACTIC FOAM
Authors: Al-sahlani Kadhim , G. Hassan Ahmed , Salim Hadawi Zainab
Published: November 2024

This research investigates the manufacturing of metal syntactic foams (MSFs) using a packed bed of porous (2-2.8 mm) expanded glass (EG) within an A356 alloy matrix. To this end, the counter-gravity infiltration casting technique is employed to manufacture the specimens. The density of the MSFs ranges from 1.05 to 1.17 g/cm3, making it one of the lowest densities foams, attributed to the filler particles' low bulk density. The study investigates the influence of T6 heat treatment on the mechanical properties and microstructural characteristics of the manufactured MSFs. The mechanical properties of the MSFs are characterized under quasi-static compressive loads at 1 mm/min. After heat treatment, the compression test results indicate a significant enhancement in most mechanical properties. Compression strength and plateau stress are approximately doubled compared to as-cast foams for samples with similar densities. While energy absorption of the MSFs triples in heat-treated conditions. These improvements are attributed to changes in the matrix microstructure due to thermal treatment. Microstructural analysis reveals that Si particles, initially sharp and continuous within inter-dendritic boundaries, become blurry and discontinuous through spheroidization after thermal treatment. This hinders crack growth in the cell wall and mitigates the effects of casting defects and the columnar dendritic structure. The majority of mechanical properties in both heat-treated (HT) and as-cast (AC) foams exhibited an increase in density due to an increase in the matrix fraction. However, plateau end strain and energy absorption efficiency demonstrated an independent effect of heat treatment and density.
On the relative weight of pitch and durational cues in the perception of accentuation by French listeners
Authors: Michelas Amandine , Dufour Sophie
Published: November 2024

Accentuation is encoded by both durational and pitch cues in French. While previous research agrees that the sole presence of pitch cues is sufficient to encode accentuation in French, the role of durational cues is less clear. In four cue-weighting accent perception experiments, we examined the role of pitch and durational cues in French listeners' perception of accentuation. French listeners were tested on acoustic continua ranging from an unaccented first syllable [deplaˈse] “moved” to an accented first syllable [ˈde] [plaˈse] “a dice placed.” The continua were obtained by manipulating pitch and durational cues either separately or conjointly. In Experiments 1 and 2, participants identified each step of the continuum by choosing between two possible segmentations while in Experiments 3 and 4, participants performed an AX discrimination task on two adjacent steps. Results indicate that participants' performance was better when pitch cues were varied compared to when durational cues were varied in both the identification and discrimination tasks. In addition, while participants always benefited from the additional presence of pitch cues, participants did not consistently benefit from the additional presence of durational cues. Together, these results suggest that pitch cues are a better marker of French accentuation than durational cues.
The Mediator complex subunit MoMed15 plays an important role in conferring sensitivity to isoprothiolane by modulating xenobiotic metabolism in
M. oryzae
Authors: Meng Fan-Zhu , Wei Wen-Kai , Cai Min-Zheng , Wang Zuo-Qian , Yin Liang-Fen , Yin Wei-Xiao , Schnabel Guido , Luo Chao-Xi
Published: November 2024

Rice blast caused by
Magnaporthe oryzae
is one of the most economically important rice diseases. Fungicides such as isoprothiolane (IPT) have been used extensively for rice blast control, but resistance to IPT in
M. oryzae
is an emerging threat. In this study, molecular mechanisms of resistance in IPT-resistant mutants were identified. Through whole-genome sequencing and genetic transformation, we identified the gene
MoMed15
, encoding a transcriptional glutamine-rich co-activator Mediator complex subunit, in which mutations or deletion resulted in moderate IPT resistance. Further research found that MoMed15 physically interacted with the IPT resistance regulatory factor MoIRR to simultaneously regulate both MoIRR expression and the expression of multiple xenobiotic-metabolizing enzymes in response to IPT stress. We hypothesize that some xenobiotic-metabolizing enzymes enhance IPT toxicity by modifying the IPT structure. Variation of MoMed15 affected the recruitment of the transcriptional Mediator complex and decreased the expression of these xenobiotic-metabolizing enzymes, resulting in moderate IPT resistance. We also found that
MoPGR1,
encoding a protein that activates cytochrome P450 enzymes, was essential to confer IPT sensitivity, and its expression was directly regulated by MoIRR.

IMPORTANCE

Isoprothiolane (IPT) has been used extensively for the management of rice blast disease and IPT-resistant subpopulations have emerged in Chinese rice fields. The emergence of resistant pathogen populations has led to a steep increase in fungicide use, increasing pesticide risk for the applicator and the environment. The molecular mechanisms of IPT resistance in
M. oryzae
remain elusive. In this study, we demonstrated that transcriptional co-activator MoMed15 interacts with IPT resistance regulator MoIRR to recruit the Mediator complex, which promotes the expression of xenobiotic-metabolizing enzymes, leading to exacerbated IPT toxicity. The
MoMed15
could be used for IPT resistance detection in rice fields.
Draft genome sequence of
Ferrimicrobium acidiphilum
strain YE2023, isolated from a pulp of bioleach reactor
Authors: Elkina Yulia A. , Bulaev Aleksandr G. , Beletsky Alexey V. , Mardanov Andrey V.
Published: November 2024

We report the draft genome sequence of
Ferrimicrobium acidiphilum
strain YE2023, isolated from a pulp of a laboratory-scale bioleach reactor. The genome is 3,221,954 Mbp long with a guanine-cytosine content of 58.16%.
Improved resolution of microbial diversity in deep-sea surface sediments using PacBio long-read 16S rRNA gene sequencing
Authors: Gao Jie , Wang Ziming , Deng Wenjie , Sa Boxuan , Chen Xiaoxia , Cai Ruanhong , Yan Yi , Jiao Nianzhi , Leung Elaine Lai-Han , Liu Di , Yan Wei
Published: November 2024

16S rRNA gene sequencing is the gold standard for identifying microbial diversity in environmental communities. The Illumina short-read platform is widely used in marine environment studies due to its cost-effectiveness and high accuracy, but its limited read length restricts taxonomic identification mainly to genus or family levels. Recently, the PacBio long-read sequencing platform was developed. This method has exceptional base-level resolution exceeding 99%, thereby effectively mitigating the challenges associated with high error rates commonly observed in long-read sequencing technologies. However, few studies have compared the PacBio long-read and Illumina short-read platforms in marine deep-sea sediments. Here, the PacBio long-read and Illumina short-read platforms were compared with samples collected from the deep-sea surface sediments from the cold seep in the Shenhu area of the South China Sea offshore Pearl River Estuary. Comparisons revealed a more comprehensive taxonomic identification, α-diversity, and β-diversity by PacBio long-reads. The PacBio long-read platform exhibited higher classified rates and classified taxonomy at all levels, particularly at the species level. The PacBio long-read platform was also more accurate at capturing fine spatial-scale variations in microbial communities in sediments. Our studies will facilitate the selection of 16S rRNA sequencing platforms for investigating fine spatial-scale patterns in microbial communities in deep-sea surface sediments and serve as a crucial methodological reference for future studies on microbial diversity.

IMPORTANCE

The PacBio long-read platform, with its exceptional base-level resolution exceeding 99%, has advanced our comprehension of deep-sea microbial diversity. By comparing microbial community analyses conducted using the Illumina short-read and PacBio long-read sequencing platforms, we have provided an enhanced understanding of fine spatial-scale patterns in microbial community diversity with depth across a deep-sea sediment core, as well as methodological insights that will be valuable for future research in this field.
Alternative Idea About the Source of the Baryon Asymmetry of the Universe
Authors: Vergeles S. N.
Published: November 2024

The paper proposes an alternative scenario for the emergence of the baryon asymmetry of the Universe. This scenario is realized in the lattice gravity model associated with the Dirac field as follows. At ultrahigh temperatures of the Grand Unification order $${{T}_{c}} \sim {{10}^{{18}}}$$ GeV and higher, the system is in a PT-symmetric phase. But when the temperature decreases, a phase transition to an asymmetric phase occurs, in which a non-zero tetrad appears, that is, space-time with the Minkowski metric, and the system’s wavefunction splits into two: $$|\,\rangle = {\text{|}} + \rangle + \,{\text{|}} - \rangle $$. The fields of tetrads in states $${\text{|}} + \rangle $$ and $${\text{|}} - \rangle $$ differ in sign. At the very first moment of time with a duration of the order of the Planck time, a transition of fermions between these states is possible. These transitions in different parts of space are not correlated with each other. Therefore, the final asymmetry of the fermion charge between these states is relatively extremely small and it is preserved in time, since the interaction of the states $${\text{|}} + \rangle $$ and $${\text{|}} - \rangle $$ ceases at times greater than the Planck time.
Pure signet ring cell carcinoma of the breast: a rare entity
Authors: Costa Teresa Maria , Alves Fatima , Miranda Helena , Sampaio Rita
Published: November 2024

Signet ring cell carcinoma (SRCC) is defined as carcinoma composed of epithelial cells with intracytoplasmic mucin that causes peripheral displacement of the nucleus, creating a crescent-shaped morphology. It can arise in many organs; however, pure primary SRCC of the breast is very rare. The WHO classification of tumours placed SRCC of the breast under mucin-producing carcinomas; however, nowadays, it is no longer regarded as a histological variant of invasive carcinoma. To date, only few cases have been reported in the literature. This report presentsa woman in her 70s with primary pure SRCC of the breast.The patient underwent right lumpectomy with sentinel lymph node dissection and was proposed adjuvant chemotherapy followed by radiotherapy and hormonal treatment. She had no disease relapse until today. The histological features and treatment approach of this rare entity are debated in light of relevant literature.
Unexpected delivery: cryptic pregnancy
Authors: Dunphy Louise , Boyle Stephanie , Coughlin Lynda
Published: November 2024

Cryptic pregnancy was first described in the early 17th century and occurs when the pregnant person is unaware of their pregnant state and discovers this late in pregnancy or when labour starts. Historically, the term ‘concealed pregnancy’ has been used synonymously. In a concealed pregnancy, the patient is aware of their pregnancy but chooses to hide it. Cryptic pregnancies can be divided into psychotic or non-psychotic types (affective, pervasive or persistent); however, it can also occur without any clinical manifestation of a psychiatric disorder. Lack of antenatal care may result in adverse maternal and fetal outcomes such as pre-eclampsia, small for gestational age babies or untreated diabetes. The risk factors for pregnancy denial include young age, low level of education, a precarious work situation and being single. The psychological and developmental impact of pregnancy denial on children and mothers is still unknown. The authors present the case of a nulliparous woman with polycystic ovary syndrome (PCOS) in her early 40s presenting to the Emergency Department with abdominal pain and hypertension with proteinuria. Her body mass index (BMI) was 51.6 kg/m2. Physical examination revealed a gravid uterus, and the woman was in labour. Further investigation with a transabdominal ultrasound scan confirmed a term fetus. She was unaware that she was pregnant. She was diagnosed with pre-eclampsia and commenced treatment with labetalol. The woman presented to primary care with non-specific symptoms of weight gain, lethargy, carpal tunnel syndrome and acid reflux over a 6-month period. Despite being sexually active and not using contraception, a pregnancy test was not offered. She was delivered of a live neonate by an emergency lower segment caesarean section at 9 cm dilatation. The neonate plotted on the 45.2nd centile. This case emphasises the need for doctors to request a pregnancy test in women of reproductive age who present with recurrent pregnancy-related symptoms irrespective of their BMI, history of PCOS or inability to conceive over a long period. This case also highlights the need for primary care and emergency physicians to be aware of the phenomenon of cryptic pregnancy. It also provides a cautionary reminder of having a high index of clinical suspicion to establish the diagnosis due to the paucity of cases in the literature.
Primary neuroendocrine tumour of the extrahepatic biliary duct
Authors: Fennelly Sarah , Teoh Basilie , Velaga Jyothirmayi , Houli Nezor
Published: November 2024

Neuroendocrine tumours of the extrahepatic bile ducts are extremely rare, accounting for only 0.2–2% of gastrointestinal tract neuroendocrine neoplasms. Here, we present an incidental finding of this rare tumour, identified during staging scans post-resection of a malignant rectosigmoid polyp and treated with resection and biliary reconstruction. A suspicious, arterially enhancing porta hepatis lymph node was identified on CT and further investigated with liver MRI and 68Ga DOTATATE PET. These revealed a lobulated lesion of the hilum which showed marked avidity without metastases. The patient underwent a successful radical resection of the extrahepatic biliary ducts (including the left, right and common hepatic ducts), the common bile duct and hepaticojejunostomy formation. Histology revealed a 20-mm well-differentiated NET, WHO Grade 2. Two years later, the patient is alive and well without recurrence. This fascinating case illustrates the importance of thorough preoperative planning of surgical resection for tumours at an unusual primary site.
Femoral diaphyseal reconstruction using free non-vascularised fibular graft in a paediatric case of postinfective gap non-union
Authors: Agrawal Alok Chandra , Singh Jagprit , Garg Ankit Kumar , chauhan Shivam
Published: November 2024

Free non-vascularised fibular grafts are an autologous grafting option that requires a simple technique and minimal expertise to replicate. However, due to limited intrinsic biological activity, they are less preferred than their vascularised counterparts for reconstructing large bone defects. We present a case of a female child in her middle childhood with limb length discrepancy due to extensive femoral diaphyseal bone loss following successful treatment of chronic osteomyelitis of the femur. In this case, successful reconstruction of the femoral diaphysis was achieved using a free non-vascularised fibular graft, resulting in a good range of motion around the knee with no graft donor site morbidity at the latest follow-up.

Therefore, we conclude that with adequate soft tissue coverage and vascularity for large bone defects, even a free, non-vascularised fibular graft can yield promising results with complete union and hypertrophy at the graft host junction.
Oculopharyngeal muscular dystrophy, myasthenia gravis, systemic lupus erythematosus: overlap and interactions
Authors: M Barbosa Joana , A Pereira Pedro
Published: November 2024

Ptosis and proximal weakness may develop in multiple diseases including oculopharyngeal muscular dystrophy (OPMD) and myasthenia gravis (MG). These two entities can be challenging to differentiate since they may have important clinical and neurophysiological overlap. Systemic lupus erythematosus (SLE), a common autoimmune disease, has been described in association with MG.

We present a woman in her 60s with fluctuating bilateral ptosis and proximal muscle weakness. Single fibre electromyography showed increased jitter. Her brother has genetically proven OPMD. The investigation revealed a positive genetic test for OPMD and positive antibodies for acetylcholine receptor. Additionally, she has SLE, treated with hydroxychloroquine for more than 30 years.

This case highlights the importance of a thoughtful anamnesis with personal and familial history and raises awareness for the rare coexistence of three pathologies with some common clinical characteristics but different treatments and management.
From locked-in syndrome to recovery: thrombolysis success in bilateral pontine infarction with ‘heart appearance’ sign
Authors: Nikolaidou Foteini , Krasnikova Eleni , Vamvaka Evdoxia , Potolidis Evangelos
Published: November 2024

Locked-in syndrome (LIS) is a severe neurological condition characterised by tetraplegia and anarthria, with preserved consciousness and vertical eye movements. It often results from bilateral pontine infarctions, which sometimes demonstrate a characteristic ‘heart appearance’ sign on MRI. We report a case of a mid-60s female with acute onset LIS and dyspnoea. Clinical examination suggested a pontine infarction, later confirmed by an MRI scan revealing a characteristic ‘heart appearance’ on axial diffusion-weighted imaging sequence. As the patient presented within the thrombolysis time window and had no contraindications, alteplase was administered. The patient demonstrated an exceptional neurological improvement within 10 days of hospitalisation, transitioning from tetraplegia and anarthria to moving all four limbs against gravity and mild dysarthria. She was subsequently discharged to a rehabilitation centre. This case underscores the efficacy of timely thrombolysis in severe pontine strokes and highlights the diagnostic significance of MRI findings in such cases.
Statins are rarely prescribed for incidentally discovered covert cerebrovascular disease: a retrospective cohort in a large electronic health record (EHR) identified using natural language processing
Authors: Leung Lester Y , Puttock Eric , Kallmes David F , Luetmer Patrick , Fu Sunyang , Zheng Chengyi X , Liu Hongfang , Chen Wansu , Kent David M
Published: November 2024

Introduction

While incidentally discovered covert cerebrovascular diseases (id-CCD) are associated with future stroke, it is not known if patients with id-CCD are prescribed statins.

Methods

Patients age ≥50 with id-CCD on neuroimaging from 2009 to 2019 with no prior ischaemic stroke, transient ischaemic attack or dementia were identified using natural language processing in a large real-world cohort. Robust Poisson multivariable regression was used to assess statin prescription among patients without prior statins.

Results

Among 2 41 050 patients, 74 975 patients (31.1%; 4.7% with covert brain infarcts (CBI); 29.0% with white matter disease (WMD)) had id-CCD. 53.5% (95% CI 53.2 to 53.9%) were not on statins within 6 months prior to the scan. Of those, 12.0% (95% CI 11.7 to 12.3%) were prescribed statins in the next 6 months compared with 9.3% (95% CI 9.1 to 9.4%) in those without CCD, a 2.7% (95% CI 2.4 to 3.1%) absolute increase in statin prescription for those with id-CCD. In adjusted analyses, the presence of id-CCD was only associated with minor increases in statin prescription (CBI or WMD (risk ratio (RR) 1.09, 95% CI 1.05 to 1.13), CBI alone (RR 1.34, 95% CI 1.21 to 1.47), WMD alone (RR 1.05, 95% CI 1.01 to 1.09), and CBI and WMD (RR 1.23, 95% CI 1.12 to 1.35)).

Discussion

Identification of id-CCD is not associated with substantial changes in statin prescription in routine clinical practice.
Fertility-sparing surgery versus radical surgery for micropapillary serous borderline ovarian tumours: a systematic review protocol
Authors: Zhao Anqi , Wang Jingyi , Xu Jin , Dong Peng , Jiang Shan , Wang Shijun
Published: November 2024

Introduction

Micropapillary serous borderline ovarian tumours (MP-SBOTs) are an aggressive subtype of serous borderline ovarian tumours (SBOTs). Surgery is the mainstay of treatment. Radical surgery (RS, including debulking) is an alternative. However, for patients who are of reproductive age, another treatment option is fertility-sparing surgery (FSS). Up to now, the best surgical approach for MP-SBOTs and whether different procedures will have an impact on postoperative recurrence are still up for debate. This protocol outlines a systematic review and meta-analysis to investigate whether FSS adversely affected outcomes compared with RS in patients with MP-SBOTs. Additionally, we will do a prognosis analysis of BOTs with no microcapillary pattern and MP-SOBTs, if possible.

Methods and analysis

This protocol will consider non-randomised studies comparing outcomes in patients with MP-SBOTs treated with RS or FSS. The following databases will be searched: Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, MEDLINE, Embase Medline, PubMed, Web of Science, China Biological Medicine Database, China National Knowledge Infrastructure and Wan Fang database. We will try our best to search the grey literature to avoid missing crucial research. Data collection and extraction will be performed according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Risk of Bias in Non-randomised Studies of intervention will be used to assess non-randomized studies. We will assess the certainty of the evidence using the GRADEpro methodology and describe the degree of certainty of our results using suggested wording based on the GRADEpro assessment. We will conduct a meta-analysis and offer summary statistics for each result if there is enough data available. Instead, we will report the findings narratively where the data do not permit a statistical assessment.

Ethics and dissemination

Ethics approval was not required for this study. Results will be published through a peer-reviewed publication and communicated at scientific events once complete.

PROSPERO registration number

CRD42023439136.
Research and development investment of Chinese chemical pharmaceutical companies under the national pooled procurement: a retrospective panel data analysis, 2013–2022
Authors: Lei Qianrun , Wu Qiyou , Wang Zhitao , Sun Jing , Liu Yuanli
Published: November 2024

Objective

To generate evidence about changes in the research and development (R&D) investment of Chinese chemical pharmaceutical companies before and after the implementation of the national pooled procurement, to respond to the concerns that significant price reductions might negatively affect R&D investment, and to facilitate the evidence-based decision-making for improvement of the national pooled procurement.

Methods

This retrospective study employed the fixed-effects models with robust SEs to analyse the changes in R&D investment intensities of 76 A-share listed Chinese chemical pharmaceutical companies before and after the procurement implementation in 2019. The analyses were based on a panel data set between 2013 and 2022. Subgroup analyses were conducted to account for the heterogeneity of the target companies. The bootstrap hypothesis test method was employed to assess potential variations across the different subgroups.

Results

Following the procurement implementation, the R&D investment intensity (RDI) of the target companies increased by 1.9% (p<0.05) compared with the RDI before the procurement implementation. Successful bidders exhibited a higher RDI of 2.2% (p<0.01) compared with that of the other suppliers. The RDI of companies engaged in traditional Chinese medicine (TCM) production was found to be 2.4% lower (p<0.01) than that of companies not involved in TCM production. Similarly, the companies engaged in the production of active pharmaceutical ingredients (APIs) had a 1.6% lower (p<0.01) RDI than those not involved in API production.

Conclusions

This study found that the enthusiasm of Chinese chemical medicines companies towards investing in R&D following the medicines regulatory reforms was not suppressed when the pilot pooled procurement was expanded and continued. The overall level of RDI following the pilot was higher than that before the pilot during the entire observation period. The enhanced investment in R&D has been a distinctive feature of Chinese chemical pharmaceutical companies that position themselves with more substantial market competitiveness.
Methodological standards in the design and reporting of pilot and feasibility studies in emergency medicine literature: a systematic review
Authors: Ruangsomboon Onlak , Lima João Pedro , Eltorki Mohamed , Worster Andrew
Published: November 2024

Objective

Pilot and feasibility studies are intended to ensure that subsequent randomised controlled trials (RCTs) are feasible, economical and rigorous, especially in a challenging research environment such as emergency medicine (EM). We aimed to evaluate the methodological quality in conducting and reporting randomised pilot and feasibility studies in the EM literature and propose recommendations to improve their quality.

Design

Methodological systematic review.

Data sources and eligibility

We searched MEDLINE and Embase (2018–29 September 2023) for pilot or feasibility RCTs published as full texts in the five top-ranked and other first-quartile EM journals according to Scimago.

Data extraction and analysis

We assessed their methodological features and reporting quality primarily based on the Consolidated Standards of Reporting Trials (CONSORT) extension.

Results

A total of 24 randomised trials identified as pilot (n=13), feasibility (n=3) or both (n=8) were included. At least one feasibility outcome was assessed in 9 trials (feasibility trials), while 15 others only focused on treatment efficacy (efficacy trials). Only three (12.5%) studies progressed to the main trials. Among 12 feasibility trials, 55.6% reported their outcomes with uncertainty estimates, and 33.3% had clear progression criteria. Efficacy trials tended to draw clinical implications on their results. Studies from the five top-ranked journals had better methodological and reporting quality than those from other first-quartile journals.

Conclusion

Main methodological concerns for pilot and feasibility studies in first-quartile EM literature include misconceptions, misuses and suboptimal design and reporting quality. These issues were more prominent in lower-ranked first-quartile journals. Our findings highlight the need for resources and training for researchers, journal editors and peer reviewers on the value, objectives and appropriate conduct of pilot and feasibility studies. The conceptual framework and standardised methodological components should be emphasised. EM journals should reinforce the reporting standards and support their publication. These actions can lead to more methodologically rigorous pilot and feasibility studies in EM.

PROSPERO registration number

CRD42023468437.
Different interventions to prevent preterm birth in pregnant women with cervical shortening during pregnancy: a protocol for a network meta-analysis
Authors: Luo JieFeng , Liu Dan , Liu Jiyong
Published: November 2024

Introduction

Premature birth is the leading cause of neonatal mortality. Cervical length shortening during pregnancy serves as the gold standard for predicting preterm birth. Although several interventions have been applied to reduce the incidence of preterm birth in short cervix pregnant women, the optimal intervention in clinical practice remains controversial. The aim of this study is to conduct a network meta-analysis to explore the optimal intervention for preventing preterm birth among pregnant women with a short cervix.

Methods and analysis

We will search electronic information databases including PubMed, Embase Ovid, Cochrane Library Ovid, Wanfang Data, China Science and Technology Journal Database(VIP) and clinical trial registry websites (US Clinical Trials Registry and China Clinical Trials Registry) until 1 January 2024. Randomised controlled trials (RCTs) comparing two or more interventions to prevent preterm birth in short cervix pregnant women will be included. The primary outcomes are preterm birth rate at <37 weeks and the composite neonatal adverse outcome, secondary outcomes include spontaneous preterm birth rate at <37 weeks, preterm birth rate at <34 weeks, spontaneous preterm birth rate at <34 weeks, week of gestation, birth weight of the newborn, perinatal mortality and neonatal admission rate. Risk of bias 2.0 (ROB 2.0） will be used to assess the risk of bias in the RCT, and the Confidence in Network Meta-Analysis software will be used to assess the certainty of the generated evidence. The network meta-analysis will be conducted using the gemtc package in R 4.2.2. Two investigators independently performed article screening, data extraction and quality assessment. In addition, subgroup analyses and sensitivity analyses will be used to assess the robustness of the findings.

Ethics and dissemination

Ethical considerations will not be required. Results will be published in a peer-review journal.

PROSPERO registration number

CRD42022315200.
Exploratory analysis of factors influencing hospital preferences among the Lebanese population: a cross-sectional study
Authors: El Zouki Christian-Joseph , Chahine Abdallah , Ghadban Elie , Harb Frederic , El-Eid Jamale , El Khoury Diala
Published: November 2024

Objectives

The primary aim of this research is to uncover the underlying factors that shape hospital selection criteria among individuals in Lebanon.

Design

Cross-sectional study.

Setting

A survey was circulated across social media platforms and messaging applications in Lebanon from February to May 2023. This questionnaire aimed to gauge participants’ opinions on the importance of various factors in their hospital selection process.

Participants

A total of 746 participants filled out the survey. We targeted Lebanese adults who were not hospitalised at the time of survey submission.

Main outcome measures

We performed an exploratory factor analysis to examine the underlying structure of our 70-question survey. Reliability analysis was conducted using Cronbach’s alpha and McDonald’s omega. Factor scores were derived by aggregating raw scores and computing the mean.

Results

The survey results identified eight key factors that accounted for 58.02% of the total variance, with excellent sampling adequacy (Kaiser-Meyer-Olkin=0.921, Bartlett’s p<0.001). These factors exhibited good internal consistency, as indicated by Cronbach’s alpha values for each factor. Ranked by importance for hospital selection, the factors are: staff qualities (α=0.773), administrative services (α=0.801), reputation (α=0.773), ease of access (α=0.704), room attributes (α=0.796), architectural and physical surroundings (α=0.828), luxury amenities (α=0.849) and affiliation and ownership (α=0.661).

Conclusion

This paper highlights the hospital characteristics that people may value before selecting a hospital. This insight provides an opportunity for hospital managers to refine their services, ensuring better resonance with people’s anticipations. Beyond this, it sheds light on areas where hospitals could strategically invest to elevate their competitive edge in the healthcare market.
Assessing if motives-based vignettes influence plans for drinking and alcohol cues: protocol for a randomised controlled trial
Authors: Crawford Joel , Collier Elizabeth , Cooke Richard , Ulfsdotter Gunnarsson Katarina , Shorter Gillian , Bendtsen Marcus
Published: November 2024

Introduction

In Sweden and the UK, there is a high prevalence of risky drinking, a pattern of drinking associated with adverse consequences. Drinking motives are a proximal predictor of risky drinking and subsequent consequences, suggesting it may be an apt intervention target. Currently, there is a lack of evidence regarding the applicability of motives for intervention efforts. The current study aims to test if motives-based materials are effective in impacting plans for future drinking and reactivity to alcohol-related cues. A secondary aim is to assess individuals’ perceptions of risky drinking as outlined by health authorities. The results of the study will inform the design of a motives-based digital alcohol intervention.

Methods and analysis

The study is a three-arm, parallel group, randomised controlled trial. Vignettes will be used to present health information, framed in terms of gains from limiting drinking and losses from excess drinking. Control vignettes will present general health information framed in terms of gains or losses. Proxies for behaviour (intentions and self-efficacy) will be assessed with questionnaire items. A Stroop task will be used to assess reactivity to alcohol cues, and an open-ended item will be used to record perceptions of risky drinking. Outcomes will be contrasted with regression models and estimated using Bayesian inference, while qualitative data will be analysed using thematic analysis within a framework analysis.

Ethics and dissemination

Ethical approval for the study was waived by the Swedish Ethical Review Authority on 16 December 2023 based on participants being anonymous (Dnr. 2023-06474-01). The results of the study will be disseminated in an academic journal and research conferences while also informing the design of a national digital alcohol intervention.

Trial registration number

ISRCTN12456514.
Maintenance immunosuppressive therapy in liver transplantation: results from CESIT study, an Italian retrospective cohort study
Authors: Bellini Arianna , Finocchietti Marco , Rosa Alessandro Cesare , Masiero Lucia , Trapani Silvia , Cardillo Massimo , Massari Marco , Spila Alegiani Stefania , Pierobon Silvia , Ferroni Eliana , Zanforlini Martina , Leoni Olivia , Ledda Stefano , Garau Donatella , Davoli Marina , Addis Antonio , Belleudi Valeria
Published: November 2024

Objectives

To investigate the use of maintenance immunosuppressive treatments following liver transplantation and to compare their risk–benefit profiles in clinical practice.

Design

Retrospective multicentrer cohort study.

Setting

Four Italian regions (Lombardy, Veneto, Lazio, Sardinia).

Methods

Data were integrated from the national transplant information system and administrative claims data from four Italian regions. All adults who underwent incident liver transplantation between 2009 and 2019 were identified and categorised into two groups: cirrhosis or hepatocellular carcinoma (HCC). The trend of immunosuppressive treatment over years was analysed, and their effectiveness/safety profiles were compared using multivariate Cox models (HR; 95% CI).

Main outcome measures

Mortality, transplant reject/graft failure, incidence of severe infections, cancer, diabetes, major adverse cardiovascular events and lipid-modifying agents use.

Results

The study comprised 750 subjects in the cirrhosis cohort and 1159 in the HCC cohort. Over the study years, there was a decline in the use of cyclosporine-CsA, while combination therapy involving tacrolimus with other drugs increased compared with monotherapy. Overall, tacrolimus monotherapy use was slightly over 40% in both groups, followed by tacrolimus+mycophenolate (39.5%-cirrhosis; 30.6%-HCC) and tacrolimus+molecular target of rapamycin inhibitors (mTORi) (8.5%-cirrhosis; 13.3%-HCC). No significant differences emerged in risk–benefit profile of different tacrolimus-based therapies, except for a higher risk of mortality in cirrhosis subjects under tacrolimus monotherapy compared with tacrolimus+mycophenolate (HR: 2.07; 1.17 to 3.65).

Conclusions

The study highlights a shift over time in postliver transplant therapeutic patterns, favouring the use of tacrolimus in combination with mycophenolate or mTORi, rather than monotherapy. Moreover, a potential association between tacrolimus monotherapy and increased mortality in the cirrhosis cohort was identified. Further research is warranted to investigate these findings more deeply and to optimise treatment strategies for liver transplant recipients.
Effectiveness evaluation of an organisational intervention, targeting pregnancy and addiction care professionals, among women who have just given birth in maternity wards and smoked tobacco during pregnancy (5A-QUIT-N): study protocol for a stepped-wedge cluster randomised trial
Authors: Kervran Charlotte , Francis-Oliviero Florence , Kret Marion , Burtin Adrianna , Ratel Rebecca , Clet Estelle , Collin Fidéline , Martiren Séverine , Brandet Claire , Martin-Fernandez Judith , Perrin Sarah , Monin Carla , Cambon Linda , Auriacombe Marc , Sentilhes Loïc , Alla François
Published: November 2024

Introduction

In 2021, among French women who smoked when they knew they were pregnant, 59% still smoked at the end of pregnancy. Support for pregnant women to stop smoking must include a structured organisational perspective. The main objective of the study is to evaluate the effectiveness of the 5A-QUIT-N organisational intervention on smoking cessation at delivery among pregnant women who smoke during pregnancy.

Methods and analysis

The overarching goal of the 5A-QUIT-N intervention, which aims to organise the healthcare professionals monitoring pregnancy, specialists in addiction and tobacco use, and clinical and training tools, using the 5As method. The 5A-QUIT-N intervention will be evaluated in a pragmatic stepped-wedge cluster randomised trial. Within each cluster, during the 6 months before (control) and after (intervention) the intervention, women who smoke tobacco during pregnancy will be enrolled during their maternity stay after delivery. A transition period is planned between the control and intervention periods to deploy the intervention. All participating women will be interviewed using a heteroquestionnaire to assess smoking cessation, tobacco use monitoring by healthcare professionals and individual factors associated with tobacco use during pregnancy. The primary outcome was the point prevalence of abstinence at delivery, which is the proportion of women reporting abstinence from smoking for at least 7 days at delivery. 4200 women who smoked tobacco during pregnancy will be recruited over the entire study period (33 months) to evaluate the effectiveness. An estimated 4585 participants will be included for all aims.

Ethics and dissemination

The study will be implemented in accordance with French regulations. The study including the consent process has been independently reviewed and approved by the French ethical board ‘CPP Ile de France I’ on 10 February 2022 (No CPPIDF1-2022-DI08-cat.2). The results will be disseminated on various academic and non-academic platforms. The results will be reported in international peer-reviewed journals and presented at international and national conferences.
What are the barriers and facilitators to help-seeking behaviour for symptoms in patients with ovarian cancer in China? A qualitative study
Authors: Yin Haining , Zha Yingjuan , Zhou Yuxin , Tao Hua , Zhu Di
Published: November 2024

Objectives

To explore the barriers and facilitators to help-seeking behaviour for symptoms among patients with ovarian cancer in China.

Design

This semistructured interview-based study used a descriptive phenomenological research method.

Setting

The study was conducted in China.

Participants

17 patients with ovarian cancer were selected based on the principle of maximum differentiation.

Outcome measures and analysis

The study followed the consolidated criteria for reporting qualitative research. Data were analysed using the Colaizzi’s seven-step method.

Results

Three main themes were identified: (1) low level of symptom perception and cancer risk awareness: unawareness of early non-specific symptoms, mistaken attribution of symptoms and delay caused by a previous diagnosis of benign tumours; (2) cognitive factors influencing help-seeking behaviour: positive health beliefs, perceived benefits of help-seeking, previous adverse medical experiences, stigma and restrained self-disclosure and medical treatment accompanied by distress and (3) practical factors affecting help-seeking behaviour: time pressure caused by social role burden, financial burden, lack of informal carers and mismatch between medical resources and patients’ needs.

Conclusion

This study shows that help-seeking behaviour for symptoms among patients with ovarian cancer is not valued. The importance of early symptom recognition, the psychosocial needs of patients and practical barriers must be considered to develop interventions to promote help-seeking behaviour.
Prognostic role of systemic inflammation response index in patients with non-small cell lung cancer: a meta-analysis
Authors: Ye Xingchen , Dai Menglu , Xiang Zhuofang
Published: November 2024

Objectives

The significance of the systemic inflammation response index (SIRI) for predicting prognostic outcomes in patients with non-small cell lung cancer (NSCLC) has been analysed in previous studies, but no consistent conclusions have been obtained. Consequently, the present meta-analysis was performed to identify the significance of SIRI in predicting the prognosis of NSCLC.

Design

This study followed the PRISMA guidelines.

Data sources

PubMed, Web of Science and Embase databases were searched between their inception and 26 November 2023.

Eligibility criteria for selecting studies

Studies investigating the relationship between SIRI and survival outcomes of patients with NSCLC were included.

Data extraction and synthesis

The value of SIRI in predicting prognosis in NSCLC cases was predicted using combined hazard ratios (HRs) and 95% CIs.

Results

Nine articles with 3728 cases were enrolled in this study. Based on our combined data, a higher SIRI value was markedly linked with poor overall survival (OS) (HR=2.08, 95% CI 1.68 to 2.58, p<0.001) and inferior progression-free survival (PFS) (HR=1.74, 95% CI 1.47 to 2.07, p<0.001) of NSCLC. According to the subgroup analysis, country, history and cut-off value did not affect the significance of SIRI in predicting OS and PFS in NSCLC (p<0.05).

Conclusions

A higher SIRI value was significantly associated with both OS and PFS in patients with NSCLC. Moreover, SIRI had a stable prognostic efficiency for NSCLC in various subgroups.
Living with a permanent ostomy: a descriptive phenomenological study on postsurgical experiences in patients with colorectal cancer
Authors: Tan Zuo , Jiang Lili , Lu Anqing , He Xiao , Zuo Yan , Yang Jie
Published: November 2024

Objectives

To explore the postsurgery lived experiences of patients with colorectal cancer with a permanent ostomy for informing initiatives to improve patient care and future quantitative research.

Design

A descriptive qualitative phenomenological study.

Setting

We conducted this study in the Colorectal Cancer Division at the Cancer Center of West China Hospital, Sichuan University, a premier institution renowned for its comprehensive cancer care and research.

Participants

12 patients who had undergone surgeries for colorectal cancer with a permanent ostomy.

Results

Our interviews revealed profound adjustments in the lives of colorectal cancer survivors living with permanent ostomies. Participants articulated a transition to a ‘new normal’, characterised by extensive daily life adjustments, psychological adaptation and ongoing management challenges. Key themes identified included the adaptation to a reshaped daily routine and altered perceptions of quality of life. Many faced substantial challenges in stoma care, requiring significant learning and adaptation. Psychological adaptations were marked by a redefinition of body autonomy and personal identity, alongside a recalibration of social interactions and privacy. The need for robust professional guidance and a comprehensive social support system was universally emphasised.

Conclusions

Patients with colorectal cancer with permanent ostomies navigate significant changes in their lives postsurgery, undertaking a complex process of reconstructing and adapting to a new normalcy. They recalibrate their physical, psychological and social well-being, demonstrating resilience and adaptability in the face of these challenges. Their pervasive expression of needs for information and support may reflect gaps in the existing patient education and support measures and communication strategies. Healthcare professionals and policy-makers should adopt a patient-centred approach acknowledging the multifaceted nature of postsurgery recovery and adaptation by fostering open communication, tailoring personalised education and facilitating supportive community networks.
Barriers and facilitators to self-management of chronic conditions reported by women: a systematic review of qualitative studies
Authors: Dwyer Lucy , Barber Charlotte , Dowding Dawn , Kearney Rohna
Published: November 2024

Objectives

This systematic review aims to identify, appraise and synthesise the findings of published qualitative research exploring the barriers and facilitators to self-management of chronic conditions reported by women.

Design

A systematic literature review and thematic synthesis of qualitative studies.

Data sources

A search of MEDLINE, CINAHL, Embase and PsycInfo was undertaken using the search terms ‘Women’, ‘Woman’ ‘Female,’ ‘Chronic’, ‘Long-term’, ‘Disease’, ‘Illness’, ‘Condition’ ‘Health,’ ‘Self-management,’ ‘Qualitative,’ ‘Barrier’ and ‘Facilitator’. A hand search for literature was also performed.

Eligibility criteria

Studies published before 2005 and those not in English were excluded.

Data extraction and synthesis

Extracted data were analysed thematically and emerging and recurring themes identified. Themes were mapped to the six components of the COM-B model. Critical appraisal of included publications was undertaken using the CASP (Critical Appraisal Skills Programme) qualitative checklist and finding weighted on quality.

Results

Eighty-four publications were identified and eligible for inclusion within the review. Studies were conducted in five continents, with a focus on 20 different chronic conditions and included a total of 1788 women. Barriers and facilitators to physical capability, psychological capability, physical opportunity, social opportunity, autonomic motivation and reflective motivation were identified with a number of recurring themes found. Self-prioritisation, support and culture all had a significant impact on whether women followed self-management recommendations. Certain groups of women such as those living remotely, those with financial difficulties, migrants and those who do not speak the predominant language appear to face additional barriers to self-management.

Conclusions

This review highlights that to self-manage chronic conditions women have to overcome various cultural, financial and social barriers. Self-management programmes should be designed taking into account these factors in order to ensure women are better supported and enabled to improve their health outcomes.