bluuebunny/crossref_metadata_2025 huggingface dataset:
Taking Charge of Men’s Health: Need for More Comprehensive Care Beyond the Prostate Cancer Diagnosis
Authors: Watts Andrew , Cooper Brennen , Luebke Marie , Johnson Scott , Jacobsohn Kenneth
Published: August 2023

Introduction: In this study, we aim to characterize diagnosed and undiagnosed comorbid conditions as well as the sufficiency of their management in order to demonstrate the opportunity available to improve the overall health in men presenting with a new prostate cancer diagnosis. Methods: A retrospective chart review was performed on patients presenting with a new prostate cancer diagnosis from January 2020 to March 2022 to determine undiagnosed conditions and adequacy of the management of comorbidities. Results: Of the included patients, 24.9% had prediabetes, 19.3% diabetes mellitus (DM), 68.5% hypertension (HTN), 70.2% hyperlipidemia (HLD), and 43.1% metabolic syndrome. For DM, HTN, and HLD, 10.5%, 18.8%, and 18.8% of patients were screened but inadequately treated, respectively; 5.5%, 13.8%, and 8.3% were not diagnosed; 2.8%, 0, and 5.5% were not screened. The average 10-year ASCVD risk in patients with metabolic syndrome was 25.6% vs 15.1% in those without ( P < .001), and 21.8% vs 15.1% in patients who were incompletely screened for chronic disease compared with those who were screened per guidelines ( P < .001). Conclusion: The study population has high rates of comorbidities, and undermanaged chronic diseases. This significant unmet health care need represents an opportunity for urologists to champion men’s health in new prostate cancer patients.
Diabetic Retinopathy Screening Using Smartphone-Based Fundus Photography and Deep-Learning Artificial Intelligence in the Yucatan Peninsula: A Field Study
Authors: Wroblewski John J. , Sanchez-Buenfil Ermilo , Inciarte Miguel , Berdia Jay , Blake Lewis , Wroblewski Simon , Patti Alexandria , Suter Gretchen , Sanborn George E.
Published: August 2023

Background:

To compare the performance of Medios (offline) and EyeArt (online) artificial intelligence (AI) algorithms for detecting diabetic retinopathy (DR) on images captured using fundus-on-smartphone photography in a remote outreach field setting.

Methods:

In June, 2019 in the Yucatan Peninsula, 248 patients, many of whom had chronic visual impairment, were screened for DR using two portable Remidio fundus-on-phone cameras, and 2130 images obtained were analyzed, retrospectively, by Medios and EyeArt. Screening performance metrics also were determined retrospectively using masked image analysis combined with clinical examination results as the reference standard.

Results:

A total of 129 patients were determined to have some level of DR; 119 patients had no DR. Medios was capable of evaluating every patient with a sensitivity (95% confidence intervals [CIs]) of 94% (88%-97%) and specificity of 94% (88%-98%). Owing primarily to photographer error, EyeArt evaluated 156 patients with a sensitivity of 94% (86%-98%) and specificity of 86% (77%-93%). In a head-to-head comparison of 110 patients, the sensitivities of Medios and EyeArt were 99% (93%-100%) and 95% (87%-99%). The specificities for both were 88% (73%-97%).

Conclusions:

Medios and EyeArt AI algorithms demonstrated high levels of sensitivity and specificity for detecting DR when applied in this real-world field setting. Both programs should be considered in remote, large-scale DR screening campaigns where immediate results are desirable, and in the case of EyeArt, online access is possible.
Dehydroevodiamine Targeting ACHE and ALDH3A1 Regulate Glycolytic Metabolism to Inhibit Hepatocellular Carcinoma Cell Apoptosis
Authors: Liu Miaomiao , Cui Yuexi , Xie Zhoutao , Zheng Yong , Chen Hui , Wei Meng , Xu Kang , Qu Linghang
Published: August 2023

Dehydroevodiamine (DHE), a natural quinazoline alkaloid used in Chinese herbal medicine, exhibits promising antitumor properties in various cancers, including gastric cancer. Glycolysis is essential for tumor proliferation and survival. The antitumor effect of DHE on hepatoma cells (hepatocellular carcinoma, HCC) and the mechanism underlying the glycolytic regulation remain unclear. In this study, the cell viability, apoptosis rate, lactate release, and glucose uptake were evaluated in hepatoma cells treated with DHE. Cell metabolites were analyzed using GC-MS, and network pharmacology was employed to identify potential drug targets for DHE. Furthermore, the antiproliferative effect of DHE on liver cancer cells was examined by silencing the identified drug target. DHE promotes the apoptosis of Huh-7 and PLC cells. Cell metabonomics studies have shown that DHE primarily modulates the glycolysis/gluconeogenesis pathway. Simultaneously, DHE can inhibit the key enzymes HK2, PFKFB3, and LDHA of the glycolysis pathway, thus inhibiting glucose uptake and lactic acid production. Network pharmacological analysis identified ACHE and ALDH3A1 as the drug targets of DHE in liver cancer. Silencing ACHE and ALDH3A1 resulted in the loss of the apoptosis-promoting effect of DHE. Thus, DHE sensitizes aerobic glycolytic hepatoma cells to apoptosis by directly downregulating ACHE and ALDH3A1, leading to the inactivation of HK2, PFKFB3, and LDHA and suppression of aerobic glycolysis. DHE effectively inhibits the progression of liver cancer, primarily by reducing glucose metabolism, thereby inhibiting apoptosis of liver cancer cells. Therefore, DHE could be a promising agent for molecular-targeted cancer treatment strategies.
“Old school socialist”
Authors: Kelley Robin D. G.
Published: August 2023

What did Mike Davis mean when he referred to himself as an “old school socialist”? In this tribute, I argue that Davis laid out a theory and praxis of revolutionary ethics. With a focus on Davis's first book, Prisoners of the American Dream, I show how he gives us one of the earliest and sharpest critiques of neoliberalism while being hopeful about multiracial insurgency. I argue that even in the bleakest of times, Davis maintained a Gramscian commitment to worker rebellions, with a keen analysis of the ebb and flow of worker power. Most of all, he knew that the work was necessary and that the work entailed fighting and organizing—as an old school socialist.
Sustainable adoption of noninvasive telemonitoring for chronic heart failure: A qualitative study in the Netherlands
Authors: Auener Stefan L. , van Dulmen Simone A. , van Kimmenade R , Westert Gert P , Jeurissen Patrick PJ
Published: August 2023

Objective

Noninvasive telemonitoring aims to improve healthcare for patients with chronic heart failure (HF) by reducing hospitalizations and improving patient experiences. Yet, sustainable adoption seems to be limited. Therefore, the goal of our study is to gain insight in the processes that support sustainable adoption of telemonitoring for patients with HF.

Methods

We conducted semi-structured interviews with 25 stakeholders that were involved with the adoption of telemonitoring, such as healthcare professionals, policymakers and healthcare insurers. We analyzed the interviews by using a combination of open-coding and the themes of the Non-adoption or Abandonment of technology by individuals and difficulties achieving Scale-up, Spread and Sustainability framework.

Results

We found that telemonitoring projects have moved beyond initial pilot phases despite a high level of complexity on multiple topics. The patient selection, the business case, the evidence, the aims of telemonitoring, integration of telemonitoring in the care pathway, reimbursement, and future centralization were items that yielded different and sometimes contradictory opinions.

Conclusions

This study showed that the sustainable adoption of telemonitoring for HF is a complex endeavor. Different aims and perspectives play an important role in the patient selection, design, evaluations and envisioned futures of telemonitoring. High conviction among participants of the added value that telemonitoring may support further adoption of telemonitoring. Structural evaluations will be needed to guide cyclical improvement and adapt programs to employ telemonitoring in such a manner that it contributes to collectively supported aims.
Evaluating an advance care planning website for people with dementia and their caregivers: Protocol for a mixed method study
Authors: Dupont Charlèss , Monnet Fanny , Pivodic Lara , Vleminck Aline De , Audenhove Chantal Van , Van den Block Lieve , Smets Tinne
Published: August 2023

Background

Web-based tools (e.g., websites, apps) for people with dementia and their family caregivers may be useful in supporting advance care planning (ACP). Using a user-centred design approach, we developed an ACP website for people with dementia and their families. This protocol describes how we will test and evaluate the ACP website. Publishing a study protocol can guide others who want to evaluate web-based tools. Moreover, the data collection methods used in this study are very innovative since they aim to involve people living with dementia without overburdening them.

Methods

We will conduct an evaluation study of the ACP website in Flanders, Belgium, using a convergent parallel mixed methods pre-post-test design with continuous follow-up. Thirty eligible dyads of people with mild to moderate dementia (both early and late onset) and their family caregivers will use the website in their everyday life for 8 weeks. We will evaluate the usage, usability, acceptability, and feasibility of the website, as well as the experiences of users. Additionally, we evaluate the effects of using the website on ACP readiness, ACP knowledge, attitudes, perceived barriers to engage in ACP, self-efficacy and skills to engage in ACP

Results

Recruitment and data collection is foreseen between end of 2022 and 2023.

Conclusion

This evaluation study of an ACP website for people with dementia and their family caregivers will be the first to evaluate how a web-based tool can support people living with dementia and their families in ACP. The strength of this study lies in the combination of interviews, surveys, and ongoing data logging, which provide insights into the use of support tools in people's daily context. We expect that recruiting people with dementia and their families will be difficult so we have set up a thorough strategy to reach the anticipated sample size.
Impact of Investor Sentiment on Contemporaneous and Future Equity Returns in Emerging Markets
Authors: Andleeb Rameeza , Hassan Arshad
Published: August 2023

The study is aimed to investigate the impact of investor sentiment on returns of selected emerging equity markets i.e., Brazil, India, China, Russia, Indonesia, and Pakistan using non-linear predictive regression analysis. Principal Component Analysis is used to generate investor sentiment index. Investor sentiment has a significant impact on current market returns and this influence is continued in the short run in most of the sample countries. However, the impact of sentiment is not much pronounced in the longer run. Therefore, decision-makers cannot ignore sentiments in at least the short run. The findings of this study may be helpful for investors to better understand the market trends under the influence of sentiments and portfolio managers and risk professionals can devise their strategies accordingly.

JEL: G02, G15, G24, M41
Simultaneous Presentation of Secondary Adrenal Insufficiency and Primary Hypothyroidism due to Pembrolizumab: A Case Report
Authors: Khatri Shivam , Alom Mulham , Kashfi Simon , Atallah Jane , Goswami Gayotri
Published: August 2023

Checkpoint inhibitors have gained increased traction in recent years as they have improved prognosis in various malignancies. Pembrolizumab, an anti-programmed cell death protein (PD-1) monoclonal antibody, has become a first-line chemotherapeutic agent for stage II non–small cell lung cancer since 2019. Although much more common with nivolumab, several immune-related adverse effects, particularly endocrinopathies, have been linked with pembrolizumab. We describe a case of a 59-year-old man with a history of unspecified lung cancer who presented with severe hyponatremia later attributed to secondary adrenal insufficiency and accompanying primary hypothyroidism secondary to pembrolizumab. Diagnosing adrenal insufficiency in patients on immune checkpoint inhibitors like pembrolizumab can be challenging due to nonspecific symptoms, making it crucial to rule out other causes of hyponatremia. Immunotherapy is known to cause thyroid immune-related adverse events, and anti-thyroid antibodies may not always be present in the diagnosis of hypothyroidism. Although there are some reported cases of pembrolizumab-induced adrenal insufficiency, the link between immunotherapy and endocrine disorders remains unclear. To our knowledge, no case reports exist that describe both primary hypothyroidism and secondary adrenal insufficiency after taking pembrolizumab, although such cases have been documented with axitinib. Timely diagnosis and treatment of adrenal insufficiency is crucial to prevent adverse effects, especially in patients with cancer receiving immunotherapy, as highlighted in this case.
Injury Patterns in Posterolateral Corner Knee Injury
Authors: Toyooka Seikai , Persson Andreas , LaPrade Robert F. , Engebretsen Lars , Moatshe Gilbert
Published: August 2023

Background:

Posterolateral corner (PLC) knee injuries associated with different injury mechanisms are not well known.

Purpose/Hypothesis:

This study sought to assess the patterns of associated injuries in the setting of PLC injury. The hypothesis was that there are recognizable injury patterns in PLC injuries that may correlate with injury mechanism.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

Patients who sustained a multiligament knee injury were retrospectively reviewed. Patients who sustained an acute grade 3 PLC injury and underwent surgery were enrolled in this study. A description of the PLC injury (location of the injury of the fibular collateral ligament [FCL], popliteus tendon, and/or popliteofibular ligament) and reported concomitant injuries (biceps femoris tendon or meniscal tears, cartilage pathology and/or peroneal nerve palsy, or bone bruises) were collected and classified based on intraoperative and magnetic resonance imaging (MRI) findings.

Results:

Of 135 patients reviewed, 83 did not have PLC involvement and 13 were excluded due to insufficient MRI scans available. Thus, 39 patients were included in this study. For both the anterior cruciate ligament (ACL)–PLC and ACL–posterior cruciate ligament–PLC injury patterns, the most frequent injury pattern entailed a bone bruise of the anteromedial (AM) femur and tibia, an FCL tear from the fibular head, the popliteus tendon avulsed off the femur, a biceps femoris tendon torn off the fibular head, and a common peroneal nerve palsy. Conversely, when no bone bruise occurred on the AM femur and tibia, the FCL was injured on the femoral side and the popliteus tendon, biceps femoris, and peroneal nerve were not injured.

Conclusion:

AM bone bruise was associated with a peroneal nerve injury in almost half of the patients, and peroneal nerve injury was not seen if there was no AM bone bruise.
Effect of endovascular therapy in large anterior circulation ischaemic strokes: A systematic review and meta-analysis of randomised controlled trials
Authors: Panigrahi Baikuntha , Thakur Hameer Subhangi , Bhatia Rohit , Haldar Partha , Sharma Agrata , Srivastava Madakasira Vasantha Padma
Published: August 2023

Introduction:

The benefit of endovascular treatment in large anterior circulation ischaemic strokes with low ASPECTS score (<6) is uncertain. Recent randomised studies have demonstrated the benefit of endovascular treatment (EVT) in large ischaemic strokes. The present meta-analysis aims to assess the combined effect of these studies on efficacy and safety of endovascular treatment in this group of patients.

Materials and methods:

We conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Databases MEDLINE, PubMed, EMBASE, SCOPUS, Google Scholar, Tripdatabase were searched for randomised controlled trials with at least 50 participants from inception until February 16, 2023. The primary efficacy outcome analysed was the relative risk of functional independence defined as mRS – 0–2 at 90 days. Secondary efficacy outcomes included early neurological improvement, death due to any cause at 90 days and proportion of patients requiring decompressive hemicraniectomy. The primary safety outcome was the risk of developing symptomatic intracerebral haemorrhage (sICH).

Results:

A total of three studies (RESCUE Japan-LIMIT, SELECT 2 and ANGEL ASPECTS) involving 1011 patients; 510 in the EVT arm and 501 in the medical management (MM) arm met the defined criteria (ASPECTS-3-5). The combined RR for the primary outcome of mRS 0–2 was 2.53 [1.84–3.47] ( p = <0.0001) favouring EVT over MM. The primary safety outcome of sICH was not significant in the EVT arm with a combined RR of 1.84 [0.94–3.60] ( p = 0.5157). Mortality rates were similar in both arms (26.67% in EVT arm vs 27.94% in MM arm) with a combined RR of 0.95 [0.78; 1.16] ( p = 1.000).

Conclusion:

In patients with Large vessel occlusion (LVO) and low ASPECTS (3–5), EVT was associated with higher likelihood of achieving functional independence and early neurologic improvement but did not provide any mortality benefit.
Expectations and barriers to the utilization of specialist palliative care services among persons living with cancer in Ghana: an exploratory qualitative study
Authors: Mensah Adwoa Bemah Boamah , Poku Abena Agyekum , Mensah Kofi Boamah , Okyere Joshua , Mikare Maurice , Apiribu Felix , Boakye Emelia Osei , Lamptey Joe-Nat Clegg
Published: August 2023

Background:

The need for palliative care among patients living with cancer is increasing globally. This need is far greater in resource-constrained settings like Ghana where there is a high unmet need for palliative care services. Consequently, there are lapses in the current palliative care regime, thus, resulting in suboptimal utilization.

Objective:

The study aims to explore patients living with cancer’s expectations of palliative care services and examine the barriers that impede palliative care utilization.

Design:

Descriptive exploratory qualitative design.

Methods:

A total of 15 patients living with cancer and receiving treatment in a tertiary health facility were purposively sampled to participate in this study. Semi-structured interviews were conducted. The data were transcribed and inductively analysed following Collaizi’s qualitative analysis framework.

Results:

From the analysis, the findings were grouped under two main categories: perceived expectations and barriers to utilizing palliative care. The participants expected to receive meaningful communication about their condition and prognosis; they also expected to be actively involved in palliative care decision-making. Regarding the barriers, the following themes emerged: financial constraints, unfavourable health appointment schedules, problems with the distance to the health facility, poor referral and follow-up from oncology specialists and being unaware of the availability of palliative care services.

Conclusion:

In conclusion, there is a need to actively involve patients and their families in all decision-making along the continuum of palliative care service delivery. The study underscores the need for Ghana to implement an integration of palliative care services in primary healthcare facilities to avert the challenges that distance to tertiary healthcare facilities poses to palliative care utilization. Service providers must implement awareness programmes to enable patients to better comprehend palliative care services.
Techniques for Fixing Anterior Cruciate Ligament Tibial Avulsion Fractures in Multiligament Knee Injuries
Authors: Fong Francis Jia Yi , Poon Glenys Mu En , Lee Yee Han Dave
Published: August 2023

Background:

In patients with multiligament knee injuries, anterior cruciate ligament (ACL) tears are often reconstructed. Recent studies have shown good results when the ACL tibial avulsions are repaired. The advantages of ACL tibial avulsion repair are the preservation of the native anatomy, reduction in donor site morbidity, and lower risk of tunnel convergence.

Indications & Technique Description:

We show 2 techniques for repairing ACL tibial avulsion fractures. The first case describes the use of hybrid fixation (screw and suture), with staged repair and reconstruction in a patient with high-energy knee fracture-dislocation. The second case describes the use of suture ACL repair via tunnels in a patient with a low-energy knee dislocation and an ACL tibial avulsion fracture. When repairing ACL tibial avulsion fractures, screw fixation is recommended for larger tibial fragments. In smaller comminuted fragments, tying sutures passed through the ACL via tibial tunnels may be more appropriate.

Results:

Several studies have demonstrated good postoperative results in patients following the fixation of ACL tibial avulsion fractures. Both screw and suture fixation are effective methods of repairing ACL tibial avulsion fractures and have similar postoperative outcomes. It has been found that screw fixation is associated with a higher risk of subsequent surgery and implant removal than suture fixation.

Conclusion:

The repair of ACL tibial avulsion fractures in multiligament knee injuries is an alternative to ACL reconstruction that demonstrates excellent postoperative patient outcomes, good patient satisfaction, and good return to sports.

Patient Consent Disclosure Statement:

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form.
Cash holdings and firm value: Evidence for increasing marginal returns
Authors: Theissen Maximilian H. , Jung Christopher , Theissen Hubertus H. , Graf-Vlachy Lorenz
Published: August 2023

Cash is an important strategic asset for firms and scholars have a longstanding interest in the optimum level of a firm's cash holdings. In this study, we revisit the relationship between cash holdings and firm value by conducting a re-examination of Kim and Bettis , who hypothesized and found positive but decreasing marginal returns of cash. We argue and demonstrate that the regression model configuration of Kim and Bettis leads to distorted regression results. Once we adjust their regression model configuration, our results show that the benefits of cash do not diminish but instead increase with increasing cash holdings. In further analyses, we find indicative evidence that these results may be driven by firms with very high investment opportunities. We also employ a larger sample over a longer period of time to corroborate the time generalizability of our findings, we perform several checks to establish their robustness, and we discuss their theoretical implications.
Cerebrospinal fluid camk2a levels at baseline predict long-term progression in multiple sclerosis
Authors: Sohaei Dorsa , Thebault Simon , Avery Lisa M. , Batruch Ihor , Lam Brian , Xu Wei , Saadeh Rubah S. , Scarisbrick Isobel A. , Diamandis Eleftherios P. , Prassas Ioannis , Freedman Mark S.
Published: August 2023

Background

Multiple sclerosis (MS) remains a highly unpredictable disease. Many hope that fluid biomarkers may contribute to better stratification of disease, aiding the personalisation of treatment decisions, ultimately improving patient outcomes.

Objective

The objective of this study was to evaluate the predictive value of CSF brain-specific proteins from early in the disease course of MS on long term clinical outcomes.

Methods

In this study, 34 MS patients had their CSF collected and stored within 5 years of disease onset and were then followed clinically for at least 15 years. CSF concentrations of 64 brain-specific proteins were analyzed in the 34 patient CSF, as well as 19 age and sex-matched controls, using a targeted liquid-chromatography tandem mass spectrometry approach.

Results

We identified six CSF brain-specific proteins that significantly differentiated MS from controls (p < 0.05) and nine proteins that could predict disease course over the next decade. CAMK2A emerged as a biomarker candidate that could discriminate between MS and controls and could predict long-term disease progression.

Conclusion

Targeted approaches to identify and quantify biomarkers associated with MS in the CSF may inform on long term MS outcomes. CAMK2A may be one of several candidates, warranting further exploration.
EDST: a decision stump based ensemble algorithm for synergistic drug combination prediction
Authors: Chen Jing , Wu Lianlian , Liu Kunhong , Xu Yong , He Song , Bo Xiaochen
Published: August 2023

Introduction

There are countless possibilities for drug combinations, which makes it expensive and time-consuming to rely solely on clinical trials to determine the effects of each possible drug combination. In order to screen out the most effective drug combinations more quickly, scholars began to apply machine learning to drug combination prediction. However, most of them are of low interpretability. Consequently, even though they can sometimes produce high prediction accuracy, experts in the medical and biological fields can still not fully rely on their judgments because of the lack of knowledge about the decision-making process.

Related work

Decision trees and their ensemble algorithms are considered to be suitable methods for pharmaceutical applications due to their excellent performance and good interpretability. We review existing decision trees or decision tree ensemble algorithms in the medical field and point out their shortcomings.

Method

This study proposes a decision stump (DS)-based solution to extract interpretable knowledge from data sets. In this method, a set of DSs is first generated to selectively form a decision tree (DST). Different from the traditional decision tree, our algorithm not only enables a partial exchange of information between base classifiers by introducing a stump exchange method but also uses a modified Gini index to evaluate stump performance so that the generation of each node is evaluated by a global view to maintain high generalization ability. Furthermore, these trees are combined to construct an ensemble of DST (EDST).

Experiment

The two-drug combination data sets are collected from two cell lines with three classes (additive, antagonistic and synergistic effects) to test our method. Experimental results show that both our DST and EDST perform better than other methods. Besides, the rules generated by our methods are more compact and more accurate than other rule-based algorithms. Finally, we also analyze the extracted knowledge by the model in the field of bioinformatics.

Conclusion

The novel decision tree ensemble model can effectively predict the effect of drug combination datasets and easily obtain the decision-making process.
Diagnostic performance of radiomics model for preoperative risk categorization in thymic epithelial tumors: a systematic review and meta-analysis
Authors: Lu Xue-Fang , Zhu Tie-Yuan
Published: August 2023

Background

Incidental thymus region masses during thoracic examinations are not uncommon. The clinician’s decision-making for treatment largely depends on imaging findings. Due to the lack of specific indicators, it may be of great value to explore the role of radiomics in risk categorization of the thymic epithelial tumors (TETs).

Methods

Four databases (PubMed, Web of Science, EMBASE and the Cochrane Library) were screened to identify eligible articles reporting radiomics models of diagnostic performance for risk categorization in TETs patients. The quality assessment of diagnostic accuracy studies 2 (QUADAS-2) and radiomics quality score (RQS) were used for methodological quality assessment. The pooled area under the receiver operating characteristic curve (AUC), sensitivity and specificity with their 95% confidence intervals were calculated.

Results

A total of 2134 patients in 13 studies were included in this meta-analysis. The pooled AUC of 11 studies reporting high/low-risk histologic subtypes was 0.855 (95% CI, 0.817–0.893), while the pooled AUC of 4 studies differentiating stage classification was 0.826 (95% CI, 0.817–0.893). Meta-regression revealed no source of significant heterogeneity. Subgroup analysis demonstrated that the best diagnostic imaging was contrast enhanced computer tomography (CECT) with largest pooled AUC (0.873, 95% CI 0.832–0.914). Publication bias was found to be no significance by Deeks’ funnel plot.

Conclusions

This present study shows promise for preoperative selection of high-risk TETs patients based on radiomics signatures with current available evidence. However, methodological quality in further studies still needs to be improved for feasibility confirmation and clinical application of radiomics-based models in predicting risk categorization of the thymic epithelial tumors.
Effect of the enhancing nutrition and antenatal infection treatment (ENAT) intervention on birth weight in Ethiopia: a cluster randomized controlled trial
Authors: Mekonnen Y , Wolde E , Bekele A , Mehari Z , Abebe S , Hagos T , Tadesse Y , Taye T , Asire G , Nigatu T , Kumar S , Girma S , Salasibew M
Published: August 2023

Background

The Enhancing Nutrition and Antenatal Infection Treatment (ENAT) intervention was implemented in Ethiopia to improve newborn birth weight (BW) by strengthening the contents and quality of antenatal care (ANC), especially point-of-care testing for maternal infections. This study examined the effect of the ENAT intervention on birth weight.

Methods

We conducted a cluster randomized controlled trial of 22 clusters (health centers), randomized equally between 11 intervention and 11 control clusters. This study enrolled and followed pregnant women from ANC booking to the end of pregnancy or loss to follow-up. The primary outcome was mean BW, and the incidence of low birth weight (LBW) was the secondary outcome. We presented univariate comparisons of outcomes between the intervention and control arms for mean BW and LBW. Multilevel analyses using random effects models were performed to adjust for clustering and individual-level covariates.

Results

We enrolled and followed up 4,868 and 4,821 pregnant women in the intervention and control arms, respectively, from March 2021-July 2022. During follow-up, 3445 pregnant women in the intervention and 3192 in the control delivered in the health centers, and BW measurements of their babies were recorded within 48 h. The mean BW was 3,152 g (standard deviation (SD) = 339.8 g) in the intervention and 3,044 g (SD = 353.8 g) in the control arms (mean difference, 108 g; 95% confidence interval (CI): 91.3-124.6; P = 0.000). Adjusting for clustering and several covariates, the mean BW remained significantly higher in the intervention arm than in the control arm (adjusted ß coef., 114.3; p = 0.011). The incidence of LBW was 4.7% and 7.3% in the intervention and control arms, respectively. The adjusted risk of LBW was significantly lower by 36% in the intervention arm than in the control arm (adjusted relative risk, 0.645; p = 0.027).

Conclusion

This study provided sufficient evidence of the effectiveness of the ENAT intervention in improving birth weight in the study population. The intervention demonstrated that an increase in birth weight can be attained by availing point-of-care testing, strengthening infection prevention, and maternal nutrition within the ANC platform of public health facilities in a low-income setting.

Trial Registration

Registered at Pan African Clinical Trial Registry (PACTR) database dated 09/05/2023, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=25493. The unique identification number for the registry is PACTR202305694761480.
Diagnostic accuracy of Panbio™ rapid antigen test for SARS-CoV-2 in paediatric population
Authors: Gallardo-Alfaro Laura , Lorente-Montalvo Patricia , Cañellas Margarita , Carandell Eugenia , Oliver Antonio , Rojo Estrella , Riera Beatriz , Llobera Joan , Bulilete Oana ,   on behalf of Balearic COVID-19 Pediatric Primary Care Research Group, Leiva Alfonso , Obieta Anaida , Pascual Victoria , Pericas Pau , Radúan Carlos , Segura Elsa , Vega Verónica
Published: August 2023

Background

Rapid antigen-detection tests (Ag-RDTs) are used to diagnose SARS-CoV-2 infection. Real-world studies of Ag-RDTs are necessary to evaluate their diagnostic yield in paediatric patients. Our aim was to evaluate the accuracy of the Panbio™ Rapid Antigen Test for SARS-CoV-2 in the setting of a primary health care centre (PHC), with use of the Reverse Transcription-Polymerase Chain Reaction (RT-PCR) as gold standard.

Methods

This prospective diagnostic study was conducted at PHCs in Mallorca, Spain. Patients were ≤ 18 years-old that attended sites for RT-PCR testing due to symptoms suggestive of infection (fever, headache, nasal congestion and dry cough, among others) or epidemiological exposure (close contacts). Two samples were collected: a nasal mid-turbinate sample for Ag-RDTs and a nasopharyngeal swab for RT-PCR testing. The sensitivity, specificity, and predictive values of the AgRDT were calculated using the RT-PCR results as the reference.

Results

We examined 1142 participants from 0 to 18 years (47.5% female, mean age 8.9 ± 4.8 years, median 9.0 [5.0–13.0]). There were 84 positive RT-PCR results (pre-test probability of 7.3%) and 52 positive Ag-RDT results. The sensitivity of the Ag-RDT was 59.5% (95% Confidence Interval (CI): 48.2–69.9%), the specificity was 99.8% (95%CI: 99.2–99.9%), the positive predictive value was 96.1% (95%CI: 85.6–99.4%), and the negative predictive value was 96.8% (95%CI: 95.6–97.7%). The sensitivity for individuals referred by a general practitioner (GP) or paediatrician due to symptoms was 71.4% (95%CI: 51.5–86.0%) and for asymptomatic individuals was 50.0% (95%CI: 9.1–90.8%). The specificity was greater than 98.9% overall and in all subgroups. The sensitivity was 73.0% (95%CI: 52.0–87.5%) for referred patients due to symptoms and who were tested within 5 days since symptom onset. No significant statistical differences between any groups were found. There were 34 false-negative Ag-RDT results (40.5%) and 2 false-positive Ag-RDT results (0.2%).

Conclusion

The sensitivity of the Panbio™ Test in paediatric individuals is below the minimum of 80% recommended by the World Health Organization for Ag-RDTs. This test had better accuracy in individuals referred by a GP or paediatrician due to symptoms, rather than those who were asymptomatic or referred due to epidemiological exposure. The RT-PCR test using a nasopharyngeal swab is accurate, but a less invasive alternative that has better sensitivity than the Panbio™ Test is needed for paediatric populations.
Factors associated with physical activity policy and practice implementation in British Columbia’s childcare settings: a longitudinal study
Authors: Tugault-Lafleur Claire N. , Naylor Patti-Jean , Carson Valerie , Faulkner Guy , Lau Erica Y. , Wolfenden Luke , Mâsse Louise C.
Published: August 2023

Background

In 2016–17, the government of British Columbia (BC) enacted a mandatory policy outlining Active Play Standards (AP Standards) alongside a capacity building initiative (Appetite to Play) focused on implementing policies and practices to support physical activity in childcare centres. We aimed to identify factors at the provider and organizational levels as well as attributes of the Standards hypothesized to influence implementation (i.e., changes in policies and practices).

Methods

We conducted surveys before (2016–2017) and after (2018–2019) enforcement of the AP Standards among 146 group childcare centres across BC. The 2018–19 surveys measured theoretically based constructs associated with implementation of policies and practices (9 childcare- and 8 provider- level characteristics as well as 4 attributes of the licensing standards). Characteristics that were associated in simple regression models were entered in multivariable regression models to identify factors associated with policy and practice changes related to fundamental movement skills (FMS), screen time, total amount of active play (AP) and total amount of outdoor AP from baseline to follow-up.

Results

In multivariable analyses, higher staff capacity (OR = 2.1, 95% 1.2, 3.7) and perceived flexibility of the standards (OR: 3.3, 95% 1.5, 7.1) were associated with higher odds of a policy change related to FMS. Higher staff commitment to the AP standards was associated with a higher odds of policy changes related to screen time (OR = 1.6, 95% CI: 1.1, 2.4) and amount of AP (OR: 1.5, 95% 1.0, 2.3). Higher institutionalization of PA policies was associated with a higher odds of policy changes related to the amount of AP (OR: 5.4, 95% CI: 1.5, 20). Higher self-efficacy was associated with a higher odds of policy changes related to outdoor AP (OR = 2.9, 95% 1.1, 7.8). Appetite to Play training was a positively associated with practice changes related to FMS (β = 0.5, 95% CI: 0.1, 0.9).

Conclusions

A hierarchy of theoretically defined factors influenced childcare providers’ implementation of the AP Standards in BC. Future research should test the feasibility of modifying these factors to improve the implementation of PA policy and practice interventions in this setting.
Translation and psychometric evaluation of the Persian version of Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS)
Authors: Minoonejad Hooman , Henteh Mohammad Amin , Keshavarz Roshanak , Safarzadeh Mehdi , Montazeri Ali
Published: August 2023

Background

The present study aimed to translate and validate the Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS) in Iran.

Methods

Following standard forward and backward translation procedure, content and face validity were tested by specialists and a sample of 32 patients. Then, in a cross sectional study, a sample of patients with knee disorders, recruited through simple sampling, completed the KOS-ADLS and the Short-Form Health Survey (SF-36) in their first visit to physiotherapy clinics in Tehran. Regarding construct validity, the Spearman’s correlation (rs) and one-way ANOVA were employed to evaluate the correlations between the Persian KOS-ADLS and SF-36 subscales (convergent validity) and known groups comparison, respectively. Test-retest reliability and internal consistency were evaluated by intraclass correlation coefficient (ICC) and the Cronbach’s α coefficient.

Results

In total 101 patients were included in the study. The mean age of patients was 42.39 (SD = 9.2). The finding indicated that the KOS-ADLS had strong correlations with SF-36 physical functioning, bodily pain subscales, and also physical component summary while it had lower correlations with other subscales of the SF-36 as expected. The KOS-ADLS was able to differentiate between the subgroups of patients who differed in BMI. The acceptable level of intraclass correlation coefficient (ICC = 0.91) and Cronbach’s α coefficient (α = 0.91) was obtained for the Persian KOS-ADLS. Also no floor and ceiling effects were observed for the questionnaire.

Conclusions

The Persian version of KOS-ADLS was found to be a reliable and valid outcome measure for assessing daily living activities in patients who suffer from knee pathological conditions.
Endodontic management of maxillary first molar with protostylid: a rare case report
Authors: Zhou Yang , Tao Ye
Published: August 2023

Background

A protostylid is a relatively rare dental developmental aberration characterized as an extra cusp located on the mesial half of the buccal surface of the molars. A protostylid is rarely to be reported due to its low rate of occurrence. This case report describes a patient referred for endodontic treatment due to the presence of a protostylid on the buccal surface of the maxillary first molar that induced apical periodontitis.

Case presentation

A 53-year-old female reported a 3-month history of pain of chewing with her upper left posterior teeth over 3 months. In the clinical examination, an abraded anomalous cusp-like structure was found on the buccal surface of tooth 26, Cone beam computed tomography (CBCT) revealed a supernumerary cusp with an intact root canal inside, which was fused with the mesiobuccal (MB) root canal in the middle of the root. In addition, extensive periapical radiolucency was observed around tooth 26. The tooth was diagnosed as apical periodontitis, and endodontic treatment was performed. The initial lesion in tooth 26 gradually healed over 1 year of observation.

Conclusions

To our knowledge, this case is the first to describe the endodontic management of a maxillary first molar with a protostylid and advances our understanding of supernumerary cusps. This case provides a reference for the treatment of protostylid.
Differences in the effects of orthodontic treatment on airway-craniocervical functional environment in adult and adolescent patients with skeletal class II high-angle: a retrospective pilot study
Authors: Shen Yiyang , Li Xin , Feng Xiaoyan , Yu Lan , Weng Luxi , Zhang Chenxing , Shang Yufeng , Lin Jun
Published: August 2023

Introduction

This retrospective cohort study aimed to compare the change in upper airway and craniocervical posture after orthodontic treatment between adolescent and adult patients with Class II high-angle malocclusion.

Methods

A total of 12 adolescent (mean ± standard deviation age = 13.0 ± 2.0 years) and 12 adult patients with Class II high-angle malocclusion (mean ± standard deviation age = 23.7 ± 6.4 years) were selected in this study. The lateral cephalograms and cone beam computed tomography images of adolescent and adult patients were taken before and after treatment, which can be employed to evaluate the variables of craniofacial morphology, upper airway, and craniocervical posture through paired t tests, respectively. An independent sample t test was performed to observe the differences between two groups after orthodontic intervention. For adults and adolescents, the correlation between craniofacial morphology, upper airway, and craniocervical posture was determined through Pearson correlation analysis.

Results

In all subjects, the improvements in vertical and sagittal facial morphology after treatment were observed. Anterior and inferior movements of the hyoid bone, an increase of upper airway dimension, posterior tipping of the head and a reduction of cervical inclination in the lower and middle segments post-treatment were identified in adolescence (P < 0.05). Adults displayed anterior movements of the hyoid bone, whereas no significant difference was observed in upper airway dimension and craniocervical posture (P < 0.05). Notable differences were identified in the change of hyoid position and airway volume between two groups (P > 0.05). Mandibular plane inclination, growth pattern, occlusal plane inclination, and chin position were all significantly correlated with craniocervical posture in adolescent patients. Besides, the mandibular growth pattern and chin position in adult patients were significantly correlated with craniocervical posture (P < 0.05).

Conclusions

Orthodontic treatment is capable of enhancing the facial profile of patients with skeletal class II high-angle while improving their upper airway morphology and craniocervical posture, where adolescents and adults differ substantially in that the former exhibit a more favorable alteration in the airway-craniocervical functional environment.
Interpretable machine-learning model for Predicting the Convalescent COVID-19 patients with pulmonary diffusing capacity impairment
Authors: Ma Fu-qiang , He Cong , Yang Hao-ran , Hu Zuo-wei , Mao He-rong , Fan Cun-yu , Qi Yu , Zhang Ji-xian , Xu Bo
Published: August 2023

Introduction

The COVID-19 patients in the convalescent stage noticeably have pulmonary diffusing capacity impairment (PDCI). The pulmonary diffusing capacity is a frequently-used indicator of the COVID-19 survivors’ prognosis of pulmonary function, but the current studies focusing on prediction of the pulmonary diffusing capacity of these people are limited. The aim of this study was to develop and validate a machine learning (ML) model for predicting PDCI in the COVID-19 patients using routinely available clinical data, thus assisting the clinical diagnosis.

Methods

Collected from a follow-up study from August to September 2021 of 221 hospitalized survivors of COVID-19 18 months after discharge from Wuhan, including the demographic characteristics and clinical examination, the data in this study were randomly separated into a training (80%) data set and a validation (20%) data set. Six popular machine learning models were developed to predict the pulmonary diffusing capacity of patients infected with COVID-19 in the recovery stage. The performance indicators of the model included area under the curve (AUC), Accuracy, Recall, Precision, Positive Predictive Value(PPV), Negative Predictive Value (NPV) and F1. The model with the optimum performance was defined as the optimal model, which was further employed in the interpretability analysis. The MAHAKIL method was utilized to balance the data and optimize the balance of sample distribution, while the RFECV method for feature selection was utilized to select combined features more favorable to machine learning.

Results

A total of 221 COVID-19 survivors were recruited in this study after discharge from hospitals in Wuhan. Of these participants, 117 (52.94%) were female, with a median age of 58.2 years (standard deviation (SD) = 12). After feature selection, 31 of the 37 clinical factors were finally selected for use in constructing the model. Among the six tested ML models, the best performance was accomplished in the XGBoost model, with an AUC of 0.755 and an accuracy of 78.01% after experimental verification. The SHAPELY Additive explanations (SHAP) summary analysis exhibited that hemoglobin (Hb), maximal voluntary ventilation (MVV), severity of illness, platelet (PLT), Uric Acid (UA) and blood urea nitrogen (BUN) were the top six most important factors affecting the XGBoost model decision-making.

Conclusion

The XGBoost model reported here showed a good prognostic prediction ability for PDCI of COVID-19 survivors during the recovery period. Among the interpretation methods based on the importance of SHAP values, Hb and MVV contributed the most to the prediction of PDCI outcomes of COVID-19 survivors in the recovery period.
Sustained response following BTK inhibitors based treatment in HIV-related primary central nervous system lymphoma: case report
Authors: Zhou Ying , Wang Xiaoxue , Lin Xuyong , Wang Jun , Yan Xiaojing , Wen Ying
Published: August 2023

Background

Despite increasing effort for treating primary central nervous system lymphoma (PCNSL), the prognosis of human immunodeficiency virus (HIV) -related PCNSL was still unsatisfactory. There is currently a lack of clinical evidence for the application of Bruton tyrosine kinase (BTK) inhibitor in HIV-related PCNSL. We reported two HIV-related PCNSL patients, who achieved sustained remission by application of BTK inhibitor based treatment. This protocol had not been previously reported for the treatment of HIV-related PCNSL.

Case presentation

The two cases were characterized by the treatment choice of Bruton tyrosine kinase (BTK) inhibitor. Rituximab was not recommended for them due to their very low CD4+ T cell counts. They both took MTX as the first-line therapy and got a relief in initial phase. For the first case, ibrutinib was kept both in the first-line therapy and in the maintenance therapy. When the second case underwent a progressive disease, we continued to use orelabrutinib as one of the salvage treatment, in combination with programmed cell death-1 (PD-1) inhibitor plus lenalidomide. They both achieved a continuous response of up to 20 months without opportunistic infection.

Conclusions

This report highlights the safety and effectiveness of BTK inhibitors, as well as lenalidomide and PD-1 inhibitor in HIV-related PCNSL patients. Both the new therapeutic approaches and a multidisciplinary team authentically contributed to improved survival outcome among HIV-positive PCNSL patients.