bluuebunny/crossref_metadata_2025 huggingface dataset:
Genome analysis of three isolates of Stemphylium lycopersici differ in their virulence and sporulation ability: Identification of effectors, pathogenesis and virulence factors
Authors: Medina Rocío , Franco Mario E. E. , Bartel Laura C. , Lucentini Cesar G. , López Diaz Silvina M. Y. , Saparrat Mario C. N. , Balatti Pedro A.
Published: February 2024

Tomato grey leaf spot is a fungal disease that provokes losses in tomato yield. The aim of this work is to analyse genomic differences among three isolates of Stemphylium lycopersici that differ in virulence and sporulation. The bioinformatics analysis led us to predict the identity of putative effectors, pathogenesis and virulence factors. Like the genome of other necrotrophic pathogens, Stemphylium encodes a wide spectrum of effectors, including an ample and diverse array of carbohydrate‐degrading enzymes. Interestingly, the number of predicted effectors was unrelated to virulence. Low virulence appeared to be associated with the presence of several double‐stranded RNAs from viruses as well as cellular processes related to protein degradation, redox and detoxifying processes and monoterpenes production. This is the first identification of the potential effectors of tomato–S. lycopersici interaction; nonetheless functional studies should be done.
Disturbed nutrient accumulation and cell wall metabolism in panicles are responsible for rice straighthead disease
Authors: Liu Qinghui , Zhang Zhijun , Bai Cuihua , Li Yi , Yin Xueying , Lin Wanting , Yao Lixian
Published: February 2024

Rice straighthead disease substantially reduces crop yield, posing a significant threat to global food security. Dimethylarsinic acid (DMA) is the causal agent of straighthead disease and is highly toxic to the reproductive tissue of rice. However, the precise physiological mechanism underlying DMA toxicity remains unknown. In this study, six rice varieties with varying susceptibility to straighthead were utilized to investigate the growth performance and element distribution in rice panicles under DMA stress through pot experiments, as well as to explore the physiological response to DMA using transcriptomic methods. The findings demonstrate significant variations in both DMA accumulation and straighthead sensitivity among cultivars. The susceptible varieties exhibited higher DMA accumulation indices and displayed typical symptoms of straighthead disease, including erect panicles, deformed rachides and husks, and reduced seed setting rate and grain yield when compared to the resistant varieties. Moreover, DMA addition promoted mineral nutrients to accumulate in rachides and husks but less in grains. DMA showed preferential accumulation in rice grains with a distribution pattern similar to that of Copper (Cu) and zinc (Zn) within the panicle. Transcriptome analyses underscored the substantial impact of DMA on gene expression related to mineral metabolism. Notably, DMA addition significantly up‐regulated the expression of pectin methylesterase, pectin lyase, polygalacturonase, and exogalacturonase genes in Nanjingxiangzhan, while these genes were down‐regulated or weakly expressed in Ruanhuayou 1179. The alteration of pectin metabolic pathways induced by DMA may lead to abnormality of cell wall assembly and modification, thereby resulting in deformed rice panicles.
A quick and effective method for thermostability differentiation in cucumber (Cucumis sativus L.)
Authors: Liang Yonggui , Xie Weiwei , Yang Chenyu , Yu Bingwei , Qin Qiteng , Wang Yixi , Gan Yuwei , Liu Renjian , Qiu Zhengkun , Cao Bihao , Yan Shuangshuang
Published: February 2024

High temperature affects the growth and production of cucumber. Selecting thermotolerant cucumber cultivars is conducive to coping with high temperatures and improving production. Thus, a quick and effective method for screening thermotolerant cucumber cultivars is needed. In this study, four cucumber cultivars were used to identify heat resistance indexes. The morphological, physiological and biochemical indexes were measured. When exposed to high temperatures, thermotolerant cucumber had a more stable photosystem, membrane, and oxidation–reduction systems. The impact of high temperatures on plants is multifaceted, and the accurate discrimination of heat resistance cannot be achieved solely based on a single or multiple indicators. Therefore, principal component analysis (PCA) was employed to comprehensively evaluate the heat resistance of cucumber plants. The results showed that the heat resistance obtained by PCA was significantly correlated with the heat injury index. In addition, the stepwise regression equation identified two heat‐related indices, hydrogen peroxide content (H2O2) and photosynthetic operating efficiency (Fq′/Fm′), and they can quickly distinguish the heat resistance of the other 8 cucumber cultivars. These results will help to accelerate the selection of thermotolerant resources and assist in cucumber breeding.
Conditional deviant repetition in the oddball paradigm modulates processing at the level of P3a but not MMN
Authors: Coy Nina , Bendixen Alexandra , Grimm Sabine , Roeber Urte , Schröger Erich
Published: February 2024

The auditory system has an amazing ability to rapidly encode auditory regularities. Evidence comes from the popular oddball paradigm, in which frequent (standard) sounds are occasionally exchanged for rare deviant sounds, which then elicit signs of prediction error based on their unexpectedness (e.g., MMN and P3a). Here, we examine the widely neglected characteristics of deviants being bearers of predictive information themselves; naive participants listened to sound sequences constructed according to a new, modified version of the oddball paradigm including two types of deviants that followed diametrically opposed rules: one deviant sound occurred mostly in pairs (repetition rule), the other deviant sound occurred mostly in isolation (non‐repetition rule). Due to this manipulation, the sound following a first deviant (either the same deviant or a standard) was either predictable or unpredictable based on its conditional probability associated with the preceding deviant sound. Our behavioral results from an active deviant detection task replicate previous findings that deviant repetition rules (based on conditional probability) can be extracted when behaviorally relevant. Our electrophysiological findings obtained in a passive listening setting indicate that conditional probability also translates into differential processing at the P3a level. However, MMN was confined to global deviants and was not sensitive to conditional probability. This suggests that higher‐level processing concerned with stimulus selection and/or evaluation (reflected in P3a) but not lower‐level sensory processing (reflected in MMN) considers rarely encountered rules.
Anti‐Müllerian hormone: A novel biomarker for detecting bovine freemartinism
Authors: Koca Davut , Nak Yavuz , Sendag Sait , Nak Deniz , Turgut Ali Osman , Avcılar Talha , Ekici Zeynep Merve , Cetin Nebi , Bagci Kemal , Aktar Ahmet , Sagirkaya Hakan , Alcay Selim , Wehrend Axel
Published: February 2024

The anti‐Müllerian hormone (AMH) indicates ovarian reserve in cattle, maintaining a consistent trajectory post‐puberty. In heterosexual pregnancies, the development of the Müllerian duct in female foetuses is inhibited, resulting in an anticipated minimal or absent ovarian reserve capacity. This investigation aimed to compare AMH levels in healthy Holstein heifers that had reached puberty with those of freemartin animals of the same breed and age. The study incorporated Holstein heifers reaching puberty between 11 and 15 months of age in Group 1 (G1, n = 20) and freemartin animals in Group 2 (G2, n = 19, 16). AMH measurements (AMH‐1/AMH‐2) were recorded at 12‐day intervals for the study participants. Notably, AMH levels in three freemartin animals could not be detected, prompting statistical analysis based on measurements from the remaining 16 freemartin animals in G2. A statistically significant correlation was observed between two separate measurements in G1 and G2 (p < .001). Furthermore, AMH‐1 and AMH‐2 levels were statistically higher in G1 than in G2 (p < .001). In G1, AMH‐1 levels ranged from 227 to 677 pg/mL, with an average of 367.3 ± 25.5 pg/mL, and AMH‐2 levels ranged from 234 to 645 pg/mL, with an average of 380.8 ± 24.4 pg/mL. Conversely, in G2, AMH‐1 levels ranged from 10 to 72 pg/mL, with an average of 26.8 ± 4.44 pg/mL, and AMH‐2 levels ranged from 12 to 68 pg/mL, with an average of 28.75 ± 4.18 pg/mL. The mean AMH levels in G1 were approximately 14 times higher than in G2 (p < .001). Consequently, ROC analysis utilizing AMH‐1 and AMH‐2 data established cut‐off values of ≤72 and ≤ 68 pg/mL respectively for distinguishing freemartin animals. In conclusion, AMH could be used as a reliable biomarker for identifying Holstein freemartin animals.
Idiopathic intracranial hypertension in two twin sisters
Authors: Jirapanyayut Patchara , March de Ribot Francesc , March de Ribot Anna
Published: February 2024

Idiopathic intracranial hypertension (IIH) is a condition of unknown aetiology characterised by an increase in the intracranial pressure. Familial cases of IIH are rare and not well-understood. We present two monozygotic twins who developed IIH two years apart. The case involves two monozygotic female twins developing IIH in their 50s. They presented with a history of blurry vision and headaches. The diagnosis included the neurological, radiological and ophthalmological examination, excluding other causes. Both patients received treatment with acetazolamide, successfully resolving the papilloedema and restoring a normal visual field. This case highlights the occurrence of IIH among twins presenting at similar periods, emphasising the potential genetic influence. Clinicians should alert and educate the family regarding the risk factors and potential symptoms of this condition in the unlikely occurrence that other family members are affected.
Retreatment of symptomatic chronic bronchitis with bronchial rheoplasty
Authors: Klemm Theresa , Krimsky William , Welz Kelly , Valipour Arschang
Published: February 2024

A man in his early 70s with a long-standing history of chronic bronchitis presented to our department 3 years ago with debilitating chronic cough and excessive sputum production. He had no previous diagnosis of chronic obstructive pulmonary disease and without evidence of severe respiratory tract infections. Due to his symptom burden and impairments in daily activities, the patient was considered to be an appropriate candidate for bronchial rheoplasty, a novel endoscopic treatment for patients with chronic bronchitis. The patient responded well to bilateral treatment but then experienced symptom recurrence roughly 14 months after completing the initial treatment. In the absence of an alternative explanation for the return of these symptoms, he then underwent uneventful retreatment. The patient, again, reported significant symptom improvement and no adverse effects since retreatment. While further studies are necessary to assess the safety and efficacy of retreatment, the findings from this case are encouraging.
Chronic diarrhoea and ichthyosis vulgaris: a rare presentation of Hodgkin’s lymphoma
Authors: Allen Jessica Michelle , Simpson Haley M , Jodon Gray
Published: February 2024

A man in his 30s presented with several months of non-bloody diarrhoea and nausea along with conjunctivitis, diffuse ichthyosis and cellulitis in the setting of progressive neck swelling. He was ultimately diagnosed with nodular sclerosing Hodgkin’s lymphoma after undergoing a broad infectious, rheumatological and neoplastic workup. This represents a rare presentation of classic Hodgkin’s lymphoma and demonstrates the known alteration of cellular immunity in Hodgkin’s lymphoma alongside manifestations of the profound inflammatory state associated with the disease. The patient was initiated on chemotherapy and many of his symptoms resolved. Hodgkin’s lymphoma may present as a multisystemic cascade of symptoms and should be high on the differential diagnosis for a patient with lymphadenopathy and associated infectious, gastrointestinal and cutaneous symptoms.
Iron overload in anaemia with underlying haemoglobin constant spring in an antenatal mother in primary care
Authors: Thew Hui Zhu , Ng Chee Han , Loo Cheng Yee
Published: February 2024

This is the case of a gravida 3 para 1 woman in her late 20s with underlying haemoglobin constant spring who visited a healthcare clinic for an antenatal check-up. Towards the end of her second trimester, she experienced lethargy. During her antenatal booking, she was diagnosed with mild asymptomatic anaemia, high serum ferritin, T saturation of 88% and abnormal liver function tests. She was referred to a hospital where an MRI scan revealed over 2 g of iron deposits in her liver, leading to a revised diagnosis of iron overload. Treatment included deferoxamine and expectant management throughout her antenatal period, and her delivery was uncomplicated. While iron deficiency anaemia is common in pregnancy, it is crucial not to overlook iron deposition and the distinction from acute fatty liver during pregnancy to prevent treatment delays.
Unilateral tonsillitis due to primary syphilis with gram-negative corkscrew-like spirochaetes confirmed by Gram stain of pus
Authors: Taniguchi Tomohiro , Yamamoto Mayu , Miyoshi Sonoko , Shimizu Satomi
Published: February 2024

A man in his 40s presented with pharyngeal pain and right cervical lymphadenopathy that persisted for 1 month. His right tonsil was swollen and covered with exudate; however, a rapid streptococcal antigen test was negative. Rapid plasma reagin andTreponema pallidumantibody were positive. Gram staining of the pus confirmed the presence of gram-negative corkscrew-like spirochaetes. The patient had unprotected oral intercourse. He did not have any skin lesions. He was diagnosed with primary syphilis and treated with benzathine penicillin G. In adults, the differential diagnosis of tonsillitis should include sexually transmitted diseases. A rapid streptococcal antigen test is not sufficient for such a case; a syphilis test is necessary, and Gram staining, which is rapid and does not need any special equipment, can support the diagnosis.
Roux-en-Y retrograde intussusception: surgical reconstruction via sequential isoperistaltic side-to-side anastomoses
Authors: Chopko Trevor C , Sudhindran Vineeth , Stephens Daniel
Published: February 2024

Intussusception following Roux-en-Y gastric bypass is a rare, potentially life-threatening complication. Patients present with intermittent obstructive symptoms, and the diagnosis is made on imaging. Treatment is surgical considering the high likelihood of non-operative failure, strangulation, incarceration, perforation and concern for malignancy. We present the case of a woman in her 60s with a history of Roux-en-Y gastric bypass who presented with retrograde jejunojejunal intussusception at the distal Roux anastomosis. She proceeded to the operating room for complete anastomotic resection with reconstruction of three blind ends via two sequential isoperistaltic anastomoses. She progressed appropriately throughout her hospitalisation and was discharged on postoperative day 5 without recurrence. While intussusception in Roux-en-Y anatomy has been previously described, a literature review yielded sparse results in detailing its surgical correction. We highlight our unique surgical approach of jejunojejunal anastomotic resection with the creation of sequential isoperistaltic side-to-side anastomoses.
Achalasia-associated megaoesophagus presenting with dyspnoea and cough
Authors: Abu Suleiman Amro , James Daniel , Wilkins Alexander , Bladel Adrian Van , Lo Terence
Published: February 2024

We present an unusual case of achalasia presenting with dyspnoea and persistent cough. These symptoms persisted for months, leading to the patient undergoing a chest X-ray by her general practitioner which showed right basal consolidation and a density extending along the right mediastinum. CT scan was done which revealed megaoesophagus with a diameter of 7 cm causing tracheal compression, as well as right basal consolidation, consistent with aspiration. Further history revealed 6-month history of progressive swallowing difficulty, retrosternal chest pain and shortness of breath which worsened when eating solid foods. After thorough workup, a diagnosis of idiopathic achalasia (type II) was made. She was treated with laparoscopic Heller cardiomyotomy and Dor fundoplication with significant improvement at follow-up. Dyspnoea and respiratory symptoms are unusual presenting symptoms, suggesting a need to consider achalasia in a wider range of presentations. Successful treatment of achalasia depends on timely diagnosis and intervention prior to oesophageal failure.
Estimating the cost of visiting hospital outpatient
Authors: Liyana Arachige Manoj , Tse Wai Chung , Zhang Roland , Ma Henry , Singhal Shaloo , Phan Thanh
Published: February 2024

Objectives

This study aims to investigate the cost incurred by people travelling to the neurology outpatient clinic of a large metropolitan hospital. As outpatients are a substantial portion of a hospital’s demographic, we aimed to understand the patient experience of various commuters.

Methods

We conducted an observational study collecting demographic details and travel information for how people attended the neurology clinic of Monash Medical Centre. Statistical analysis was performed using R. 165 participants were randomly selected and interviewed in-person. Data were collected via an anonymous questionnaire. The study was approved by the Monash Health Human Ethics Research Committee.

Results

155 responses were included in the analysis. Patients paid an average of $A16.64 to travel to Monash Medical Centre. Drivers paid on average $A16.70 and those taking public transport paid on average $A9.64, with the maximum cost overall being $A120.00. For patients driving to hospital, parking accounted for 60% of their travel costs. The average to Monash Medical centre was 20.82 km with the maximum being 190.88 km. Distance from hospital was correlated with a higher cost of travel (p<0.001, Spearman’s rank correlation coefficient=0.48). There was also an inverse association between distance from hospital and socioeconomic status (p<0.001, Spearman’s rank correlation coefficient=−0.26).

Conclusion

Travelling to hospital can be a costly endeavour. Driving is the most popular form of transport, but a large portion of the cost involved is hospital parking. Further research should be conducted at other tertiary centres with larger samples.
User requirements for non-invasive and minimally invasive glucose self-monitoring devices in low-income and middle-income countries: a qualitative study in Kyrgyzstan, Mali, Peru and Tanzania
Authors: Safary Elvis , Beran David , Vetter Beatrice , Lepeska Molly , Abdraimova Aida , Dunganova Asel , Besançon Stéphane , Lazo-Porras Maria , Portocarrero Mazanett Jill , Pérez-León Silvana , Maixenchs Maria , Nchimbi Happy , Ramaiya Kaushik , Munishi Castory , Martínez-Pérez Guillermo Z
Published: February 2024

Aims

Development of non-invasive and minimally invasive glucose monitoring devices (NI-MI-GMDs) generally takes place in high-income countries (HICs), with HIC’s attributes guiding product characteristics. However, people living with diabetes (PLWD) in low-income and middle-income countries (LMICs) encounter different challenges to those in HICs. This study aimed to define requirements for NI-MI-GMDs in LMICs to inform a target product profile to guide development and selection of suitable devices.

Methods

This was a multiple-methods, exploratory, qualitative study conducted in Kyrgyzstan, Mali, Peru and Tanzania. Interviews and group discussions/activities were conducted with healthcare workers (HCWs), adults living with type 1 (PLWD1) or type 2 diabetes (PLWD2), adolescents living with diabetes and caregivers.

Results

Among 383 informants (90 HCW, 100 PLWD1, 92 PLWD2, 24 adolescents, 77 caregivers), a range of differing user requirements were reported, including preferences for area of glucose measurement, device attachment, data display, alert type and temperature sensitivity. Willingness to pay varied across countries; common requirements included ease of use, a range of guiding functions, the possibility to attach to a body part of choice and a cost lower than or equal to current glucose self-monitoring.

Conclusions

Ease-of-use and affordability were consistently prioritised, with broad functionality required for alarms, measurements and attachment possibilities. Perspectives of PLWD are crucial in developing a target product profile to inform characteristics of NI-MI-GMDs in LMICs. Stakeholders must consider these requirements to guide development and selection of NI-MI-GMDs at country level, so that devices are fit for purpose and encourage frequent glucose monitoring among PLWD in these settings.
Life-course socioeconomic status and obesity: a scoping review protocol
Authors: Adamou Habila , François Dener , Lebel Alexandre , Paquette Marie-Claude
Published: February 2024

Objective

We aim to explore the literature that studies the links between life-course socioeconomic status and weight status and characterize the life-course approach used.

Introduction

Obesogenic environments are increasing rapidly in deprived environments, and cross-sectional studies have shown limitations in explaining the links between these environments and obesity. The life-course approach has been proposed recently to better understand the links between socioeconomic status and weight status.

Inclusion criteria

Studies that identify life-course socioeconomic status and longitudinal built environment indicators and associate them with body weight indicators between January 2000 and January 2023.

Methods

Studies in French or English were searched in Medline (PubMed), Web of Science and GeoBase (Embase) according to the strategies formulated for each database. The selected studies were exported to Covidence for evaluation according to the inclusion/exclusion criteria.

Results

The main results retained are the association between longitudinal socioeconomic indicators and weight measures; longitudinal built environment indicators and the measures of weight.
Exploring the prevalence, knowledge, attitudes and influencing factors of e-cigarette use among university students in Palestine: a cross-sectional study
Authors: Nazzal Zaher , Maraqa Beesan , Azizeh Razan , Darawsha Bara’ , AbuAlrub Ibraheem , Hmeidat Mousa , Al-Jabari Fadel
Published: February 2024

Objectives

E-cigarettes have gained popularity, especially among young adults. This study aims to determine the prevalence of e-cigarette smoking, assess knowledge and attitudes and identify associated factors among Palestinian university students.

Design

A cross-sectional study.

Setting and participants

The study was conducted among Palestinian university students in early 2023.

A self-administered questionnaire was used to survey 1792 students from six Palestine universities in the West Bank. The questionnaire covered various aspects, including sociodemographic information, daily habits, exposure to smoking, attitudes and knowledge about e-cigarettes. Data were analysed using descriptive statistics, χ2tests and multivariate regression analysis.

Results

The study revealed a high prevalence of tobacco use (41.2%), with e-cigarette use prevalent among 19.7% of participants. Knowledge about e-cigarettes was suboptimal, with misconceptions regarding their safety and health effects. Negative attitudes towards e-cigarettes were common, and students with negative attitudes were more likely to use e-cigarettes (aOR=2.6, 95% CI: 1.9 to 3.6). Gender (aOR=2.1, 95% CI: 1.4 to 3.0), waterpipe smoking (aOR=4.5, 95% CI: 3.2 to 6.3), physical inactivity (aOR=1.4, 95% CI: 1.1 to 1.9), high coffee consumption (aOR=1.6, 95% CI: 1.1 to 2.3), spending time with friends (aOR=2.4, 95% CI: 1.5 to 3.7), having a mother who is a smoker (aOR=1.5, 95% CI: 1.1 to 2.2) and having a friend who uses e-cigarettes (aOR=1.5, 95% CI: 1.1 to 2.1) were significantly associated with e-cigarettes use.

Conclusions

E-cigarette use is a growing concern among Palestinian university students. Combating this trend should include educational initiatives, social interventions and policy measures to promote informed decision-making and discourage e-cigarette use. Comprehensive tobacco control programs considering various tobacco and nicotine products and involving multiple stakeholders are warranted.
Exploring variation in timely reperfusion treatment in ST-segment elevation myocardial infarction in Norway: a national register-based cohort study
Authors: Uleberg Bård , Bønaa Kaare Harald , Govatsmark Ragna Elise Støre , Olsen Frank , Jacobsen Bjarne K , Stensland Eva , Hauglann Beate , Vonen Barthold , Førde Olav Helge
Published: February 2024

Objectives

This study aimed to investigate determinants of reperfusion within recommended time limits (timely reperfusion) for ST-segment elevation myocardial infarction patients, exploring the impact of geography, patient characteristics and socio-economy.

Design

National register-based cohort study.

Setting

Multilevel logistic regression models were applied to examine the associations between timely reperfusion and residency in hospital referral areas and municipalities, patient characteristics, and socio-economy.

Participants

7607 Norwegian ST-segment elevation myocardial infarction patients registered in the Norwegian Registry of Myocardial Infarction during 2015–2018.

Main outcome measures

The odds of timely reperfusion by primary percutaneous coronary intervention (PCI) or fibrinolysis.

Results

Among 7607 ST-segment elevation myocardial infarction patients in Norway, 56% received timely reperfusion. The Norwegian goal is 85%. While 81% of the patients living in the Oslo hospital referral area received timely reperfusion, only 13% of the patients living in Finnmark did so.

Patients aged 75–84 years had lower odds of timely reperfusion than patients below 55 years of age (OR 0.73, 95% CI 0.61 to 0.87). Patients with moderate or high comorbidity had lower odds than patients without (OR 0.81, 95% CI 0.68 to 0.95 and OR 0.61, 95% CI 0.44 to 0.84). More than 2 hours from symptom onset to first medical contact gave lower odds than less than 30 min (OR 0.63, 95% CI 0.54 to 0.72). 1–2 hours of travel time to a PCI centre (OR 0.39, 95% CI 0.31 to 0.49) and more than 2 hours (OR 0.22, 95% CI 0.16 to 0.30) gave substantially lower odds than less than 1 hour of travel time.

Conclusions

The varying proportion of patients receiving timely reperfusion across hospital referral areas implies inequity in fundamental healthcare services, not compatible with established Norwegian health policy. The importance of travel time to PCI centre points at the expanded use of prehospital pharmacoinvasive strategy to obtain the goals of timely reperfusion in Norway.
Evaluating pharmacological THRomboprophylaxis in Individuals undergoing superficial endoVEnous treatment across NHS and private clinics in the UK: a multi-centre, assessor-blind, randomised controlled trial—THRIVE trial
Authors: Machin Matthew , Whittley Sarah , Norrie John , Burgess Laura , Hunt Beverley J , Bolton Layla , Shalhoub Joseph , Everington Tamara , Gohel Manjit , Whiteley Mark S , Rogers Steven , Onida Sarah , Turner Benedict , Nandhra Sandip , Lawton Rebecca , Stephens-Boal Annya , Singer Carolyn , Dunbar Joanne , Carradice Daniel , Davies A H
Published: February 2024

Introduction

Endovenous therapy is the first choice management for symptomatic varicose veins in NICE guidelines, with 56–70 000 procedures performed annually in the UK. Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a known complication of endovenous therapy, occurring at a rate of up to 3.4%. Despite 73% of UK practitioners administering pharmacological thromboprophylaxis to reduce VTE, no high-quality evidence supporting this practice exists. Pharmacological thromboprophylaxis may have clinical and cost benefit in preventing VTE; however, further evidence is needed. This study aims to establish whether when endovenous therapy is undertaken: a single dose or course of pharmacological thromboprophylaxis alters the risk of VTE; pharmacological thromboprophylaxis is associated with an increased rate of bleeding events; pharmacological prophylaxis is cost effective.

Methods and analysis

A multi-centre, assessor-blind, randomised controlled trial (RCT) will recruit 6660 participants from 40 NHS and private sites across the UK. Participants will be randomised to intervention (single dose or extended course of pharmacological thromboprophylaxis plus compression) or control (compression alone). Participants will undergo a lower limb venous duplex ultrasound scan at 21–28 days post-procedure to identify asymptomatic DVT. The duplex scan will be conducted locally by blinded assessors. Participants will be contacted remotely for follow-up at 7 days and 90 days post-procedure. The primary outcome is imaging-confirmed lower limb DVT with or without symptoms or PE with symptoms within 90 days of treatment. The main analysis will be according to the intention-to-treat principle and will compare the rates of VTE at 90 days, using a repeated measures analysis of variance, adjusting for any pre-specified strongly prognostic baseline covariates using a mixed effects logistic regression.

Ethics and dissemination

Ethical approval was granted by Brent Research Ethics Committee (22/LO/0261). Results will be disseminated in a peer-reviewed journal and presented at national and international conferences.

Trial registration number

ISRCTN18501431.
Effect of psychosocial aspects on medication adherence in patients with heart failure amid socioeconomic challenges
Authors: Deek Hiba , Massouh Angela
Published: February 2024

Objective

To evaluate stress, depression and quality of life among community-dwelling patients with heart failure (HF) and evaluate their effect on perceived medication adherence in a socioeconomically challenged setting.

Design

A cross-sectional design with self-administered questionnaire with data collected between October 2021 and September 2022.

Methods

Patients with confirmed diagnosis of HF were sought for data collection in the community and cardiology clinics through an electronic platform. Confirmation of cases was done through the ejection fraction, medication list and frequent symptoms of the patients. The Patient Health Questionnaire-9, the COVID-19 Stress Scale, the Minnesota Living with HF Questionnaire and the Lebanese Medication Adherence Scale were used to evaluate depression, stress, quality of life and medication adherence, respectively. Univariate analysis was done to present the descriptive statistics, whereas bivariate and multivariate analyses were done to evaluate the relationship between the variables.

Results

A total of 237 participants were included in the final analysis. The mean age was 61.3±17.36 years, and the majority (57.8%) were male participants. Only 44.7% were on ACE inhibitors/angiotensin receptor blockers and 54.9% on beta-blockers. The mean scores for stress, depression, quality of life and medication adherence were 75.86 (SD=24.5), 14.03 (SD=5.7), 55.73 (SD=23.05) and 6.79 (SD=6.93), respectively, indicating high stress levels, depression, poor quality of life and medication adherence. Those with a history of hypertension and depression were significantly more adherent to their medications than those who were not. Multivariate analysis showed that anxiety, medical follow-up, quality of life and functionality class were predictors of medication adherence.

Conclusion

The study showed the population with HF in Lebanon to have psychological health problems with these variables acting as predictors for medication adherence. Sociodemographic characteristics also played a role on the outcome, which can be targeted when planning interventions to improve outcomes. Future studies should compare prescribed medication with consumed medication through longitudinal approaches and medical refilling techniques when possible.
Adenosine metabolic signature in circulating CD4+ T cells predicts remission in rheumatoid arthritis
Authors: Brown Philip M , Anderson Amy E , Naamane Najib , Lendrem Dennis W , Morgan Ann W , Isaacs John D , Pratt Arthur G
Published: February 2024

Objectives

Long-term outcomes in rheumatoid arthritis (RA) depend on early and effective disease control. Methotrexate (MTX) remains the first-line disease modifying therapy, however there are no biomarkers with which to identify those most likely to achieve remission. To address this unmet need we explored metabolic pathways involved in MTX mechanism of action within circulating CD4+T cells in a cohort of treatment naive patients with early RA.

Methods

Purified CD4+T cells were isolated from peripheral blood of 68 patients with early RA commencing MTX. The expression of a range of putative MTX metabolism and mechanism of action targets were explored by flow-cytometry and transcriptional analysis. From these data significant predictors of Disease Activity Score 28-C reactive protein (DAS28-CRP) remission (<2.4 at 6 months) were determined by logistic regression (clinical; flow-cytometry data) and linear modelling (gene expression data).

Results

Low baseline DAS28-CRP was associated with remission at 6 months (p=0.02). Expression of the ectonucleotidase CD39, involved in ATP-ADP conversion during adenosine synthesis, was higher on CD4+CD25 High regulatory T cells at baseline in those achieving remission (molecules of equivalent fluorescence 1264 vs 847; p=0.007). Expression of other adenosine signalling elements in CD4+T cells were also upregulated at baseline in patients achieving remission:AMPD1(p<0.001),ADORA2b(p=0.039) andADORA3(p=0.047). When combined into a single predictive metric, a combination of these variables outperformed baseline DAS28-CRP in prediction of early remission (area under the curve 0.92 vs 0.67, p=0.001)

Conclusions

Adenosine signalling is important in the achievement of early remission with MTX in RA and biomarkers of adenosine activity may hold utility for the stratification of therapy in early disease.
Fragmenting projectiles: a case report and literature review of the G2 Radically Invasive Projectile
Authors: Bernard Matthew , Dahlhausen Christine M , Kirk Andrew M , Bernard Andrew
Published: February 2024

Innovations in projectile design present unique challenges for trauma surgeons when treating gunshot victims. The G2 Radically Invasive Projectile (G2 Research, Winder, Georgia, USA) (G2RIP) is a frangible, rapidly expanding bullet resulting in a distinct pattern of injury consisting of diffuse hemorrhage with multicavity trauma as well as unique radiographic features of the projectile. To efficiently manage patients injured by the G2RIP, trauma surgeons must be aware of these distinct characteristics, and of previous patterns in effective management such as liberal damage control and extensive use of CT. Understanding previous presentation and management of patients injured by the G2RIP can aid in improving patient care in the trauma center.
Postoperative interictal epileptiform discharges predict seizure recurrence after antiepileptic drug withdrawal regardless of concordance with surgical site
Authors: Wu Yuxin , Zhang ZaiYu , Liang Ping , Li Lusheng , Zou Bin , Wang Difei , Dong Xinyu , Tang Haotian , Qiu Hanli , Zhai Xuan
Published: February 2024

Objective

The study aimed to explore the association between the site of interictal epileptic discharges (IEDs) on postoperative electroencephalogram (EEG) and seizure recurrence after antiepileptic drug (AED) withdrawal. The study hypothesizes that the concordance of IED sites with surgical sites indicates incomplete resection of epileptic focus, while non-concordance of IED sites with surgical sites indicates postoperative changes or cortical stimulation. The former has a higher risk of seizure recurrence.

Methods

We retrospectively analyzed the postoperative EEG pattern of 182 consecutive children who underwent resection surgery. To identify the risk factors for seizure recurrence, we compared the attributes of seizure recurred and seizure-free groups by univariate and multivariate analyses. AED tapering was standardized, involving a 25% reduction in the dose of a single type of AED every 2 weeks, independent of the presurgical AED load.

Results

We attempted AED withdrawal in 116 (63.7%) children. Twenty-eight (24.1%) children experienced seizure recurrence during or after AED withdrawal. A greater number of AEDs used at the time of surgery (p=0.005), incomplete resection (p=0.001), and presence of IED on postoperative EEG (p=0.011) are predictors of seizure recurrence. The completeness of resection and seizure recurrence after AED withdrawal were related to the presence of IED on the EEG, but not to the concordance of IED with surgical sites.

Conclusion

For children with abnormal EEG, the decision to discontinue AED should be made more cautiously, regardless of the relative location of the discharge site and the surgical site.
Finsler metrizabilities and geodesic invariance
Authors: Bucataru Ioan , Constantinescu Oana
Published: February 2024

We demonstrate that various metrizability problems for Finsler sprays can be reformulated in terms of the geodesic invariance of two tensors, namely the metric and angular tensors. We show that a spray [Formula: see text] is the geodesic spray of some Finsler metric if and only if its metric tensor is geodesically invariant. Moreover, we establish that gyroscopic sprays constitute the largest class of sprays characterized by a geodesic-invariant angular metric. Scalar functions associated with these geodesically invariant tensors will also be invariant, thereby providing first integrals for the given spray.
A non-integrated defect relation for general divisors incorporating the beta constants
Authors: Yang Chin Jui
Published: February 2024

In this paper, we incorporate the beta constants into the defect relation and deduce a non-integrated defect relation for meromorphic maps from a Kähler manifold whose universal covering is a ball into a projective variety intersecting general divisors properly.
Contact instantons with Legendrian boundary condition: A priori estimates, asymptotic convergence and index formula
Authors: Oh Yong-Geun , Yu Seungook
Published: February 2024

In this paper, we establish nonlinear ellipticity of the equation of contact instantons with Legendrian boundary condition on punctured Riemann surfaces by proving the a priori elliptic coercive estimates for the contact instantons with Legendrian boundary condition, and prove an asymptotic exponential [Formula: see text]-convergence result at a puncture under the uniform [Formula: see text] bound. We prove that the asymptotic charge of contact instantons at the punctures under the Legendrian boundary condition vanishes. This eliminates the phenomenon of the appearance of spiraling cusp instanton along a Reeb core, which removes the only remaining obstacle towards the compactification and the Fredholm theory of the moduli space of contact instantons in the open string case, which plagues the closed string case. Leaving the study of [Formula: see text]-estimates and details of Gromov-Floer-Hofer style compactification of contact instantons to [ 27 ], we also derive an index formula which computes the virtual dimension of the moduli space. These results are the analytic basis for the sequels [ 27 – 29 ] and [ 36 ] containing applications to contact topology and contact Hamiltonian dynamics.
Fuzzers for Stateful Systems: Survey and Research Directions
Authors: Daniele Cristian , Andarzian Seyed Behnam , Poll Erik
Published: February 2024

Fuzzing is a very effective testing methodology to find bugs. In a nutshell, a fuzzer sends many slightly malformed messages to the software under test, hoping for crashes or incorrect system behaviour. The methodology is relatively simple, although applications that keep internal states are challenging to fuzz. The research community has responded to this challenge by developing fuzzers tailored to stateful systems, but a clear understanding of the variety of strategies is still missing. In this paper, we present the first taxonomy of fuzzers for stateful systems and provide a systematic comparison and classification of these fuzzers.
Social Network Analysis: A Survey on Process, Tools, and Application
Authors: Singh Shashank Sheshar , Muhuri Samya , Mishra Shivansh , Srivastava Divya , Shakya Harish Kumar , Kumar Neeraj
Published: February 2024

Due to the explosive rise of online social networks, social network analysis (SNA) has emerged as a significant academic field in recent years. Understanding and examining social relationships in networks through network analysis opens up numerous research avenues in sociology, literature, media, biology, computer science, sports, and more. Therefore, certain studies review and discuss some research verticals of SNA, such as viral marketing, information diffusion, clustering, link prediction, and so on, to provide background knowledge and understanding. These studies still lack the SNA process, tools, and practical aspects in multidisciplinary applications. Inspired by these facts, we have discussed the background, process, tools, and application of SNA. First, we have presented a detailed description of the SNA process. Thereafter, we presented a comparative analysis of SNA tools and languages. Finally, we have discussed the various applications corresponding to SNA research verticals.
Redefining Counterfactual Explanations for Reinforcement Learning: Overview, Challenges and Opportunities
Authors: Gajcin Jasmina , Dusparic Ivana
Published: February 2024

While AI algorithms have shown remarkable success in various fields, their lack of transparency hinders their application to real-life tasks. Although explanations targeted at non-experts are necessary for user trust and human-AI collaboration, the majority of explanation methods for AI are focused on developers and expert users. Counterfactual explanations are local explanations that offer users advice on what can be changed in the input for the output of the black-box model to change. Counterfactuals are user-friendly and provide actionable advice for achieving the desired output from the AI system. While extensively researched in supervised learning, there are few methods applying them to reinforcement learning (RL). In this work, we explore the reasons for the underrepresentation of a powerful explanation method in RL. We start by reviewing the current work in counterfactual explanations in supervised learning. Additionally, we explore the differences between counterfactual explanations in supervised learning and RL and identify the main challenges that prevent the adoption of methods from supervised in reinforcement learning. Finally, we redefine counterfactuals for RL and propose research directions for implementing counterfactuals in RL.
Guiding the Design of Inclusive Interactive Systems: Do Younger and Older Adults Use the Same Image-schematic Metaphors?
Authors: Li Jingyi , Crilly Nathan , Kristensson Per Ola
Published: February 2024

The use of image-schematic metaphors is often promoted for being near-universal across user groups, suggesting that these metaphors have the potential to make novel interactive systems easy to use by both younger and older adults. This study empirically investigates this by eliciting image-schematic metaphors from the spoken language and interaction behaviors of 12 younger adults and 12 older adults undertaking tasks in a technology learning domain. For the first time, we reveal an almost-perfect overlap between image-schematic metaphors used by the younger and older groups, despite the two groups showing significant differences in prior technological knowledge. This finding provides empirical evidence for the near-universality of image-schematic metaphor use across age groups. The study also identifies 37 image-schematic metaphors shared between the two age groups in the technology learning domain to support future design of age-inclusive interactive systems.
Identification of a Novel Prognostic Lymphangiogenesis‐Related Signature Associated with Tumor Immunity for Guiding Therapy in Lung Adenocarcinoma
Authors: Peng Juan , Liu Dan , Zhang Hong-feng , Hu Qi-hao , Chen Wen , Zou Juan , Zhang Juan , Li Hui , Gao An-bo , Li Yu-kun
Published: February 2024

Lymphangiogenesis, an integral contributor to lymphatic metastasis, is a significant reason for the poor prognosis of cancer patients. Anti‐lymphangiogenesis treatment is a promising novel therapeutic direction, especially for tumors resistant to conventional therapies. We confirmed the ectopic expression of lymphangiogenesis‐related genes (LRGs) in lung adenocarcinoma (LUAD) cohorts based on the TCGA database. We constructed a prediction signature with 15 LRG prognostic signatures (F2RL1, LOXL2, MKI67, PTPRM, GPI, POSTN, INHA, LDHA, LINC00857, ITGA2, PECAM1, SOD3, GDF15, SIX1, and FGD5), and the overall survival (OS) was significantly different between the high‐ and low‐risk groups (TCGA‐training: p < 0.001, TCGA‐test: p = 0.02, GSE30219: p < 0.001, GSE37745: p = 0.002, and GSE50081: p = 0.002). Moreover, the risk score was also associated with the PIK3CA and BRCA1 pathways. In the nomogram, the prognostic prediction of the risk score was better than that of clinicopathologic parameters in OS, including age, sex, stage, T stage, N stage, and M stage. In summary, we constructed and validated a 15‐LRG signature, which may help predict the prognosis of LUAD and offer a possible direction for future research on downstream molecular mechanisms.
Enhancing Paternal Support: A Concept Analysis of Social Support for First-Time Fathers
Authors: Francis Xavier Josephine , Khanlou Nazilla , Nielsen Lisa Seto , Moradian Saeed
Published: February 2024

Introduction. Social support, as a multidimensional concept, is studied across disciplines. However, examining the concept in relation to first-time fathers in the perinatal period remains an underexplored avenue. This analysis aims to clarify what social support for first-time fathers means through an operational definition that will assist healthcare providers in supporting fathers as valuable assets to the wellbeing of their partners and children. Design. Walker and Avant’s concept analysis approach is used to identify the attributes, antecedents, and consequences of social support for first-time fathers during the perinatal period. Data Source. A thorough title and abstract review led to the analysis of 41 articles from databases, including MEDLINE, CINAHL, PsycINFO, the Social Sciences Citation Index, and Embase databases from 1970 to 2022. Results. Social support for first-time fathers can be described as a relational strategy and supportive intervention from both informal and formal sources. This concept analysis broadens the meaning of social support by considering structural and functional attributes. It offers fresh insights into how support can be coordinated across microsystems and macrosystems to address the distinctive requirements of current-day fathers within the intricate family dynamics. Furthermore, gender, cultural, and generational differences affect the preferences and needs of fathers, as well as their ability to support their partners and infants. Fathers preferred emotional support from their partners and sought informational and appraisal support from healthcare professionals. In addition, supportive relationships are characterized by proximity, reciprocity, congruency, and continuity during the perinatal period. Conclusion. Conceptualizing social support encompasses both upstream and downstream approaches across structures and systems to support fathers. Support for first-time fathers includes developing father-specific approaches to perinatal nursing care and practice. Social support carries implications for fostering socially inclusive policies, interdisciplinary curriculum integration, advocacy, and research aimed at improving paternal mental health and perinatal wellbeing.