bluuebunny/crossref_metadata_2025 huggingface dataset:
Phylogeography of Microphis retzii (Bleeker, 1856) and Microphis brachyurus (Bleeker, 1854) in the Pacific
Authors: Haÿ Vincent , Mennesson Marion I. , Carpentier Camille , Dahruddin Hadi , Sauri Sopian , Limmon Gino , Wowor Daisy , Hubert Nicolas , Keith Philippe , Lord Clara
Published: November 2024

Syngnathidae are a charismatic family of teleost fishes, represented by seahorses, seadragons, and pipefishes. Syngnathidae are mainly composed of marine species, but about 30 species of pipefishes inhabit freshwater insular environments of the Indo‐Pacific realm. Recent research has shown that some freshwater pipefish species are amphidromous and exhibit high intraspecific divergences across their distribution range, like Microphis brachyurus (Bleeker, 1854) distributed from Sri Lanka to French Polynesia and Microphis retzii (Bleeker, 1856) distributed from Taiwan to Indonesia. In this study, we used the mitochondrial cytochrome oxidase I (COI) partial gene of 91 specimens of M. brachyurus and 30 specimens of M. retzii from localities representative of their respective distribution area to improve knowledge on the population structure of these two widespread species. Genetic species delimitation and phylogeographic analyses were combined to explore spatial patterns of genetic diversity across the distribution ranges of the two species. We have highlighted deep genetic structuring within the two species and relate these results to various biotic and abiotic factors. For M. brachyurus, the population in Polynesia is distinct from those in the West Pacific, suggesting its distinctiveness and recognition as an evolutionary significant unit (ESU). For M. retzii, three lineages are delimited in its range distribution, suggesting the existence of two distinct species in Southeast Asia (Bali/Java/Lombok and China/Taiwan). Pipefish species are particularly vulnerable to anthropogenic pressures (inherent to Syngnathidae and insular environments). The present results, revising species delimitation and geographic distribution, will help implement effective conservation and management measures.
Cognitive decline in Cushing's syndrome: A systematic review
Authors: Katragadda Anila , Kunadia Jessica , Kirsch Polly , Dorcely Brenda , Shah Shruti , Henig Zachary , Job Asha , Feelders Richard A. , Agrawal Nidhi
Published: November 2024

The neurocognitive and psychiatric effects of Cushing's syndrome (CS) are well recognized and negatively impact quality of life. The aim of this systematic review is to compare neurocognitive disease, psychiatric symptoms, and structural brain changes in patients with Cushing's disease (CD)/CS and those with non‐functioning pituitary adenoma (NFPA), both before and after surgical treatment, and in comparison to healthy controls. Possible predictors of persistent neurocognitive symptoms and reduced quality of life in patients with CS are highlighted. We reviewed the English literature published in Medline/Pubmed until 2021 to identify eligible studies. This systematic review was registered on Prospero and reported following the PRISMA statement guidelines. The initial literature search yielded 1772 articles, of which 1096 articles remained after removing duplicates. After excluding case reports, animal studies, narrative reviews, comparative reviews, and articles not in English, 86 papers underwent full‐text review. Studies eligible for inclusion met the following criteria: (1) described patients with CD/CS, (2) reports of psychiatric symptoms, (3) written in English or with available English translation, and (4) published in a peer‐reviewed journal. The full‐text review process identified 40 eligible studies. The 40 studies included a total of 2603 participants with CD or CS, with 45.2% of the total participants having CD. The majority of studies were case–control studies and used validated questionnaires such as the Beck's Depression Index, Trail Making Test, Hospital Anxiety and Depression Scale, and Cushing Quality of Life for screening. Compared to NFPA controls, patients with CD who had greater baseline serum cortisol levels had worse cognitive function, even after surgical remission. This suggests a possible association between greater baseline cortisol levels in patients with CS and persistent cognitive impairment. A longer duration of uncontrolled CS was associated with worse cognitive function; however, there was no association found between the length of remission and memory. Overall brain volume was increased in patients in remission from CD compared to active disease. However, temporal and frontal lobe volumes did not recover to normal volumes. Patients with CS experience neurocognitive dysfunction, psychiatric disorders, and diminished quality of life, and symptoms may persist after curative surgery. We found several factors consistently associated with persistent cognitive and neuropsychiatric symptoms in patients with CS including higher pre‐operatively baseline cortisol production, longer duration of disease, frontal and temporal lobe atrophy, and the presence of cognitive and neuropsychiatric symptoms at baseline. Larger prospective studies are required to validate these findings.
Isotretinoin Combined Laser/Light‐Based Treatments Versus Isotretinoin Alone for the Treatment of Acne Vulgaris: A Meta‐Analysis
Authors: He Shi‐xin , Wang Yi , Wang Jun , Tang Li , Yang Li , Ye Fei‐lun
Published: November 2024

Objectives

This study aims to compare the efficacy and safety of oral isotretinoin with and without laser/light‐based treatments for acne.

Methods

This study was conducted under the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines; this meta‐analysis utilized data from PubMed, EMBASE, ClinicalTrial.gov, and the Cochrane Central Register of Controlled Trials until December 2023. We evaluated clinical improvement, lesion reduction, adverse events, as well as intraoperative and postoperative discomfort rates. Analyses were performed using Review Manager 5.3.

Results

This review included six articles with a total of 285 patients. Isotretinoin combined with laser/light therapy outperformed in clinical improvement rates, significantly reducing acne vulgaris and acne scars lesions compared to isotretinoin alone. Additionally, there was no significant difference in the incidence of adverse events between the two groups.

Conclusion

The study suggests that combining isotretinoin with laser/light‐based therapy for acne yields superior efficacy and satisfaction without increased complications (e.g., dryness, hyperpigmentation, and scarring). However, patients experience notable treatment‐related discomfort.
Transmissible diseases, vaccination, and inequality
Authors: Camacho Carmen , Vasilakis Chrysovalantis
Published: November 2024

We construct a Susceptible–Infected–Vaccinated Economic two‐sector growth model to explore the dynamics of inequality in an economy with distinct groups of workers exposed to a transmissible disease. Our analysis reveals a spectrum of outcomes in the long term, ranging from a disease‐free economic environment to a scenario where only the most susceptible group suffers from the disease. Long‐term outcomes are influenced by the reproduction rates both of the overall economy and those of the two groups of workers. If one group remains infected over time, the other will surely follow, leading to a perpetual disease burden for both. Additionally, because long‐term equilibria may not be unique, there is a possibility of long‐term uncertainty, posing additional challenges for policymakers. Notably, our calibrated model suggests that if the vaccination rate exceeds 24%, the relationship between disease exposure and inequality in capital assets becomes nonmonotonic.
A diversity of temperature and pressure conditions recorded by zircon within suevite from Ries crater, Germany
Authors: Stadermann A. C. , Erickson T. M. , Seifert L. B. , Chang Y. , Zeszut Z. , Zega T. J. , Michels Z. D. , Barnes J. J.
Published: November 2024

The temperature and pressure conditions experienced by rocks during an impact event can be constrained using petrologic and microstructural analysis and is crucial to providing ground truth to the impact cratering process. Suevite is a polymict, impact melt‐bearing breccia, specific to Ries crater in Germany. There are competing models for suevite formation and emplacement, such as clastic flows pushed out of the crater rim or ejecta plume fallback. Knowledge of the temperature and pressure pathways recorded by grains within the suevite can help distinguish between these and other models. The accessory phase zircon (ZrSiO4) and its high‐pressure polymorph reidite are particularly useful in such circumstances as they are highly refractory minerals that can record the high‐temperature and/or high‐pressure conditions of an impact event. Here, we present evidence for a wide array of temperature and pressure conditions recorded in zircon grains within a single thin section of suevite. Zircons in this study range from unshocked to highly shocked (>53 GPa), and record temperatures more than 1673°C. These findings confirm previous studies concluding that suevites contain material exposed to very diverse pressure and temperature conditions during initial shock compression and excavation but do not, as a whole, experience extreme temperatures (>1673°C) or pressures (>30 GPa).
A single phosphorylatable amino acid residue is essential for the recognition of multiple potyviral HCPro effectors by potato Nytbr
Authors: Alex Bryce G. , Zhang Zong‐Ying , Lasky Danny , Garcia‐Ruiz Hernan , Dewberry Ronnie , Allen Caitilyn , Halterman Dennis , Rakotondrafara Aurélie M.
Published: November 2024

Potato virus Y (PVY, Potyviridae) is among the most important viral pathogens of potato. The potato resistance gene Nytbr confers hypersensitive resistance to the ordinary strain of PVY (PVYO), but not the necrotic strain (PVYN). Here, we unveil that residue 247 of PVY helper component proteinase (HCPro) acts as a central player controlling Nytbr strain‐specific activation. We found that substituting the serine at 247 in the HCPro of PVYO (HCProO) with an alanine as in PVYN HCPro (HCProN) disrupts Nytbr recognition. Conversely, an HCProN mutant carrying a serine at position 247 triggers defence. Moreover, we demonstrate that plant defences are induced against HCProO mutants with a phosphomimetic or another phosphorylatable residue at 247, but not with a phosphoablative residue, suggesting that phosphorylation could modulate Nytbr resistance. Extending beyond PVY, we establish that the same response elicited by the PVYO HCPro is also induced by HCPro proteins from other members of the Potyviridae family that have a serine at position 247, but not by those with an alanine. Together, our results provide further insights in the strain‐specific PVY resistance in potato and infer a broad‐spectrum detection mechanism of plant potyvirus effectors contingent on a single amino acid residue.
Arthroscopic Management of Juxta‐Articular Proximal Tibial Chondroblastoma: A Case Report and Literature Review
Authors: Xiao Cong , Zhang Shaoyun , Gao Zhixiang , Wang Lifu , Dai Yixin , Li Jian
Published: November 2024

Background

Chondroblastoma is a rare bone tumor that originates from the epiphysis, constitutes around 1% of all primary bone tumors and is recognized for its tendency to exhibit local invasiveness, as well as the possibility of metastasis and recurrence in nearby areas. Currently, the main surgical treatment for chondroblastoma is open surgery, involving excision of the lesion. There are relatively few reports on arthroscopic surgery for the treatment of chondroblastoma. However, open surgical curettage is associated with operation‐related trauma and potential for damage to the osteoepiphysis resulting in growth disturbances.

Case Presentation

This case study presents the application of an arthroscopic technique in a 14‐year‐old male patient with chondroblastoma affecting the proximal tibia and tibial eminence. The procedure involved thorough removal of the lesion using direct visualization with the management of the cavity utilizing a substitute for autologous bone graft. After 1 year of follow‐up, the patient remains free from symptoms, exhibits normal knee functionality, and radiographic analysis reveals a good autologous bone graft fusion without any signs of recurrence.

Conclusions

Based on the existing cases of arthroscopic treatment for chondroblastoma and the report of this case, arthroscopic treatment for chondroblastoma can be considered as a specific treatment option for certain patients. In some cases, this technique could be an effective alternative to open surgery.
Foreign competition and export diversification: Evidence from domestic firms in China
Authors: Wang Xuefeng , Liu Haiyun , Wang Lixia
Published: November 2024

This study investigates the effects of foreign firms on the product diversification of domestic exporters in China. The result shows that domestic exporters react to the competition of foreign firms by reducing their product diversification. Firms drop the marginal products and concentrate on core products, and they distribute their exports more evenly among the product varieties they retained. Mechanism tests suggest that the competition of foreign firms reduces the sales, efficiency and R&D expenditure of domestic firms. And the effects are more pronounced for SOEs and firms with larger scales. This study explains the decline in the export diversification of domestic firms in China and contributes to the understanding of the variety adjustment of firms in the face of competitive pressure.
Integration of Cooling Holes Into a Turbine Vane Made Using Additive Manufacturing
Authors: Gailey Nicholas L. , Barringer Michael D. , Berdanier Reid A. , Thole Karen A.
Published: November 2024

Additive manufacturing (AM) has emerged as a method to prototype novel designs for turbine airfoil cooling with complex internal and film cooling geometries. Creating engine scale features with AM comes with challenges that impact flow and heat transfer, which consequently affect the overall performance of the component. While AM has proven to be faster and more cost-effective than traditional casting methods, the scalability of AM requires further investigation. The purpose of this study was to integrate various film-cooling hole geometries identified through large-scale models and true-scale simple coupons into a true-scale turbine vane to assess overall cooling effectiveness. The National Experimental Turbine (NExT) vane was additively manufactured with a singular cooling passage feeding two rows of film-cooling holes: a row of baseline 7-7-7 holes; and a row of holes containing both parametrically optimized 15-15-1 holes and modified adjoint optimized cross flow holes. The internal passage was designed to have a section with ribs and a section without ribs to assess how internal features impact the cooling holes' performance. The vane was tested in the Steady Thermal Aero Research Turbine (START) rig over a range of film cooling blowing ratios. A combination of computed tomography scanning and non-contact infrared thermal imaging measurements were used to evaluate how as-built geometries impacted the overall cooling effectiveness on the NExT vane for each hole group. The 15-15-1 film-cooling holes with no internal ribs were shown to be the most effective in lowering surface temperatures relative to the other cooling hole configurations. Also, the 15-15-1 holes with no internal ribs to affect the cooling flow entrance to the hole were the least affected by blowing ratio changes. The 7-7-7 hole was found to have a negative impact on the vane because the downstream surface was warmed by a separating internal channel wall.
Enhancement of antibacterial activities of green synthesized-CuO/ZnO nanocomposites using Boehmeria nivea leaf extract
Authors: Le Truong Phi , Nguyen Ngoc Hong , Le Vien Ky , Pham Phu-Quan , Duong Trung Bao Ngoc , Le Quy Ngoc Nguyen , Nguyen Tien Cam Thi , Ung Thuy Dieu Thi , Pham Anh Tuan Thanh , Nguyen Linh Ho Thuy , Mai Ngoc Xuan Dat , Nguyen Lan Thi My , Pham Ngoc Kim
Published: November 2024

This study investigated CuO and ZnO nanoparticles and CuO/ZnO nanocomposites in a friendly environment with a low-cost and renewable biosynthesis method. This approach involved using Boehmeria nivea leaf extract to facilitate the growth and formation of nanocomposites with performance-enhancing phytochemicals released during the co-precipitation process. All nanoparticles/nanocomposites explored the microstructure, morphology, and point defects using FTIR, XRD, SEM, and PL characterization techniques. The synthesized CuO and ZnO nanoparticles and CuO/ZnO nanocomposites were evaluated for their antibacterial ability against both bacteria Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus). Combining different copper and zinc salt ratios creates different arrangements and morphologies between the CuO sheets and the spherical ZnO nanoparticles. The heterojunction of CuO/ZnO samples enhances the antibacterial effects of nanocomposites compared to pure CuO and ZnO nanoparticles. The maximum antibacterial performance was achieved at 250 ppm against E. coli and 500 ppm against S. aureus in CuO50/ZnO50 nanocomposites. This study shows that a green synthesis of CuO/ZnO nanocomposites promises great potential for environmental treatment and biochemical applications.
Impact of in situ heating on the structure, morphology, and electrical and optical properties of RF-sputtered NiO thin films
Authors: Binh Nguyen Khac , Yen Nhi Pham Ngoc , Quan Tran Bao , Tam Pham Minh , Phuong Nguyen Ngoc , Tuan Dao Minh , Kim Hang Pham Thi , Phuong Pham Hoai
Published: November 2024

In this work, NiO thin films were deposited on glass and n-type Si at different substrate temperatures utilizing reactive RF-sputtering technique. The influence of substrate heating on the crystal structure, surface morphology, and optical and electrical properties of NiO thin films was studied using x-ray diffraction, scanning electron microscopy, UV-vis transmission spectroscopy, and Hall effect measurements. The x-ray diffraction data revealed a significant improvement in crystallinity, with the NiO films preferentially growing along the (111) direction as the substrate temperature increased. The scanning electron microscope images indicated the more explicit grain boundaries above 250 °C. The average light transmittance of the NiO thin film exhibited a significant improvement from 31% to 72% in the visible range. In addition, the optical bandgap was found to increase from 3.19 to 3.51 eV as the substrate temperature increased. The NiO films presented high carrier concentrations ranging from 1.044 × 1019 to 2.847 × 1019 cm−3 and a low surface resistivity of 0.260 Ω.cm. The optimal characteristic parameters of the p-NiO/n-Si diodes (VOC = 0.702 V, n = 4.998, and ΦB = 0.761 eV) were recognized at a substrate temperature of 250 °C. The results demonstrate that sputtered NiO thin films are highly applicable for ultraviolet optoelectronic devices.
Functional and structural analyses of IMP-27 metallo-β-lactamase: evolution of IMP-type enzymes to overcome Zn(II) deprivation
Authors: Kato Yoshiki , Yamaguchi Toshio , Nakagawa-Kamura Haruka , Ishii Yoshikazu , Shimizu-Ibuka Akiko
Published: November 2024

IMP-type metallo-β-lactamases are di-Zn(II) enzymes that can inactivate a wide range of bicyclic β-lactam agents used in clinical practice. IMP-27 shares 82% amino acid sequence identity with IMP-1, the first IMP-type enzyme identified. Herein, we conducted structural determination, kinetic, and chelating agent resistance analyses of IMP-27. Once determined, IMP-27 was then compared to its mutant, namely, G262S, and IMP-1. Crystallographic structural analysis of IMP-27 showed an overall structure comparable to that of IMP-1 and other IMP-type enzymes; the positions of the zinc (Zn) ions varied across enzymes. Kinetic analysis showed that IMP-27 had lower catalytic efficiency against penicillins, ceftazidime, cephalexin, and imipenem than IMP-1; however, it had higher affinity and catalytic efficiency against meropenem, especially in the presence of Zn(II). This suggests that the catalytic site of IMP-27 is optimized to hydrolyze meropenem during molecular evolution at the expense of catalytic efficiency against penicillins. However, Zn(II) content analysis after EDTA treatment revealed no significant difference between enzymes. Moreover, analysis of IMP-27 mutants indicated that the differences in kinetic properties and chelator resistance between IMP-1 and IMP-27 were mainly due to an amino acid substitution at position 262.

IMPORTANCE

The residue at position 262 has been reported as a key determinant of substrate specificity in IMP-type enzymes. Among more than 80 IMP-type metallo-β-lactamase (MBL) variants, IMP-27 was the first reported IMP-type MBL isolated from
Proteus mirabilis
. This enzyme has a glycine residue at position 262, which is occupied by serine in IMP-1. Compared with IMP-1, IMP-27 had a significantly higher affinity and catalytic efficiency against meropenem and improved metal-binding capacity, maintaining its activity under Zn(II)-limited conditions better than IMP-1. The analysis of the IMP-27 mutants indicated that differences between IMP-27 and IMP-1 were mainly due to an amino acid substitution at position 262. In the case of IMP-27, the G262S mutation optimized the catalytic site of IMP-27 for meropenem hydrolysis, at the expense of catalytic efficiency against penicillins.
Slit-ventricle syndrome masking shunt disconnection in adulthood
Authors: Casanovas Ortega Marta , Pandit Anand S , Abussuud Zeid , Watkins Laurence D
Published: November 2024

A male in his 20s was referred to the neurosurgical service with headaches, vomiting and personality changes. He had a previous history of bilateral ventriculoperitoneal (VP) shunts and bitemporal decompressive surgery for neonatal intraventricular haemorrhage. There were appearances of slit-ventricles on his CT head scan typically associated with adequate cerebrospinal fluid drainage and normal intracranial pressure (ICP), which ordinarily will have limited further investigation. However, an X-ray shunt series demonstrated a right shunt disconnection at the neck and ICP monitoring confirmed raised ICP with poor brain compliance. He underwent revision of the right VP shunt with distal catheter replacement. Postoperatively, his symptoms, ICP and brain compliance improved.

This case highlights the value of obtaining shunt series in patients presenting with symptoms of shunt obstruction regardless of a normal CT head. It emphasises awareness of slit-ventricle syndrome in adult patients with shunts, particularly those with complex childhood hydrocephalus.
Neonatal adrenal haemorrhage presenting with bowel obstruction in a term neonate
Authors: Bickerstaff Emily Ann , Ashour Khaled , Fawkner-Corbett David
Published: November 2024

Neonatal adrenal haemorrhage affects approximately 0.17%–0.21% of babies, although, usually, it remains asymptomatic, and therefore, the exact incidence is probably greater. The increased vascularity and relatively large size of the adrenal glands in neonates increases their vulnerability to haemorrhage during labour. There have been few cases that have presented with bowel obstruction.

A term neonate was admitted with bilious vomiting, dehydration and mottled skin. He was afebrile but hypoglycaemic. Dark green aspirations were present on placement of a nasogastric tube, and emergent upper gastrointestinal contrast study demonstrated failure of contrast to pass and deviation of the duodenum. Together these features raised concern of malrotation with volvulus promoting surgical exploration. Intraoperatively, a left suprarenal mass was discovered, causing bowel obstruction. An ileostomy was created, and a biopsy was taken. Adrenal haemorrhage was diagnosed, which is an extremely rare cause of bowel obstruction. Serial ultrasound scans have been done since, showing reduction of the haemorrhage and his ileostomy has been reversed.

Adrenal haemorrhage is rarely reported to cause bowel obstruction. A neonate with bilious vomiting and an abnormal contrast may represent malrotation; however, adrenal haemorrhage is an uncommon, but important, differential to consider in these scenarios.
Identifying future research priorities in the field of interpersonal violence (IV) towards athletes in sport: a Delphi study
Authors: Parent Sylvie , Radziszewski Stephanie , Aghedo Osazemen , Daignault Isabelle , Kavanagh Emma , Lang Melanie , Mountjoy Margo , Pankowiak Aurélie , Topart Julia , Woessner Mary , Vertommen Tine
Published: November 2024

Objective

Our aim was to define the priorities for future research in safeguarding athletes from interpersonal violence (IV) in sport through a Delphi consensus study of researchers in the field.

Methods

An internet-based three-round Delphi method was used as a multistage facilitation technique to arrive at a group consensus (set at ≥75% agreement). A targeted literature search was conducted to develop a list of potential research priorities that were presented as short statements in the first round.

Results

A total of 52 participants (researchers in IV in sport) took part in the first round, 52 completed the second round and 44 completed the third round. Respectively, 47 items, 83 items and 60 items were included in each round. The participants achieved consensus on 11 statements in the first round, seven in the second round and 31 in the third round, for a total of 49 consensus research priorities. The first four priorities that reached consensus (78.8–80.8% agreement) directly following the first Delphi round were scored with high importance (between 6.2 and 6.3 on a scale of 7). Those four priorities included: (1) documenting the experiences of children athletes and minors, (2) studying the disclosure or reporting of violence, (3) developing, evaluating and advising on interventions targeting education and training and (4) documenting the experiences of violence of para athletes.

Conclusion

This study defines research priorities for IV in sport that may elucidate further gaps in current policies and practices.
Environmentally sustainable surgical systems
Authors: Ledda Virginia , Adisa Adewale , Agyei Fareeda , Caton Lucy , George Christina , Ghaffar Abdul , Ghosh Dhruva , Hachach-Haram Nadine , Haque Parvez David , Ingabire J C Allen , Kudrna Laura , Li Elizabeth , McClain Craig , Nepogodiev Dmitri , Ntirenganya Faustin , Shrime Mark G , Williams Iestyn , Bhangu Aneel
Published: November 2024

Surgeons, anaesthetists, wider surgical teams and hospital managers are a large global group that has the capacity and power to play a leadership role to contribute to change. Hospitals are a good target for improvement since they are centres of communities, linking together surrounding healthcare facilities and influencing wider determinants of the environment. District and rural hospitals are good sites to start since they serve large populations, have the least sustained energy and clean water supplies and will benefit most from quality improvement. Within hospitals, surgeons and surgical pathways are the ideal places to start decarbonising healthcare. Surgery is a high-resource activity, but it focuses on one patient at a time, allowing measures to be introduced, and their effects closely monitored. Through a mass movement, surgical teams should be able to influence policy-makers for healthcare and industry supply chains, amplifying their effect. This article describes how we can make personal, professional and organisational changes to start creating impact. Change can be hard, especially in healthcare, so this new community needs to blend carbon literacy and behavioural change techniques for success. The article is focused on the front-line team and written by clinician experts in behavioural change and sustainable practice. As such, it will not tackle the technicalities of sustainability and carbon accounting. It intends to challenge individual readers to start making changes now, and to challenge systems leaders to start making larger-scale changes urgently.
Feasibility and cross-cultural validation of an adapted social skills group training programme (KONTAKTTMCHILD) for Chinese autistic children: a waitlist RCT protocol
Authors: Lao Uchong , Zhu Huilin , Liang Fengjing , Bai Wuxia , Yin Peipei , Huang Xiaoqian , Girdler Sonya , Bölte Sven , Zou Xiaobing
Published: November 2024

Introduction

School-age autistic children commonly experience social communication and interaction challenges in their everyday lives. While international evidence suggests that social skills group training (SSGT) programmes can support autistic children, improving their psychosocial functioning, to date there is no standardised evidence-based SSGT tailored towards the needs of autistic children aged 8–12 years living in the Chinese Mainland. Therefore, the primary objective of this study will be to evaluate the feasibility and acceptability of a culturally adapted 16-session version of the social skills programme KONTAKT in Chinese autistic children. Additionally, preliminary efficacy and cost-effectiveness will be assessed to inform a future definitive trial.

Methods and analysis

This study will employ a randomised, single-blinded, waitlist-controlled feasibility design with 36 Chinese autistic children aged 8–12 years with IQ over 70 referred to the Child Development and Behavior Center in Guangzhou, China. Participants will be randomly assigned to either the immediate training group or the delayed training group stratified by sex. Feasibility will be assessed using quantitative and qualitative data obtained from the KONTAKT CHILD participants, their parents and facilitators of the programme. Preliminary efficacy and cost-effectiveness are assessed via quantitative data obtained at five time points. The primary efficacy outcome is participants’ improvement in social skills as measured by the Contextual Assessment of Social Skills. Other outcomes include parents and teachers’ reports of participants’ autistic traits and adaptive functioning, participants’ self-report and projective tests for self-assertiveness and psychosocial functioning, and parent reports on parental reflective functioning and perceived school support. Common process factors and their effects on outcomes will also be explored. Cost-effectiveness will consider from both societal and healthcare perspectives.

Ethics and dissemination

The current study protocol has been reviewed and ethics approval has been obtained from the Ethical Board Committee at the Third Affiliated Hospital of Sun Yat-sen University (II2023-119-01). The trial was pre-registered in Chinese Clinical Trials (ChiCTR2300072136) on 5 June 2023. The results of this trial will be actively disseminated through peer-reviewed publications and conference presentations. Any identifiable personal information will be anonymised to protect confidentiality.

Protocol version

2.0, 31 July 2024.

Trial registration number

ChiCTR2300072136.
Experiences of physiotherapists working with adults living with Long COVID in Canada: a qualitative study
Authors: Kim Caleb , Lin Chantal , Wong Michelle , Al Hamour Al Jarad Shahd , Gao Amy , Kaufman Nicole , McDuff Kiera , Brown Darren A. , Cobbing Saul , Minor Alyssa , Chan Carusone Soo , O'Brien Kelly K
Published: November 2024

Objectives

To explore experiences of physiotherapists working with adults living with Long COVID in Canada.

Design

Cross-sectional descriptive qualitative study involving online semi-structured interviews.

Participants

We recruited physiotherapists in Canada who self-identified as having clinically treated one or more adults living with Long COVID in the past year.

Data collection

Using an interview guide, we inquired about physiotherapists’ knowledge of Long COVID, assessment and treatment experiences, perspectives on physiotherapists’ roles, contextual and implementation factors influencing rehabilitative outcomes, and their recommendations for Long COVID rehabilitation. Interviews were audio-recorded, transcribed verbatim and analysed using a group-based thematic analytical approach. We administered a demographic questionnaire to describe sample characteristics.

Results

13 physiotherapists from five provinces participated; most were women (n=8; 62%) and practised in urban settings (n=11; 85%). Participants reported variable amounts of knowledge of existing guidelines and experiences working with adults living with Long COVID in the past year. Physiotherapists characterised their experiences working with adults living with Long COVID as a dynamic process involving: (1) a disruption to the profession (encountering a new patient population and pivoting to new models of care delivery), followed by (2) a cyclical process of learning curves and evolving roles of physiotherapists working with persons living with Long COVID (navigating uncertainty, keeping up with rapidly emerging evidence, trial and error, adapting mindset and rehabilitative approaches and growing prominence of roles as advocate and collaborator). Participants recommended the need for education and training, active and open-minded listening with patients, interdisciplinary models of care, and organisational- and system-level improvements to foster access to care.

Conclusions

Physiotherapists’ experiences involved a disruption to the profession followed by a dynamic process of learning curves and evolving roles in Long COVID rehabilitation. Not all participants demonstrated an in-depth understanding of existing Long COVID rehabilitation guidelines. Results may help inform physiotherapy education in Long COVID rehabilitation.
Effects of paravertebral block on postoperative analgesia in children undergoing unilateral thoracotomy cardiac surgery with cardiopulmonary bypass: protocol for a randomised controlled trial
Authors: Guo Jingfei , Tian Lijuan , Kang Wenying , Jia Yuan , Yuan Su
Published: November 2024

Introduction

This study aims to determine whether paravertebral block (PVB) provides better postoperative analgesia, lower incidence of complications and faster recovery compared with local anaesthetic wound infiltration for school-aged children undergoing cardiac surgery with cardiopulmonary bypass via thoracotomy.

Method and analysis

This is a single-centre, randomised controlled trial. We will enrol 100 children aged 6–14 years with atrial or ventricular septal defects scheduled for thoracotomy cardiac surgery with cardiopulmonary bypass. The patients will be randomly assigned to the PVB group and the control group in a ratio of 1:1. After the surgery, we will conduct unilateral PVB with ropivacaine for patients in the PVB group, and local anaesthetic wound infiltration for patients in the control group. We will use the double-dummy design to ensure blinding. The patients will not be administered analgesics after returning to the PICU(paediatric intensive care unit). Their bedside nurse will monitor their pain condition. When the Faces Pain Scale-Revised (FPS-R) Pain Score is ≥4, sufentanil infusion will be started. The primary outcome will be total opioid consumption within 24 hours after surgery. Secondary outcomes will be (1) FPS-R Scores at 6 hours, 12 hours, 18 hours and 24 hours after surgery; (2) The rate of opioid treatment for remedial analgesia; (3) The first time of FPS-R Score is ≥4 postoperatively. Exploratory outcomes will be: (1) Length of postoperative mechanical ventilation, ICU stay and hospital stay; (2) The rate of postoperative nausea and vomiting and respiratory depression 24 hours after surgery.

Ethics and dissemination

This study was approved by the Ethics Committee of the Chinese Academy of Medical Sciences, Fuwai Hospital (No 2023–2135) and PUMC. Written informed consent will be obtained from each patient or their legal representatives before enrolment. The results of this trial will be published in an international peer-reviewed scientific journal.

Trial registration number

Chinese Clinical Trial Registry (ChiCTR2400081773) Clinical Trial（NCT06312904）
Validity of data extraction in acupuncture meta-analysis: a reproducibility study protocol
Authors: Duan Yuting , Zhao Pinge , Deng Yuening , Luo Wenting , Chen Zewei , Liu Shujuan , Zhou Jinjin , Xu Ziwen , Tang Binbin , Yu Lin
Published: November 2024

Introduction

Systematic review and meta-analysis occupy the apex of the evidence pyramid, serving as the most comprehensive and reliable form of evidence-based assessment. Data extraction is a crucial juncture in meta-analysis, establishing the underpinnings for the outcomes and deductions drawn from systematic reviews (SRs). However, the frequency of data extraction errors in meta-analysis is quite significant. Data extraction errors can lead to biased study results, affect the credibility of study results and even mislead clinical practice. The quantity of acupuncture randomised controlled trials and SRs has expanded rapidly recently, yet the validity of data extraction remains unexplored. Hence, our study aims to investigate the validity of data extraction errors in acupuncture SRs, the effect of data extraction errors on results and the relevant guidelines used erroneous results.

Methods and analysis

Four databases including MEDLINE, Web of Science, Cochrane linbrary and EMBASE will be searched from 1 January 2019 to 31 December 2023 for acupuncture SRs. Two researchers will independently extract data from the meta-analysis and the original study into a standardised data extraction table. A senior investigator, who did not participate in the data extraction process, will verify the results. In cases of discrepancies, the senior researcher will conduct further extraction and consult with another senior researcher to determine the final results. We will analyse the frequency and type of data extraction errors and data estimation errors and evaluate the effect of data extraction errors on results. Quantile regression will be used to explore the factors influencing data extraction error frequency at 25th, 50th and 75th percentiles. Finally, we will further search for guidelines used erroneous results.

Ethics and dissemination

Ethical approval is not necessary for this study. This protocol has been registered in Open Science Framework Registries.

Registration DOI

https://doi.org/10.17605/OSF.IO/CHMPA.
Total retinal thickness is an important factor in evaluating diabetic retinal neurodegeneration
Authors: Ahmad Noor-Us-Sabah , Staggers Kristen , Lee Kyungmoo , Mehta Nitish , Domalpally Amitha , Frankfort Benjamin J , Liu Yao , Channa Roomasa
Published: November 2024

Objective

Macular retinal nerve fibre layer (mRNFL) and ganglion cell-inner plexiform layer thickness (GC-IPL) measurements are important markers of diabetic retinal neurodegeneration (DRN). In this cross-sectional study, we aimed to quantify the contribution of total retinal thickness (TRT) and other factors in the variation of mRNFL and GC-IPL thickness among participants with diabetes.

Methods and analysis

We used macular-centred spectral domain-optical coherence tomography scans from participants with diabetes in the UK Biobank. Two multiple linear regression models (prior to and after adjusting for TRT) were used to determine factors associated with mRNFL and GC-IPL thicknesses. A p value of less than 0.05 was considered statistically significant.

Results

A total of 3832 eyes from 3832 participants with diabetes were analysed. Factors that explained the greatest variation in thickness were TRT (20.9% for mRNFL and 57.2% for GC-IPL), followed by spherical equivalent (8.0% for mRNFL only), gender (2.2% for mRNFL only) and age (1.4% for GC-IPL only). Other factors significantly associated with mRNFL and/or GC-IPL thickness explained less than 1% of the variation in their thicknesses. Self-reported ancestral background was not significantly associated with mRNFL thickness after accounting for TRT.

Conclusions

Although many factors were significantly associated with mRNFL and GC-IPL thickness in participants with diabetes, they accounted for a fraction of the variation in the thickness of both layers. TRT explained most of the variation in these measurements, hence accounting for TRT is needed when using these metrics to evaluate DRN.
Improving the non-ST-segment elevation acute coronary syndrome (NSTEACS) pathway using quality improvement methodology
Authors: Goodfellow Susan , Goodfellow Jonathan
Published: November 2024

Background

The National Institute for Health and Care Excellence (NICE) guideline quality standard for non-ST-segment elevation acute coronary syndrome (NSTEACS) pathway states that adults who have an intermediate or higher risk of future adverse cardiovascular events should undergo coronary angiography within 72 hours of first admission to hospital.

The aim was to improve compliance with the 72-hour NICE quality standard for the acute coronary syndrome pathway between one district general hospital (DGH) and its cardiac tertiary centre by reducing the time from admission to angiography by 50%.

Participants were front-line staff in the DGH and staff in the cardiac catheter laboratory in the tertiary centre.

Methods

Continuous data were collected prospectively on all patients entering the NSTEACS pathway with time of arrival to hospital; referral to angiography; and start of angiogram to measure the NSTEACS pathway duration against the NICE quality standard. We used process mapping, ease-benefit matrix, Pareto analyses and the Institute for Healthcare Improvement (IHI) Plan-Do-Study-Act (PDSA) method of quality improvement.

Intervention

Staff in both hospitals performed process mapping of their respective parts of the NSTEACS pathway. Their data informed decisions on process changes using the ease-benefit matrix. PDSA cycles were commenced, and changes were assessed using continuous measurement of pathway duration. In the tertiary centre, Pareto analysis was performed to help identify the major service constraints.

Results

Between January 2021 and March 2023, there were four separate PDSA cycles, two each in the DGH and tertiary centre. Across the four PDSA cycles, the time to complete the pathway reduced from an average of 172 to 94.72 hours, an improvement of 45%, along with an overall reduction in variability of data. In the DGH, the process changes were sustained, but in the tertiary centre they were not, as PDSA 4 required staff recruitment to enable a 6-day rather than a 5-day service per week.
What do we mean when we talk about socioeconomic status? Implications for measurement, mechanisms and interventions from a critical review on adolescent mental health
Authors: Zaneva Mirela , Dumbalska Tsvetomira , Reeves Aaron , Bowes Lucy
Published: November 2024

Low socioeconomic status (SES) is a well-established risk factor for general and mental health problems. However, there is no widely accepted definition or operationalisation for SES, leading to varied interpretations in research. In a critical review of the child and adolescent mental health literature, we map how SES is defined and measured. We examined 334 relevant papers from 2013 to 2024 and found significant variability in the operationalisation of SES. Our analysis revealed fundamental problems such as the lack of clear definitions, insufficient detail on variables used and limited measures directly reported by adolescents. We discuss issues related to measurement techniques and their impact on reproducibility, policy development and intervention design. Based on our findings, we recommend using SES measures that directly assess the socioeconomic position of children and adolescents. Additionally, we recommend researchers improve transparency and specificity in reporting the measures used and the rationale behind their selection. The wide range of distinct measures used to represent SES, coupled with insufficient reporting, likely hampers our understanding of which underlying factors truly drive observed effects and impedes the establishment of causal relationships. This, in turn, makes the path to effective health interventions more challenging.
Body mass index and type 2 diabetes mellitus as metabolic determinants of immune checkpoint inhibitors response in melanoma
Authors: Jan Yu Jen Alexander , Chiang Cho-Han , Osataphan Soravis , Lawless Aleigha R , Reynolds Kerry L , Sullivan Ryan J
Published: November 2024

Background

Immune checkpoint inhibitors (ICIs) have improved survival outcomes in melanoma. Studies exploring the correlations between body mass index (BMI), type 2 diabetes (T2DM) and the outcomes of ICI treatment have yielded inconsistent results. In this study, we aim to investigate the effects of BMI and T2DM on survival outcomes of patients with melanoma receiving ICIs.

Methods

A retrospective multicenter cohort of patients with melanoma treated with ICIs was analyzed. Overall survival was evaluated with Kaplan-Meier survival analysis, univariate Cox and multivariate Cox proportional hazards model. Propensity-score matching (1:1) analysis between overweight and non-overweight groups was done and survival analyses and Cox analyses were performed again. Subgroup analyses and secondary analyses stratifying patients with different weights and T2DM statuses were also performed.

Results

A total of 2,078 patients were included, of whom 1,412 were overweight (BMI≥25 kg/m2) and 666 were non-overweight (BMI<25 kg/m2). Overweight patients had better overall survival compared with non-overweight (median 71.7 vs 36.7 months, p<0.001). Patients with T2DM had worse overall survival compared with patients without T2DM (median 28.5 vs 67.3 months, p<0.001). After propensity-score matching (666 overweight were matched to 666 non-overweight), overweight patients remained to have better overall survival compared with non-overweight (median 67.7 vs 36.7 months, p<0.001). Patients with T2DM had worse survival in univariate Cox (HR 1.71, (95% CI: 1.20 to 2.43)) and multivariate Cox (HR 1.58, (95% CI: 1.08 to 2.31)) analyses. Overweight patients without T2DM had the best survival outcomes compared with other weight and T2DM combinations.

Conclusion

In patients with melanoma treated with ICIs, being overweight had better survival outcomes compared with non-overweight. Having T2DM was associated with worse survival compared with those without T2DM. Further studies are needed to investigate the underlying mechanisms of these associations.
Chronic kidney disease in patients with psoriatic arthritis: a cohort study
Authors: Kharouf Fadi , Gao Shangyi , Al-Matar Shahad , Cook Richard J , Chandran Vinod , Gladman Dafna D
Published: November 2024

Objectives

Chronic kidney disease (CKD) is a comorbidity in psoriatic arthritis (PsA). We aimed to define the prevalence of CKD in patients with PsA, describe their long-term renal outcomes and identify risk factors for CKD development.

Methods

We included patients with PsA followed by our prospective observational cohort. We defined CKD as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2for at least 3 months. We characterised long-term renal outcomes of CKD cases identified following clinic entry. We used time-dependent Cox regression models to identify factors associated with CKD development.

Results

Of 1336 patients included in the study, 123 (9.2%) had CKD. Of these, 25 (20.3%) were observed to have CKD at clinic entry and 98 (79.7%) developed CKD during follow-up at a median (IQR) of 8.2 (2.8–14.0) years from baseline. Doubling of baseline creatinine was observed in 18 of 98 (18.3%) new patients with CKD. 49 (50%) patients developed a sustained ≥40% reduction in baseline eGFR. Two patients developed eGFR <15 mL/min/1.73 m2. In the multivariate Cox regression model adjusted for age at study entry, sex and baseline eGFR, factors independently associated with the development of CKD included diabetes mellitus (HR 2.58, p<0.001), kidney stones (HR 2.14, p=0.01), radiographic damaged joint count (HR 1.02, p=0.02), uric acid (HR 1.21, p<0.001; 50-unit increase), daily use of non-steroidal anti-inflammatory drugs (NSAIDs) (HR 1.77, p=0.02) and methotrexate use (HR 0.51, p=0.01).

Conclusion

CKD is not infrequent in PsA. Its development is associated with related comorbidities, joint damage and NSAID use. Methotrexate seems to be protective.