bluuebunny/crossref_metadata_2025 huggingface dataset:
The development, incidence and treatment trends of trochanteric fractures in Germany: a cohort study
Authors: Rau Yannick , Amtsfeld Jasper , Reimers Nils , Matrisch Ludwig , Frese Jasper , Schulz Arndt-Peter
Published: July 2023

Background

Hip fractures are a major public health problem worldwide and can lead to disability, increased mortality, and reduced quality of life. We aim to provide a nationwide epidemiological analysis of trochanteric and subtrochanteric fractures and their respective surgical treatments.

Methods

Data were retrieved from the national database of the German Department of the Interior. ICD-10-GM and OPS data from the period of 2006 to 2020 were analysed and all patients with trochanteric and subtrochanteric fractures as their main diagnosis, who were treated in a German hospital, were included. Patients were grouped by age and gender and linear regression was performed where suitable to calculate statistically significant correlations between variables and incidences.

Results

985,104 pertrochanteric fractures and 178,810 subtrochanteric fractures were reported during the analysed period. We calculated a mean incidence of 80.08 ± 6.34 for pertrochanteric and 14.53 ± 1.50 for subtrochanteric fractures per million inhabitants. In both fracture types, a distinct dependence of incidence on age can be determined. Incidence rates equally rise in both sexes through the age groups with an increase of about 288-fold from those under the age of 60 to those over the age of 90 in pertrochanteric fractures, and about 123-fold in subtrochanteric fractures. Intramedullary nailing was the most common kind of treatment for both fracture types with augmentative cerclages on the rise throughout the whole period. Plate and dynamic compression screws were decreasing in frequency over the analysed period in both fractures.

Conclusions

We provided incidence data on per- and subtrochanteric fractures and their treatment. We calculated an economic impact of approximately 1.563 billion € per year in Germany. With regards to recent literature on costs of treatment and our findings regarding the implementation and utilization of different treatment methods, we conclude that the reinforcement of nationwide prevention programs is a relevant step in lessening the economic burden. We welcome the increased utilisation of intramedullary nailing as many studies show beneficiary outcomes and cost effectiveness in most of the included fracture types.
Basilar artery diameter as neuroimaging biomarker in Chinese Fabry disease patients
Authors: Lam Yan Lok Tiffany , Sheng Bun , Kwok Hoi Ming , Yu Ellen Lok Man , Ma Ka Fai Johnny
Published: July 2023

Background

Fabry disease (FD) is an X-linked lysosomal storage disease resulting from mutations of α-galactosidase A gene, and has been emphasized as one of the etiologies of young stroke and leukoencephalopathy. Vertebrobasilar dolichoectasia (VBD) is a highlighted finding in FD. We aim to examine the utility of VBD in Chinese FD by comparing the differences in basilar artery (BA) diameter of Chinese FD patients against age-matched controls with and without stroke.

Methods

This was a matched case-control study involving 37 Chinese FD patients. The BA diameters were evaluated on axial T2-weighted magnetic resonance imaging and compared to two age-and-gender matched control groups, one with stroke and one without. The association between BA diameter and stroke occurrences and white matter hyperintensities (WMH) were analyzed among all FD patients.

Results

Patients with FD had significantly increased BA diameter compared to controls with and without stroke (p < 0.001). A BA diameter of 4.16 mm could distinguish FD from controls in the stroke subgroup (ROC AUC 0.870, p = 0.001, sensitivity 80% specificity 100%), and with a cut-off of 3.21 mm in the non-stroke subgroup (ROC AUC 0.846, p < 0.001, sensitivity 77.8% specificity 88.9%). Larger BA diameter had more stroke occurrences and was moderately associated with heavier WMH load in terms of higher total FAZEKAS scores. (Spearman’s rho = 0.423, p = 0.011).

Conclusion

VBD was also present in Chinese FD patients. BA diameter has high diagnostic utility in identifying FD from a mixed cohort of stroke and normal controls, and carried predictive value in evaluating neurological complications of FD.
Dose-dense regimen versus conventional three-weekly paclitaxel combination with carboplatin chemotherapy in first-line ovarian cancer treatment: a systematic review and meta-analysis
Authors: Gong Wenjian , Yu Ruidi , Cao Canhui , Fang Yong , Zhao Xuejiao , Gao Qinglei
Published: July 2023

Background

Paclitaxel dose-dense regimen has been controversial in clinical trials in recent years. This systematic review and meta-analysis tried to evaluate the efficacy and safety of paclitaxel dose-dense chemotherapy in primary epithelial ovarian cancer.

Methods

An electronic search following PRISMA guidelines was conducted (Prospero registration number: CRD42020187622), and then a systematic review and meta-analysis of included literature were initiated to determine which regimen was better.

Results

Four randomized controlled trials were included in the qualitative evaluation, and 3699 ovarian cancer patients were included in the meta-analysis. The meta-analysis revealed that the dose-dense regimen could prolong PFS (HR0.88, 95%CI 0.81–0.96; p = 0.002) and OS (HR0.90, 95%CI 0.81–1.02; p = 0.09), but it also increased the overall toxicity (OR = 1.102, 95%CI 0.864–1.405; p = 0.433), especially toxicity of anemia (OR = 1.924, 95%CI 1.548–2.391; p < 0.001), neutropenia (OR = 2.372, 95%CI 1.674–3.361; p < 0.001). Subgroup analysis indicated that the dose-dense regimen could significantly prolong not only PFS (HR0.76, 95%CI 0.63–0.92; p = 0.005 VS HR0.91, 95%CI 0.83–1.00; p = 0.046) but also OS (HR0.75, 95%CI 0.557–0.98; p = 0.037 VS HR0.94, 95%CI 0.83–1.07; p = 0.371) in Asian, and overall toxicity was significantly increased in Asians (OR = 1.28, 95%CI: 0.877–1.858, p = 0.202) compared to non-Asians (OR = 1.02, 95%CI 0.737–1.396, p = 0.929).

Conclusion

Paclitaxel dose-dense regimen could prolong PFS and OS, but it also increased the overall toxicity. Therapeutic benefits and toxicity of dose-dense are more obvious in Asians compared to non-Asians, which need to be further confirmed in clinical trials.
A multicentre randomised controlled trial of a guided self-help cognitive behavioural therapy to MANage the impact of hot flushes and night sweats in patients with prostate CANcer undergoing androgen deprivation therapy (MANCAN2)
Authors: Crabb Simon , Morgan Alannah , Hunter Myra S. , Stefanopoulou Evgenia , Griffiths Gareth , Richardson Alison , Fenlon Deborah , Fleure Louisa , Raftery James , Boxall Cherish , Wilding Sam , Nuttall Jacqueline , Eminton Zina , Tilt Emma , O’Neill Alice , Bacon Roger , Martin Jonathan
Published: July 2023

Background

Androgen deprivation therapy (ADT) is prescribed to almost half of all men diagnosed with prostate cancer. Although ADT is effective treatment, with virtually all men with advanced disease showing initial clinical response, it is associated with troublesome side effects including hot flushes and night sweats (HFNS). HFNS can be both frequent and severe and can have a significant impact on quality of life (QoL). They can occasionally be so debilitating that patients stop ADT altogether, despite the increased risk of disease relapse or death. Previous research has found that guided self-help cognitive behavioural therapy (CBT) can be effective in reducing HFNS due to ADT when delivered by a clinical psychologist. MANCAN2 aims test whether we can train the existing NHS Prostate Cancer Nurse Specialist (CNS) team to deliver guided self-help CBT and whether it is effective in reducing the impact of HFNS in men undergoing ADT.

Methods

MANCAN2 is a phase III multicentre randomised controlled trial and process evaluation. Between 144 and 196 men with prostate cancer who are currently receiving ADT and are experiencing problematic HFNS will be individually randomised in a 1:1 ratio in groups of 6–8 participants to either treatment as usual (TAU) or participation in the guided self-help CBT intervention plus TAU. A process evaluation using the normalisation process theory (NPT) framework will be conducted, to understand the CNS team’s experiences of delivering the intervention and to establish the key influencers to its implementation as a routine practice service. Fidelity of implementation of the intervention will be conducted by expert assessment. The cost-effectiveness of the intervention and participant adherence to the trial intervention will also be assessed.

Discussion

MANCAN2 will advance the program of work already conducted in development of management strategies for HFNS. This research will determine whether the severity of ADT-induced HFNS in men with prostate cancer can be reduced by a guided self-help CBT intervention, delivered by the existing NHS prostate cancer CNS team, within a multicentre study. The emphasis on this existing team, if successful, should facilitate translation through to implementation in routine practice.

Trial registration

ISRCTN reference 58720120. Registered 13 December 2022
Necessity of fusion following decompression surgery in patients with single-level lumbar stenosis: study protocol for an open-label multicentre non-inferiority randomized controlled clinical trial
Authors: Grin Andrey , Lvov Ivan , Talypov Aleksandr , Smirnov Vladimir , Kordonskiy Anton , Lebedev Valeriy , Zuev Andrey , Senko Ilya , Pogonchenkova Iren , Krylov Vladimir
Published: July 2023

Background

The necessity of spinal segment fusion after decompression is one of the most controversial and unresolved issues in single-level lumbar spinal stenosis surgery. To date, only one trial carried out 15 years ago focused on this problem. The key purpose of the current trial is to compare the long-term clinical results of the two surgical methods (decompression vs. decompression and fusion) in patients with single-level lumbar stenosis.

Methods

This study is focused on the non-inferior clinical results of decompression compared with the standard fusion procedure. In the decompression group, the spinous process, the interspinous and supraspinous ligaments, part of the facet joints, and corresponding parts of the vertebral arch are to be preserved intact. In the fusion group, decompression is to be supplemented with transforaminal interbody fusion. Participants meeting the inclusion criteria will be randomly divided into two equal groups (1:1), depending on the surgical method. The final analysis will include 86 patients (43 per group). The primary endpoint is Oswestry Disability Index dynamics at the end of the 24-month follow-up compared to the baseline level. Secondary outcomes included those estimated using the SF-36 scale, EQ-5D-5L, and psychological scales. Additional parameters will include sagittal balance of the spine, fusion results, total cost of surgery, and hospital stay followed by two-year treatment. Follow-up examinations will be performed at 3, 6, 12, and 24 months

Discussion

Authors suggest that this study will improve the evidence for application of various surgical techniques for lumbar spine stenosis surgery and verify the existing protocol for surgical management.

Trial registration

ClinicalTrials.gov NCT05273879. Registered on March 10, 2022.
Comparison of in vitro and in vivo repellency bioassay methods for Ixodes scapularis nymphs
Authors: Burtis James C. , Ford Shelby L. , Parise Christina M. , Foster Erik , Eisen Rebecca J. , Eisen Lars
Published: July 2023

Background

Numerous bioassay methods have been used to test the efficacy of repellents for ticks, but the comparability of results across different methods has only been evaluated in a single study. Of particular interest are comparisons between bioassays that use artificial containers (in vitro) with those conducted on a human subject (in vivo) for efficacy testing of new potential unregistered active ingredients, which most commonly use in vitro methods.

Methods

We compared four different bioassay methods and evaluated three ingredients (DEET [N,N-Diethyl-meta-toluamide], peppermint oil and rosemary oil) and a negative control (ethanol) over a 6-h period. Two of the methods tested were in vivo bioassay methods in which the active ingredient was applied to human skin (finger and forearm bioassays), and the other two methods were in vitro methods using artificial containers (jar and petri dish bioassays). All four bioassays were conducted using Ixodesscapularis nymphs. We compared the results using nymphs from two different tick colonies that were derived from I.scapularis collected in the US states of Connecticut and Rhode Island (northern origin) and Oklahoma (southern origin), expecting that ticks of different origin would display differences in host-seeking behavior.

Results

The results between bioassay methods did not differ significantly, even when comparing those that provide the stimulus of human skin with those that do not. We also found that tick colony source can impact the outcome of repellency bioassays due to differences in movement speed; behavioral differences were incorporated into the assay screening. DEET effectively repelled nymphs for the full 6-h duration of the study. Peppermint oil showed a similar repellent efficacy to DEET during the first hour, but it decreased sharply afterwards. Rosemary oil did not effectively repel nymphs across any of the time points.

Conclusions

The repellency results did not differ significantly between the four bioassay methods tested. The results also highlight the need to consider the geographic origin of ticks used in repellency bioassays in addition to species and life stage. Finally, our results indicate a limited repellent efficacy of the two essential oils tested, which highlights the need for further studies on the duration of repellency for similar botanically derived active ingredients and for evaluation of formulated products.

Graphical Abstract
Sub-minute acquisition with deep learning-based image filter in the diagnosis of colorectal cancers using total-body 18F-FDG PET/CT
Authors: Liu Entao , Lyu Zejian , Yang Yuelong , Lv Yang , Zhao Yumo , Zhang Xiaochun , Sun Taotao , Jiang Lei , Liu Zaiyi
Published: July 2023

Background

This study aimed to retrospectively evaluate the feasibility of total-body 18F-FDG PET/CT ultrafast acquisition combined with a deep learning (DL) image filter in the diagnosis of colorectal cancers (CRCs).

Methods

The clinical and preoperative imaging data of patients with CRCs were collected. All patients underwent a 300-s list-mode total-body 18F-FDG PET/CT scan. The dataset was divided into groups with acquisition durations of 10, 20, 30, 60, and 120 s. PET images were reconstructed using ordered subset expectation maximisation, and post-processing filters, including a Gaussian smoothing filter with 3 mm full width at half maximum (3 mm FWHM) and a DL image filter. The effects of the Gaussian and DL image filters on image quality, detection rate, and uptake value of primary and liver metastases of CRCs at different acquisition durations were compared using a 5-point Likert scale and semi-quantitative analysis, with the 300-s image with a Gaussian filter as the standard.

Results

All 34 recruited patients with CRCs had single colorectal lesions, and the diagnosis was verified pathologically. Of the total patients, 11 had liver metastases, and 113 liver metastases were detected. The 10-s dataset could not be evaluated due to high noise, regardless of whether it was filtered by Gaussian or DL image filters. The signal-to-noise ratio (SNR) of the liver and mediastinal blood pool in the images acquired for 10, 20, 30, and 60 s with a Gaussian filter was lower than that of the 300-s images (P < 0.01). The DL filter significantly improved the SNR and visual image quality score compared to the Gaussian filter (P < 0.01). There was no statistical difference in the SNR of the liver and mediastinal blood pool, SUVmax and TBR of CRCs and liver metastases, and the number of detectable liver metastases between the 20- and 30-s DL image filter and 300-s images with the Gaussian filter (P > 0.05).

Conclusions

The DL filter can significantly improve the image quality of total-body 18F-FDG PET/CT ultrafast acquisition. Deep learning-based image filtering methods can significantly reduce the noise of ultrafast acquisition, making them suitable for clinical diagnosis possible.
Impact of palmiped farm density on the resilience of the poultry sector to highly pathogenic avian influenza H5N8 in France
Authors: Bauzile Billy , Durand Benoit , Lambert Sébastien , Rautureau Séverine , Fourtune Lisa , Guinat Claire , Andronico Alessio , Cauchemez Simon , Paul Mathilde C. , Vergne Timothée
Published: July 2023

We analysed the interplay between palmiped farm density and the vulnerability of the poultry production system to highly pathogenic avian influenza (HPAI) H5N8. To do so, we used a spatially-explicit transmission model, which was calibrated to reproduce the observed spatio-temporal distribution of outbreaks in France during the 2016–2017 epidemic of HPAI. Six scenarios were investigated, in which the density of palmiped farms was decreased in the municipalities with the highest palmiped farm density. For each of the six scenarios, we first calculated the spatial distribution of the basic reproduction number (R0), i.e. the expected number of farms a particular farm would be likely to infect, should all other farms be susceptible. We also ran in silico simulations of the adjusted model for each scenario to estimate epidemic sizes and time-varying effective reproduction numbers. We showed that reducing palmiped farm density in the densest municipalities decreased substantially the size of the areas with high R0 values (> 1.5). In silico simulations suggested that reducing palmiped farm density, even slightly, in the densest municipalities was expected to decrease substantially the number of affected poultry farms and therefore provide benefits to the poultry sector as a whole. However, they also suggest that it would not have been sufficient, even in combination with the intervention measures implemented during the 2016–2017 epidemic, to completely prevent the virus from spreading. Therefore, the effectiveness of alternative structural preventive approaches now needs to be assessed, including flock size reduction and targeted vaccination.
The effect of intraoperative goal-directed fluid therapy combined with enhanced recovery after surgery program on postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection: a prospective randomized controlled study
Authors: Ma Hongmei , Li Xin , Wang Zhe , Qiao Qiao , Gao Yanfeng , Yuan Hui , Guan Bin , Guan Zheng
Published: July 2023

Background

To investigate the effect of intraoperative goal-directed fluid therapy (GDFT) combined with enhanced recovery after surgery (ERAS) program on postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection.

Methods

Patients, more than 60 years old, undergoing thoracoscopic pulmonary resection for non-small cell lung cancer were randomly divided into GDFT group and restrictive fluid therapy (RFT) group. ERAS program was implemented in all patients. In GDFT group, the intraoperative fluid management was guided by stroke volume variation (SVV), cardiac index (CI), and mean arterial pressure (MAP) and maintained the SVV < 13%, CI > 2.5 L/min/m2, and MAP > 65 mmHg. In RFT group, fluid maintenance with 2 ml/kg/h of balanced crystalloid solution, norepinephrine was used to maintain MAP > 65 mmHg. The incidence of postoperative acute kidney injury (AKI) and pulmonary and cardiac complications was compared.

Results

Two-hundred seventy-six patients were enrolled and randomly divided into two groups (138 in each group). Compared to RFT group, the total intraoperative infusion volume, colloids infusion volume, and urine output were more; the dosage of norepinephrine was lower in GDFT group. Although there were no significant differences of postoperative AKI (GDFT vs RFT; 4.3% vs 8%; P = 0.317) and composite postoperative complications (GDFT vs RFT; 66 vs 70) between groups, but the postoperative increase degree of serum creatinine was lower in GDFT group than that in RFT group (GDFT vs RFT; 91.9 ± 25.2 μmol/L vs 97.1 ± 17.6 μmol/L; P = 0.048).

Conclusions

Under ERAS program, there was no significant difference of AKI incidence between GDFT and RFT in elderly patients undergoing thoracoscopic pulmonary resection. But postoperative increase degree of serum creatinine was lower in GDFT group.

Trial registration

Registered at ClinicalTrials.gov, NCT04302467 on 26 February 2020.
Molecular epidemiology of hepatitis C virus genotypes in different geographical regions of Chinese mainland and a phylogenetic analysis
Authors: Tang Qiao , Chen Zhiwei , Li Hu , Zhang Li , Peng Mingli , Zeng Yi , Liu Xiaoqing , Liu Zubi , Hu Peng
Published: July 2023

Background

Hepatitis C virus (HCV) infection remains a major public health problem in Chinese mainland. Investigation of the distribution of genotypes contributed to the prevention, diagnosis and treatment of HCV infection. Therefore, we conducted a study on the distribution of HCV genotypes and phylogenetic analysis to provide an up-to-date understanding of the molecular epidemiology of genotypes in Chinese mainland.

Methods

Our retrospective multicenter study enrolled 11,008 samples collected between August 2018 and July 2019 from 29 provinces/municipalities (Beijing, Hebei, Inner Mongolia, Shanxi, Tianjin, Gansu, Ningxia, Shaanxi, Xinjiang, Heilongjiang, Jilin Liaoning, Henan, Hubei Hunan, Anhui, Fujian, Jiangsu, Jiangxi, Shandong, Shanghai Zhejiang, Guangdong, Guangxi, Hainan, Chongqing, Guizhou, Sichuan and Yunnan). Phylogenetic analysis of each subtype was performed to infer the evolutionary relationship of sequences from diverse regions. Two independent samples t tests were used for the comparison of continuous variables, and chi-square tests were used for the comparison of categorical variables.

Results

Four genotypes (1, 2, 3 and 6) were found, including 14 subtypes. HCV genotype 1 was dominant, accounting for 49.2%, followed by genotypes 2, 3 and 6, accounting for 22.4%, 16.4%, and 11.9%, respectively. Additionally, the top five subtypes were 1b, 2a, 3b, 6a and 3a. Proportions of genotypes 1 and 2 decreased while genotypes 3 and 6 increased over past years (P < 0.001). Genotypes 3 and 6 were concentrated in the population aged 30 to 50 years, and male carriers had lower proportions of subtypes 1b and 2a than female carriers (P < 0.01). Genotypes 3 and 6 were more prevalent in southern parts of Chinese mainland. Nationwide spreads of subtypes 1b and 2a were associated with sequences from northern parts of Chinese mainland, while subtypes 3a, 3b and 6a were associated with sequences from southern parts of Chinese mainland.

Conclusions

HCV subtypes 1b and 2a remained the most common subtypes in Chinese mainland, and their proportions decreased over the past years, while the proportions of genotypes 3 and 6 increased. Our investigation provided an accurate epidemiological picture of the circulating viral strains in Chinese mainland, contributing to the prevention, diagnosis and treatment of HCV infection.

Trial registration: Not applicable.
Beyond vulnerability: contextualizing migrant worker views on rights and wellbeing in the Gulf Arab states
Authors: Ewers Michael , Diop Abdoulaye , Duma Nathan , Le Kien
Published: July 2023

This paper examines migrant workers’ subjective views of their rights and wellbeing in the Gulf Arab state of Qatar. Since the announcement of the World Cup, Qatar has been roundly criticized for the living and working conditions of the low-wage migrant workers responsible for building the country’s social and economic infrastructure. These critiques, however, either emphasize individual migrant experiences of mistreatment or the kafala migration regime that regulates migration and employment. Few quantitative and representative studies ask migrants how they understand and experience their rights and wellbeing, or how these views have changed as the country has embarked on key labor law reforms in response to international pressure. Therefore, we present results from a large-scale, nationally representative survey of low-wage migrant workers conducted in labor accommodations over four years, supplemented by a separate phone survey. The analysis emphasizes the views of migrants—including satisfaction with rights, awareness of rights, fulfillment of contracts, and quality of life—which are critical to successful policy implementation. We examine the objective factors that best explain these views and study the interaction between subjective and objective wellbeing dimensions. The results inform scholarly understandings of the living and working conditions of migrants and provide essential context for questions surrounding migrant rights and global justice in temporary labor migration regimes.
Gender differences in two-dimensional and three-dimensional speckle tracking echocardiography left ventricular measurements among healthy preschool pediatric population
Authors: Elsayegh Ayah Tarek , Nazmi Hany , Attia Hebatallah Mohamed , Kamel Heba
Published: July 2023

Background

Speckle-tracking echocardiography (STE) is an upcoming echocardiographic modality to measure global as well as segmental left ventricular systolic function expressed numerically as strain values independent of angle and ventricular geometry. We conducted this prospective study on 200 healthy preschool children with structurally normal hearts, to determine gender-based differences in two-dimensional (2D) global longitudinal strain (GLS) and three-dimensional (3D) GLS.

Results

Age-matched 104 males and 96 females were included, 2D GLS results for the males showed longitudinal strain ranging from − 18.1 to − 29.8 with a mean of − 21.7202 ± 5.094322, while for females 2D GLS ranged from − 18.1 to − 30.7 with a mean of − 22.0646 ± 2.167802, also 3D GLS values were measured and compared based on gender, where 3D GLS in males ranged from − 18 to − 24 with a mean value of 20.49 ± 1.28, while for females ranged from − 17 to − 30 with a mean value of 20.47 ± 1.755. The gender-based difference for both 2D GLS and 3D GLS showed non-significant P values.

Conclusion

In healthy subjects below 6 years, 2D STE and 3D STE values showed no difference between males and females, unlike the adult population, to the best of our knowledge, this is one of the few studies in the literature that aims at comparing these measurements in the healthy pediatric group. In routine clinical practice, these values may be used to assess myocardial function or the early signs of malfunction.
Absolute eosinophil count is a reliable prognostic marker in patients with liver cirrhosis: a cross-sectional study at rural central India
Authors: Kumar Sunil , Shah Param , Acharya Sourya , Wanjari Anil , Bawankule Shilpa , Agrawal Sachin , Bagga Charan , Talwar Dhruv , Patel Mansi
Published: July 2023

Background

Various laboratory parameters like C-reactive protein (CRP), Cortisol, and Von Willebrand factor antigen have been evaluated independently in foreseeing outcomes of cirrhotic patients. As these parameters lack cost-effectiveness in a rural setup, there is a need for a cost effective and feasible prognostic marker for cirrhotic patients. The present study was aimed at evaluating the role of Absolute Eosinophil Count (AEC) as a prognostic marker in cirrhotic patients.

Methods

This cross-sectional study was conducted at a rural tertiary care teaching hospital in central India from August 2019 to September 2021. AEC was measured from counter report as a part of automated complete blood counts. Child-Turcotte-Pugh (CTP) score and Model for end stage liver disease (MELD) score were calculated at the time of admission. AEC levels on admission were correlated with mortality and with CTP score and MELD score.

Results

A total of 110 patients were enrolled with mean age of 46.37 ± 11.6 years. AEC was the significant predictor of mortality at cut off point of ≤ 120 with 80.30% (AUC 0.803; 95% CI: 0.716 to 0.873). AEC was the significant predictor of CTP score ≥ 11 at cut off point of ≤ 148 (AUC 0.726; 95% CI: 0.633 to 0.807). AEC was the significant predictor of MELD score ≥ 25 at cut off point of ≤ 136 (AUC 0.74; 95% CI: 0.647 to 0.819). Significant negative correlation was seen between AEC with Child–Pugh score and MELD score with correlation coefficient of -0.257 and -0.258.

Conclusion

Low level of AEC on admission fairly predicted raised CTP score and MELD score on admission. Low AEC levels predicted increased mortality in cirrhotic patients making it a cheap and reliable prognostic marker in a rural setup.
Hepatoprotective effects of N-acetylcysteine on liver injury by irisin upregulation and oxidative stress reduction in diabetic rats
Authors: Erdogan Mehmet Mustafa , Erdogan Mehmet Ali , Koc Suleyman , Yalcin Alper , Turk Ahmet , Yetkin Esra Akkus
Published: July 2023

Background

The current study aimed to investigate the oxidative stress in rat liver with diabetes mellitus (DM) as well as the protective effects of N-acetylcysteine (NAC) on irisin expression.

Methods

Twenty-eight male Wistar rats were divided into four groups, 7 rats in each group, and 30-day regimens of experimental or control groups. NAC-treated group is as follows: 100 mg/kg once daily was administered intraperitoneally (i.p.). Diabetes-induced group is as follows: single-dose intraperitoneal injection of streptozotocin (STZ) (50 mg/kg) was used to induce DM in overnight fasting Wistar rats. By determining blood glucose concentration in STZ-induced rats 72 h after injection of STZ, DM was assessed. DM + NAC group is as follows: STZ-induced DM plus NAC is described previously. On the 30th day of the experiment, liver samples were collected after fasting and anesthesia. Biochemical analyses were performed to measure total antioxidant status (TAS), total oxidant status (TOS), and malondialdehyde (MDA) levels. Each liver sample was weighed and then prepared for histopathologic evaluation by light microscopy.

Results

There was a statistically significant decrease in TAS levels and an increase in TOS and MDA levels in the DM group compared to the control group. In contrast, TOS and MDA levels were found significantly decreased, and TAS levels increased in the serum and liver tissues of the DM + NAC group compared to the DM group. Liver samples were also used for histopathological examination using hematoxylin-eosin and immunohistochemical staining. STZ-induced liver damage was detected as oxidative stress, increased irisin immunoreactivity, sinusoidal dilatation, and hepatocyte degeneration. In the DM + NAC group, it was observed that NAC significantly reduced the aforementioned histopathological changes due to STZ.

Conclusion

In the early period of diabetes, due to the antioxidant properties of irisin related to the sudden response of liver tissue to oxidative stress, it is thought that the immunoreactivity in the tissue increases in the early period. As a result, NAC in diabetic rat liver tissue was found to suppress oxidative damage and irisin immunoreactivity.
Pancreatic schwannoma: a rare differential diagnosis for a pancreatic mass
Authors: AlNuaimi Dana , Abdulghaffar Shareefa , Iuppa Giuseppe , AlDuaij Ahmad , Badrawi Noor , Balci Numan Cem
Published: July 2023

Pancreatic schwannomas are rare benign tumors with low malignant potential and are often difficult to diagnose due to their non-specific presenting symptoms and overlapping radiological imaging characteristics. Cross-sectional imaging plays an important role in the initial diagnosis and in delineating the extent of the lesion. However, biopsy and histopathological examination remains the gold-standard for a definite diagnosis. The management of pancreatic schwannomas includes surgical resection often yielding excellent clinical outcomes with low recurrence rates. We present a case of a 33-year-old female patient with a history of a recurrent vague upper abdominal pain where CT of the upper abdomen showed a hypodense pancreatic mass. Robotic subtotal pancreatectomy was done with histopathology showing spindled Schwann cells indicative of a pancreatic schwannoma.
Does cone-beam CT convex triangular field of view influence the image shape distortion of high-density materials?
Authors: Cascante-Sequeira Deivi , Coelho-Silva Fernanda , Lopes Rosado Lucas P , Lucca Luiza Valdemarca , Queiroz Freitas Deborah , Lins de-Azevedo-Vaz Sergio , Haiter-Neto Francisco
Published: July 2023

Objectives:

To assess the distortion of high-density materials using two CBCT devices presenting convex triangular and cylindrical fields of view (FOVs).

Methods and materials:

Four high-density cylinders were individually placed in a polymethylmethacrylate phantom. 192 CBCT scans were acquired using the convex triangular and cylindrical FOVs of Veraviewepocs® R100 (R100) and Veraview® X800 (X800) devices. Using HorosTM’s software, two oral radiologists determined the cylinders’ horizontal and vertical dimensional alterations. Nine oral radiologists subjectively identified each cylinder’s axial shape distortion. Statistical analysis comprised Multiway ANOVA (α = 5%), and the Kruskal–Wallis test.

Results:

The distortion in the axial plane was greater in the convex triangular FOVs for both devices in almost all the materials (p < 0.05). The evaluators subjectively identified a shape distortion in both FOVs for R100 device (p < 0.001), while no distortion was identified for X800 device (p = 0.620). A vertical magnification of all materials was observed in both FOVs for both devices (p < 0.05). No differences among vertical regions (p = 0.988) nor FOVs (p = 0.544) were found for the R100 device, while all materials showed higher magnification in all regions in the cylindrical FOV (p < 0.001) of the X800 device.

Conclusions:

The convex triangular FOV influenced the axial distortion of the high-density materials in both devices. A vertical magnification was observed in both FOVs of both devices, but it was greater in the cylindrical FOV of the X800 device.
Synthetic MRI for the quantitative and morphologic assessment of head and neck tumors: a preliminary study
Authors: Zhang Zanxia , Li Shujian , Wang Weijian , Zhang Yong , Wang Kaiyu , Cheng Jingliang , Wen Baohong
Published: July 2023

Objectives:

To evaluate the feasibility of synthetic MRI for quantitative and morphologic assessment of head and neck tumors and compare the results with the conventional MRI approach.

Methods and materials:

A total of 92 patients with different head and neck tumor histology who underwent conventional and synthetic MRI were retrospectively recruited. The quantitative T1, T2, proton density (PD), and apparent diffusion coefficient (ADC) values of 38 benign and 54 malignant tumors were measured and compared. Diagnostic efficacy for differentiating malignant and benign tumors was evaluated with receiver operating characteristic (ROC) analysis and integrated discrimination index. The image quality of conventional and synthetic T1W/T2W images on a 5-level Likert scale was also compared with Wilcoxon signed rank test.

Results:

T1, T2 and ADC values of malignant head and neck tumors were smaller than those of benign tumors (all p < 0.05). T2 and ADC values showed better diagnostic efficacy than T1 for distinguishing malignant tumors from benign tumors (both p < 0.05). Adding the T2 value to ADC increased the area under the curve from 0.839 to 0.886, with an integrated discrimination index of 4.28% (p < 0.05). In terms of overall image quality, synthetic T2W images were comparable to conventional T2W images, while synthetic T1W images were inferior to conventional T1W images.

Conclusions:

Synthetic MRI can facilitate the characterization of head and neck tumors by providing quantitative relaxation parameters and synthetic T2W images. T2 values added to ADC values may further improve the differentiation of tumors.
Correlation between levels for stress with level of empathy in undergraduate medical students
Authors: Rafi Shumaila , Prof. Marie Andrades  , Rahat Naz  , Asad Jiskani
Published: July 2023

Objective: To determine the correlation between levels of stress with level of empathy in all five years of undergraduate medical students of a private medical college in Pakistan.

Methods: This descriptive correlation study was conducted at Al Tibri Medical College, Karachi from 15th June to 14th November 2021. Of the 500 students in the medical school, 408 participants filled out the questionnaires through online Google Forms. The student’s version of the Jefferson Scale of Empathy (JSE-S) estimated the self-reported student’s empathy levels. At the same time, Perceived Stress Scale (PSS) was utilized to assess the student’s levels of stress. Data was analyzed using SPSS version 22.0 and correlation between empathy and perceived stress was calculated by Pearson’s coefficient. A p-value <.05 was considered statistically significant.

Results: Out of 408 participants, there were 217(53.2%) males, and 191(46.8%) females. The overall mean JSE-S score was 94.60±11.85, and the mean PSS score was 20.20 ±5.70. Empathy scores improved over the basic sciences years and then significantly decreased in the clinical years of medical college with a significant p-value of .019. The highest stress was present in third year medical students with a p-value of <.001. No statistically significant difference was present between empathy and stress levels (r = 0.04, p = .40).

Conclusions: The study showed no statistically significant correlation between empathy and stress. Future research is needed to investigate other main factors for the decline in empathy among medical students.

doi: https://doi.org/10.12669/pjms.39.5.7211

How to cite this: Rafi S, Andrades M, Naz R, Jiskani A. Correlation between levels for stress with level of empathy in undergraduate medical students. Pak J Med Sci. 2023;39(5):---------. doi: https://doi.org/10.12669/pjms.39.5.7211

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Clinical Efficacy of Bolus of Six Drugs Including Rehmannia as an Adjunct to Metformin in the Treatment of Senile Type-2 Diabetes Mellitus and its Influence on Insulin Resistance, Inflammatory Factors and Blood Glucose-related Indicators
Authors: Li Ning , Yao Yanru , An Erhui
Published: July 2023

Objective: To investigate the clinical efficacy of Bolus of Six Drugs Including Rehmannia (Liuwei Dihuang pill) as an adjunct to metformin in the treatment of senile Type-2 diabetes mellitus and its influence on insulin resistance, inflammatory factors and blood glucose-related indexes.

Methods: This is a Retrospective study. Eighty senile Type-2 diabetes mellitus admitted to Baoding Hospital of Traditional Chinese Medicine from January 2019 to December 2021 were enrolled and divided into two groups using the random number method. Patients in the control group were given oral metformin, while those in the observation group were treated with Bolus of six Drugs Including Rehmannia as an adjunct to metformin. The clinical efficacy, blood glucose-related indicators, insulin-related indicators, inflammatory factors-related indicators and adverse drug reactions were compared between the two groups.

Results: The overall response in the observation group was higher than that in the control group(P<0.05). After treatment, the levels of FPG, 2hPG and HbA1 being more significantly lower in the observation group than that in the control group(P<0.05). Moreover, the levels of FINS, HOMA-IR and HOMA-IS were all significantly improved in the observation group than that the control group (P<0.05). HOMA-β levels in the observation group were significantly higher than those in the control group (P<0.05). The levels of TNF-α, IL-6 and IL-8 in the observation group were significantly lower than those in the control group (P<0.05).

Conclusion: Bolus of six Drugs Including Rehmannia as an adjunct to metformin is a regimen with satisfactory safety profile for the treatment of senile Type-2 diabetes mellitus.

doi: https://doi.org/10.12669/pjms.39.5.7262

How to cite this: Li N, Yao Y, An E. Clinical Efficacy of Bolus of Six Drugs Including Rehmannia as an Adjunct to Metformin in the Treatment of Senile Type-2 Diabetes Mellitus and its Influence on Insulin Resistance, Inflammatory Factors and Blood Glucose-related Indicators. Pak J Med Sci. 2023;39(5):---------. doi: https://doi.org/10.12669/pjms.39.5.7262

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
A comparative study of early functional outcomes in undisplaced neck of femur fracture treated with partially threaded and fully threaded cannulated screw fixation in patients above 60 years age
Authors: Awais Muhammad Zarak , Salik Eman , Bokhari Syed Hassan Raza , Iqbal Muhammad Tahir
Published: July 2023

Objective: To compare the partially threaded versus fully threaded cannulated screw fixation methods in stable neck of femur fracture in terms of early functional outcomes in patients of age 60 and above.

Methods: A randomized controlled trial was conducted at Orthopedic Unit-II, Mayo Hospital Lahore, Pakistan from July 2021 to July 2022. A total of 82 (41 in each group) patients of both genders, aged 60 or above were included. All patients had garden Type-I or II and were mobile before they fractured the femoral neck were included. In Group-A, cannulated screw fixation (cancellous screws 6 mm) was done using partially threaded screws while fully threaded screws (cancellous screws 6 mm) were used in Group-B. Patients were followed up at six weeks, three months and six months interval for “Radiographic Union Scale for Hip (RUSH)” and “Harris Hip score”.

Results: In a total of 82 (41 in each group) patients, 66 (80.5%) we male. At 6th week (p=0540) and 3rd month (p=0.653) postoperatively, no significant differences were seen between groups for Hip Harris score. However, at 6th month, functional outcome of Group-B patients was significantly better as compared to Group-A (p=0.038). Mean RUSH score in Group-A and in Group-B at 6th month postoperative was 25.45±2.73 and 30.52±2.39 (p<0.001).

Conclusion: Fully threaded cannulated screw fixation is better in treating undisplaced neck of femur fracture as compared to partially threaded cannulated screw fixation in terms of early functional outcomes among the age group of 60 years and above.

RCT Registration number: NCT05587660.

doi: https://doi.org/10.12669/pjms.39.5.7330

How to cite this: Awais MZ, Salik E, Bokhari SHR, Iqbal MT. A comparative study of early functional outcomes in undisplaced neck of femur fracture treated with partially threaded and fully threaded cannulated screw fixation in patients above 60 years age. Pak J Med Sci. 2023;39(5):---------.  doi: https://doi.org/10.12669/pjms.39.5.7330

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
A primer for choosing, designing and evaluating registered reports for qualitative methods
Authors: Karhulahti Veli-Matti , Branney Peter , Siutila Miia , Syed Moin
Published: July 2023

Registered reports are a publication format that involves peer reviewing studies both before and after carrying out research procedures. Although registered reports were originally developed to combat challenges in quantitative and confirmatory study designs, today registered reports are also available for qualitative and exploratory work. This article provides a brief primer that aims to help researchers in choosing, designing, and evaluating registered reports, which are driven by qualitative methods.
Childhood life events of women enrolled in the Avon Longitudinal Study of Parents & Children (ALSPAC)
Authors: Gregory Steven , Iles-Caven Yasmin , Northstone Kate , Golding Jean
Published: July 2023

At the time of planning ALSPAC there was accumulating evidence that abuse and other childhood traumas were related to psychiatric problems later in life. In addition, the age at which such trauma occurred was likely to be important in influencing its long-term impact. Detailed data was therefore collected from enrolled women on traumatic events occurring during their own childhoods, along with their age at the time.

The questionnaire entitled ‘About Yourself’ was sent out to expectant women who had enrolled in the study, which included a page in the form of a grid (an events diary) with one row per year of childhood and columns for recording where she was living at the time, who was looking after her, and any traumatic events that occurred. These free-text responses were then coded, and any events were assigned a score indicating the level of trauma the event was likely to have caused on a scale of 1 (highly traumatic) to 6 (least traumatic).  This paper describes the variety of text data collected and how it was coded.

The ALSPAC study has a great deal of follow-up data collected on the original respondents, as well as on their parents and grandparents, partners, offspring and their grandchildren, providing huge potential for analyses on the antecedents and outcomes of adverse childhood events across multiple generations.
Recognizing Series-Parallel Matrices in Linear Time
Authors: Walter Matthias
Published: July 2023

A series-parallel matrix is a binary matrix that can be obtained from an empty matrix by successively adjoining rows or columns that are copies of an existing row/column or have at most one one-entry. Equivalently, series-parallel matrices are representation matrices of graphic matroids of series-parallel graphs, which can be recognized in linear time. We propose an algorithm that, for an m-by-n matrix A with k nonzeros, determines in expected time whether A is series-parallel or returns a minimal non–series-parallel submatrix of A. We complement the developed algorithm by an efficient [Formula: see text]implementation and report about computational results.

History: Accepted by Andrea Lodi, Area Editor for Design & Analysis of Algorithms–Discrete.

Funding: This work was supported by Nederlandse Organisatie voor Wetenschappelijk Onderzoek [Grant OCENW.M20.151].

Supplemental Material: The software that supports the findings of this study is available at the GitHub software repository ( https://github.com/discopt/cmr-series-parallel ).
Unearthing New Sensors
Authors: Knight Helen
Published: July 2023

Better detection for underground objects
Safer Autonomous Driving
Authors: Tyler Neil
Published: July 2023

ARM HAS UNVEILED WHAT IT SAYS IS THE FIRST AUTONOMOUS-CLASS PROCESSOR WITH INTEGRATED SAFETY.
Xilinx Unveils Versal
Authors: Tyler Neil
Published: July 2023

THE FIRST IN A NEW CATEGORY OF PLATFORMS DELIVERING RAPID INNOVATION AND SCALABLE AI INFERENCE.
5G Problems
Authors: Grylls Bethan
Published: July 2023

SECURITY GAPS IN THE 5G MOBILE COMMUNICATION STANDARD UNCOVERED.
Testing Times
Authors: Tyler Neil
Published: July 2023

WITH THE ADVENT OF AUTONOMOUS VEHICLES THE TESTING ENVIRONMENT IS HAVING TO CHANGE.