bluuebunny/crossref_metadata_2025 huggingface dataset:
The 2024 revision of the Declaration of Helsinki: a modern ethical framework for medical research
Authors: Wen Boyuan , Zhang Guochao , Zhan Chang , Chen Chen , Yi Hang
Published: December 2024

The Declaration of Helsinki, established in 1964, remains a foundational document in medical research ethics. This review examines the 2024 revision, endorsed by the 75th World Medical Association (WMA) Assembly, highlighting its impact on modern clinical research. Major updates include the shift from “subjects” to “participants,” promoting autonomy and active involvement, and the introduction of dual ethical review requirements for cross-border studies to strengthen accountability. New guidelines for data privacy address AI–related ethical concerns, while enhanced community engagement fosters transparency and shared decision-making. Additionally, standards for environmental sustainability encourage research practices that minimize ecological impacts. In response to global health crises such as COVID-19, the revised Declaration sets forth ethical protections to balance participant safety with research urgency during emergencies. Despite these advances, areas for improvement remain, especially in AI ethics, emergency research protocols, and the extension the Declaration's scope to include forensic and specimen research. The 2024 revision thus strengthens the Declaration's role as an adaptive, relevant framework for safeguarding participant rights and research integrity in a changing landscape.
Who's That Knocking? A Study of the Strategic Choices Facing Large-Scale Grassroots Canvassing Efforts
Authors: Ferguson Grant L , Gimpel James G , Owens Mark E , Shaw Daron R
Published: December 2024

Although recent political science research has established that face-to-face contacting mobilizes eligible citizens to vote, the emphasis on field experiments to facilitate causal inference has occasionally come at the expense of a deeper knowledge of how campaigns develop and implement canvassing and get-out-the-vote (GOTV) programs. We rely on a case study from a major statewide campaign in Texas to identify and explore the strategic considerations leading to the deployment of a large-scale paid field operation. Among the campaign management challenges in carrying out a statewide canvassing effort, we address the recruitment, retention, and supervision of canvassers; the choice of target neighborhoods and voters; the variable response of voters at the doorstep; setting and reaching performance goals; the timing of contacts; detailed recordkeeping; and the turnout results. In detailing this effort, we draw upon insights from interviews with staffers, field observations, and the campaign's detailed data on response at the doorstep for a target list of 2.5 million voters. In the end, we find that strategic decisions are myriad and complex, and that they almost certainly condition the impact of canvassing and GOTV operations.
Fractures in the academic publishing business model: a stakeholder perspective
Authors: Fassin Yves , Teixeira da Silva Jaime A
Published: December 2024

The recent listing of Springer-Nature on the Frankfurt stock exchange triggers the debate for more fairness and equity in the academic publishing business model.
Wind tunnel experimental investigation on the performance of the ice-melting system for high-speed train bogies
Authors: Zhao Changlong , Wang Tiantian , Zhou Guo , Wang Yu , Feng Yonghua , Jiang Chen , Song Zhiyang , Li Hengkui
Published: December 2024

In strong wind-snow environments, the icing phenomenon in the bogie region can adversely affect the operational safety of high-speed trains. This study aims to design an ice-melting system that applies to high-speed train bogies and to investigate its de-icing performance. The icing experiments with a scaled real bogie were first conducted in the Icing and Snowing Wind Tunnel at Central South University to obtain the icing distribution and thickness characteristics in the bogie region. Based on the results of icing experiments, a heating ice-melting system was designed, and the flat plate ice-melting experiments with different ice thicknesses were further carried out. The influence of ice-melting power, ice thickness, and the angle between the ice layer and the incoming flow on ice-melting characteristics were comprehensively analyzed. Findings indicated that ice-melting power and ice thickness were negatively and positively correlated with ice-melting time, respectively. As the angle between the ice layer and the incoming flow increases, the ice-melting time increases first and then decreases. Additionally, considering ice-melting energy consumption, lower ice-melting power results in reduced energy consumption for the same ice thickness and inclination angle. The ice-melting characteristics obtained in this study can provide valuable information and insights for the design of bogie ice-melting schemes and ice-melting energy saving for high-speed trains operating in cold regions.
Hidden species’ diversity and phylogenetic relationships within the terrestrial isopod genus Tiroloscia (Crustacea: Isopoda: Oniscidea)
Authors: Gardini Pietro , Sabatelli Simone , Taiti Stefano , Audisio Paolo
Published: December 2024

Defining species boundaries may result challenging and has been a widely debated issue in the last decades. In cases of cryptic or “pseudocryptic” species, molecular approaches can be a valuable tool to provide taxonomic hypotheses and significantly complement morphological taxonomy. Here, two mitochondrial and one nuclear markers were used to study the phylogenetic relationships within the genus Tiroloscia, paying particular attention to Tiroloscia exigua. Moreover, we used a molecular clock to define a time window for the diversification of the main lineages within the species and explore aspects of its evolutionary history. Finally, four species delimitation methods were applied to clarify taxonomy and validate species boundaries. We found strong evidence against the monophyly of Tiroloscia and a surprisingly high level of genetic diversity within Tiroloscia exigua, supported by morphology. Notably, five evolutionary lineages were identified within T. exigua, suggesting the presence of distinct taxonomic entities. Divergence time estimation places the onset of T. exigua diversification around the middle Miocene (~12.2 Mya). Based on phylogenetic and morphological results, we propose the resurrection of Tiroloscia squamuligera as a valid species. Our results underscore the importance of molecular approaches to uncover hidden diversity, particularly in terrestrial isopods which may hide still underestimated biodiversity.
The role of extracorporeal membrane oxygenation in thoracic anesthesia
Authors: Tschernko Edda , Geilen Johannes , Wasserscheid Thomas
Published: December 2024

Purpose of review

Circulatory and respiratory support with extracorporeal membrane oxygenation (ECMO) has gained widespread acceptance during high-end thoracic surgery. The purpose of this review is to summarize the recent knowledge and give an outlook for future developments.

Recent findings

A personalized approach of ECMO use is state of the art for monitoring during surgery. Personalization is increasingly applied during anesthesia for high-end surgery nowadays. This is reflected in the point of care testing (POCT) for anticoagulation and cardiac function during surgery on ECMO combining specific patient data into tailored algorithms. For optimizing protective ventilation MP (mechanical power) is a promising parameter for the future. These personalized methods incorporating numerous patient data are promising for the improvement of morbidity and mortality in high-end thoracic surgery. However, clinical data supporting improvement are not available to date but can be awaited in the future.

Clinical practice during surgery on ECMO is increasingly personalized. The effect of personalization on morbidity and mortality must be examined in the future. Undoubtedly, an increase in knowledge can be expected from this trend towards personalization.
Preventing, identifying and managing myocardial injury after non cardiac surgery – a narrative review
Authors: Wittmann Maria , Dinc Tugce , Kunsorg Andrea , Marcucci Maura , Ruetzler Kurt
Published: December 2024

Purpose of review

There is mounting and convincing evidence that patients with postoperative troponin elevation, with or without any clinical symptoms, are at higher risk for both, short- and long-term morbidity and mortality. Myocardial injury after noncardiac surgery (MINS) is a relatively newly described syndrome, and the pathogenesis is not fully understood yet. MINS is now an established syndrome and multiple guidelines address potential etiologies, triggers, as well as preventive and management strategies.

Recent findings

Surveillance in high-risk patients is required, as most MINS would otherwise be missed. There is no reliable and established preventive strategy, but several potentially avoidable triggers like hypotension, pain and anemia have been identified. Managing patients with MINS postoperatively includes minimizing triggers (such as hemodynamic abnormalities and anemia) that can continue the damage. Long-term pharmacologic strategies include beta-blockers, statins, antiplatelet agents, and anticoagulation.

MINS affects up to 20% of surgical patients, remains clinically mostly silent, but is associated with elevated morbidity and mortality. A multidisciplinary approach, that includes involvement of anesthesiologists, for the prevention, diagnosis, and treatment of MINS is recommended.
Establishment of a Rabbit Model of Rib Tethering-induced Early-onset Scoliosis
Authors: Wang Yonggang , Wang Dongmin , Zhang Guangzhi , He Xuegang , Wang Kun , Ma Bing , Yang Yong , Kang Xuewen
Published: December 2024

Study Design.

Experimental study.

Objective.

To create an early-onset scoliosis (EOS) rabbit model and use a design-based stereological method to quantitatively assess lung structure changes at 24 weeks of age.

Summary of Background Data.

Scoliosis affects thoracic and lung development, impacting children’s chest and lung growth.

Materials and Methods.

EOS was induced via rib tethering in 4-week-old rabbits with ongoing CT scans and weight measures. Lungs were extracted postfixation for volume estimation and tissue sampling, followed by microscopic analysis of lung morphology.

Results.

The mean Cobb angle increased with the rabbits’ growth. The EOS group showed significant decreases in total and right lung volumes. Quantitative lung stereology revealed reduced volumes of lung parenchyma and nonparenchymal tissue in all lobes. Alveolar duct volumes decreased significantly in multiple lobes, and alveolar septal volume was notably reduced in the right upper, middle, and lower lobes. The alveolar septal area decreased, and septal thickness increased in the EOS group. Alveoli numbers dropped, with variable changes in mean alveolar volume across lobes. Vascular lumen volume decreased in the right middle and lower lobes, and blood vessel and perivascular tissue volumes were significantly reduced in the right lung. Vessel diameter changes varied across lobes, with significant decreases in the right middle and lower lobes and increases in the left upper and lower lobes. Vascular endothelial surface area decreased in the left lower, right middle, and right lower lobes, with increased vessel and perivascular tissue thickness in the left upper and lower lobes compared with the right lobes.

Conclusion.

The EOS rabbit model demonstrated reduced lung volume, impaired alveolarization, septal thickening, and vascular changes, indicating scoliosis’s negative impact on thoracic and lung development, especially on the concave lung.
mRNA vaccines as cancer therapies
Authors: Huang Shaoxiong , Que Haiying , Wang Manni , Wei Xiawei
Published: December 2024

Cancer remains a major global health challenge, with conventional treatments like chemotherapy and radiotherapy often hindered by significant side effects, lack of specificity, and limited efficacy in advanced cases. Among emerging therapeutic strategies, mRNA vaccines have shown remarkable potential due to their adaptability, rapid production, and capability for personalized cancer treatment. This review provides an in-depth analysis of messenger RNA (mRNA) vaccines as a therapeutic approach for cancer immunotherapy, focusing on their molecular biology, classification, mechanisms, and clinical studies. Derived from reported literature and data on clinicaltrials.gov, it examines studies on mRNA vaccines encoding tumor-specific antigens (TSAs), tumor-associated antigens (TAAs), immunomodulators, and chimeric antigen receptors (CARs) across various cancer types. The review highlights the ability of mRNA vaccines to encode TSAs and TAAs, enabling personalized cancer treatments, and classifies these vaccines into non-replicating and self-amplifying types. It further explores their mechanisms of action, including antigen presentation and immune activation, while emphasizing findings from clinical studies that demonstrate the potential of mRNA vaccines in cancer therapy. Despite their promise, challenges remain in enhancing delivery systems, improving immunogenicity, and addressing tumor heterogeneity. Overcoming these obstacles will require further investigation to fully harness the potential of mRNA vaccines in personalized cancer treatment.
The Recent Rise in Homicide: An Analysis of Weekly Mortality Data, United States, 2018–2022
Authors: Degli Esposti Michelle , Schell Terry L. , Smart Rosanna
Published: December 2024

Background:

From 2019 to 2020, homicide showed its largest single-year increase in modern US history. While many have cited the COVID-19 pandemic or the police killing of George Floyd as initiating the rise, there has been limited systematic investigation of how the timing of the increase corresponded with these key events. We investigated trends in firearm and nonfirearm homicide across sociodemographic and geographic groups to clarify the timing and nature of the recent increase.

Methods:

We conducted a descriptive epidemiologic study using the National Vital Statistics System weekly mortality data from January 2018 to December 2022 in the United States. We seasonally adjusted and smoothed weekly firearm and nonfirearm homicide data, quantifying changes in relation to key event dates for the COVID-19 pandemic, the killing of George Floyd, and the 2020 national election. We disaggregated trends by sociodemographic and geographic characteristics.

Results:

Between January 2018 and December 2022, firearm homicide increased by 54% while nonfirearm homicide was stable. The increase in firearm homicide started in October 2019 and stabilized by November 2020; 28% of the eventual increase had already occurred by the time COVID-19 was declared a national emergency. All sociodemographic and geographic groups experienced large recent increases in firearm homicide.

Conclusions:

The magnitude and timing of the recent increase in homicide have been previously understated and obscured by crude data and seasonal patterns. Existing theories, including the COVID-19 pandemic, fall short in explaining the historic surge, which is specific to firearm homicide, started in late 2019, and affected all persons and places across the United States.
Preliminary Determination of the Therapeutic Reference Range of Lurasidone in Chinese Patients and Analysis of the Factors Influencing Lurasidone Dose-Corrected Concentrations
Authors: Yang Ye , Wang Zhanzhang , Xiao Tao , Ni Xiaojia , Song Emei , Dai Lijing , Chen Yuqing , Lu Haoyang , Shang Dewei , Wen Yuguan
Published: December 2024

Background:

The aim of this study was to determine the therapeutic reference range of lurasidone, and to analyze the factors influencing the dose-corrected concentration of lurasidone in Chinese psychiatric patients, thereby providing a basis for the development of individualized dosing of lurasidone.

Methods:

A retrospective analysis was conducted for hospitalized patients who had received lurasidone and undergone blood concentration monitoring from May 2022 to September 2023 at the Affiliated Brain Hospital of Guangzhou Medical University. Analyses were based on patient demographic data, treatment regimens, and administered drug concentrations.

Results:

Data for a total of 123 lurasidone steady-state trough concentrations were collected from 120 hospitalized patients. It was found that 85.56% of lurasidone steady-state trough concentrations were below the lower limit of the lurasidone therapeutic reference range (15 ng·mL−
1), and that the median steady-state trough concentration was 7.09 ng·mL−1 (IQ1–IQ3 = 4.12–11.82 ng·mL−1). Gender, age, and co-medication with valproic acid were found to be significant factors influencing lurasidone steady-state trough concentration/daily dose (C/D) values. C/D values for females were 14% higher than those obtained for males. Among patients who did not receive concomitant administration of valproic acid, the C/D values were 55% higher than those who had received co-administered valproic acid. Furthermore, C/D values obtained for elderly patients (≥60 years) were 140% higher than those recorded for adolescents (<18 years) and 157% higher than those in younger adults (18–60 years).

Conclusions:

The findings of this study indicated that the guideline-recommended therapeutic reference range (15–40 ng·mL−1) for lurasidone may not be appropriate, at least for the Chinese population. More extensive therapeutic drug monitoring is recommended for elderly female patients and those receiving co-medication with lurasidone and valproic acid.
Personalizing Quality Improvement: Addressing Anticoagulation Gaps in Atrial Fibrillation
Authors: Owen Gary D. , Terry Christopher J. , Neal Erin B. , Nelson Scott D. , Omar Mohamed , Pettapiece-Phillips Mariah J. , Kripalani Sunil
Published: December 2024

Introduction:

Risk of stroke is greater in patients with atrial fibrillation. Anticoagulation is effective at decreasing risk, yet 40–50% of eligible patients are not prescribed anticoagulation and seem to have a concerning gap in care quality. This quality improvement initiative implemented a pharmacist-led approach to identify, verify, and close apparent anticoagulation treatment gaps.

Methods:

We included adult primary care patients with diagnosis of atrial fibrillation; congestive heart failure, hypertension, age ≥75 years (doubled), diabetes, stroke/transient ischemic attack (doubled), vascular disease, age 65–74 years, and sex (female) (CHA2DS2-VASc) score of at least 2, and no current anticoagulant use. We identified patients using claims and electronic health record data and evaluated explanations through chart review and provider contact. A provider outreach protocol was developed and implemented to address opportunities for anticoagulation.

Results:

Of 242 patients with an apparent gap, 84% had a verified treatment gap. However, 86% of verified treatment gaps were explained through pharmacist chart review and outreach to providers, and they did not require further action. Explanations included spontaneous resolution of atrial fibrillation, patient declining treatment, completion of a procedure to correct atrial fibrillation or mitigate stroke risk, and high bleeding risk.

Conclusions:

Relying solely on claims- and electronic health record-based algorithms may substantially overestimate gaps in care quality.
Cholesterol metabolism and tumor radiotherapy
Authors: Kuang Hao , Lyu Jia-Hua , Li Tao
Published: December 2024

Cholesterol is a lipid that is an essential component of the membrane structure in mammals. Cholesterol homeostasis regulates vital activities of individual cells and governs the overall function of the mammalian body. Cholesterol is mainly obtained through the biosynthesis of endogenous cholesterol and the intake of exogenous cholesterol. Cholesterol metabolism in tumor cells is abnormally active, and cholesterol and its metabolites (precursors and derivatives) play important roles in cancer proliferation, survival, invasion, metastasis, and the resistance to radiation. Preclinical studies have indicated that blocking cholesterol synthesis and uptake can reduce tumor progression and improve the response to anticancer treatment. Therapeutic strategies that target cholesterol synthesis, reduce plasma cholesterol levels, and prevent cholesterol esterification represent promising ways to improve the clinical outcome of cancer patients.
Cancer nutrition research in China from 2013 to 2022: A bibliometric and visualization analysis
Authors: Zhang Chu-Ying , Zhang Ge-Ge , Wu Tian-Tian , Fida Saba , Zhou Ming-Ming , Song Chun-Hua
Published: December 2024

Background

Although cancer is a global concern, China has the highest incidence and mortality rates for malignant tumors. The main goals of the present study were to gain a deeper understanding of the current limitations and focal points in the field of cancer nutrition research, to identify potential areas for further investigation, and to provide a valuable reference for Chinese researchers who are interested in studying “cancer nutrition.”

Methods

The Web of Science Core Collection was searched for literature published from 2013 to 2022. The R Language 4.3.1, VOSviewer 1.6.19, and CiteSpace 6.2.2 software programs were adopted to conduct the analysis.

Results

Based on the specified inclusion and exclusion criteria, a total of 3,994 documents were gathered. The annual issuance of articles exhibited a fluctuating increase. These documents were authored by 19,577 individuals affiliated with 2,961 institutions and were published in 1,008 journals. The most productive authors in this field were Han-Ping Shi, Qi Zhang, and Wei Li. The most productive institutions were Sun Yat-sen University and Sichuan University. A total of 1,008 journals contributed to this field, and the journals with the most relevant publications were Frontiers in Nutrition and Frontiers in Oncology. The most frequently occurring author keywords were prognosis, gastric cancer, sarcopenia, cancer, and meta-analysis. Oncology was the hottest research area.

Conclusions

Cancer nutrition research is a crucial area of study that has significant implications for human health as well as social and economic progress. This study provides a comprehensive overview of the current status and emerging trends in cancer nutrition research in China based on studies published from 2013 to 2022. The research findings presented in this study lay the foundation for further development in this research field. In addition to the traditional research on cancer nutrition, the development of interdisciplinary research should be promoted.
The Role of Social Network on Social Isolation and Anxiety on Attentional Switching of Students
Authors: Zhu Jiawu
Published: December 2024

The study is devoted to the study of the relationship between stress caused in students by social isolation and the ability to switch tasks as one of the basic functions of attention. The study draws on the theoretical background of The Attentional Control Theory as the most appropriate method to study the factors influencing attention control under the influence of the effects of stress. The experiment includes a sample of 76 Chinese university students who experienced forced social isolation for 6 months. A statistically significant increase in physiological markers of stress was found in both cases, indicating that social isolation leads to an accumulation of stress and an increase in the intensity of stress reactions when students reexperience social stress after isolation. The practical significance lies in changing the approach to coping with the results of social isolation stress in students through changing the method of presenting educational information.
The effect of transient increase in intraocular pressure on subfoveal choroidal thickness
Authors: Niyazmand Hamed , Jeyakumar Vibu , Feng Ian , Jansen Lisa , Mahindra Anson , Menage Amy , Alam Khyber
Published: December 2024

SIGNIFICANCE

Myopia prevalence has increased over the last few decades. Studies have documented that the choroid is considered an important biomarker in myopia development. As myopia and choroidal thinning are associated with increased glaucoma risk, understanding the role of the choroid in myopia and glaucoma is imperative.

PURPOSE

This study investigates the effect of transiently elevated intraocular pressure on axial length, subfoveal choroidal thickness, and central retinal thickness in emmetropes, low myopes, and high myopes.

METHODS

This study involved 29 young adults (23 ± 1 years), including 10 emmetropes (−0.50 D < SE < +0.50 D), 10 low myopes (−6.00 D < SE ≤ −0.50 D), and 9 high myopes (SE ≤ −6.00 D). Participants were fitted with modified swimming goggles for 5 minutes to transiently change intraocular pressure. Noncontact tonometry, optical biometry, and optical coherence tomography were used to measure intraocular pressure, axial length, central retinal thickness, and subfoveal choroidal thickness, respectively. Measurements were taken at before, during goggle wear, immediately after, and 3 minutes after goggles removal. Repeated-measures analysis of variance with Bonferroni adjustment was used to assess the effect of transiently changed intraocular pressure and to elucidate any differences between refractive groups in response to the intraocular pressure change.

RESULTS

Intraocular pressure increased by 1.7 ± 2.1 mmHg (p=0.002) from baseline, accompanied by axial elongation of 14 ± 21 μm (p = 0.012) and subfoveal choroidal thinning of 13 ± 15 μm (p=0.01). However, central retinal thickness did not change significantly (p>0.05). Most of the changes in the axial length were due to changes in the choroidal thickness. Observed changes returned to baseline immediately following goggles removal. There was no significant difference between refractive error groups' changes associated with the transient increase in intraocular pressure (p>0.05).

CONCLUSIONS

Transiently increased intraocular pressure caused temporary axial elongation and subfoveal choroidal thinning, with no significant differences between refractive groups. Further studies are required to assess the impact of long-term increased intraocular pressure on ocular components.
Randomized clinical trial: MGrx versus standard debridement and expression for meibomian gland dysfunction
Authors: Semp David A. , Dutta Debarun , Wolffsohn James S.
Published: December 2024

SIGNIFICANCE

Evaporative dry eye disease, due to meibomian gland dysfunction, causes significant suffering for millions of people globally, yet satisfactory long-term treatment remains elusive for many. Investigation of potential therapies for meibomian gland dysfunction is therefore of high importance to clinicians and their patients.

PURPOSE

This study aimed to compare the efficacy of a new device for meibomian gland debridement and expression to that of the conventional way of providing this treatment.

METHODS

Thirty participants (mean age, 36.4 ± 15.4 years; 77% female) fulfilling current Tear Film & Ocular Surface Society diagnostic criteria for dry eye disease and meibomian gland dysfunction were recruited (Research Registry, 10340). Fifteen participants each were randomized to receive a single treatment with either traditional debridement (using a golf-club spud), heating (10 minutes of Blepha EyeBag, Théa Laboratories, Clermont-Ferrand, France) and expression (with forceps), or the multimodal MGrx, which comprises a handheld device with heated debridement, massage, and expression attachments. Symptomatology, tear film, and ocular surface measures were assessed at baseline and at 4 and 8 weeks post-treatment.

RESULTS

Ocular Surface Disease Index, 5-Item Dry Eye Questionnaire, and Symptom Assessment in Dry Eye symptom questionnaire scores all improved significantly with both treatments (all p<0.001), with no subsequent deterioration for at least 8 weeks. The improvement was similar between treatment groups (all p>0.05). Clinical signs, of blink rate, tear film quality and quantity, ocular surface characteristics, and meibomian gland expressibility, were all unchanged with both treatments (all p>0.05) except for noninvasive tear breakup time, which deteriorated in the conventional treatment group (p=0.006) between 4 and 8 weeks post-treatment. No adverse reactions were reported, and all participants were able to tolerate treatment.

CONCLUSIONS

A single application of meibomian gland debridement and expression resulted in sustained improvements in the symptoms of dry eye disease, in both treatment groups. The MGrx device provides a safe and effective in-office treatment for evaporative dry eye disease, and has time and space advantages compared with conventional treatment.
Self-reported Dizziness, Postural Stability, and Sensory Integration After Mild Traumatic Brain Injury
Authors: Chang Pao-Lung , Chen Kai-Yun , Ou Ju-Chi , Chiang Yung-Hsiao , Chen Hung-Chou , Liou Tsan-Hon , Escorpizo Reuben , Lin Li-Fong
Published: December 2024

Objective

The aim of the study is to evaluate changes in dizziness, postural stability, and sensory integration after mild traumatic brain injury over a 12-wk period.

Methods

One hundred adults with mild traumatic brain injury were analyzed. The Dizziness Handicap Inventory questionnaire was used for subjective evaluations. Postural stability and modified Clinical Test of Sensory Interaction in Balance were used as objective measures at 0, 6, and 12 wks after mild traumatic brain injury.

Design

Observational follow-up study.

Results

Dizziness Handicap Inventory scores decreased significantly over time, indicating improved functional, emotional, physical, and overall aspects. Most indices of postural stability and modified Clinical Test of Sensory Interaction in Balance decreased significantly over time. The postural stability indices (overall and anteroposterior) and the modified Clinical Test of Sensory Interaction in Balance indices (eyes open on firm and foam surfaces) differed significantly between weeks 0 and 6, according to post hoc analysis. Furthermore, the modified Clinical Test of Sensory Interaction in Balance indices of eyes open on firm and foam surfaces and eyes closed on foam surface demonstrated significant differences between weeks 0 and 12.

Conclusions

Subjective and objective measurements indicated improvements in included adults from 0 wks to 6 and 12 wks after mild traumatic brain injury. However, balance dysfunction and sensory integration issues may persist beyond 12 wks after mild traumatic brain injury. The findings highlight the need for longer follow-up and tailored rehabilitation programs.
Dual-Time Point 68Ga-FAPI-04 PET/CT Improves Tumor Delineation and Cervical Lymph Node Metastasis Identification in Patients With Head and Neck Squamous Cell Carcinoma
Authors: Jiang Yaqun , Huang Shuo , Tian Yueli , Xing Diankui , Xiao Zhiwei , Huang Jianying , He Yong
Published: December 2024

Purpose

The purpose of this study was to evaluate the benefit of dual-time point 68Ga-FAPI-04 PET/CT in staging head and neck squamous cell carcinoma (HNSCC).

Patients and Methods

Sixty-nine treatment-naive patients with HNSCC were enrolled. Each patient underwent whole-body 68Ga-FAPI-04 PET/CT at approximately 30 minutes postinjection and a delayed scan in head and neck region at 2 hours. Radiotracer uptake (SUVmax), tumor-to-background ratio, change in SUVmax (∆SUVmax), retention index, diagnostic performance, and staging were explored. Histopathology was the reference standard.

Results

Primary tumors showed similar average SUVmax between early (17.89) and delayed scans (17.86, P = 0.241). However, the tumor-to-background ratios of delayed imaging were all significantly higher than those of early imaging (all P < 0.001). In 38 patients who underwent neck dissection, metastatic lymph nodes showed higher mean SUVmax on delayed imaging than on early imaging (early 10.53 ± 5.98 vs delayed 11.71 ± 6.36, P < 0.001), whereas nonmetastatic lymph nodes showed the opposite result (early 3.51 ± 0.51 vs delayed 2.58 ± 0.63, P = 0.002). The mean ∆SUVmax and retention index of metastatic and nonmetastatic lymph nodes were 1.19 versus −0.93 and 12.79% versus −26.55%, respectively. N staging was correctly altered in 3 (3/38) patients based on delayed images.

Conclusions

Delayed 68Ga-FAPI-04 PET/CT can effectively acquire high-contrast images, better tumor delineation, and detect hidden lesions near or within the tissues influenced by physiological uptake for HNSCC. In addition, dual-time point imaging adds diagnostic value for the differentiation of metastatic from nonmetastatic lymph nodes.
A Rare Case of High-Grade Fetal Adenocarcinoma of the Lung Demonstrated by 18F-FDG PET/CT
Authors: Xu Ling , Nan Yule , Wu Jingbo , Dong Aisheng , Lu Tong
Published: December 2024

An 85-year-old non-smoking woman with right back pain for 1 month underwent a chest CT, which showed a mass with a maximum diameter of 12.2 cm in the upper lobe of right lung. The lesion demonstrated heterogeneous uptake on FDG PET scanning. The final pathology of the lung mass was a high-grade fetal adenocarcinoma of the lung, which was a rare histological form of malignant lung neoplasm. This case revealed the glucose avidity of the rare lung cancer.
Improving Electroencephalography Screening via an Online Module for Neurology Trainees: A Multicenter Study
Authors: Lemus Hernan Nicolas , Gutierrez Camilo , Fields Madeline , Ziemba Kristine , Landazuri Patrick , Shanker Vicki , Acosta Daniela Riveros , McCarthy Louise , Jadeja Neville , Bothwell Mia , Nagaraja Adithya , Patino Gustavo A. , Karakis Ioannis , Milligan Tracey A. , Tobochnik Steven
Published: December 2024

Purpose:

To investigate the utility of a 15-minute online module to improve the self-confidence and knowledge of neurology trainees when screening an EEG.

Methods:

We developed a fast, convenient, and accessible 15-minute online module to teach basic concepts of EEG screening using a five-step approach. To assess the efficacy of the module among neurology trainees, three surveys were developed. The EEG module and surveys were distributed to neurology trainees at multiple institutions in the United States. Associations between continuous variables were evaluated using t-test and ANOVA test.

Results:

A total of 199 residents from 7 different adult neurology residency programs participated in the study. We obtained a response rate of 38% (76/199) for EEG survey 1 and 25% (49/199) for the demographic survey, among junior and senior residents; 22 senior residents completed EEG survey 2. The online EEG module improved confidence when interpreting an EEG among junior residents (1.67 vs. 2.56, p < 0.0001). Senior residents improved their EEG survey score after completing the online module (53.9 vs. 68.6%, p < 0.001). Most of the trainees would recommend the online module to other trainees (93.9%) and would consider including it in an introductory course (93.9%).

Conclusions:

A brief and accessible online EEG module was easily implemented as an early introduction to EEG screening for junior neurology trainees and to improve EEG screening skills for senior trainees. These findings clarify specific areas where EEG learning may be optimized and reinforce the importance of implementing innovative curricula that are accessible and efficient for all neurology trainees.
Amycolatopsis heterodermiae sp. nov. and Actinacidiphila polyblastidii sp. nov., two new actinobacteria isolated from foliose lichens
Authors: Somphong Achiraya , Polyiam Wetchasart , Buaruang Kawinnat , Suriyachadkun Chanwit , Sripreechasak Paranee , Harunari Enjuro , Igarashi Yasuhiro , Tanasupawat Somboon , Phongsopitanun Wongsakorn
Published: December 2024

Two novel actinomycete strains, designated as V23-08T and V4-01T, were isolated from a foliose lichen collected in Doi Inthanon National Park, Chiang Mai Province, Thailand. Strain V23-08T showed the highest similarity (98.40%) to Amycolatopsis tolypomycina DSM 44544T. Similarly, strain V4-01T showed the highest 16S rRNA gene similarity relatedness (98.89%) to Actinacidiphila acidipaludis PLK6-54T. Chemotaxonomic analysis revealed distinct characteristics for each strain. The isomers of diaminopimelic acid were identified as meso-DAP in strain V23-08T and
ll
-DAP in strain V4-01T. The predominant menaquinones were MK-9(H2) for strain V23-08T and MK-9(H6) and MK-9(H8) for strain V4-01T. Strain V23-08T contained mannose, glucose, galactose and arabinose as whole-cell sugars, with iso-C16:0 as the major fatty acid. The polar lipid profile included diphosphatidylglycerol, phosphatidylethanolamine, phosphatidylglycerol, unidentified aminophospholipids, unidentified phospholipids and unidentified lipids. In contrast, strain V4-01T exhibited glucose and galactose as whole-cell sugars, with iso-C16:0, anteiso-C16:0 and C16:0 as major fatty acids, and a polar lipid composition of diphosphatidylglycerol, phosphatidylethanolamine, phosphatidylinositol and phosphatidylinositol mannoside. The taxonomic data, supported by digital DNA–DNA hybridization and average nucleotide identity analyses, confirm that strains V23-08T and V4-01T represent novel species within the genera Amycolatopsis and Actinacidiphila, respectively. Based on these findings, the names Amycolatopsis heterodermiae sp. nov. (strain V23-08T: TBRC 16208T and NBRC 115837T) and Actinacidiphila polyblastidii sp. nov. (strain V4-01T: TBRC 16209T and NBRC 115865T) are proposed.
Predicting intentions towards long-term antidepressant use in the management of people with depression in primary care: A longitudinal survey study
Authors: Dewar-Haggart Rachel , Muller Ingrid , Bishop Felicity , Geraghty Adam W A , Stuart Beth , Kendrick Tony
Published: December 2024

Background

Over the last two decades, antidepressant prescribing in the UK has increased considerably, due to an increased number of people staying on antidepressants for longer. Even when treatment is no longer clinically indicated, qualitative research suggests many people continue due to a fear of depressive relapse or antidepressant withdrawal symptoms. The quantitative effects of peoples’ beliefs and attitudes towards long-term antidepressant use remain relatively unexplored.

Objectives

To determine the extent to which beliefs and attitudes towards antidepressant treatment predict intentions to stop or continue long-term use; and whether intentions translate into actual discontinuation.

Methods

A questionnaire survey formed the main component of an embedded mixed-methods study. Twenty general practices posted questionnaires to adults aged over 18 receiving continuous antidepressant prescriptions for over two years. Outcomes and predictors were determined using an extended model of the Theory of Planned Behaviour, conducting exploratory descriptive and regression analyses. The primary outcome was participants’ intentions to discontinue antidepressants. The secondary outcome of behaviour change was determined by any change in antidepressant dosage at six months.

Results

277 people were surveyed from 20 practices, with 10 years median antidepressant duration. Mean questionnaire scores for intention and subjective norms towards starting to come off antidepressants were low, and 85% of participants declared that continuing their antidepressant was necessary. Prescribing outcomes retrieved from 175 participants’ medical records six months after they completed the survey found 86% had not changed their antidepressant, 9% reduced the dose, only 1% discontinued their antidepressant, and 4% increased the dose. More favourable attitudes towards stopping, and normative beliefs about depression, were the strongest predictors of intentions to stop long-term antidepressant treatment.

Conclusion

Given few intentions to stop taking antidepressants, patients should be made more aware of the importance of ongoing antidepressant monitoring and review from their primary care practitioners. This would promote discussion to support an attitudinal change and initiation of antidepressant tapering where appropriate.
Combining participatory mapping and route optimization algorithms to inform the delivery of community health interventions at the last mile
Authors: Randriamihaja Mauricianot , Ihantamalala Felana Angella , Rafenoarimalala Feno H. , Finnegan Karen E , Rakotonirina Luc , Razafinjato Benedicte , Bonds Matthew H. , Evans Michelle V , Garchitorena Andres
Published: December 2024

Community health programs are gaining relevance within national health systems and becoming inherently more complex. To ensure that community health programs lead to equitable geographic access to care, the WHO recommends adapting the target population and workload of community health workers (CHWs) according to the local geographic context and population size of the communities they serve. Geographic optimization could be particularly beneficial for those activities that require CHWs to visit households door-to-door for last mile delivery of care. The goal of this study was to demonstrate the feasibility and utility of geographic optimization in the context of community health programs in rural areas of the developing world. We developed a decision-making tool based on participatory mapping and route optimization algorithms in order to inform the micro-planning and implementation of two kinds of community health interventions requiring door-to-door delivery: mass distribution campaigns and proactive community case management (proCCM) programs. We applied the Vehicle Routing Problem with Time Windows (VRPTW) algorithm to optimize the on-foot routes that CHWs take to visit households in their catchment, using a geographic dataset obtained from participatory mapping onOpenStreetMapcomprising over 100,000 buildings and 20,000 km of footpaths in the rural district of Ifanadiana, Madagascar. We found that personnel-day requirements ranged from less than 15 to over 60 per CHW catchment for mass distribution campaigns, and from less than 5 to over 20 for proCCM programs, assuming 1 visit per month. To facilitate local use of VRPTW algorithms by operational teams, we developed an “e-health” platform to visualize resource requirements, CHW optimal schedules and itineraries according to customizable intervention designs and hypotheses. Further development and scale-up of these tools could help optimize community health programs and other last mile delivery activities, in line with WHO recommendations, linking a new era of big data analytics with the most basic forms of frontline care in resource poor areas.
Effect of and Interventions in Prevention and Management of Maternal Anemia in the Advent of COVID-19
Authors: Muthuka John K. , Fondo Diana , Wambura Francis , Mativo Japheth , Kelly Oluoch J. , Nabaweesi Rosemary
Published: December 2024

Background

There were many unknowns for pregnant women during the COVID-19 pandemic. Most of these could have been silent however lethal and anemic conditions could escalate the worsening of pregnancy outcomes. Existing evidence indicate that, array of factors is associated with the ability of compromising maternal anemia, some directly and others indirectly.

Objective

This review aimed at ascertaining the pooled effect of several anemia interventions. Specifically, the aim of this study was to establish if pregnancy status is associated with COVID-19 severity characterized by a cytokine storm.

Methods

We searched the Google Scholar, PubMed, Scopus, Web of Science, and Embase databases to studies suitable for inclusion in this meta-analysis. Studies examining women of reproductive age on any maternal anemia intervention were included. The risk of bias was assessed using the Cochrane risk of bias tool. Review Manager 5.4.1 was used to calculate rate ratios (RRs) with 95% CIs, which were depicted using forest plots. Quantitative variables were summarized in total numbers and percentages. The effect on prevention, control, management and or treatment of anemia was calculated and compared between the intervention and the comparator arms. Heterogeneity was evaluated with the Cochran Q statistic and Higgins test.

Results

A total of 11 articles including data for 6,129 were included. With sensitivity analysis, the interventions had a utility of 39% on maternal anemia prevention and management (random effects model RR 0.61, 95% CI 0.43, 0.87;P= 0.006) (χ26=286.98, P<.00001; I2=97%). All the interventions against maternal anemia showed an effect of 17% (fixed-effect model RR 0.83, 95% CI 0.79-0.88; P<.00001) (χ24=2.93, P=0.57; I2=0%). Education to pregnant women showed a 28% effect (RR 0.72 95% CI 0.58, 0.89), medicinal administration 19% (RR 0.81 95% CI 0.73, 0.90), iron supplementation 17% (RR 0.83 95% CI 0.75, 0.92) and I.V Ferric Carboxy-maltose 15% (RR 0.85 95% CI 0.74, 0.97) (I2= 0%). Interventions in African region had a higher (16%) and significant effect compared to other regions (fixed-effects model RR 0.84, 95% CI 0.79-0.89; P<.001) (χ25=176.53, P<.00001; I2=97%). Multiple center studies had a significant predictive effect (16%) compared to single center studies (fixed-effects model RR 0.84, 95% CI 0.79-0.89; P<.00001)(χ25=176.53, P<.00001; I2=97%). The year 2020 recorded the highest effect of maternal anemia interventions at 28% (random-effects model RR 0.72, 95% CI 0.67-0.78; P<.00001) (χ23=167.34, P<.00001; I2=98%)

Conclusion

In the advent of COVID-19, maternal anemia interventions were compromised demonstrated by a low effectiveness trend from the year 2020 to the year 2022. During this period, even the most effective and recommended interventions against maternal anemia were somehow affected.
Trajectories of menstrual symptoms and blood pressure in midlife: A prospective cohort study on Australian women
Authors: Mishra Gita D , Jin Chuyao , Chan Hsiu-Wen , Doust Jenny
Published: December 2024

Aim

To investigate the associations between the trajectories of menstrual symptoms over 18 years and blood pressure in midlife using longitudinal data.

Methods

Using data from the Menarche-to-PreMenopause (M-PreM) study, sampled from the Australian Longitudinal Study on Women’s Health, 494 participants were followed from their early 20s to mid-40s. Distinct trajectories of heavy menstrual bleeding, irregular periods, and severe period pain were identified by group-based trajectory modelling. The associations between menstrual symptom trajectories and blood pressure were examined by linear regression models.

Results

We identified three distinct heavy menstrual bleeding trajectories and two for irregular periods and severe period pain. After accounting for blood pressure monitors and socio-demographic factors, women in the chronic heavy menstrual bleeding group and late onset heavy menstrual bleeding group exhibited higher systolic (SBP) and diastolic (DBP) blood pressure compared to the normative group. The late onset irregular periods group also had higher DBP than the normative group. When we further adjusted for lifestyle factors, body mass index, and waist-to-hip ratio, the associations were attenuated (chronic heavy bleeding: SBP [B=3.0; 95% CI: −1.1, 7.0] and DBP [B=2.5; 95% CI: −0.3, 5.2]; late onset heavy menstrual bleeding: SBP [B=3.4; 95% CI: 0.3, 6.5] and DBP [B=3.1; 95% CI: 1.0, 5.2]). We found no associations between severe period pain and blood pressure.

Conclusions

The trajectories of heavy menstrual bleeding and irregular periods during the reproductive span were associated with blood pressure in midlife. This suggests that tracking menstrual symptoms in women could help predict their midlife blood pressure.