bluuebunny/crossref_metadata_2025 huggingface dataset:
An unusual case of adult-onset still’s disease complicated with anti-complement factor H antibodies associated atypical haemolytic uraemic syndrome
Authors: Fung Winston Wing-Shing , Chao Amelia Chien-Wei , Pang Wing-Fai , Wong Raymond Siu-Ming , Chow Kai-Ming , Szeto Cheuk-Chun
Published: May 2024

Background

Atypical haemolytic uremic syndrome (aHUS) is an uncommon form of thrombotic microangiopathy (TMA). However, it remains difficult to diagnose the disease early, given its non-specific and overlapping presentation to other conditions such as thrombotic thrombocytopenic purpura and typical HUS. It is also important to identify the underlying causes and to distinguish between primary (due to a genetic abnormality leading to a dysregulated alternative complement pathway) and secondary (often attributed by severe infection or inflammation) forms of the disease, as there is now effective treatment such as monoclonal antibodies against C5 for primary aHUS. However, primary aHUS with severe inflammation are often mistaken as a secondary HUS. We presented an unusual case of adult-onset Still’s disease (AOSD) with macrophage activation syndrome (MAS), which is in fact associated with anti-complement factor H (anti-CFH) antibodies related aHUS. Although the aHUS may be triggered by the severe inflammation from the AOSD, the presence of anti-CFH antibodies suggests an underlying genetic defect in the alternative complement pathway, predisposing to primary aHUS. One should note that anti-CFH antibodies associated aHUS may not always associate with genetic predisposition to complement dysregulation and can be an autoimmune form of aHUS, highlighting the importance of genetic testing.

Case presentation

A 42 years old man was admitted with suspected adult-onset Still’s disease. Intravenous methylprednisolone was started but patient was complicated with acute encephalopathy and low platelet. ADAMTS13 test returned to be normal and concurrent aHUS was eventually suspected, 26 days after the initial thrombocytopenia was presented. Plasma exchange was started and patient eventually had 2 doses of eculizumab after funding was approved. Concurrent tocilizumab was also used to treat the adult-onset Still’s disease with MAS. The patient was eventually stabilised and long-term tocilizumab maintenance treatment was planned instead of eculizumab following haematology review. Although the aHUS may be a secondary event to MAS according to haematology opinion and the genetic test came back negative for the five major aHUS gene, high titre of anti-CFH antibodies was detected (1242 AU/ml).

Conclusion

Our case highlighted the importance of prompt anti-CFH antibodies test and genetic testing for aHUS in patients with severe AOSD and features of TMA. Our case also emphasized testing for structural variants within the CFH and CFH-related proteins gene region, as part of the routine genetic analysis in patients with anti-CFH antibodies associated aHUS to improve diagnostic approaches.
Prevalence, factors associated and management of needle phobia among the general population in Saudi Arabia and Egypt
Authors: Alwafi Hassan , Naser Abdallah Y. , Alsaleh Nada A. , Asiri Jamila Kamal , Almontashri Rawan M. , Alqarni Lujain Mohammed , Salawati Rawan Sulaiman , Alsharif Alaa , Aldhahir Abdulelah M. , Alqarni Abdullah A. , Hafiz Waleed , Alqahtani Jaber S. , Salawati Emad , Almatrafi Mohammed A. , Bahlol Mohamed
Published: May 2024

Objective

This study aims to assess the prevalence of needle phobia among Saudi and Egyptian adult populations. In addition, underlying causes and strategies that can be utilized to address needle fear were investigated.

Methods

A cross-sectional online survey study was conducted in Saudi Arabia and Egypt between 1 May and 30 June 2023. Participants aged 18 years and above and living in Saudi Arabia and Egypt were eligible to complete the survey. Participants were invited to participate in this study through social media platforms (Facebook, X, Snapchat, and Instagram). A convenience sampling technique was used to recruit the study participants. A 21-item questionnaire consisting of four sections including a Likert scale score was used to answer the research objectives. Numeric data were presented as mean ± SD. For categorical variables, percentages were used. Comparison between groups were made by Student’s t-test or Mann Whitney test according to data distribution. Chi squared tests for categorical values were conducted. A binary logistic regression analysis was conducted to investigate factors associated with needle phobia.

Results

A total of 4065 participants were involved in this study (Saudi Arabia: 2628 and Egypt: 1437). Around one-third of the study participants (36.5%) confirmed that they have needle phobia. Most of the study participants (81.1%) reported that they have had needle phobia since they were under 18 years of age. Pain, general anxiety, and fear of making a mistake during the procedure were the most commonly reported contributors for fear of needles during or before a medical procedure. Around 15.8% of the study participants reported that they have tried to get rid of phobia from needles. Non-surgical alternatives (such as oral medications and patches) and using smaller/thinner needles were the most commonly reported interventions that reduced fear of needles. Binary logistic regression analysis identified that females, those who are aged (41–50 years), widowed, those with bachelor’s degrees and higher education, and those unemployed were more likely to have needle phobia compared to others.

Conclusion

Our study highlighted the high prevalence of needle fear within an adult population in Egypt and Saudi Arabia. Females, those who are aged (41–50 years), those widowed, those with higher education degrees, those unemployed, those working in the health sector and people with low income were more likely to have needle phobia compared to others.
Concentrated transdiagnostic and cross-disciplinary micro-choice based group treatment for patients with depression and with anxiety leads to lasting improvements after 12 months: a pilot study
Authors: Wilhelmsen-Langeland Ane , Børtveit Tore , Jürgensen Marte , Søfteland Eirik , Hystad Sigurd William , Kvale Gerd
Published: May 2024

Background

A concentrated transdiagnostic and micro choice-based group treatment for patients with depression and anxiety has previously shown to yield significant reduction in symptoms and increased level of functioning from pre to 3-month follow-up. In the present study, we report the results after 12 months follow-up.

Methods

This was a non-randomized clinical intervention pilot study, conducted in line with a published protocol. Sixty-seven consecutively referred patients, aged 19–47 (mean age 32.5, SD = 8.0) were included and completed treatment. All had a severity of their problems that entitled them to care in the specialist public mental health care. Self-reported age at onset of symptoms was 17.6 (SD = 7.9) years. Mean number of prior treatment courses was 3.5 (SD = 3.3; range 0–20). The main objective was to assess the treatment effectiveness by questionnaires measuring relevant symptoms at pre-treatment, 7 days-, 3 months-, 6 months- and at 12-months follow-up.

Results

Validated measures of functional impairment (WSAS), depression (PHQ9), anxiety (GAD7), worry (PSWQ), fatigue (CFQ), insomnia (BIS) and illness perception (BIPQ) improved significantly (p < .0005) from before treatment to 12 months follow-up, yielding mostly large to extremely large effect sizes (0.89–3.68), whereas some moderate (0.60–0.76). After 12 months, 74% report an overall improvement in problems related to anxiety and depression. Utilization of specialist, public and private mental health care was reported as nonexistent or had decreased for 70% of the patients at 12-month follow up.

Conclusions

The concentrated, micro-choice based group treatment approach yielded a highly clinically significant reduction in a wide range of symptoms already one week after treatment, and the positive results persisted at 12-month follow-up.

Trial registration

ClinicalTrials.gov Identifier: NCT05234281, first posted date 10/02/2022.
Knowledge, attitude, and practice toward allergic rhinitis among parents in Ningbo, China
Authors: Lu Lingya , Feng Jinyan , Zhu Lihua , Chen Aina , Chen Xuenai , Lu Yanming
Published: May 2024

Background

This study examined the knowledge, attitude, and practice (KAP) toward allergic rhinitis (AR) among parents.

Methods

This cross-sectional study enrolled parents of children with AR at Ningbo Hangzhou Bay Hospital between December 2022 and March 2023. A self-administered questionnaire was developed to collect the demographic characteristics, knowledge, attitudes, and practices toward AR.

Results

This study included 480 questionnaires, and 78.33% were mothers. The mean knowledge, attitude, and practice scores were 13.49 ± 6.62 (possible range: 0–24), 33.99 ± 3.40 (possible range: 8–40), and 21.52 ± 3.36 (possible range: 5–26), indicating poor knowledge, positive attitudes, and proactive practice. Multivariable logistic regression analysis showed living in urban areas in Ningbo outside Hangzhou Bay New Zone (OR = 4.33, 95%CI: 1.52–12.34, P = 0.006), living in rural areas in Ningbo (OR = 2.15, 95%CI: 1.00-4.59, P = 0.049), being self-employed (OR = 1.99, 95%CI: 1.00-3.95, P = 0.049), monthly income per capita ≥ 20,000 CNY (OR = 1.89, 95%CI: 1.02–3.47, P = 0.042), child with one biological sibling (OR = 0.48, 95%CI: 0.30–0.78, P = 0.003), and ≥ 6 times hospital visits for AR (OR = 2.32, 95%CI: 1.40–3.86, P = 0.001) were independently associated with adequate knowledge. The knowledge (OR = 1.09, 95%CI: 1.05–1.13, P < 0.001) and ≥ 6 times hospital visits for AR (OR = 1.84, 95%CI: 1.06–3.22, P = 0.032) were independently associated with a positive attitude. The knowledge (OR = 1.08, 95%CI: 1.04–1.13, P = 0.001), attitude (OR = 1.41, 95%CI: 1.28–1.55, P < 0.001), monthly income per capita ≥ 20,000 CNY (OR = 3.59, 95%CI: 1.49–8.65, P = 0.004), no previous hospital visit for AR (OR = 0.35, 95%CI: 0.16–0.78, P = 0.003), and ≥ 6 times hospital visits for AR (OR = 0.40, 95%CI: 0.20–0.81, P = 0.011) were independently associated with the practice scores.

Conclusions

The parents of children with AR had poor knowledge but positive attitudes and proactive practice toward AR. This study has identified a need for specific and reliable information initiatives to be introduced as a means of reducing parental concern and ensuring evidence-based strategies for managing children with AR.
Anterior cruciate ligament femoral side retained stump technique reduces enlargement of the femoral bone tunnel after anterior cruciate ligament reconstruction
Authors: Li Xiaobo , Li Hanlin , Su Jixian , Ding Ran
Published: May 2024

Background

Enlargement of the bone tunnel has become an unavoidable early complication after anterior cruciate ligament (ACL) reconstruction, whether it is a single or double-bundle ACL reconstruction. Preservation of the ACL stump in ACL reconstruction reduces enlargement of the bone tunnel. The purpose of this study was to investigate the question of whether single-bundle ACL reconstruction using the ACL femoral side retained stump technique reduces enlargement of the femoral tunnel.

Methods

Forty patients who underwent single-bundle reconstruction of the ACL were included in this study. The patients were categorized into a Remnant preservation group (Group R) and the Non-remnant preservation group (Group N). In the Remnant preservation group, a high-flexion femoral side retained stump technique was used intraoperatively for the establishment of the femoral side bone tunnel, and in the Non-remnant preservation group, the conventional femoral positioning method was used (we used a femoral positioning drill for localization and drilling of the femoral bone tunnel), and MRI of the operated knee joints was performed at 6 months postoperatively. We measured the internal diameter of the femoral bone tunnel at 5 mm from the intra-articular outlet of the femoral bone tunnel on an MRI scan image perpendicular to the femoral bone tunnel. The size of the tunnel was compared between the intraoperative drilling of the bone tunnel and the size of the bone tunnel at 6 months postoperatively. Postoperative clinical assessment was Lysholm score.

Results

After a 6-month follow-up of 40 patients, the diameter of the femoral tunnel at a distance of 5 mm from the inner opening of the femoral tunnel was 10.96 ± 0.67 mm and 10.11 ± 0.62 mm in patients of group N and group R, respectively, and the difference was statistically significant (P < 0.05).The diameter of the femoral tunnel at 6 months postoperatively in group N and group R compared to the intraoperative bone tunnel increased by 2.58 ± 0.24 mm and 1.94 ± 0.31 mm, and the difference was statistically significant (P < 0.05).The femoral tunnel enlargement rates of group N and group R were 30.94 ± 3.00% and 24.02 ± 5.10%, respectively, and the differences were significant (P < 0.05).

Conclusion

ACL femoral side retained stump technique does not sacrifice the ideal location of the femoral tunnel and is able to preserve the possible benefits of the ACL stump: reduced femoral tunnel enlargement.
Validity of endoscopic ossiculoplasty immediately after its introduction for ossicular chain disruption
Authors: Fukuda Atsushi , Morita Shinya , Hoshino Kimiko , Fujiwara Keishi , Nakamaru Yuji , Homma Akihiro
Published: May 2024

Background

Transcanal endoscopic ear surgery (TEES) reportedly requires a long learning curve and may be associated with more complications and longer operative times than microscopic ear surgery (MES). In this study, we aimed to examine the usefulness and validity of TEES for ossicular chain disruption in the early stages of its introduction in our institution.

Methods

TEES was performed on 11 ears (10 with congenital ossicular chain discontinuity and 1 with traumatic ossicular chain dislocation), and MES was performed with a retroauricular incision on 18 ears (6 with congenital ossicular chain discontinuity and 12 with traumatic ossicular chain dislocation) in a tertiary referral center. Postoperative hearing results, operative times, and postoperative hospital length of stay were retrospectively reviewed. The Mann–Whitney U test and Fisher’s exact test was performed to compare variables between the TEES and MES groups. Pre- and postoperative air- and bone-conduction thresholds and the air–bone gap of each group were compared using the Wilcoxon signed-rank test. The Mann–Whitney U test and Wilcoxon signed-rank was performed to compare the pre- and postoperative air–bone gaps between the diagnoses.

Results

No significant differences in the postoperative air-conduction thresholds, bone-conduction thresholds, air–bone gaps, or incidence of air–bone gap ≤ 20 dB were observed between the TEES and MES groups. The air-conduction thresholds and air–bone gaps of the TEES group significantly improved postoperatively. The air-conduction thresholds and air–bone gaps of the MES group also significantly improved postoperatively. No significant difference was observed in the operative times between the groups (TEES group: median, 80 min; MES group: median, 85.5 min). The TEES group had a significantly shorter postoperative hospital stay (median, 2 days) than the MES group (median, 7.5 days).

Conclusions

TEES was considered appropriate for the treatment of ossicular chain disruption, even immediately after its introduction at our institution. For expert microscopic ear surgeons, ossicular chain disruption may be considered a suitable indication for the introduction of TEES.
The first reported values of microplastics in prostate
Authors: Demirelli Erhan , Tepe Yalçın , Oğuz Ural , Aydın Handan , Kodat Murat , Tok Doğan Sabri , Sönmez Mehmet Giray , Öğreden Ercan
Published: May 2024

Background

Microplastics are ubiquitous, widespread environmental pollutants with unavoidable human exposure. Herein, it was aimed to investigate the presence of microplastics in prostate tissue.

Methods

Prostate tissues from 12 patients who underwent Trans Urethral Resection of the Prostate (TUR-P) were analyzed to investigate the presence of microplastics. Initially, the prostate tissues were analyzed for microplastic particles using a light microscope after extraction. Subsequently, the chemical composition of the particles found in the prostate tissues was characterized using Attenuated Total Reflection-Fourier Transform Infrared (ATR-FTIR) spectrophotometry.

Results

Microplastic particles of various types were detected in 6 out of 12 patients. All detected plastic particles in this study were microplastics, with sizes below 26 μm in size. These microplastics exhibited different shapes as pellets, spheres or fibers. Overall, among the 12 analyzed prostate tissue samples, four different types of plastic were identified in six samples. The most common type of microplastic detected was Polyamide (Nylon 6), found in samples from three patients. Other detected types, Polypropylene, Polyacrylic Acid and Poly (dimethylsiloxane) were each determined in samples from one patient.

Conclusions

This is the first study to demonstrate the presence of microplastics in prostate tissue, serving as an exploratory investigation, which can trigger further research to validate the results in a larger patient cohort.
Clinical effect of chlorhexidine and sodium fluoride on corrosion behavior and surface topography of nitinol orthodontic archwires
Authors: Farrag Osama Gamil Abd El Gawad , Shamaa Nabeel El-Desouky Abou , Elgameay Walaa Elsayed , Bayoumi Dalia A.
Published: May 2024

Background

Alterations in the mechanical properties of the materials utilized in orthodontic appliances could affect the working properties of the appliances, thereby affecting clinical progress and outcome. Numerous studies have confirmed the correlation between alloy corrosion and raised surface roughness, which has a direct impact on the working characteristics of orthodontic archwires.

Methods

Thirty nickel-titanium (NiTi) orthodontic archwires were utilized in this study. Patients were randomly selected and allocated into three groups according to the randomization plan; (The control group): subjects practiced regular oral hygiene; (The fluoride group): subjects used fluoride for intensive prophylaxis; (The chlorhexidine group): subjects used chlorhexidine. Representative samples were evaluated by SEM, and then SEM images with high resolution were examined using Image J software to determine the surface roughness and obtain the results for further statistical analysis.

Results

Our findings indicated a significant difference was found between the three groups regarding the anterior and posterior parts between the control and the two other groups and a non-significant difference between NaF and CHX groups. Overall, the p-value for group comparisons was 0.000 for both parts, indicating a highly significant difference especially between the control and NaF groups.

Conclusion

Mouthwashes containing sodium fluoride demonstrated more significant surface alterations than the control and CHX groups and should be prescribed in accordance with orthodontic materials to reduce side effects.
Key factors in the future of oral and dental health in Iran using scenario writing approach
Authors: Mehrolhassani Mohammad Hossein , Mozhdehifard Mostafa , Rahimisadegh Rohaneh
Published: May 2024

Background

Oral and dental health can significantly impact individuals’ quality of life. The World Health Organization introduces oral health as one of the essential priorities of public health worldwide. Given the lack of studies on the future of oral and dental health in Iran, this study used a futures studies approach to identify the factors in oral and dental health in Iran through scenario writing.

Methods

This study was conducted in three stages including the scenario writing approach, qualitative methods, and exploratory future research. First, potential variables affecting future oral and dental health systems were extracted through interviews. The focus group discussion determined the uncertainty and importance of the variables. Then, the cross-impact balance matrix was imported into the Scenario Wizard software to identify the different states of the scenario generator variables and compatible scenarios were extracted.

Results

Seventy variables were extracted as key variables affecting the future of oral and dental health. Regarding the importance and uncertainty, seventeen variables scored higher and fell into policy and governance, economy and financing, social, service delivery, and technology, serving as five categories of scenario generators. Fifteen scenarios with weak consistency and three with strong consistency were obtained using the Cross-Impact Balance matrix in Scenario Wizard software.

Conclusion

The probability of a pessimistic scenario where all five categories of the scenarios were in the worst possible state was higher due to its consistency. The government’s support policies and commitment to oral and dental health were two key factors in the future. Achieving an optimistic and favorable scenario for the future of the country’s oral and dental health system depends on the government and policymakers in the health sector adopting a positive attitude towards the role of oral and dental health services in improving societal health. In this scenario, the five categories of the scenario generators were in the best condition.
Breast cancer and the steadily increasing maternal age: are they colliding?
Authors: Londero Ambrogio P. , Bertozzi Serena , Xholli Anjeza , Cedolini Carla , Cagnacci Angelo
Published: May 2024

Background

Pregnancy-related cancers are mostly breast cancers, and their incidence is likely to increase as a result of the modern trend of delaying childbearing. In particular, advanced maternal age increases breast cancer risk, and younger breast cancer patients are more likely to die and metastasize. This study compared a population with a high incidence of delayed childbearing with another population with a lower mean age at childbirth in order to determine whether breast cancer diagnosis and childbearing age overlap.

Methods

We retrospectively analyzed multiple data sources. The Surveillance, Epidemiology, and End Results (SEER) program, the United States National Center for Health Statistics as part of the National Vital Statistics System, the United Nations Population Division, the GLOBOCAN Cancer Observatory, the CLIO-INFRA project database, the Human Fertility Database, and anonymized local data were used.

Results

As women’s age at delivery increased, the convergence between their age distribution at breast cancer diagnosis and childbearing increased. In addition, the overlap between the two age distributions increased by more than 200% as the average age at delivery increased from 27 to 35 years.

Conclusions

As women’s average childbearing age has progressively risen, pregnancy and breast cancer age distributions have significantly overlapped. This finding emphasizes the need for increased awareness and educational efforts to inform women about the potential consequences of delayed childbearing. By providing comprehensive information and support, women can make more informed decisions about their reproductive health and cancer prevention strategies.
The relationship between personality traits and happiness: the mediating role of emotional regulation
Authors: Shdaifat Emad , Shudayfat Tamadur , Alshowkan Amira
Published: May 2024

Background

Understanding the factors contributing to happiness in the nursing profession is essential, particularly considering the high levels of stress associated with the job. This study aimed to explore the role of emotion regulation in mediating the relationship between personality traits and nurses’ happiness.

Objective

This study aimed to explore the relationship between personality traits and happiness by examining the mediating role of emotion regulation.

Methods

A cross-sectional study was conducted with 324 Jordanian and 408 Saudi nurses. Data, including the Big Five personality traits, happiness levels, and measures of emotional regulation, were collected through an online survey. The model’s fit and explanatory capability were verified by Structural Equation Modeling (SEM) using SmartPLS 3.

Results

In the structural model, agreeableness had a significant effect on happiness, influencing both reappraisal and suppression. Extraversion strongly influences happiness, positively affects reappraisal, and negatively affects suppression. Neuroticism hampers happiness and reappraisal, and has a detrimental effect on suppression. Openness had a positive effect on suppression, whereas consciousness positively affected happiness. Mediation analysis revealed direct effects on happiness, with varying indirect contributions from emotional regulation. Multiple-group analysis revealed no significant differences between Jordan and Saudi Arabia in the association between personality traits and happiness.

Conclusion

The findings emphasize the nuanced effects of agreeableness, extraversion, neuroticism, consciousness, and openness on happiness, mediated by emotional regulation. Implementing specific interventions to improve emotional regulation can increase nurses’ happiness regardless of their personality traits. The lack of significant differences between Jordanian and Saudi nurses implies that these relationships are consistent across cultures, offering valuable information for cross-cultural healthcare interventions.
Care fragmentation and readmission mortality and length of stay before and during the COVID-19 pandemic: data from the National Readmissions Database, 2018–2020
Authors: Turbow Sara , Walker Tiffany , Culler Steven , Ali Mohammed K.
Published: May 2024

Importance

A quarter of all 30-day readmissions involve fragmented care, where patients return to a different hospital than their original admission; these readmissions are associated with increased in-hospital mortality and longer lengths-of-stay (LOS). The stress on healthcare systems at the beginning of the COVID-19 pandemic could worsen care fragmentation and related outcomes.

Objective

To compare fragmented readmissions in 2020 versus 2018–2019 and assess whether mortality and LOS in fragmented readmissions differed in the two time periods.

Design

Observational study

Setting

National Readmissions Database (NRD), 2018–2020

Participants

All adults (> 18 y/o) with 30-day readmissions

Main outcomes and measures

We examined the percentage of fragmented readmissions over 2018–2020. Using unadjusted and adjusted logistic and linear regressions, we estimated the associations between fragmented readmissions and in-hospital mortality and LOS.

Results

24.0–25.7% of readmissions in 2018–2020 and 27.3%-31.0% of readmissions for COVID-19 were fragmented. 2018–2019 fragmented readmissions were associated with 18–20% higher odds of in-hospital mortality compared to nonfragmented readmissions. Fragmented readmissions for COVID-19 were associated with an 18% increase in in-hospital mortality (AOR 1.18, 95% CI 1.12, 1.24). The LOS of fragmented readmissions in March-November 2018–2019 were on average 0.81 days longer, while fragmented readmissions between March-November of 2020 were associated with a 0.88–1.03 day longer LOS.

Conclusions and relevance

A key limitation is that the NRD does not contain information on several patient/hospital-level factors that may be associated with the outcomes of interest. We observed increased fragmentation during COVID-19, but its impact on in-hospital mortality and LOS remained consistent with previous years.
Pivotal functions and impact of long con-coding RNAs on cellular processes and genome integrity
Authors: Sharma Siddhant , Houfani Aicha Asma , Foster Leonard J.
Published: May 2024

Recent advances in uncovering the mysteries of the human genome suggest that long non-coding RNAs (lncRNAs) are important regulatory components. Although lncRNAs are known to affect gene transcription, their mechanisms and biological implications are still unclear. Experimental research has shown that lncRNA synthesis, subcellular localization, and interactions with macromolecules like DNA, other RNAs, or proteins can all have an impact on gene expression in various biological processes. In this review, we highlight and discuss the major mechanisms through which lncRNAs function as master regulators of the human genome. Specifically, the objective of our review is to examine how lncRNAs regulate different processes like cell division, cell cycle, and immune responses, and unravel their roles in maintaining genomic architecture and integrity.
A scoping review to create a framework for the steps in developing condition-specific preference-based instruments de novo or from an existing non-preference-based instrument: use of item response theory or Rasch analysis
Authors: Tsui Teresa C. O. , Torres Sofia C. , Bielecki Joanna M. , Mitsakakis Nicholas , Trudeau Maureen E. , Bremner Karen E. , Davis Aileen M. , Krahn Murray D.
Published: May 2024

Background

There is no widely accepted framework to guide the development of condition-specific preference-based instruments (CSPBIs) that includes both de novo and from existing non-preference-based instruments. The purpose of this study was to address this gap by reviewing the published literature on CSPBIs, with particular attention to the application of item response theory (IRT) and Rasch analysis in their development.

Methods

A scoping review of the literature covering the concepts of all phases of CSPBI development and evaluation was performed from MEDLINE, Embase, PsychInfo, CINAHL, and the Cochrane Library, from inception to December 30, 2022.

Results

The titles and abstracts of 1,967 unique references were reviewed. After retrieving and reviewing 154 full-text articles, data were extracted from 109 articles, representing 41 CSPBIs covering 21 diseases or conditions. The development of CSPBIs was conceptualized as a 15-step framework, covering four phases: 1) develop initial questionnaire items (when no suitable non-preference-based instrument exists), 2) establish the dimensional structure, 3) reduce items per dimension, 4) value and model health state utilities. Thirty-nine instruments used a type of Rasch model and two instruments used IRT models in phase 3.

Conclusion

We present an expanded framework that outlines the development of CSPBIs, both from existing non-preference-based instruments and de novo when no suitable non-preference-based instrument exists, using IRT and Rasch analysis. For items that fit the Rasch model, developers selected one item per dimension and explored item response level reduction. This framework will guide researchers who are developing or assessing CSPBIs.
Breastfeeding mother’s experiences with breastfeeding counselling: a qualitative study
Authors: Hamnøy Ingvild Lande , Kjelsvik Marianne , Baerug Anne Bergljot , Dahl Berit Misund
Published: May 2024

Background

Mothers are recommended to breastfeed their children but can find it challenging and experience breastfeeding problems. Qualified breastfeeding counselling from healthcare professionals can help mothers master breastfeeding, but there is a need to explore mothers’ lived experiences with receiving breastfeeding counselling. We aimed to reveal breastfeeding mothers’ experiences with receiving breastfeeding counselling from midwives and public health nurses (PHNs) to provide a deeper insight into the phenomenon of breastfeeding counselling, which may improve breastfeeding counselling in practice.

Methods

A qualitative design with a hermeneutic phenomenological approach was used. Individual interviews of 11 breastfeeding mothers from Norway were conducted from September 2021 to 2022. Van Manen’s guided existential inquiry guided the reflective process to provide deeper insights into the phenomenon of breastfeeding counselling.

Results

The study captured the meaning of breastfeeding mothers’ lived experiences with breastfeeding counselling. Three themes and eight sub-themes were found. Breastfeeding was at stake for the mothers because breastfeeding could be reduced or stopped, and qualified breastfeeding counselling from midwives and PHNs was essential for them to establish and continue breastfeeding. They needed to be perceived as both breastfeeding mothers and as women with their own needs to master everyday life during the breastfeeding period.

Conclusions

This study offers insights to midwives, PHNs and others offering breastfeeding counselling by facilitating an understanding of being a breastfeeding mother receiving breastfeeding counselling. Qualified breastfeeding counselling and a trusting relationship with midwives and PHNs are essential for mothers to establish and continue breastfeeding, while deficient counselling may cause breastfeeding difficulties. Mothers need to be treated as whole and competent persons to avoid objectification and fathers/partners need to be included in breastfeeding counselling. The ‘Baby-Friendly Hospital Initiative’ should be continued, and guidelines should align with the mothers’ need to incorporate breastfeeding into their daily lives during the breastfeeding period.
Astaxanthin-mediated Nrf2 activation ameliorates glucocorticoid-induced oxidative stress and mitochondrial dysfunction and impaired bone formation of glucocorticoid-induced osteonecrosis of the femoral head in rats
Authors: Wang Weidan , Jiang Hongyi , Yu Jiachen , Lou Chao , Lin Jian
Published: May 2024

Background

Osteonecrosis of the femoral head caused by glucocorticoids (GIONFH) is a significant issue resulting from prolonged or excessive clinical glucocorticoid use. Astaxanthin, an orange-red carotenoid present in marine organisms, has been the focus of this study to explore its impact and mechanism on osteoblast apoptosis induced by dexamethasone (Dex) and GIONFH.

Methods

In this experiment, bioinformatic prediction, molecular docking and dynamics simulation, cytotoxicity assay, osteogenic differentiation, qRT-PCR analysis, terminal uridine nickend labeling (TUNEL) assay, determination of intracellular ROS, mitochondrial function assay, immunofluorescence, GIONFH rat model construction, micro-computed tomography (micro-CT) scans were performed.

Results

Our research demonstrated that a low dose of astaxanthin was non-toxic to healthy osteoblasts and restored the osteogenic function of Dex-treated osteoblasts by reducing oxidative stress, mitochondrial dysfunction, and apoptosis. Furthermore, astaxanthin rescued the dysfunction in poor bone quality, bone metabolism and angiogenesis of GIONFH rats. The mechanism behind this involves astaxanthin counteracting Dex-induced osteogenic damage by activating the Nrf2 pathway.

Conclusion

Astaxanthin shields osteoblasts from glucocorticoid-induced oxidative stress and mitochondrial dysfunction via Nrf2 pathway activation, making it a potential therapeutic agent for GIONFH treatment.
Impact of “hypotension on arrival” on required surgical disciplines and usage of damage control protocols in severely injured patients
Authors: Witzenhausen Moritz , Hossfeld Björn , Kulla Martin , Beltzer Christian
Published: May 2024

Background

For trauma patients with subsequent immediate surgery, it is unclear which surgical disciplines are most commonly required for treatment, and whether and to what extend this might depend on or change with “hypotension on arrival”. It is also not known how frequently damage control protocols are used in daily practice and whether this might also be related to “hypotension on arrival”.

Methods

A retrospective analysis of trauma patients from a German level 1 trauma centre and subsequent “immediate surgery” between 01/2017 and 09/2022 was performed. Patients with systolic blood pressure > 90 mmHg (group 1, no-shock) and < 90 mmHg (group 2, shock) on arrival were compared with regard to (a) most frequently required surgical disciplines, (b) usage of damage control protocols, and (c) outcome. A descriptive analysis was performed, and Fisher’s exact test and the Mann‒Whitney U test were used to calculate differences between groups where appropriate.

Results

In total, 98 trauma patients with “immediate surgery” were included in our study. Of these, 61 (62%; group 1) were normotensive, and 37 (38%, group 2) were hypotensive on arrival. Hypotension on arrival was associated with a significant increase in the need for abdominal surgery procedures (group 1: 37.1 vs. group 2: 54.5%; p = 0.009), more frequent usage of damage control protocols (group 1: 59.0 vs. group 2: 75.6%; p = 0.019) and higher mortality (group 1: 5.5 vs. group 2: 24.3%; p 0.027).

Conclusion

Our data from a German level 1 trauma centre proof that abdominal surgeons are most frequently required for the treatment of trauma patients with hypotension on arrival among all surgical disciplines (> thoracic surgery > vascular surgery > neurosurgery). Therefore, surgeons from these specialties must be available without delay to provide optimal trauma care.
Predicting outcome after aneurysmal subarachnoid hemorrhage by exploitation of signal complexity: a prospective two-center cohort study
Authors: Bögli Stefan Yu , Olakorede Ihsane , Veldeman Michael , Beqiri Erta , Weiss Miriam , Schubert Gerrit Alexander , Willms Jan Folkard , Keller Emanuela , Smielewski Peter
Published: May 2024

Background

Signal complexity (i.e. entropy) describes the level of order within a system. Low physiological signal complexity predicts unfavorable outcome in a variety of diseases and is assumed to reflect increased rigidity of the cardio/cerebrovascular system leading to (or reflecting) autoregulation failure. Aneurysmal subarachnoid hemorrhage (aSAH) is followed by a cascade of complex systemic and cerebral sequelae. In aSAH, the value of entropy has not been established yet.

Methods

aSAH patients from 2 prospective cohorts (Zurich—derivation cohort, Aachen—validation cohort) were included. Multiscale Entropy (MSE) was estimated for arterial blood pressure, intracranial pressure, heart rate, and their derivatives, and compared to dichotomized (1–4 vs. 5–8) or ordinal outcome (GOSE—extended Glasgow Outcome Scale) at 12 months using uni- and multivariable (adjusted for age, World Federation of Neurological Surgeons grade, modified Fisher (mFisher) grade, delayed cerebral infarction), and ordinal methods (proportional odds logistic regression/sliding dichotomy). The multivariable logistic regression models were validated internally using bootstrapping and externally by assessing the calibration and discrimination.

Results

A total of 330 (derivation: 241, validation: 89) aSAH patients were analyzed. Decreasing MSE was associated with a higher likelihood of unfavorable outcome independent of covariates and analysis method. The multivariable adjusted logistic regression models were well calibrated and only showed a slight decrease in discrimination when assessed in the validation cohort. The ordinal analysis revealed its effect to be linear. MSE remained valid when adjusting the outcome definition against the initial severity.

Conclusions

MSE metrics and thereby complexity of physiological signals are independent, internally and externally valid predictors of 12-month outcome. Incorporating high-frequency physiological data as part of clinical outcome prediction may enable precise, individualized outcome prediction. The results of this study warrant further investigation into the cause of the resulting complexity as well as its association to important and potentially preventable complications including vasospasm and delayed cerebral ischemia.
The benefits of leisure activities on healthy life expectancy for older people with diabetes
Authors: Huang I-Wen , Weng Shao-Jen , Liao Cheng-Hsi , Xu Yeong-Yuh , Hsieh Liang-Po , Liu Shih-Chia , Tsai Yao-Te
Published: May 2024

Purpose

The purpose of this study is to examine whether leisure activities can help reduce years lived with disability and increase healthy life expectancy of diabetics aged 50 years and above.

Methods

Analysis was based on five waves of follow-up survey data (Taiwan Longitudinal Study of Aging, TLSA) from 1996 to 2011. A total of 5131 participants aged 50 years and above in 1996 were included in the analysis, and gender, leisure activity participation, and diabetes mellitus were used as primary variables to examine the variation trend in health status in the participants. The health status in the various waves of surveys was measured using the activities of daily living scale, and nondisabled was defined as healthy. A multivariate logistic regression model was used to calculate the life expectancy (LE) and healthy life expectancy (HLE) of the people aged 50 years and above.

Results

The diabetes older people with a high frequency of leisure activities have longer HLE than those with lower activity frequency. Using 50-year-old diabetic women as an example, the LE (HLE) of those with six or more leisure activities and those with three or fewer leisure activities was 30.40 (25.34) and 24.90 (20.87), respectively. The LE (HLE) of men with the same conditions was 24.79 (22.68) and 20.30 (18.45), respectively.

Conclusions

This study used life expectancy and healthy life expectancy as markers to evaluate health benefits and provided evidence that leisure activities can help extend the life span and maintain the health status of middle-aged and older diabetics.
A phase I/II clinical trial of ex-vivo expanded human bone marrow derived allogeneic mesenchymal stromal cells in adult patients with perianal fistulizing Crohn’s Disease
Authors: Swaroop Shekhar , Vuyyuru Sudheer Kumar , Kante Bhaskar , Kumar Peeyush , Mundhra Sandeep Kumar , Arora Umang , Goyal Ankur , Kandasamy Devasenathipathy , Sharma Raju , Kabilan Kavirajan , Kedia Saurabh , Dash Nihar Ranjan , Ahuja Vineet
Published: May 2024

Background

Perianal fistulas (PF) affect one-third patients with Crohn’s disease (CD) with limited therapeutic options. There is dearth of literature on safety and efficacy of bone marrow-derived mesenchymal stromal cells (BMSCs) in this population.

Methods

An open-label, phase I/II, single-arm study was conducted involving local administration of human allogeneic bone marrow-derived mesenchymal stromal cells in perianal fistula of patients with Crohn’s disease refractory to standard therapies. Clinical severity and biomarkers were assessed at baseline and periodically until week 104 , and MRI at week 24 and 104. Primary and secondary objectives were to assess safety and efficacy respectively. Fistula remission was complete closure of fistula openings with < 2 cm perianal collection on MRI, and fistula response was decrease in drainage by ≥ 50%. Change in perianal disease activity index, quality-of-life and Van Assche index on MRI over time was assessed using mixed-effect linear regression model.

Results

Ten patients (male:8, mean age:27.4 ± 12.0years) were recruited. Self-resolving procedure-related adverse events occurred in three patients, with no follow-up adverse events. In intention to treat analysis at week 24, two patients (20%) achieved fistula remission and seven (70%) had fistula response. At week 52, two (20%) patients were in remission and seven (70%) maintained response. At 104 weeks, two (20%) patients maintained response and one (10%) was in remission. Statistically significant decrease in perianal disease activity index (P = 0.008), Van Assche Index (P = 0.008) and improvement in quality-of-life (P = 0.001) were observed over time.

Conclusions

Allogeneic BMSCs are safe and effective for the treatment of perianal fistulizing CD with significant improvement in clinical severity and radiological healing.

Trial registration

The study was prospectively registered on Clinical trials registry – India (CTRI), CTRI/2020/01/022743 on 14 January 2020, http://ctri.nic.in.
A bizarre synthesized cascaded optimized predictor (BizSCOP) model for enhancing security in cloud systems
Authors: Menezes R. Julian , Jayarin P. Jesu , Sekar A. Chandra
Published: May 2024

Due to growing network data dissemination in cloud, the elasticity, pay as you go options, globally accessible facilities, and security of networks have become increasingly important in today's world. Cloud service providers, including AWS, Azure, GCP, and others, facilitate worldwide expansion within minutes by offering decentralized communication network functions, hence providing security to cloud is still remains a challenging task. This paper aims to introduce and evaluate the Biz-SCOP model, a novel intrusion detection system developed for cloud security. The research addresses the pressing need for effective intrusion detection in cloud environments by combining hybrid optimization techniques and advanced deep learning methodologies. The study employs prominent intrusion datasets, including CSE-CIC-IDS 2018, CIC-IDS 2017, and a cloud intrusion dataset, to assess the proposed model's performance. The study's design involves implementing the Biz-SCOP model using Matlab 2019 software on a Windows 10 OS platform, utilizing 8 GB RAM and an Intel core i3 processor. The hybrid optimization approach, termed HyPSM, is employed for feature selection, enhancing the model's efficiency. Additionally, an intelligent deep learning model, C2AE, is introduced to discern friendly and hostile communication, contributing to accurate intrusion detection. Key findings indicate that the Biz-SCOP model outperforms existing intrusion detection systems, achieving notable accuracy (99.8%), precision (99.7%), F1-score (99.8%), and GEO (99.9%). The model excels in identifying various attack types, as demonstrated by robust ROC analysis. Interpretations and conclusions emphasize the significance of hybrid optimization and advanced deep learning techniques in enhancing intrusion detection system performance. The proposed model exhibits lower computational load, reduced false positives, ease of implementation, and improved accuracy, positioning it as a promising solution for cloud security.