bluuebunny/crossref_metadata_2025 huggingface dataset:
Barriers to Transanal Endoscopic Surgery Referral in Canada
Authors: Raskin Robert , Neumann Katerina , Jones Jennifer
Published: October 2023

Backgroud:
Transanal endoscopic surgery (TES) is a minimally invasive procedure that allows for full thickness local excision of adenomas and select early rectal adenocarcinomas. Despite its advantages, TES is not uniformly utilized across Canada.
Methods
Potential barriers to TES referral were explored via a survey distributed to endoscopists across Canada, using a stratified sampling method.
Results
In total, 199/501 endoscopists completed our survey, including 62 (31%) gastroenterologists and 136 (69%) surgeons, consistent with a 39% response rate. For patients with clear and unclear indications for TES, 30/146 (27%) and 64/146 (44%) of referring endoscopists have a low referral rate, respectively. On univariable analysis, factors associated with low referral rate include lack of confidence with indications for TES [OR 9.9 (CI 3.15–31.4) p < 0.001], poor understanding regarding the advantages of TES [OR 11.3 (CI 3.83–33.1) p < 0.001], low comfort with referring [OR 183.7 (CI 21.9-1537.5) p < 0.001], distance greater than one hour from a TES surgeon [OR 5.786 (CI 2.63–12.8) p < 0.001] and lack of access to TES [OR 7.8 (CI 3.34-18.0) p < 0.001]. Gastroenterologists are more likely to have a low referral rate than surgeons [OR 2.76 (CI 1.30–5.8) p < 0.01]. On multivariable analysis, low comfort with referring [OR 67.4 (CI 5.8-779.8) p < 0.001] and greater distance to a TES surgeon [OR 4.5 (CI 1.17–16.9 p < 0.001)] remained independently associated with low referral rate. Provinces with a population of > 1 million [OR 3.66 (CI 1.49-9.0) p < 0.01], academic practice settings [OR 3.05 (CI 1.29–7.3) p < 0.05], and surgeon endoscopists [OR 4.5 (CI 1.68, 12.1) p < 0.01] were all independently associated with greater TES accessibility.
Conclusions
Many patients who are potentially eligible for TES are not being referred for consideration. An educational gap regarding indications, lack of comfort among referring physicians and geographic inaccessibility are among the greatest barriers to referral.
Quantifying Site Burden to Optimize Protocol Performance
Authors: Florez Maria , Smith Zachary Peter , Olah Zachary , Martin Mike , Getz Kenneth
Published: October 2023

Background:
The increase in protocol complexity—and the resulting rise in the effort required by investigative sites to implement protocols has been well documented, but existing measures of site burden only offer an incomplete view of the burden experienced by site personnel. The introduction of Decentralized Clinical Trials – trials supported by remote and virtual technologies and services – is expected to impact the burden imposed on sites, but this impact has not yet been systematically measured.
Methods:
The Tufts Center for the Study of Drug Development conducted an online survey among clinical research sites worldwide and gathered 355 responses assessing the burden associated with distinct activities and procedures related to the implementation of clinical trial protocols using traditional and decentralized approaches.
Results:
A high percentage of investigative sites (50.5%) have had no experience with DCT solutions and only a small percentage (6.6%) have participated in fully decentralized clinical trials. Overall, half of respondents view DCT solutions as more burdensome than traditional clinical trials. In general, activities related to operational and managerial aspects of trial implementation were viewed as less burdensome when done remotely, while clinical procedures or elements that require study team-patient interactions are viewed as more burdensome when using DCT approaches versus in-person or traditional methods.
Multiple isotopes reveal the nitrate sources in Aojiang River Basin, Eastern China
Authors: Li Jiangnan , Sun Qianhang , Cui Liang , Lei Kun
Published: October 2023

Excessive levels of nitrate (NO3−) in water pose a significant environmental challenge on a global scale. Hence, it is of utmost importance to determine the sources of NO3−and evaluate their corresponding contributions as a means to improve aquatic quality. To address this issue, a recent research undertaking was conducted in the Aojiang River basin located in Eastern China. The study involved the collection of surface water samples throughout both the dry and wet seasons. Various hydrochemical indicators, along with dual NO3−isotopes (δ15N–NO3−and δ18O–NO3−), were utilized to determine the sources of NO3−contamination and assess the relative contributions made by various sources. The findings revealed that nitrification, a process involving the conversion of nitrogen, was the primary nitrogen transformation mechanism within the study area throughout the sampling period. According to the isotopic analysis of NO3−, it was revealed that the primary contributors to the elevated NO3−were manure and sewage (M&S), soil nitrogen (SN), and nitrogen fertilizer (NF). Furthermore, the results obtained from the MixSIAR model, a Bayesian model that employs stable isotope analysis within the R software, demonstrated that the proportional contributions of atmospheric deposition (AD), NF, M&S, and SN to NO3−were 2.84%, 19.63%, 44.67%, and 34.87%, respectively, during the dry season. In the wet season, the corresponding contributions were 3.61%, 22.32%, 32.37%, and 41.70%, respectively. This study serves as valuable evidence for advancing our understanding of the sources, transport, and transformation of nitrogen in the Aojiang River basin, thereby facilitating improved management strategies for nitrogen contamination.
Economic growth and healthy eating: some international evidence and implications for emerging countries
Authors: García Carlos J. , González Wildo
Published: October 2023

We analyze the effects of healthy eating on productivity. By using panel data economet-rics (PV AR), we find the impact on productivity is positive and statistically significant worldwide, but it follows a Kuznets curve: its effect decreases as countries’ income increases. Below, in a highly stylized model of economic growth, we show that this productivity impact more than doubles economic growth in a representative emerging economy. The improvement in workers’ health is transmitted throughout the economy, favoring especially the owners of capital and, to a lesser extent, workers with more labor and wages.
JEL Codes: I15; O47; O57.
Development and Validation of the Physical Exercise Program “Active Mums” for Postpartum Recovery. Qualitative study with application of the CReDECI-2 Guidelines
Authors: Brites-Lagos Carla , Maranhão Cristiana , Szumilewicz Anna , Santos-Rocha Rita
Published: October 2023

Postnatal physical activity is a public health issue. Reporting on the quality of exercise interventions designs must be ensured in view of the reproducibility and successful implementation of such studies. The objective was to develop and validate a physical exercise program for postpartum recovery, aiming to promoting physical fitness and health of the new mothers. A qualitative pilot study was carried out through the three stages of development, piloting, and evaluation. The Consensus on Exercise Reporting Template (CERT) was used to describe the postpartum exercise program. The Criteria for Reporting the Development and Evaluation of Complex Interventions in Healthcare (CReDECI2) was followed to validate the program. A tailored postpartum exercise program was designed and validated based on evidence-based international recommendations to be implemented by qualified exercise professionals. A pilot intervention of 16 weeks was carried out, engaging a group of postpartum women. The viability of the program was subsequently evaluated by all participants. The presented intervention can assist exercise specialists, health professionals and researchers in the planning, promoting, and implementation of an exercise program for postpartum recovery.
Evaluation of cardiac biomarkers among dead and alive COVID-19 patients in Southwest Iran
Authors: Adel Seyed Mohammad Hassan , Sardabi Ebrahim Heydari , Akiash Nehzat , Mohammadi Mohammad , Sayadian Mona , pour Sanaz Saki , Amini Payam
Published: October 2023

Introduction:
The need to understand the global burden of heart failure following the pandemic has arisen as a result of an increase in papers that support cardiac involvement in coronavirus disease 2019 (COVID-19). Therefore, the current study aims to provide a more thorough explanation of the function and use of cardiac biomarkers in dead and alive COVID-19 patients.
Methods
All patients who were referred and admitted to Razi Hospital, Ahvaz, Iran, from March 2020 to March 2021 with a diagnosis of COVID-19 were included in this study.
Results
During the study period, 753 patients were hospitalized with a diagnosis of COVID-19. In total, 157 cases died from the disease (case fatality rate: 20.84%). Pre-existing cerebrovascular accidents (CVAs) were more frequent in dead cases (14% vs. 6.4%). It was observed that atrial fibrillation was normal in most of the alive cases in comparison to dead patients (p-value = 0.014). Moreover, it was seen that CRP, IL-6, and procalcitonin were increased in dead patients. Also, an association was found between ejection fraction (EF) value and death rate (P-value = 0.035). The higher frequency of positive troponin occurring in the dead group suggested a possible adverse effect on the mortality rate (22.3% vs. 16.4%).
Conclusion
Adults with COVID-19 commonly had cardiac manifestations, including symptoms of myocardial damage. In light of the recognized utility of troponin, ejection fraction, procalcitonin, IL-6, and CRP in COVID-19 patients with suspected myocardial damage, we should develop a safe and precise diagnostic algorithm that may contain patients’ clinical histories and additional variables that may facilitate the prediction of myopericarditis.
Single nucleus RNA-sequencing study revealed expansion of Gpnmb+ microglia in aged mouse spinal cord
Authors: Gao Yajing , Zhang Ziyan , Guo Wuyier , Qian Peipei , Xie Gangcai
Published: October 2023

Neurodegenerative diseases tend to occur later in life, and studies of central nervous system (CNS) aging could deepen our understanding of those diseases. In this study, we profiled the transcriptomes of 71,144 spinal cord cells from both of young and old mice, and identified 1, 215 aging-associated differentially expressed genes, including up regulation of C4b and Gfap. Interestingly, we observed significant expansion of DAM (Disease-Associated Microglia)/ATM (Axon Tract-Associated Microglia)-like Gpnmb+ microglia in old spinal cord, which were enriched with DAM/ATM marker genes of Gpnmb, Spp1, Lpl, Igf1, Itgax, Lgals3, Apoe and displayed highest enrichment with senescent genes. Furthermore, we also discovered 619 age-associated Ligand-Receptor Interaction changes and revealed 1277 age-related DEGs in 30 neuronal subpopulations. Overall, our study provided the first single-cell transcriptomic study of mouse spinal cord aging, and our finding of age-related expansion of Gpnmb+ microglia could have potential implications for the treatment of associated CNS diseases.
Investigation of different parameters on nonlinear dynamic behaviors of vertical rotor system supported by aerostatic bearings
Authors: qiu shun , Ke Changlei , Li Kongrong , Shi Ningyu , Zhang Xiaohua , Dong Bin , Peng Nan , Xiong Lianyou , Liu Liqiang
Published: October 2023

A common issue associated with gas bearings is the tendency to generate self-excited vibrations, leading to instability. In this paper, the fluid-structure coupling dynamic model of aerostatic bearing-rotor system is established to address this problem, and a hybrid method including the finite difference method and direct integration method are employed to simultaneously solve the transient Reynolds equation and rotor dynamic equation. Furthermore, based on the orbit of rotor center, frequency spectrum diagram, Poincaré map, waterfall diagram and bifurcation diagram, the effects of rotational speed, rotor mass, orifice diameter and bearing clearance on the nonlinear dynamic behaviors of the bearing-rotor system are investigated. The results reveal that the system has abundant nonlinear behavior with the increasing of rotational speed and rotor mass, including typical half-speed whirl. But the nonlinear vibration of the system can be restricted by selecting appropriate bearing structural parameters, which can provide the theoretical guidance for the design of the aerostatic bearing-rotor system.
Plasma Phosphoethanolamine Levels as a Biomarker for Monitoring Major Depressive Disorder
Authors: Kawamura Noriyuki , Nakata Akinori , Harada Tsuyoto , Ohashi Yoshiaki , Sato Hajime , Sasaki Kazunori , Higuchi Teruhiko
Published: October 2023

This study is the first to identify a promising candidate monitoring biomarker for major depressive disorder (MDD), plasma phosphoethanolamine (PEA) concentrations. A naturalistic observational study in clinical psychiatry was conducted with Japanese subjects between 2011 and 2020. Out of the 576 patients, 295 had depressive disorders, 264 had psychiatric disorders other than depression, and 17 had physical disorders without psychiatric disorders. In 170 patients with MDD only, in whom remission was easily identified, plasma PEA levels were measured at two or more time points. These levels dropped significantly in depressive episodes, increased as remission approached and were significantly higher in remission. Psychiatric diagnosis alone explained 38% of the variance in plasma PEA concentrations. Receiver operating characteristic (ROC) curve analysis also showed sufficient discriminatory power to detect depression, with an area under the curve (AUC) of 0.84 (95% confidence interval (CI): 0.80-0.87). Further researches are needed.
High neutrophil-lymphocyte ratio indicates a worse response to ursodeoxycholic acid in primary biliary cholangitis: a retrospective cohort study
Authors: Zhu Huiling , Zheng Mengyao , He Haiyu , Lei Hongtao , Tai Wenlin , yang jinhui
Published: October 2023

Background: Primary biliary cholangitis (PBC) is a chronic cholestatic liver disease characterized by inflammation of the interlobular bile ducts. Ursodeoxycholic acid (UDCA) is the only FDA approved first-line therapy for PBC, but up to 40% of patients with PBC have an incomplete response to UDCA. Neutrophil-to-lymphocyte (NLR) has been used to predict prognosis in various liver diseases. There is limited evidence on the treatment response to UDCA in PBC patients. The aim of this study was to elucidate the changes in NLR in response to one-year UDCA treatment of PBC patients.
Methods:A total number of 257 primary biliary cholangitis (PBC) patients treated with UDCA (13–15 mg/kg/d) were enrolled in this retrospective study. The response to treatment was evaluated based on alkaline phosphatase levels < 1.67 times the upper limit of the normal value after 12 months of UDCA treatment. Multivariable logistic regression analysis was performed to investigate the association between NLR at baseline and the response to 12- month UDCA treatment after adjusting for important confounding variables. The quartiles of increased baseline NLR was assessed as a predictor of future nonresponse to UDCA treatment. The stability of the results was evaluated by unadjusted and adjusted models.
Results: The result of multiple regression analysis showed that NLR at baseline was positively associated with the nonresponse to UDCA treatment after adjustments for potential confounders (age, sex, BMI, hypertension, arterial plaque,thyroid disease, jaundice, albumin, globulin, total bile acid, ALP, GGT, LDLC, total cholesterol, hemoglobin, and APTT) (OR = 1.370, 95% CI 1.066-1.761). When NLR was translated into a categorical variable, the OR and 95% CI in the fourth quartile versus the first quartile was OR = 3.782, 95% CI 1.094-13.073, respectively (P for trend = 0.036). These results reveal that NLR is an independent risk factor of UDCA treatment nonresponse.
Conclusions: Our results suggest that NLR is an independent risk factor of UDCA treatment nonresponse.
The Effects of Lockdown during the Covid Pandemic on Fetal Movement Profiles
Authors: Reissland N. , Ustun Beyza , Einbeck J.
Published: October 2023

Purpose
The current study aimed to investigate the direct impact of the Covid-19 lockdown on fetal movements, addressing a critical research gap. While previous research has predominantly examined the effects of lockdown on maternal health and postnatal outcomes, little attention has been paid to the direct consequences on fetal well-being.
Methods
We conducted a comparative analysis of movement profiles in 20 healthy fetuses during the Covid-19 pandemic lockdown (third national UK lockdown period between January and March 2021) and compared them with 20 healthy fetuses from pre-covid pregnancies, all at 32 weeks gestation. We controlled for maternal stress, depression, and anxiety.
Results
Pregnant mothers during pre-covid compared with those during the Covid-19 lockdown reported similar levels of stress (p = 0.47), depression (p = 0.15), and anxiety (p = 0. 07). Their fetuses, however, differed in their movement profiles with mouth movement frequencies significantly higher during Covid-19 lockdown (Covid-19 lockdown: mean of 5.909; p = 0.029) being compared to pre-Covid pregnancies (mean of 3.308). Controlling for maternal anxiety a regression analysis indicated that fetal mouth movements (p = 0.017), upper face movements (p = 0.008), and touch movements (p = 0.031) were all significantly higher in fetuses observed during lockdown compared to fetuses before the Covid period.
Conclusion
Fetuses show an effect of lockdown independent of maternal anxiety, stress, or depression. These findings contribute to our understanding of fetal development during extraordinary circumstances, raising questions about the potential effects of reduced light exposure and its implications for maternal thyroid function during lockdowns.
Robotic- vs laparoscopic-assisted proctectomy: short-term efficacy and long-term outcomes at a colorectal center in China
Authors: Liu Dunbo , Guo Fangliang , Sun Zhiwei , Zhang Qianshi , Ren Shuangyi
Published: October 2023

Background
The latest statistics indicate a gradual increase in the incidence of rectal cancer, with approximately 60–70% of patients being diagnosed at an advanced stage. Presently, robot-assisted surgery is extensively performed in numerous countries worldwide. To evaluate the short-term efficacy and long-term outcomes of Da Vinci robot in patients with middle and low rectal cancer.
Methods
A case series analysis was conducted on 235 patients with middle and low rectal cancer who were admitted to the First Department of Gastrointestinal Surgery, the Second Affiliated Hospital of Dalian Medical University from January 2020 to March 2023. They were divided into Da Vinci robot-assisted proctectomy group and 3D laparoscopic-assisted proctectomy group, with 125 patients in robot-assisted proctectomy group and 110 patients in 3D laparoscopic-assisted proctectomy group.
Results
Baseline data, perioperative outcomes, morbidity, pathological data, as well as 3-year overall survival and disease-free survival rates were analyzed and compared between the two groups. Intraoperative blood loss was significantly lower in the robot-assisted proctectomy group while hospitalization cost was higher (P < 0.05). No significant differences were observed in exhaust time, catheter removal time, indentation catheter time, postoperative complications or number of lymph nodes dissection between the two groups (P > 0.05). After a follow-up period of 40 months, there were no significant differences in local recurrence, distant metastasis, sexual dysfunction, urinary dysfunction or disease-free survival and overall survival rates (P > 0.05).
Conclusion
Robot-assisted proctectomy is a safe and feasible treatment option for rectal cancer with comparable short-term oncological results.
Degradation of direct black 22 textile dye using the photo-Fenton and electro-Fenton processes: a comparative study
Authors: Santana Ingrid L. da S. , Silva Marina G. , Ourem Gabriel P. , Neves Naiana S. da C. S. , Cavalcanti Vanessa de O. M. , Lucena Alex L. de A. , Duarte Marta M. M. B. , Napoleão Daniella Carla
Published: October 2023

The dyes present in textile effluents have a complex structure and low biodegradability, making it necessary to use efficient treatments such as advanced oxidation processes (AOP). The aim of this study was to compare the efficiency of photo-Fenton (PF) and electro-Fenton (EF) AOPs in the degradation of direct black dye 22 (PD22), defining the best experimental conditions and evaluating the kinetics and toxicity of the proposed treatments. Initially, for the PF system, using UV-C and sunlight radiation, 99.08% and 99.98% degradations were reached, respectively for [H2O2] = 20 mg·L− 1 and [Fe] = 1.0 mg·L− 1. From the volume variation study, it was observed that the increase in volume did not compromise the degradation of the dye. For the EF process, the [Fe] that promoted the highest percentage of degradation (95.16%) was equal to 1 mg·L− 1. The volume study for the EF process also did not interfere significantly in the efficiency of the process. The PF and EF systems presented satisfactory adjustments to the proposed kinetic models, suggesting that the treatment follows a pseudo-first-order kinetics. The ecotoxicological tests showed no toxicity for the thyme seed after using the EF process. Therefore, it is evident that different AOP techniques can be applied in the treatment of PD22.
Hospital Overcrowding and Care of Stroke Patients. Irish National Audit of Stroke
Authors: Harbison Joseph , McCormack Joan , Brych Olga , Collins Ronan , Cassidy Tim
Published: October 2023

Introduction: Hospital overcrowding where patient admissions exceed capacity is associated with worse outcomes in Emergency Department. Developments in emergency stroke care have been associated with improvements in stroke outcome but are dependent on effective, organised care. We examined if overcrowding in the hospital system was associated with negative changes in stroke outcome.
Methods Data on overcrowding were obtained from the Irish Nurses and Midwives Organisation (INMO) ‘Trolley Count’ database recording the number of patients cared for on trolleys/chairs in all acute hospitals each midnight. These were compared with quarterly data from the Irish National Audit of Stroke from 2013 to 2021 inclusive. Variables analysed were inpatient mortality rate, thrombolysis rate for ischaemic stroke, median door to needle time and median length of stay.
Results: 579449 patient episodes were recorded by Trolley Watch over the period, (Quarterly Median 16719.5, range 3389-27015). Average Quarterly Thrombolysis rate was 11.3% (sd 1.3%) Median Quarterly Inpatient Mortality rate was 11.8% (Range 8.9%-14.0%). Median Quarterly Length of stay was 9 days (8-11 days). Median quarterly door to needle was 65 minutes (45-80 minutes). Q1 was typically the worst for overcrowding with on average 19777 incidences (sd 4786). This was significantly higher than for Q2 (mean 13540 (sd 4785) p =0.005 t-test) and for Q3 (mean 14542 (sd 4753) p=0.03). No significant correlation was found between quarterly Trolley watch episodes and inpatient mortality (r=0.084, p=0.63), median length of stay r=-0.15, p= 0.37) or thrombolysis rate (r=0.089 p=0.61). There was an unexpected significant negative correlation between trolley watch data and median door to needle time (r=-0.36, p=0.03).
Conclusion. Despite increasing hospital overcrowding, stroke services still managed to preserve standard of care. We could find no association between levels of overcrowding and deterioration in selected indices of patient care
Bridging the Intention–Behavior Gap in eHealth Use among Chinese Medical Students: The Role of Trust and Privacy Risk Perception
Authors: Meng Yao , Zhu Junhua , Yang Rumei , Jiang Yun
Published: October 2023

Background
eHealth utilizes technology to enhance healthcare services, but its adoption is hindered by the intention-behavior gap (IBG). It is important to understand the intention-behavior use of eHealth among medical students, who can play a significant role in the promotion of eHealth use.
Objective
1) whether there is an IBG in eHealth use among Chinese medical students; 2) whether intuitive (e.g., trust in eHealth information) and deliberate (e.g., eHealth literacy) processes are mediators in the intention-behavior use of eHealth, and 3) how the motivation processes (e.g., privacy risk perception of eHealth) potentially moderate the eHealth use intention and intuitive or deliberate processes relationship.
Methods
All measures were self-reported by 363 Chinese medical students. SPSS macro-PROCESS was used to explore mediation and moderation effects between the intention to use and actual use of eHealth.
Results
Only 22% of students who reported eHealth use intention used eHealth services, particularly telemedicine. Trust in eHealth information mediated the relationship between use intention and actual use of eHealth (95% CI [0.003, 0.048]). Privacy risk perception of eHealth moderated this mediation relationship (95% CI [0.09, 0.009]). However, eHealth literacy did not mediate the relationship between use intention and actual use of eHealth.
Conclusion
The association between Chinese medical students’ eHealth use intention and actual eHealth use is partially mediated by their trust in eHealth information, which is moderated by their privacy risk perceptions. Enhancing students’ trust in eHealth information and reducing their concerns about privacy risks can be integrated into future medical training programs.
Acute Coronary Syndrome patterns in the Young: risk factor profile and in-hospital outcome in a tertiary referral hospital in Kenya
Authors: kassam Nadeem , Varwani Mohamed , Ngunga Mzee , Msunza Miriam , Mohamed Jeilan
Published: October 2023

Introduction
Acute coronary syndrome (ACS) accounts for coronary artery disease–related morbidity and mortality. There has been growing concern about the rising incidence of ACS among young adults globally both in developed and developing countries, including Sub Saharan Africa. This groups phenotypic characteristics; risk factors and clinical outcomes are not well described. Contextual and regional studies are necessary to understand the magnitude of ACS among young Individuals and help highlight challenges and opportunities for improved ACS outcomes in the region. The study aimed to describe the characteristics of young individuals hospitalized with ACS and report on in-hospital outcomes.
Methodology
This single-center retrospective study was conducted at the Aga Khan University Hospital, Nairobi. Medical records of young individuals hospitalized with ACS from 30th June 2020 to 1st May 2023 were reviewed. We defined young as 50 years or below. Categorical variables were reported as frequencies and proportions, and compared with chi- squared or Fisher’s exact tests. Continuous variables were reported as means or medians and compared with t-tests or Mann-Whitney U tests.
Results
Among 506 Patients hospitalized with ACS, (n= 138,27.2%) were aged 50 years and below. The study population was male (n=107, 79.9%) and African(n=82,61.2%) Predominant with a median age of 46.5 years (IQR 41.0- 50.0). Hypertension (n=101,75.4%) was noted in most study participants. More than half of the cohort were smokers (n=69,51.5%) having a family history of premature ASCVD(n=70,52.2%) and were on lipid-lowering therapy(n=68,50.7%) prior to presentation. ST-segment–elevation myocardial infarction (STEMI) was the most common clinical manifestation of ACS (n=77, 57.5%). Of the significant coronary artery disease (n=75,56.0%), majority of the individuals had single vessel disease (n=60, 80%) with a predilection of Left Anterior deciding artery(n=47,62.6%). The Main cause of ACS was atherosclerosis (n=41,54.6%). The mean left ventricular ejection fraction was 46.0 (± 12.4). The In-hospital mortality was (n= 2, 1.5%)
Conclusion
This study highlights that young patients contribute to a relatively large proportion of patients presenting with ACS at our center. The most common presentation was STEMI. Findings of this study highlight the importance of awareness campaigns and developing systems of care that enable early detection and reperfusion. Traditional cardiovascular risk factors were prevalent and thus targets of intervention.
Loss of ULK1 impairs autophagy activation, spheroid viability, and tumor progression in epithelial ovarian cancer
Authors: Webb Jack D. , Viola Lauren , Buensuceso Adrian , Borrelli Matthew J. , Valdes Yudith Ramos , Singha Bipradeb , Shepherd Trevor G.
Published: October 2023

Introduction: Epithelial ovarian cancer (EOC) remains a leading cause of gynecological cancer-related deaths due its late diagnosis and the absence of effective treatments for chemo-resistant disease. EOC metastasizes through peritoneal dissemination, often forming multicellular spheroids, in which autophagy—a cell survival mechanism—is induced, requiring ULK1 (Unc-51-like kinase 1) activity. Our study aims to further understand the role of ULK1 in EOC tumor growth and metastasis.
Methods: Using CRISPR/Cas9 technology, we ablated the ULK1 gene in EOC cell lines OVCAR8 and HEYA8, and the fallopian tube derived FT190 control line. Western blotting confirmed ULK1 loss and key autophagy markers. Autophagic flux was assessed using fluorescence microscopy and cell viability by Trypan Blue, Cell Titer-Glo, and Caspase-Glo assays. We tested sensitivity to carboplatin and paclitaxel treatments in cell culture, while bioluminescent imaging monitored tumor progression of xenograftsULK1KO. Immunohistochemistry (IHC) was performed to assess Ki67 for cell proliferation and cleaved caspase-3 for apoptosis.
Results: Our results show that ULK1 loss leads to impaired autophagy in EOC spheroids, with reduced LC3 processing and elevated p62 levels. Intriguingly, FT190 cells maintained autophagy which correlated with elevated ULK2 expression. All cell lines lacking ULK1KO had reduced spheroid cell viability and spheroid integrity. Surprisingly, ULK1 loss led to differential sensitivity to chemotherapy agents carboplatin and paclitaxel between OVCAR8 and HEYA8 cells. ULK1 deficiency reduced tumor burden in xenografted mice, although differences were observed in tumor growth rate and extent of metastasis between OVCAR8 and HEYA8 cells. Furthermore, Ki67 and cleaved caspase-3 staining revealed reduced cell proliferation and increased apoptosis respectively in tumors derived from ULK1KO cells.
Conclusions: ULK1 is required for EOC spheroid formation and cell survival while in suspension likely through its regulation of autophagy, but it may have a lesser role for autophagy regulation in precursor cells. ULK1 deficiency does not increase EOC cell sensitivity to standard-of-care chemotherapy, possibly indicating that other therapeutic strategies would be needed to synergize with autophagy inhibition for EOC treatment.. Altogether, ULK1 may have a multifaceted role in EOC beyond autophagy regulation, by contributing to early dissemination of as spheroids and establishment of secondary tumors
Sedentary Patterns and Health Outcomes in the Oldest-Old: a Latent Profile Analysis
Authors: Lebuf Elien , Dyck Delfien Van , de Velde Laura Van , Beeckman Melanie , Cauwenberg Jelle Van , Compernolle Sofie
Published: October 2023

Background. Sedentary behavior is most prevalent among those aged 80 and above. Current literature emphasizes the significance of SB patterns, but further evidence is required to understand how these patterns relate to specific health outcomes and to identify at-risk profiles for tailored interventions in the oldest old. Therefore, the aim of this study was to identify profiles of older adults based on their sedentary patterns and health outcomes, and to examine associations between profiles and socio-demographics.
Methods. A cross-sectional study was performed between February 2021 and December 2022 in Flanders, Belgium. Distinct profiles of device-based sedentary patterns and physical and cognitive functioning, mental health-related quality of life (QoL) and social isolation were identified using a latent profile analysis on data of 90 older adults (80+). Associations with socio-demographics were analyzed using one-way ANOVAs and chi2-tests.
Results. Three distinct profiles were identified: (1) the ‘cognitively and physically frail’ profile, (2) the ‘healthy’ profile and (3) the ‘lower mental health-related QoL’ profile. Those in the ‘cognitively and physically frail’ profile exhibited the least favorable sedentary pattern, and had a higher likelihood of residing in a nursing home. No significant differences were found for the other socio-demographic variables, being age, sex, educational degree and family situation.
Conclusions. Individuals with lower physical and cognitive functioning have the most unhealthy sedentary patterns, often involving prolonged bouts lasting at least one hour. Therefore, it is crucial to prioritize interventions that address and interrupt extended sedentary behavior in this subgroup.
Intermolecular interactions probed by rotational wavepackets in gas-phase clusters
Authors: Lin Kang , Lu Chenxu , Zhou Lianrong , Shi Menghang , Lu Peifen , Li Wenxue , Xu Long , Dorner Reinhard , Wu Jian
Published: October 2023

The rotational dynamics of a molecule is sensitive to neighboring atoms or molecules, which can be used to probe the intermolecular interactions in the gas phase. Here, we real-time track the laser-driven rotational dynamics of a single N2 molecule affected by neighboring Ar atoms using coincident Coulomb explosion imaging. We find that the alignment trace of N-N axis decays fast and only persists for a few picoseconds when an Ar atom is nearby. We show that the decay rate depends on the rotational geometry of whether the Ar atom stays in or out of the rotational plane of the N2 molecule. Furthermore, we investigate the quantity effect of the neighboring atoms on the rotational dynamics and find that the laser-induced alignment of the N-N axis is immediately impeded when surrounded by two Ar atoms. The observations are well reproduced by solving the time-dependent Schrödinger equation after taking the interaction potential between the N2 and Ar into consideration. Our results pave the way to probe the environmental effect on a molecular level by directly visualizing the rotational dynamics.
Effect of molecular weight on the properties and structure of biodegradable Poly-lactic acid melt-blown nonwovens
Authors: Yu JinShuo , Tian Hanlin , Wang Zepeng , Tan Zhiyong , Pan Hongwei , Zhao Yan , Zhang Huiliang , Bian Junjia
Published: October 2023

This work has successfully prepared biodegradable poly-lactic acid (PLA) melt-blown nonwovens with varying molecular weights through the process of melt spinning. To achieve a reduced molecular weight PLA, the Lewis acid Tin (II) 2-ethyl hexanoate (Sn(Oct)2) was employed for degradation. The investigation encompassed the phase morphology, rheological behavior, hydrophobicity, and crystalline characteristics of the melt-blown nonwovens. The examination of crystallization characteristics revealed that PLA molecules with lower molecular weights, comprising shorter-chain segments, exhibit enhanced mobility. Consequently, these molecules tend to crystallize more readily, resulting in a higher degree of crystallinity. Polarized optical microscopy (POM) analysis demonstrates that PLA with lower molecular weights generates the largest spherical crystal size within the same time frame. The storage modulus (G′), loss modulus (G′′), and complex viscosity |η*| were increased with the increase in molecular weight from rheological measurement. The increase in viscosity led to an increase in the distribution of melt-blown nonwoven fiber diameters, and the average diameter increased from 11.86 to 21.07 μm. Furthermore, it triggers a reduction in the water contact angle (WCA), causing it to drop from 128.9° to 114.9°.
q-Space Myelin Map: A new myelin-specific imaging technique for treatment monitoring of multiple sclerosis
Authors: Kitagawa Satoshi , Kufukihara Kenji , Motegi Haruhiko , Sekiguchi Koji , Sato Yayoi , Nakahara Jin
Published: October 2023

Background
The hallmark of multiple sclerosis (MS) is demyelination of the central nervous system. In the McDonald diagnostic criteria, hyperintense signals on T2-weighted image (so-called “T2-lesions”) by magnetic resonance imaging (MRI) can substitute for clinical findings as evidence of disease activities; however, T2 signals are theoretically non-specific for demyelination and its over-reliance may lead not only to misdiagnosis but also to the failure of accurately monitoring disease activities, hence potentially causing over or under-treatment. In order to provide a more myelin-specific modality, we have recently developed q-space Myelin Map (qMM) and preliminary reported its utility in MS patients, particularly for depicting remyelination. This current study aimed to analyze clinical factors associated with qMM-supported remyelination in a series of consecutive MS patients initiating different disease-modifying drugs (DMDs), and to examine the utility and the feasibility of qMM in daily clinical practice.
Methods
Data from sequential patients with relapsing-remitting MS (RRMS) initiating one of the following DMDs at our center were collected: interferon β (IFN β), glatiramer acetate (GA), fingolimod (FTY), dimethyl fumarate (DMF), or natalizumab (NTZ). After treatment initiation, qMM was performed at 6-month intervals and the resulting images analysed for evidence of remyelination.
Results
48 patients with RRMS were included: 22 with DMF, 14 with FTY, 4 with GA, 8 with NTZ, and 0 with IFN β. qMM revealed qMM-remyelination in 22 patients (45.8%), including 10 receiving DMF, 6 receiving FTY, 1 receiving GA, and 5 receiving NTZ. qMM-remyelination was significantly associated with younger age in the NTZ group(p = 0.036), and associated with female sex in the DMF group(p = 0.015).
Conclusions
This study demonstrated the potential clinical utility of qMM for visualizing remyelination in MS patients and fine-tuning their pharmacotherapy. Two potential clinical factors promoting qMM-remyelination were identified: female sex with DMF and younger baseline age with NTZ; a larger prospective study is warranted to confirm these results.
Research on MPPT control strategy based on CCAOA algorithm
Authors: Xiao Yiping , Shen Zongtao , Zhao Yunfeng , Jiao Hongjian
Published: October 2023

Photovoltaic (PV) arrays under partial shading conditions (PSC) can lead to multiple peaks in the power-voltage curve of PV system output. The traditional maximum power point tracking (MPPT) algorithm is difficult to solve the multi-peak problem and generally has slow convergence speed and easy fall into local optimality. To address this problem, a collaborative and cosine arithmetic optimization algorithm (CCAOA) was proposed in this paper. The cosine factor was introduced into the mathematical optimization acceleration function in traditional AOA to enhance the global search capability of the algorithm. And the circle chaotic mapping and cross-variance strategy were introduced to increase the diversity and randomness of the algorithm population. Meanwhile, a cooperative search strategy of addition and subtraction is used to strengthen the local search capability of the algorithm, thus accelerate the convergence speed of the algorithm. The effectiveness of the CCAOA is evaluated by using six typical IEEE standard test functions, and the simulation results show that compared with AOA, TSO and PSO algorithms it outperforms other algorithms in terms of convergence speed and accuracy. Appling the CCAOA into the MPPT control, the performance of MPPT control strategy based on CCAOA was verified by simulation. The simulation results illustrate that the CCAOA has better performance in tracking speed, stability and efficiency when comparing with AOA, TSO and PSO algorithms. In conclusion, the MPPT control based on CCAOA can significantly improve the power generation efficiency of PV arrays under PSC.
What is the purpose of ultra-processed food? An exploratory analysis of the financialisation of ultra-processed food corporations and implications for public health
Authors: Wood Benjamin , Robinson Ella , Baker Phillip , Paraje Guillermo , Mialon Mélissa , Tulleken Christoffer van , Sacks Gary
Published: October 2023

Background
In recent decades there has been a global rise in consumption of ultra-processed foods (UPFs) to the detriment of population health and the environment. Large corporations that have focused heavily on low-cost manufacturing and extensive marketing of UPFs to maximise profits have driven this dietary transition. The same corporations claim to serve the interests of multiple ‘stakeholders’, and that they are contributing to sustainable development. This paper aimed to test these claims by examining the degree to which UPF corporations have become ‘financialised’, focusing on the extent to which they have been prioritising the financial interests of their shareholders relative to other actors, as well as the role that various types of investors have played in influencing their governance. Findings were used to inform discussion on policy responses to improve the healthiness of population diets.
Methods
We adopted an exploratory research design using multiple methods. We conducted quantitative analysis of the financial data of U.S. listed food and agricultural corporations between 1962 and 2021, share ownership data of a selection of UPF corporations, and proxy voting data of a selection of investors between 2012 and 2022. We also conducted targeted narrative reviews using structured and branching searches of academic and grey literature.
Results
Since the 1980s, corporations that depend heavily on manufacturing and marketing UPFs to generate profits have been increasingly transferring money to their shareholders relative to their total revenue, and at a level considerably higher than other food and agricultural sectors. In recent years, hedge fund managers have had a substantial influence on the governance of major UPF corporations in their pursuit of maximising short-term returns. In comparison, investors seeking to improve population diets have had limited success, in part because large asset managers mostly oppose public health-related shareholder proposals.
Conclusions
The operationalisation of ‘shareholder primacy’ by major UPF corporations has driven inequity, and undermines their claims that they are creating ‘value’ for diverse actors. Measures that protect population diets and food systems from the extractive forces of financialisation are needed as part of efforts to improve the healthiness of population diets.
Response to COVID-19 vaccination imaged by PD-L1 PET scanning
Authors: MacManus Michael , Akhurst Tim , Lewin Sharon R , Hegi-Johnson Fiona
Published: October 2023

Background
During a phase 0 clinical trial of an investigational PD-L1 PET tracer in patients with non-small cell lung cancer (NSCLC), three patients received booster doses of COVID-19 vaccines before PD-L1 imaging. Five patients underwent whole-body PET/CT imaging with a novel PD-L1 tracer, constructed by attaching 89Zr to the anti PD-L1 antibody durvalumab. Intramuscular (deltoid) booster doses of mRNA BNT162b2 COVID-19 mRNA vaccine were coincidentally given to three patients in the month before PD-L1 tracer injection.
Results
Two recently-vaccinated patients, in remission of NSCLC and receiving nonimmunosuppressive cancer therapies (immunotherapy and tyrosine kinase inhibitor respectively), showed PD-L1 tracer uptake in ipsilateral axillary lymph nodes. No abnormal nodal uptake was seen in a third recently-vaccinated patient who was receiving immunosuppressive chemotherapy, or in two patients not recently-vaccinated.
Conclusions
Immune response to mRNA BNT162b2 vaccination appears to involve regulation by PDL1 positive immune cells in local draining lymph nodes in immunocompetent patients.
Malocclusion worsens survival following sepsis due to the disruption of the innate and acquired immunity
Authors: Fujinami Yoshihisa , Saito Masafumi , Ono Yuko , Akashi Masaya , Inoue Shigeaki , Kotani Joji
Published: October 2023

Sepsis is a major health care concern worldwide. Recently, frailty -physical, cognitive, and mental dysfunction- has been recognized as one of the poor prognostic factors for critically ill patients. Poor oral health is also recognized as an inducing factor of frailty, which is called “oral frailty.” However, few previous studies clarifies whether and how oral frailty does harm in septic condition. Therefore, we introduced an additional sepsis model into the tooth extraction mouse model to determine how malocclusion affect the immune response during sepsis. The group of sepsis with malocclusion had a significantly lower survival rate than the group of sepsis without malocclusion, and both neutrophil and T cell counts in the blood were also significantly lower. Therefore, it implies that tooth extraction impaired both innate and acquired immunity during sepsis. The implication of this study is to determine the immunological impact of tooth loss during sepsis.
Demonstration of Enhanced Long-Range Cosmic Time Synchronization for Wireless and Secure Dissemination of Standard Time
Authors: Tanaka Hiroyuki K.M.
Published: October 2023

Accurate traceability of time is prerequisite to the proper functioning of many necessary aspects of our modern life including making financial transactions, managing automated technology and navigating the transport of goods and human beings. One of the most reliable international time references is Coordinated Universal Time (UTC) that can be distributed wirelessly in principle. However, this wireless option is currently limited to GPS and other global navigation satellite systems. GPS signals are weak and easily affected by environmental conditions. Moreover, since GPS signals are unencrypted, the possibility of a signal spoofing attack remains a continuous threat. Prior works showed the potential of the alternative wireless time synchronization technique called Cosmic Time Synchronization (CTS); its clocks located 50 m apart were wirelessly synchronized with a sub-microsecond level accuracy, and its operation time was limited to 20 minutes. However, for the actual implementation of CTS to real-life situations, these distance and stability are not sufficient. In this study, we constructed a dedicated CTS facility and conducted a long-haul (180 m) CTS demonstration. As a result, it was verified that this long-range CTS is capable of maintaining stable sub-microsecond time synchronization for 3 days with a granularity of 148.8 ns (SD) and an offset of 22.97 ns. Since the current version of CTS can now operate over an area that has been enlarged by more than one order of magnitude, it is possible to utilize for more diverse applications. As a case study, it is shown that CTS now has the capability to offer wireless time synchronization service to large clusters of financial firms in large cities. With its accurate time dissemination (UTC compatible traceability), its reasonable cost, and its hack-proof, stable design, this latest CTS model has the capacity to improve the accuracy of timing for a wide variety of sectors.