bluuebunny/crossref_metadata_2025 huggingface dataset:
Rehabilitation for revision total knee replacement: survey of current service provision and systematic review
Authors: Omar Ifrah , Kunutsor Setor K. , Bertram Wendy , Moore Andrew J. , Blom Ashley W. , Lenguerrand Erik , Whitehouse Michael R. , Wylde Vikki
Published: February 2023

Background

Revision total knee replacement (TKR) is a major operation with a long recovery period and many patients report suboptimal outcomes. Rehabilitation has the potential to improve outcomes. The aim of this study was to understand current provision of rehabilitation for revision TKR in England and evaluate the existing evidence.

Methods

Phase 1: An online national survey of education and rehabilitation provision for patients receiving revision TKR was completed by physiotherapy staff at 22 hospitals across England that were high volume for revision TKR (response rate of 34%).

Phase 2: Systematic review to identify studies evaluating rehabilitation programmes for revision joint replacement. Searches were conducted in MEDLINE, EMBASE, PsycINFO, CINAHL, and Cochrane databases from inception to 15th June 2022. Randomised controlled trials (RCTs) and observational studies that evaluated post-operative rehabilitation for adults undergoing revision joint replacement were included. Screening, data extraction and quality assessment was undertaken by two reviewers.

Results

Phase 1: Pre-operative education which aimed to prepare patients for surgery and recovery was provided in most hospitals, predominately involving a single session delivered by a multidisciplinary team. Inpatient physiotherapy commonly commenced on post-operative day 1 and was provided twice daily, with most hospitals also providing occupational therapy. Rehabilitation was often provided in the first four weeks after hospital discharge, either in an outpatient, community or home setting. In most hospitals, the education and rehabilitation provided to patients receiving revision TKR was the same as that provided to patients undergoing primary TKR.

Phase 2: Of the 1,445 articles identified, three retrospective cohort studies based on hospital records review were included. The studies evaluated intensive inpatient rehabilitation programmes, consisting of 2–3 h of daily group or individual physiotherapy, with additional occupational therapy in one study. All three studies reported improvement in functional outcomes for patients undergoing rehabilitation after revision TKR. All studies were limited by their retrospective design, short duration of follow-up and lack of sample size calculation. No RCTs evaluating effectiveness of rehabilitation for revision TKR were identified.

Conclusion

This study identified the need for future research to develop and evaluate tailored rehabilitation to optimise patient outcomes following revision TKR.
Self-reported perceptions and knowledge of telemedicine in medical students and professionals who enrolled in an online course in Peru
Authors: García-Gutiérrez Fabrizio M. , Pino-Zavaleta Francis , Romero-Robles Milton A. , Patiño-Villena Ana F. , Jauregui-Cornejo Abigail S. , Benites-Bullón Alejandro , Goméz-Mendoza Alina , Alarcon-Ruiz Christoper A. , Huapaya-Huertas Oscar
Published: February 2023

Background

Telemedicine has become more relevant during the COVID-19 pandemic. However, medical students and professionals do not acquire competences in telemedicine during their training. Our objective was to describe the self-reported perception and baseline knowledge of telemedicine among medical students and professionals enrolled in a virtual course.

Methods

Cross-sectional study that included physicians or medical students aged 18 years or older who were interested in a free virtual telemedicine course and who completed the data collection questionnaire. We used a Likert scale to assess the self-reported perceptions of four domains related to telemedicine. The participants were grouped into three levels for each domain: low, medium and high. We also objectively assessed telemedicine knowledge by means of 10 questions, with a cut-off point of 50% of correct answers. The Fisher's exact test, the Chi-square test, and the Mann–Whitney U test were used for the comparison of categorical data. Ap-value < 0.05 was considered statistically significant.

Results

We included 161 participants: 118 medical students and 43 physicians. We observed no significant differences between medical students and physicians in self-reported perceptions of knowledge, security, or utility of telemedicine. However, students had a high self-reported perception of the disadvantages of telemedicine especially related to patient security (p = 0.018), efficiency of care (p = 0.040), and the possibility of medical malpractice (p = 0.010) compared to physicians. Nearly half of the students (n = 53,44.9%) and physicians (n = 22,51.7%) answered 50% or more of the questions related to telemedicine knowledge correctly.

Conclusion

Among the physicians and medical students enrolled in the course, the students perceived the disadvantages of telemedicine more frequently. Although physicians and students have limited knowledge of telemedicine, there appears to be no influence of experience and prior training in telemedicine.
Diagnostic approach and grading scheme for canine allergic conjunctivitis
Authors: Delgado Esmeralda , Gomes Érica , Gil Solange , Lourenço Ana Mafalda
Published: February 2023

Background

In humans, allergic conjunctivitis is a well described disease. In contrast, allergic conjunctivitis has not received much attention from the veterinary community so far. Canine allergic conjunctivitis (cAC) is one of the possible manifestations associated with canine atopic dermatitis (cAD), being often underdiagnosed and undertreated. Our aim is to contribute to disease characterization and clinical stagingfor cAC severity.

Results

A retrospective observational study including 122 dogs that underwent a complete ophthalmological and dermatological examinations and diagnosed with allergic conjunctivitis was conducted. A total of six ophthalmic clinical signs were considered for disease characterization and clinical staging: conjunctival hyperemia, chemosis, ocular pruritus, epiphora, seromucoid to mucopurulent discharge and keratitis, classified from 0 (absent) to 3 (severe). Scores comprised between 1–5 were considered mild, 6–10 moderate and 11–18 severe. The majority of dogs (64%) presented with moderate cAC followed by 24% of mild stages and only 12% of severe presentations. The severity of allergic conjunctivitis was not correlated to sex or age at the time of diagnosis and all presented with a bilateral form of the disease. Chemosis (84%), hyperemia (83%) and ocular pruritus (79%) was observed in 55% of the cases. Seromucoid to mucopurulent discharge (62%) and epiphora (69%) were less frequent, with keratitis being the least encountered clinical sign (15%). The degree of keratitis showed a positive correlation with both severity and chronicity of cAC (rho = 0.21–0.29, p ≤ 0.02)). Severity of cAD and cAD were not significantly correlated (p-value = 0.4).

Discussion and conclusion

The triad hyperemia, chemosis and ocular pruritus, already known in human medicine to be a reliable way of diagnosing human allergic conjunctivitis, also proved to be important in cAC Mild forms of the disease may pass unnoticed, ocular pruritus being hard to assess in canine patients.The proposed standardized diagnostic approach and novel grading scheme for cAC may be of value for both veterinary ophthalmologists and dermatologists, as well as general practitioners.
Lipoprotein subfraction patterns throughout gestation in The Gambia: changes in subfraction composition and their relationships with infant birth weights
Authors: Woo Jessica G. , Melchior John T. , Swertfeger Debi K. , Remaley Alan T. , Sise Ebrima A. , Sosseh Fatou , Welge Jeffrey A. , Prentice Andrew M. , Davidson W. Sean , Moore Sophie E. , Woollett Laura A.
Published: February 2023

Background

Lipoprotein subfraction concentrations have been shown to change as gestation progresses in resource-rich settings. The objective of the current study was to evaluate the impact of pregnancy on different-sized lipoprotein particle concentrations and compositions in a resource-poor setting.

Method

Samples were collected from pregnant women in rural Gambia at enrollment (8–20 weeks), 20 weeks, and 30 weeks of gestation. Concentrations of different-sized high-density, low-density, and triglyceride-rich lipoprotein particles (HDL, LDL, and TRL, respectively) were measured by nuclear magnetic resonance in 126 pooled plasma samples from a subset of women. HDL was isolated and the HDL proteome evaluated using mass spectroscopy. Subfraction concentrations from women in The Gambia were also compared to concentrations in women in the U.S. in mid gestation.

Results

Total lipoprotein particles and all-sized TRL, LDL, and HDL particle concentrations increased during gestation, with the exception of medium-sized LDL and HDL particles which decreased. Subfraction concentrations were not associated with infant birth weights, though relationships were found between some lipoprotein subfraction concentrations in women with normal versus low birth weight infants (< 2500 kg). HDL’s proteome also changed during gestation, showing enrichment in proteins associated with metal ion binding, hemostasis, lipid metabolism, protease inhibitors, proteolysis, and complement activation. Compared to women in the U.S., Gambian women had lower large- and small-sized LDL and HDL concentrations, but similar medium-sized LDL and HDL concentrations.

Conclusions

Most lipoprotein subfraction concentrations increase throughout pregnancy in Gambian women and are lower in Gambian vs U.S. women, the exception being medium-sized LDL and HDL particle concentrations which decrease during gestation and are similar in both cohorts of women. The proteomes of HDL also change in ways to support gestation. These changes warrant further study to determine how a lack of change or different changes could impact negative pregnancy outcomes.
Loss of miR-26b-5p promotes gastric cancer progression via miR-26b-5p-PDE4B/CDK8-STAT3 feedback loop
Authors: Xu Tingting , Xie Mengyan , Jing Xinming , Jiang Huning , Wu Xi , Wang Xinzhu , Shu Yongqian
Published: February 2023

Background

Chronic inflammation is a well-known risk factor for the development of gastric cancer (GC). Nevertheless, the molecular mechanisms underlying inflammation-related GC progression are incompletely defined.

Methods

Bioinformatic analysis was performed based on data from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO), and the expression of miR-26b-5p in GC cells and tissues was validated by quantitative real-time PCR (qRT-PCR). Cell proliferation was examined through Cell Counting Kit-8 (CCK8), 5-Ethynyl-2’-deoxyuridine (EdU), colony formation, flow cytometry, and tumor xenografts. Correlation between miR-26b-5p and Cyclin dependent kinase 8 (CDK8) or Phosphodiesterase 4B (PDE4B) was analyzed by dual-luciferase reporter assays, qRT-PCR, and Western blot. The effect of miR-26b-5p on the Signal transducer and activator of transcription 3 (STAT3) pathway was investigated using Western blot, immunofluorescence (IF), and immunohistochemistry (IHC). The impact of STAT3 on miR-26b-5p was determined by dual-luciferase reporter assays and qRT-PCR.

Results

The expression of miR-26b-5p was significantly downregulated in Helicobacter Pylori (H. pylori)-infected GC cells. The decreased expression of miR-26b-5p was also detected in GC cells and tissues compared to normal gastric epithelium cells (GES1) and normal adjacent gastric tissues. The low expression of miR-26b-5p promoted GC proliferation in vitro and in vivo and was related to the poor outcome of GC patients. In terms of mechanism, miR-26b-5p directly targeted PDE4B and CDK8, resulting in decreased phosphorylation and nuclear translocation of STAT3, which was associated with the regulation of GC proliferation by miR-26b-5p. Notably, miR-26b-5p was transcriptionally suppressed by STAT3, thus forming the miR-26b-5p-PDE4B/CDK8-STAT3 positive feedback loop.

Conclusion

The newly identified miR-26b-5p-PDE4B/CDK8-STAT3 feedback loop plays an important role in inflammation-related GC progression and may serve as a promising therapeutic target for GC.
5-HT attenuates chronic stress-induced cognitive impairment in mice through intestinal flora disruption
Authors: Ma Junxing , Wang Ran , Chen Yaoxing , Wang Zixu , Dong Yulan
Published: February 2023

Background

The microbiota–gut–brain axis plays an important role in the development of depression. The aim of this study was to investigate the effects of 5-HT on cognitive function, learning and memory induced by chronic unforeseeable mild stress stimulation (CUMS) in female mice. CUMS mice and TPH2 KO mice were used in the study. Lactococcus lactis E001-B-8 fungus powder was orally administered to mice with CUMS.

Methods

We used the open field test, Morris water maze, tail suspension test and sucrose preference test to examine learning-related behaviours. In addition, AB-PAS staining, immunofluorescence, ELISA, qPCR, Western blotting and microbial sequencing were employed to address our hypotheses.

Results

The effect of CUMS was more obvious in female mice than in male mice. Compared with female CUMS mice, extracellular serotonin levels in TPH2 KO CUMS mice were significantly reduced, and cognitive dysfunction was aggravated. Increased hippocampal autophagy levels, decreased neurotransmitter levels, reduced oxidative stress damage, increased neuroinflammatory responses and disrupted gut flora were observed. Moreover, L. lactis E001-B-8 significantly improved the cognitive behaviour of mice.

Conclusions

These results strongly suggest that L. lactis E001-B-8 but not FLX can alleviate rodent depressive and anxiety-like behaviours in response to CUMS, which is associated with the improvement of 5-HT metabolism and modulation of the gut microbiome composition.
The magnitude of teenage pregnancy and its associated factors among teenagers in Dodoma Tanzania: a community-based analytical cross-sectional study
Authors: Moshi Fabiola V. , Tilisho Olympia
Published: February 2023

Background

Teenage pregnancies cause serious health, social and economic consequences including death among adolescent girls worldwide. It is estimated that in 2019 about 55% of unintended pregnancies among adolescent girls aged 15–19 years ended up in abortions, which are often unsafe in developing countries. Little was known about the magnitude of teenage pregnancy and its associated factors in Dodoma Tanzania. Therefore, the study aimed at establishing the magnitude and factors associated with teenage pregnancies among adolescents in Dodoma Region Tanzania.

Method

It was a community-based analytical cross-sectional study that included 539 adolescent girls aged 15 to 19 years old. A multistage sampling technique was used to recruit study participants. An interviewer-administered structured questionnaire was used to collect data. Data were analyzed by using SPSS v23. Descriptive statistics were used to describe the distribution of the entire study variable while the inferential statistics helped to establish factors associated with teenage pregnancy among adolescent girls and the level of significance was set at two sides of less than 0.05.

Results

The magnitude of teenage pregnancy in Dodoma was 29%. After controlling for possible confounders, factors associated with teenage pregnancy were; urban residence [AOR: 3.02, 95%CI: (1.60–5.68), p = 0.001], low mothers’ education status [AOR: 3.46, 95%CI: (1.47–8.11), p = 0.004]; Poor knowledge on sexual and reproductive health [AOR: 2.09, 95%CI: (1.2–3.63), p = 0.009]; Low family economic status [AOR: 3.83, 95%CI: (1.77–8.30), p = 0.001]; Peer group [AOR: 2.92, 95%CI: (1.33–6.40), p = 0.007]; Early marriage [AOR: 2.58, 95%CI: (1.57–4.26), p < 0.0001]; and Sexual abuse [AOR: 13.56, 95%CI: (7.98–23.06), p < 0.0001].

Conclusion

This study found a high magnitude of teenage pregnancy among youth in Dodoma. Teenagers who were more likely to teenage pregnancy were those with limited knowledge about sexual and reproductive health living in urban, from families with low economic status, their mothers had a low level of education, from a culture that encourage early marriages, with the influence of peer and who experienced sexual abuse. An innovative intervention study to come up with a cost-effective strategy to address the challenge of teenage pregnancy in Dodoma is highly recommended.
The impact of depression on language function in individuals with Alzheimer’s disease: a pre/post-treatment design
Authors: Yoon Kyung Hee , Moon Yoo Sun , Kim Do Hoon
Published: February 2023

Background

It is uncertain whether depression might affect cognitive function in Alzheimer’s disease (AD). Most of studies on the effect of depression treatment on cognitive function in AD were briefly evaluated by Mini-Mental State Examination (MMSE). MMSE is poor sensitive to detect cognitive change. This study examined the cognitive response to depression treatment in AD via multi-domain assessment. In addition, we explored whether effect of depression treatment in AD is different those of late-life depression (LLD).

Methods

This study include AD patients with depression (AD + D) and without depression (AD − D), LLD patients (LLD), and healthy controls (HC). The patients were treated according to their diagnosis for 16 weeks: acetylcholinesterase inhibitors (AChEIs) and selective serotonin reuptake inhibitors (SSRIs) for AD + D, AChEIs for AD − D, and SSRIs for LLD. The cognitive changes from pre- to post-treatment were compared between AD + D and AD − D or LLD and HC. An independent sample t test was performed to compare the degree of change between the groups. Paired t tests were used to determine cognitive function changes in each depression treatment responder group.

Results

At baseline, AD + D had more impairment in language function compared to AD − D, and LLD had greater deficit in executive function than HC. After depression treatment, more impaired cognitive domains at baseline were improved in AD + D and LLD, respectively. Moreover, AD + D showed an improvement in the global cognitive function (MMSE).

Conclusions

Results indicated that language function was influenced by depression in AD, which is first evidence for specific cognitive domain related to depression in AD. Our finding indicates that depression could negatively impact cognitive function, and depression treatment may have beneficial cognitive effect in both AD and LLD. This study suggests the importance of early detection and treatment of depression in AD and LLD.

Trial registration Clinical Research Information Service, CRIS, ID#: KCT0004041, Registered 5 June 2019, retrospectively registered after first patient enrollment date (4 March 2014) https://cris.nih.go.kr/cris/search/detailSearch.do?seq=14140&status=5&seq_group=14140&search_page=M.
Randomized double-blind, placebo-controlled study of oral gabapentin for prevention of neuropathy in patients receiving paclitaxel
Authors: Pandey Praful , Kumar Akash , Pushpam Deepam , Khurana Sachin , Malik Prabhat Singh , Gogia Ajay , Arunmozhimaran Elavarasi , Singh Mamta Bhushan , Chandran Dinu Santha , Batra Atul
Published: February 2023

Background

Peripheral neuropathy is a common dose-limiting side effect of paclitaxel. To date, there is no effective strategy to prevent paclitaxel-induced peripheral neuropathy. A recent small phase II study demonstrated the potential role of oral gabapentin in this setting. This phase III study is aimed to assess the efficacy of oral gabapentin in preventing paclitaxel-induced neuropathy.

Objective

To compare the efficacy of oral gabapentin with placebo in preventing clinically significant peripheral neuropathy (NCI CTCAEv5.0 grade 2 or higher) in patients receiving paclitaxel.

Methods

This is a randomized, placebo-controlled, double-blind, parallel-group superiority trial. The primary outcome is the development of grade 2 or higher chemotherapy-induced peripheral neuropathy. Secondary outcomes include any grade neuropathy, the percentage change in sensory nerve conduction velocities in peripheral nerves, time to development of any grade neuropathy, paclitaxel dose reductions and delays due to peripheral neuropathy, patient-reported outcomes, adverse events, and adherence to oral therapy. A total of 136 patients receiving paclitaxel will be randomly allocated (stratified by weekly vs. non-weekly administration) to receive either oral gabapentin or placebo till three weeks after the last dose of chemotherapy or occurrence of the primary outcome.

Conclusion

This study aims to find if oral gabapentin reduces the incidence of grade 2 or higher chemotherapy-induced peripheral neuropathy in patients receiving paclitaxel.

Trial registration

The trial is registered prospectively with the Clinical Trials Registry of India (CTRI/2022/02/040030) on April 4, 2022.
Mucinous carcinoma originating from uterine adenomyosis: a case report
Authors: Ohira Satoshi , Tachibana Ryota , Yasaki Sayaka , Tsunemi Koji , Uchiyama Natsuki , Ikeda Eri , Sano Kenji
Published: February 2023

Background

Uterine adenomyosis is rarely a precursor of malignant tumors, but the most frequent histological subtype is endometrioid carcinoma. We observed a rare case of mucinous carcinoma originating from uterine adenomyosis.

Case presentation

A 63-year-old Japanese woman presented to our hospital with lower abdominal pain. She had no atypical genital bleeding. Ultrasound demonstrated thickening of the entire uterine wall, but the endometrium was not thick. Magnetic resonance imaging demonstrated an enlarged uterus with thickening of the entire uterine wall, suggesting adenomyosis. On the basis of the specimen of endocervical curettage, adenocarcinoma originating from the endometrium was suspected. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed to confirm the diagnosis. Macroscopically, the resected enlarged uterus had no nodules and exudation of mucin was observed from the cut surface of the thickened myometrium. The surface of the endometrium was smooth. On histological examination, mucinous carcinoma invaded almost the entire myometrium. Adenomyotic lesions were distributed focally in the uterine wall, and transition from adenomyotic glandular epithelium to mucinous carcinoma was detected within several foci. Although adenocarcinoma cells proliferated adjacent to the endometrium, the primary endometrial epithelium was atrophic without atypia. Throughout the myometrium, the mucinous carcinoma cells proliferated and floated in dilated lymph vessels with abundant mucin pools. We diagnosed this case as mucinous carcinoma originating from adenomyosis. Although the patient received 11 courses of intravenous adjuvant chemotherapy, she died of disease 18 months after the first operation.

Conclusion

As only one case of mucinous carcinoma originating from adenomyosis has been reported to date, this is the second case report of mucinous carcinoma. Moreover, an abnormal manner of proliferation with marked lymphatic permeation of the tumor cells throughout the myometrium was observed.
A hybrid compartmental model with a case study of COVID-19 in Great Britain and Israel
Authors: Malaspina Greta , Racković Stevo , Valdeira Filipa
Published: February 2023

Given the severe impact of COVID-19 on several societal levels, it is of crucial importance to model the impact of restriction measures on the pandemic evolution, so that governments are able to make informed decisions. Even though there have been countless attempts to propose diverse models since the rise of the outbreak, the increase in data availability and start of vaccination campaigns calls for updated models and studies. Furthermore, most of the works are focused on a very particular place or application and we strive to attain a more general model, resorting to data from different countries. In particular, we compare Great Britain and Israel, two highly different scenarios in terms of vaccination plans and social structure. We build a network-based model, complex enough to model different scenarios of government-mandated restrictions, but generic enough to be applied to any population. To ease the computational load we propose a decomposition strategy for our model.
A physiologically based pharmacokinetic model for [68Ga]Ga-(HA-)DOTATATE to predict whole-body distribution and tumor sink effects in GEP-NET patients
Authors: Siebinga Hinke , de Wit-van der Veen Berlinda J. , Beijnen Jos H. , Dorlo Thomas P. C. , Huitema Alwin D. R. , Hendrikx Jeroen J. M. A.
Published: February 2023

Background

Little is known about parameters that have a relevant impact on (dis)similarities in biodistribution between various 68Ga-labeled somatostatin analogues. Additionally, the effect of tumor burden on organ uptake remains unclear. Therefore, the aim of this study was to describe and compare organ and tumor distribution of [68Ga]Ga-DOTATATE and [68Ga]Ga-HA-DOTATATE using a physiologically based pharmacokinetic (PBPK) model and to identify factors that might cause biodistribution and tumor uptake differences between both peptides. In addition, the effect of tumor burden on peptide biodistribution in gastroenteropancreatic (GEP) neuroendocrine tumor (NET) patients was assessed.

Methods

A PBPK model was developed for [68Ga]Ga-(HA-)DOTATATE in GEP-NET patients. Three tumor compartments were added, representing primary tumor, liver metastases and other metastases. Furthermore, reactions describing receptor binding, internalization and recycling, renal clearance and intracellular degradation were added to the model. Scan data from GEP-NET patients were used for evaluation of model predictions. Simulations with increasing tumor volumes were performed to assess the tumor sink effect.

Results

Data of 39 and 59 patients receiving [68Ga]Ga-DOTATATE and [68Ga]Ga-HA-DOTATATE, respectively, were included. Evaluations showed that the model adequately described image-based patient data and that different receptor affinities caused organ uptake dissimilarities between both peptides. Sensitivity analysis indicated that tumor blood flow and blood volume impacted tumor distribution most. Tumor sink predictions showed a decrease in spleen uptake with increasing tumor volume, which seemed clinically relevant for patients with total tumor volumes higher than ~ 550 mL.

Conclusion

The developed PBPK model adequately predicted tumor and organ uptake for this GEP-NET population. Relevant organ uptake differences between [68Ga]Ga-DOTATATE and [68Ga]Ga-HA-DOTATATE were caused by different affinity profiles, while tumor uptake was mainly affected by tumor blood flow and blood volume. Furthermore, tumor sink predictions showed that for the majority of patients a tumor sink effect is not expected to be clinically relevant.
An MMSE graph spectral magnitude estimator for speech signals residing on an undirected multiple graph
Authors: Wang Tingting , Guo Haiyan , Ge Zirui , Zhang Qiquan , Yang Zhen
Published: February 2023

The paper uses theK-graphs learning method to construct weighted, connected, undirected multiple graphs, aiming to reveal intrinsic relationships of speech samples in the inter-frame and intra-frame. To benefit from the learned multiple graphs’ property and enhance interpretability, we study the spectral property of speech samples in the joint vertex-frequency domain by using the new graph weight matrix. Moreover, we propose the representation of minimum mean-square error (MMSE) graph spectral magnitude estimator for speech signals residing on undirected multiple graphs. We use the MMSE graph spectral magnitude estimator to improve speech enhancement performance. The numerical simulation results show that the proposed method outperforms the existing methods in graph signal processing (GSP) and the baseline methods for speech enhancement in discrete signal processing (DSP) in terms of PESQ, LLR, output SNR, and STOI results. These results also demonstrate the validity of the learned multiple graphs.
On the degree of approximation of Fourier series based on a certain class of product deferred summability means
Authors: Jena Bidu Bhusan , Paikray Susanta Kumar , Mursaleen M.
Published: February 2023

In this article, we first introduce and study the basic concepts of deferred Euler and deferred Nörlund product summability means of Fourier series of arbitrary periodic functions. We then estimate the degree of approximation of Fourier series of an arbitrary periodic function in the generalized Zygmund class based upon our proposed product deferred summability means. Moreover, we discuss some important concluding remarks in connection with our findings. Finally, we suggest a direction for future studies on this subject, which are based upon the basic notion of statistical product deferred summability means of Fourier series of arbitrary periodic functions in the generalized Zygmund class.
Bipolar disorder and sexuality: a preliminary qualitative pilot study
Authors: Krogh Helle B. , Vinberg Maj , Mortensen Gitte Lee , Skakke Ditte , Nielsen Dorthe , Giraldi Annamaria
Published: February 2023

Background

Individuals with mental health disorders have a higher risk of sexual problems impacting intimate relations and quality of life. For individuals with bipolar disorder (BD) the mood shifts might to a particular degree affect their sexual function with possible hypersexual interest during manic episodes and low sexual interest during depressive episodes. The diagnosis is often given in late adolescence, which may impact sexual identity and development. Only a few studies have looked at BD and sexual life, with no qualitative research on the topic.

We conducted a qualitative pilot study exploring sexuality in connection to mood swings in five participants with BD.

Results

Thematic content analysis revealed five themes: (1) sexual drive and impulses, (2) sexual behavior, (3) thoughts and feelings in relation to sexual issues, (4) intimate relationships, and (5) sexuality and identity. During manic episodes the participants described having a higher sexual drive, leading for some to more sexual interactions. During depressed episodes, the sexual drive in the three female participants was low, however, in the two men, rather than a reduced sexual drive, a more self-destructive way of engaging in sex prevailed. The sexual outgoing behavior during manic phases was described as joyful, with no feelings of shame connected to it. However, the shifts in sexual drive connected to mood shifts affected the participants’ relationships negatively. Further, all the participants described having outgoing sexual behavior in their youth.

Conclusions

Overall, changes in sexual drive may act as a trigger or early warning symptoms of new episodes, pinpointing the clinical relevance of addressing sexuality in individuals with BD. In general, sexual drive followed affective episodes. However, during depressive episodes sex could be, instead of reduced drive, associated with negative feelings.

All participants described having an outgoing sexual behavior in their youth before the onset of BD, which might be essential to consider if there is a clinical suspension of BD in an individual.
International undergraduates’ perceptions of social engagement in online and face-to-face learning environments: a photo-elicitation approach to thematic analysis
Authors: McLaughlan Toni
Published: February 2023

This mixed-methods study explores international undergraduates’ perceptions of social engagement with American peers at a US university comparing online to face-to-face environments. It addresses gaps in research on the social engagement of international undergraduates and on employing participant-generated visual approaches to investigation. Descriptive statistics from survey data showed that, while international students reported greater satisfaction, frequency, and comfort in engaging with American peers in face-to-face versus online contexts, they did not rate their overall of face-to-face interaction as highly as Americans did nor as lowly for online environments. Thematically analyzed qualitative data from photo-elicitation interviews prompted seven themes (disconnectedness, loneliness/homesickness, discourse expectations, building friendships, diversity and intercultural issues, anxieties, conflict) illuminating the nuances in attitudes among international undergraduates toward social engagement. Results suggest possible distinctions between international students based on region as a potential area of future study.
A novel stochastic modeling framework for coal production and logistics through options pricing analysis
Authors: Alfeus Mesias , Collins James
Published: February 2023

We propose a novel stochastic modeling framework for coal production and logistics using option pricing theory. The problem of valuing the inherent real optionality a coal producer has when mining and processing thermal coal is modelled as pricing spread options of three assets under the stochastic volatility model. We derive a three-dimensional Fast Fourier Transform (“FFT”) lower bound approximation to value the inherent real optionality and for robustness check, we compare the semi-analytical pricing accuracy with the Monte Carlo simulation. Model parameters are estimated from the historical monthly data, and stochastic volatility parameters are obtained by matching the Kurtosis of the low-ash diff data to the Kurtosis of the stochastic volatility process which is assumed to follow Cox–Ingersoll–Ross (“CIR”) model.
Parotid gland masses: outcomes in the pediatric age group
Authors: Younes Alaa , Taher Mohammad Fouad , Sidhom Iman , Zekri Wael , Zaky Iman , Elfendy Habiba , Taher Azza Niazy , Khedr Suzan Adlan , Gamal Rana , Ahmed Gehad
Published: February 2023

Background

Childhood parotid neoplasms appear to have different characteristics from adults. This point, in addition to the rarity of these tumors, reflects the challenges faced in diagnosing and treating parotid neoplasms in children.

Patients and methods

This retrospective study included all children who presented to the Children’s Cancer Hospital Egypt (CCHE, 57357) with parotid masses from January 2008 to December 2020.

Results

Twenty-one patients were included. Malignant neoplasms were found in 12 (57.1%) of which mucoepidermoid carcinoma was the most common. Benign neoplasms were found in 6 (28.6%) all of them were pleomorphic adenoma, and non-neoplastic lesions were found in 3 (14.3%). Superficial, deep, or total parotidectomy was performed according to the involved lobes. The facial nerve was sacrificed in three cases because of frank invasion by the tumor. Neck dissection was considered in clinically positive lymph nodes and/or T3/4 masses. Complications occurred in 7 (33.3%) all were of the malignant cases. Adjuvant radiotherapy was restricted to high-risk cases (7 cases). Recurrence occurred in two cases, and one patient died of distant metastasis. Fine needle aspiration cytology (FNAC) showed 88.9% sensitivity and 100% specificity for diagnosing malignant neoplasms. The correlation of radiological and pathological staging was fair (66.74% for overall staging).

Conclusions

Parotidectomy is the backbone treatment for benign and malignant pediatric parotid tumors. Neck nodal dissection should be considered after preoperative FNAC of suspicious nodes. Adjuvant radiotherapy is considered only in high-risk tumors. Preoperative FNAC of parotid masses and clinically suspicious lymph nodes is highly recommended.
Pembrolizumab Plus Chemotherapy in Squamous Non–Small-Cell Lung Cancer: 5-Year Update of the Phase III KEYNOTE-407 Study
Authors: Novello Silvia , Kowalski Dariusz M. , Luft Alexander , Gümüş Mahmut , Vicente David , Mazières Julien , Rodríguez-Cid Jeronimo , Tafreshi Ali , Cheng Ying , Lee Ki Hyeong , Golf Alexander , Sugawara Shunichi , Robinson Andrew G. , Halmos Balazs , Jensen Erin , Schwarzenberger Paul , Pietanza M. Catherine , Paz-Ares Luis
Published: February 2023

Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.

We report 5-year efficacy and safety outcomes from the phase III KEYNOTE-407 study (ClinicalTrials.gov identifier: NCT02775435 ). Eligible patients with previously untreated, metastatic squamous non–small-cell lung cancer (NSCLC) were randomly assigned 1:1 to pembrolizumab 200 mg or placebo plus carboplatin and paclitaxel/nab-paclitaxel once every 3 weeks for four cycles, followed by pembrolizumab or placebo for up to 35 cycles. Primary end points were overall survival (OS) and progression-free survival (PFS) per RECIST version 1.1 by blinded independent central review (BICR). Five hundred fifty-nine patients were randomly assigned in the intention-to-treat population (pembrolizumab plus chemotherapy, n = 278; placebo plus chemotherapy, n = 281). The median time from random assignment to data cutoff was 56.9 (range, 49.9-66.2) months. OS and PFS were improved with pembrolizumab plus chemotherapy versus placebo plus chemotherapy (hazard ratio [95% CI], 0.71 [0.59 to 0.85] and 0.62 [0.52 to 0.74]), with 5-year OS rates of 18.4% versus 9.7%, respectively. Toxicity was manageable. Among 55 patients who completed 35 cycles of pembrolizumab, the objective response rate was 90.9% and the 3-year OS rate after completion of 35 cycles (approximately 5 years after random assignment) was 69.5%. Pembrolizumab plus chemotherapy maintained an OS and PFS benefit versus placebo plus chemotherapy in previously untreated, metastatic squamous NSCLC and is a standard-of-care first-line treatment option for metastatic squamous NSCLC regardless of programmed death ligand 1 expression.
Pre-Meal Whey Protein Alters Postprandial Insulinemia by Enhancing β-Cell Function and Reducing Insulin Clearance in T2D
Authors: Smith Kieran , Taylor Guy S , Walker Mark , Brunsgaard Lise H , Bowden Davies Kelly A , Stevenson Emma J , West Daniel J
Published: February 2023

Context

Treatments that reduce postprandial glycemia (PPG) independent of stimulating insulin secretion are appealing for the management of type 2 diabetes (T2D). Consuming pre-meal whey protein (WP) reduces PPG by delaying gastric emptying and increasing plasma insulin concentrations. However, its effects on β-cell function and insulin kinetics remains unclear.

Objective

To examine the PPG-regulatory effects of pre-meal WP by modeling insulin secretion rates (ISR), insulin clearance, and β-cell function.

Methods

This was a single-blind, randomized, placebo-controlled, crossover design study in 18 adults with T2D (HbA1c, 56.7 ± 8.8 mmol/mol) who underwent 2 240-minute mixed-meal tolerance tests. Participants consumed WP (15 g protein) or placebo (0 g protein) 10 minutes before a mixed-macronutrient breakfast meal. PPG, pancreatic islet, and incretin hormones were measured throughout. ISR was calculated by C-peptide deconvolution. Estimates of insulin clearance and β-cell function were modeled from glucose, insulin, and ISR. Changes in PPG incremental area under the curve (iAUC; prespecified) and insulin clearance (post hoc) were measured.

Results

β-cell function was 40% greater after WP (P = .001) and was accompanied with a −22% reduction in postprandial insulin clearance vs placebo (P < .0001). Both the peak change and PPG iAUC were reduced by WP (−1.5 mmol/L and −16%, respectively; both P < .05). Pre-meal WP augmented a 5.9-fold increase in glucagon and glucagon-like peptide 1 iAUC (both P < .0001), and a 1.5-fold increase in insulin iAUC (P < .001). Although the plasma insulin response was greater following WP, ISR was unaffected (P = .133).

Conclusion

In adults with T2D, pre-meal WP reduced PPG by coordinating an enhancement in β-cell function with a reduction in insulin clearance. This enabled an efficient postprandial insulinemic profile to be achieved without requiring further β-cell stimulation.

Trial registry ISRCTN ID: ISRCTN17563146

Website link: www.isrctn.com/ISRCTN17563146
Spectrum of Clinical Presentations, Imaging Findings, and HLA Types in Immune Checkpoint Inhibitor–Induced Hypophysitis
Authors: Quandt Zoe , Kim Stephanie , Villanueva-Meyer Javier , Coupe Catherine , Young Arabella , Kang Jee Hye , Yazdany Jinoos , Schmajuk Gabriela , Rush Stephanie , Ziv Elad , Perdigoto Ana Luisa , Herold Kevan , Lechner Melissa G , Su Maureen A , Tyrrell J Blake , Bluestone Jeffrey , Anderson Mark , Masharani Umesh
Published: February 2023

Context

Hypophysitis is a known immune-related adverse event (irAE) of immune checkpoint inhibitors (CPIs), commonly associated with CTLA-4 inhibitors and less often with PD-1/PD-L1 inhibitors.

Objective

We aimed to determine clinical, imaging, and HLA characteristics of CPI-induced hypophysitis (CPI-hypophysitis).

Methods

We examined the clinical and biochemical characteristics, magnetic resonance imaging (MRI) of the pituitary, and association with HLA type in patients with CPI-hypophysitis.

Results

Forty-nine patients were identified. Mean age was 61.3 years, 61.2% were men, 81.6% were Caucasian, 38.8% had melanoma, and 44.5% received PD-1/PD-L1 inhibitor monotherapy while the remainder received CTLA-4 inhibitor monotherapy or CTLA-4/PD-1 inhibitor combination therapy. A comparison of CTLA-4 inhibitor exposure vs PD-1/PD-L1 inhibitor monotherapy revealed faster time to CPI-hypophysitis (median 84 vs 185 days, P < .01) and abnormal pituitary appearance on MRI (odds ratio 7.00, P = .03). We observed effect modification by sex in the association between CPI type and time to CPI-hypophysitis. In particular, anti-CTLA-4 exposed men had a shorter time to onset than women. MRI changes of the pituitary were most common at the time of hypophysitis diagnosis (55.6% enlarged, 37.0% normal, 7.4% empty or partially empty) but persisted in follow-up (23.8% enlarged, 57.1% normal, 19.1% empty or partially empty). HLA typing was done on 55 subjects; HLA type DQ0602 was over-represented in CPI-hypophysitis relative to the Caucasian American population (39.4% vs 21.5%, P = 0.01) and CPI population.

Conclusion

The association of CPI-hypophysitis with HLA DQ0602 suggests a genetic risk for its development. The clinical phenotype of hypophysitis appears heterogenous, with differences in timing of onset, changes in thyroid function tests, MRI changes, and possibly sex related to CPI type. These factors may play an important role in our mechanistic understanding of CPI-hypophysitis.
Implementing Preoperative Penicillin Allergy Testing in Surgical Patients
Authors: Gupta Ravindra Alok , Lee Howard , Okocha Obianuju
Published: February 2023

Penicillin allergy is the most reported immunoglobulin E (IgE)-mediated reaction. About 10% of the general population and 20% of hospitalized patients have a history of penicillin allergy. Unconfirmed penicillin allergy with subsequent administration of second-line antibiotics has been associated with increased morbidity. However, when penicillin allergy testing is performed, the incidence of IgE-mediated reactions is extremely low; in fact, the negative predictive value of penicillin allergy testing exceeds 99%. This article aims to briefly describe implementing safe penicillin allergy testing as a routine test during the preoperative evaluation of surgical patients.
Harlequin Syndrome Related to Perioperative Intercostal Blockade: A Case Report
Authors: Sperling Phillip , Læbel Julie , Danielsen Allan Vestergaard , Bisgaard Jannie
Published: February 2023

Harlequin syndrome is a rare syndrome characterized by hemifacial flushing and altered facial sweating, with only a few case reports related to intercostal blockades. We present a case of Harlequin syndrome in a 65-year-old woman after intercostal blockade for video-assisted thoracoscopic lobectomy. One hour postoperatively, the patient became nauseated and presented with flushing of the right half of the face with a clear line of demarcation. Within 3 hours, the flushing disappeared. In this case report, we discuss Harlequin syndrome in relation to intercostal blockade and encourage clinicians to consider this syndrome in the differential diagnosis when encountering similar symptoms.
Successful Treatment of Pure Aqueductal Pilomyxoid Astrocytoma and Arrested Hydrocephalus With Endoscopic Tumor Resection Followed by Chemotherapy: A Case Report and Technical Considerations
Authors: Sakata Kiyohiko , Hashimoto Aya , Kotaki Yoshikuni , Yoshitake Hidenobu , Shimokawa Shoko , Komaki Satoru , Nakamura Hideo , Furuta Takuya , Morioka Motohiro
Published: February 2023

BACKGROUND AND IMPORTANCE

Pure aqueductal tumors are extremely rare and may lead to death, regardless of histopathology. We report the first case of pure aqueductal pilomyxoid astrocytoma in an adult woman with arrested hydrocephalus. Endoscopic tumor resection for securing aqueductal patency followed by chemotherapy allowed control of both the tumor and the hydrocephalus.

CLINICAL PRESENTATION:

A 20-year-old woman presented with mild cognitive dysfunction and marked ventricular dilatation. She had no preoperative symptoms of intracranial hypertension, and her head circumference was more than 2 SDs above the 98th percentile. The aqueduct of Sylvius was entirely occupied by a neoplastic lesion with 2 periventricular nodules at the wall of the third ventricle and anterior horn of the right lateral ventricle. She was treated successfully with endoscopic tumor resection followed by chemotherapy, and the patency of the aqueduct of Sylvius was secured throughout the duration of treatment.

CONCLUSION:

Pure aqueductal tumors may be an appropriate indication for endoscopic tumor resection to secure the aqueductal patency of cerebrospinal fluid. This case demonstrates the surgical technique of a combined rigid-flexible endoscopic transforaminal approach, which was a useful surgical intervention for the management of this patient.
Unraveling the Hispanic Health Paradox
Authors: Fernandez José , García-Pérez Mónica , Orozco-Aleman Sandra
Published: February 2023

In 2019, Hispanics in the US had a life expectancy advantage of 3.0 years and 7.1 years over non-Hispanic Whites and non-Hispanic Blacks, respectively, despite having real-household income values 26 percentage points lower than Non-Hispanic White households. Hispanics appear to have equal or even better health outcomes relative to non-Hispanic Whites across various health measures. This is known as the Hispanic health paradox. This paper underscores the importance of disaggregating Hispanics by ancestry and age profile when discussing the paradox across key health outcomes. It also provides an overview of the leading explanations, such as the salmon bias and the healthy immigrant effect. Further, it highlights the role of healthcare access and usage in this discussion. Ignoring these sources of bias have important consequences for how morbidity and mortality among Hispanics are measured within widely used national datasets.