bluuebunny/crossref_metadata_2025 huggingface dataset:
Multidisciplinary Support To Access living donor Kidney Transplant (MuST AKT): A Clinical Research Protocol for a Pilot Randomized Controlled Trial to Increase Living Kidney Donation
Authors: Selzler Anne-Marie , Davoodi Parastoo Molla , Klarenbach Scott , Lam Ngan N. , Smith Terry , Ackroyd Abigail , Wiebe Natasha , Corradetti Bonnie , Ferdinand Sharron , Iyekekpolor Dorothy , Smith Gordon , Verdin Nancy , Bello Aminu K. , Wen Kevin , Shojai Soroush ,   on behalf of the Multidisciplinary Support To Access living donor Kidney Transplant (MuST AKT) Research Group
Published: October 2023

Background:

Living donor kidney transplantation (LDKT) is the optimal treatment for eligible patients with kidney failure, although it is underutilized. Contextually tailored patient- and family-centered interventions may be effective to increase LDKT.

Objective:

We outline a protocol to test the feasibility of the Multidisciplinary Support To Access living donor Kidney Transplant (MuST AKT) intervention designed to increase LDKT.

Design:

Non-blinded single-center pilot randomized controlled trial with a qualitative interview component.

Setting:

Academic transplant referral center in Northern Alberta Region with a population of more than 2 million in its catchment area.

Patients:

English-speaking patients of the age range 18 to 75 years who are referred for kidney transplantation are eligible to participate.

Measurements:

Feasibility will be assessed by indicators of recruitment, retention, and completion rates, treatment fidelity, adherence to intervention, engagement in intervention, and acceptability.

Methods:

Participants will be randomly assigned 1:1 to either standard care (control) or the experimental group who receive standard care plus the MuST AKT intervention, a person-centered program designed to assist and enable the kidney transplant candidate to achieve what is required to receive an LDKT. The intervention consists of an introductory session and 4 intervention sessions delivered in-person or virtually.

Limitations:

Inferences cannot be drawn regarding the efficacy/effectiveness of the MuST AKT intervention. This study is non-blinded.

Conclusions:

This pilot study is the first step in our broader initiative to increase LDKT in our health care jurisdiction. The results of this study will be used to inform the development of a future definitive randomized controlled trial.

Trial registration number:

NCT04666545.
Digital Finance and Entrepreneurial Return Rate: Effects, Mechanisms and Inequality
Authors: Chai Shijun , Zhou Li , Chen Yang
Published: October 2023

This study matches the digital financial inclusion index with micro panel data from the China Household Finance Survey (CHFS) in 2015, 2017, and 2019, and explores the impact of digital finance on the return rate of entrepreneurship. The results show that the effect is positive—entrepreneurial households in prefectures with higher digital finance obtain higher return rates—and remarkably reliable to a battery of endogeneity and robustness tests. Mechanism analysis indicates that the positive effect of digital finance on the return rate of entrepreneurship is achieved mainly through facilitating external financing and reducing financial transaction costs. Further research finds that the spillover effect of digital finance has obvious Internet bias: the “digital dividend” only extends to the advantaged classes who have access to the Internet—non-rural and migrating rural entrepreneurs, but for non-migrating rural entrepreneurs generally facing digital exclusion, digital finance has little effect on their return rate. The empirical evidence presented in this study has important policy implications for accelerating the digital finance process, promoting high-quality entrepreneurship development, and boosting digital poverty groups to break stratum solidification.
Self-Control Depletion, Frustration Tolerance, Irritability, and Engagement in Risky Behaviors in College Students With and Without Attention-Deficit/Hyperactivity Disorder Risk
Authors: Montgomery Catherine L. , Antshel Kevin M.
Published: October 2023

College students with Attention-Deficit/Hyperactivity Disorder (ADHD) often have poor self-control, low frustration tolerance (FT), and associated irritability. These features are associated with engagement in risky behaviors (ERBs). The Self-Control Strength Model (SCSM) was used to examine relationships between ADHD symptoms, FT, irritability, and self-control resource depletion and associations with ERBs in 247 college students randomized into depletion/non-depletion groups. Participants completed state and trait measures and two experimental tasks: the Stroop Color-Word Task to deplete resources, and the Paced Auditory Serial Addition Task (Computerized) to induce frustration and measure frustration tolerance. Linear and logistic regressions were used to analyze associations, and demonstrated that ADHD symptoms and FT were positively associated with several ERBs. However, due to failure of the Stroop to adequately deplete self-control resources, the SCSM cannot be fully analyzed. Ultimately, these results provide additional support for positive associations between ADHD symptoms, state irritability, and ERB in college students.
Is it Stress O’Clock?: Comparing Cardiac Data from Industry-Leading Smartwatches against Subjective Workload Measures
Authors: Horde Lauren , Moore Aaron , Riggs Dr. Sara Lu
Published: October 2023

Health information like heart rate (HR) and electrocardiogram (ECG) patterns are available to the public on smartwatches; however, there may be a disconnect between these health measures and how users subjectively experience feelings of stress. This study examines the health detection features of two leading smartwatches in the industry, the Apple Watch Series 6 and Fitbit Sense, to determine if these devices may be used to accurately measure stress. Participants engaged in a multi-tasking program (MATB-II) that varied in cognitive workload demand while wearing smartwatches measuring cardiac data. Subjective workload responses resulted in significant differences between low and high workload conditions, indicating an increase in stress. However, both smartwatches were unable to detect significant differences in stress responses between low and high workload conditions. Overall, these results indicate that smartwatch HR and ECGs may not reflect internal feelings of stress and are sensitive to variability in measurement.
Predicting Progression in Adolescent Idiopathic Scoliosis at the First Visit by Integrating 2D Imaging and 1D Clinical Information
Authors: Chu Kenneth , Kuang Xihe , Cheung Prudence W. H. , Li Sofia , Zhang Teng , Cheung Jason Pui Yin
Published: October 2023

Study Design

Retrospective observational study.

Objectives

The prediction of curve progression in patients with adolescent idiopathic scoliosis (AIS) remains an unresolved area in orthopedic surgery. To make a rapid meaningful prediction, easily accessible multi-dimensional data at the patient’s first consultation should be used. Current studies use clinical growth parameters and numerical values extracted from radiographs to compile a predictive model, leaving out the radiographs themselves. Such practice inevitably wastes a lot of information. Thus, this study aims to create a neural network that can predict AIS progression among patients with curves indicated for bracing by integrating both one-dimensional (1D) clinical and two-dimensional (2D) radiological data collected at the patient’s first visit in a fully automated manner.

Methods

513 idiopathic scoliosis patients indicated for and managed with bracing orthosis were recruited. After exclusion, 463 patients were included in deep learning analysis. Processed first-visit growth parameters and posteroanterior radiographs are used as training inputs and the curve progression outcomes obtained in follow ups are used as binary training outputs. The CapsuleNet architecture was modified and trained accordingly to make a prediction.

Results

The final model achieved 90% sensitivity with an overall accuracy of 73.9% in the prediction of AIS in-brace curve progression by using first-visit multi-dimensional data, outperforming conventional convolutional neural networks.

Conclusions

This first-ever multidimensional-input model shows promise in serving as a screening tool for AIS in-brace curve progression. The incorporation of such a model into routine AIS diagnostic pipeline can assist orthopedics clinicians in personalizing the most appropriate management for each patient.
Experience of Parents with Children Undergoing Chemotherapy
Authors: Alghamdi Salmah , Alqurashi Afnan , Almarbae Nura , Fadul Yara , Alharbi Maha , Bashammakh Reham
Published: October 2023

Background

The care of a child receiving chemotherapy has a significant impact on the parents and family structure, which has been explored in depth in a few studies in Saudi Arabia. The purpose of this study is to further explore the lived experiences of Saudi Arabian parents in caring for their children receiving chemotherapy.

Methodology

A qualitative descriptive design was used in this study with a sample of 17 parents of children receiving chemotherapy. The participants were recruited using the snow-balling technique throughout the community, as well as from the University Hospital, Pediatric Oncology Department. The data were collected via in-person and virtual methods using semi-structured, open-ended interviews and analyzed using thematic analysis.

Results

The findings of the study were placed into two main themes: family experience and stages of disease. Family experiences include the parents and siblings’ experiences. The stages of disease include three sub-themes: the pre-diagnosis phase, diagnosis phase, and treatment phase.

Conclusion

The cancer journey had a huge impact on the parents and siblings. The study revealed important findings related to the experiences during the stages of diseases and lived experiences of parents and siblings including psychological, physiological, social, and financial impacts.
Serum uric acid and prognosis of ischemic stroke: Cohort study, meta-analysis and Mendelian randomization study
Authors: Zhong Jinghui , Cai Huan , Zhang Zhizhong , Wang Jinjing , Xiao Lulu , Zhang Pan , Xu Yingjie , Tu Wenqing , Zhu Wusheng , Liu Xinfeng , Sun Wen
Published: October 2023

Introduction:

The role of serum uric acid (UA) levels in the functional recovery of ischemic stroke remains uncertain. To evaluate whether UA could predict clinical outcomes in patients with ischemic stroke.

Patients and methods:

A three-stage study design was employed, combining a large-scale prospective cohort study, a meta-analysis and a Mendelian randomization (MR) analysis. Firstly, we conducted a cohort study using data from the Nanjing Stroke Registry Program (NSRP) to assess the association between UA levels and 3-month functional outcomes in ischemic stroke patients. Secondly, the meta-analysis was conducted to integrate currently available cohort evidence. Lastly, MR analysis was utilized to explore whether genetically determined UA had a causal link to the functional outcomes of ischemic stroke using summary data from the CKDGen and GISCOME datasets.

Results:

In the first stage, the cohort study included 5631 patients and found no significant association between UA levels and functional outcomes at 3 months after ischemic stroke. In the second stage, the meta-analysis, including 10 studies with 14,657 patients, also showed no significant association between UA levels and stroke prognosis. Finally, in the third stage, MR analysis using data from 6165 patients in the GISCOME study revealed no evidence of a causal relationship between genetically determined UA and stroke functional outcomes.

Discussion and conclusion:

Our comprehensive triangulation approach found no significant association between UA levels and functional outcomes at 3 months after ischemic stroke.
Soil erosion effects and mechanisms in the karst peak-cluster depression area from a multi-scale landscape perspective
Authors: Du Fujun , Zhang Yibo , Gao Jiangbo , Li Chao , Huang Fengxian , Zuo Liyuan , Jiang Yuan
Published: October 2023

The karst regions in southwest China are integral to maintaining regional ecological security. However, escalating human activities in these areas have intensified soil erosion and landscape fragmentation. Clarifying the role of landscape patterns in karst regions as drivers of soil erosion processes is essential for providing crucial support in mitigating regional soil erosion. By utilizing unmanned aerial vehicle detection, this study examined the soil erosion characteristics, driving factors, and interaction effects in peak-cluster depression landscapes. The investigation was conducted at multiple scales, including peak-cluster depression, grid, and patch levels, under the combined ecology–agriculture, ecology–economy and near–nature landscape utilization types. Furthermore, an optimal landscape pattern for alleviating soil erosion was identified. The research findings indicate that the proportions of mild and moderate erosion were higher in the ecology-agriculture landscape utilization type compared to the other two landscapes. In the ecology-economy type, slight soil erosion predominated. Increasing vegetation cover led to a decrease in soil erosion risk in the near-nature landscape utilization type. The interaction effects among factors contributed to an enhanced explanatory power for soil erosion. Particularly, the synergistic effect between vegetation coverage and land use exhibited the most significant influence on soil erosion. The mosaic distribution pattern of soil erosion sources and sinks, as well as the distribution pattern of fragmented source and aggregated sink distribution pattern, effectively mitigated soil loss, leading to reduced soil erosion rates.
Self-assembled micro and nano rod-shaped porphyrin@Bi12O17Cl2 composite as an efficient photocatalyst for degradation of organic contaminants
Authors: Ogbeifun Osemeikhian , Tichapondwa Shepherd M. , Chirwa Evans M. N.
Published: October 2023

Bi12O17Cl2 is a potential photocatalyst in practical applications due to its excellent photostability, visible light activity, and competitive bandgap energy. However, the fast recombination of photogenerated charge carriers makes it impractical for pollution mitigation. Recently, aggregated porphyrins have emerged as photosensitizers in light-dependent applications such as photocatalysis. Although Bi12O17Cl2 and porphyrin can function as separate photocatalysts, their photocatalytic properties in terms of visible light adsorption, charge separation and transport, can be improved when they are combined to form heterostructure. In this study, rod-shaped aggregated 5,10,15, 20-Tetrakis (4-carboxyphenyl) porphyrin was synthesized by CTAB-assisted, self-assembly strategy and Bi12O17Cl2 by a facile microwave method. The porphyrin and Bi12O17Cl2 were combined to generate a series of x%Porphyrin@Bi12O17Cl2 having 0.02% wt., 0.1% wt., 0.4% wt., 1% wt. and 10% wt. as compositions of porphyrin. The materials’ photocatalytic degradation efficiency was tested on Rhodamine B dye as a representative pollutant. The best and worst performances were reported for 1%Porphyrin@Bi12O17Cl2 and 10%Porphyrin@Bi12O17Cl2, respectively, which are 3.1 and 0.5 times increases in efficiency compared to pure Bi12O17Cl2. From the radical trapping experiment, electrons and superoxide were the dominant reactive species in the degradation process. The enhanced photocatalytic capability of the materials was attributed to the photosensitizing property of porphyrin and the heterojunction formation, which promotes the separation of photogenerated charge carriers. A plausible step-scheme (S-scheme) was proposed for the photocatalytic degradation mechanism. The S-scheme provided the high redox potential of the photogenerated charge carriers. The findings herein offer a new option for improving the photocatalytic performance of Bi12O17Cl2 for environmental applications through the photosensitization strategy.

Graphical abstract
Preparation, characterization, and magnetic resonance imaging of Fe nanowires
Authors: Cao Xiaoming , Hu Shike , Zheng Hua , Mukhtar Aiman , Wu KaiMing , Gu Liyuan
Published: October 2023

A facile template method was employed to synthesize Fe nanowires of different sizes, dimensions. Comprehensive analyses were conducted to explore their morphology, structure, composition, and magnetic properties. The surface of as-prepared Fe nanowires was modified with SiO2 by sol–gel method to improve the dispersion of as-prepared Fe nanowires in aqueous solution. Furthermore, the relaxation properties, biocompatibility and in vivo imaging abilities of the Fe@SiO2 nanowires were evaluated. The study revealed that the SiO2-coated Fe nanowires functioned effectively as transverse relaxation time (T2) contrast agents (CAs). Notably, as the length of the Fe@SiO2 nanowires increased, their diameter decreased, leading to a higher the transverse relaxivity (r2) value. Our study identified that among the Fe nanowires synthesized, the Fe3@SiO2 nanowires, characterized by a diameter of around 30 nm and a length of approximately 500 nm, exhibited the highest r2 value of 59.3 mM−1 s−1. These nanowires demonstrated good biocompatibility and non-toxicity. Notably, upon conducting small animal imaging a 1.5 T with Sprague–Dawley rats, we observed a discernible negative enhancement effect in the liver. These findings indicate the promising potential of Fe@SiO2 nanowires as T2 CAs, with the possibility of tuning their size for optimized results.
Diminished ovarian reserve causes adverse ART outcomes attributed to effects on oxygen metabolism function in cumulus cells
Authors: Zhang Cong , Song Shi , Yang Ming , Yan Liying , Qiao Jie
Published: October 2023

Background

Declining oocyte quality in women with advanced age has been a major impediment to assisted reproductive treatments’ (ART) success rate. However, aging is often accompanied by a diminished ovarian reserve (DOR). Cumulus cells (CCs) are known to play an important role in the development and maturation of oocytes, and the quality of CCs actually reflects the quality of the oocyte. In this study, CCs were used to investigate the real reasons for the decline in oocyte quality in older women.

Methods

Ninety-nine CC samples were subdivided into 4 different groups according to the different age and ovarian reserve status. Other than clinical ART results, transcriptional expression profiles were performed in CCs to detect the differences.

Results

The results were that DOR, no matter in young or advanced age group, was found to be significantly associated with adverse ART outcomes. Of note, there were no statistically significant changes in ART outcomes in the group at advanced age with normal ovarian reserve (NOR), compared to the young with NOR. DOR induced a series of transcriptional variations in CCs commonly enriched in oxygen metabolism.

Conclusion

Our results revealed that the ART outcomes in advanced patients were attributable to the DOR. The oxygen metabolic changes may interfere with CCs’ function of supporting oocytes. This study can provide guidance for ART practice that not age but ovarian reserve status is the main predictor for ART outcomes, and ovarian reserve status should be timely assessed when the clinical manifestations are still mild in elderly women.
Identification of novel flavin-dependent monooxygenase from Strobilanthes Cusia reveals molecular basis of indoles’ biosynthetic logic
Authors: Liu Chang , Cheng Mengya , Ma Chao , Chen Junfeng , Tan Hexin
Published: October 2023

Background

Strobilanthes cusia (Nees) Kuntze is a traditional medical plant distributed widely in south China. The indole compounds that originated from the plant are responsible for its pharmacological activities. However, the reason why indole ingredients are accumulated in this herb and how it is biosynthesized has remained largely unknown.

Results

In this study, metabolic and transcriptional profiling measurement experiments of different S. cusia organs were carried out to understand the underlying molecular basis of indoles’ biosynthetic logic. A metabolic investigation demonstrated that the indoles are primarily accumulated mainly in aerial parts, particularly in leaves. RNA-seq was employed to reveal the organ specific accumulation of indoles in different S. cusia organs. Meanwhile, a flavin-dependent monooxygenase gene (ScFMO1) was found in S. cusia, and it has capacity to produce indoxyl from indole by the fermentation assay. Finally, we assessed the outcomes of transient expression experiment in tobacco and confirmed that ScFMO1 localizes in cytoplasm.

Conclusions

Our results suggest that ScFMO1 plays a key role in biosynthesis of indoles (Indigo, indirubin, indican, etc.), it will be useful for illuminating the molecular basis of the medicinal indoles’ biosynthesis and developing strategies for improving their yields.
Early outcomes of a triple-branched stent graft implantation in elderly patients with acute type a aortic dissection
Authors: Dong Yi , Wang Xuefei , Chen Liangwan , Wu Qingsong , Li Qianzhen
Published: October 2023

Purpose

Older patients with acute type A aortic dissection (ATAAD) have higher risk of mortality than that of younger patients when a total arch reconstruction (TAR) is required. Triple-branched stent graft (TBSG) implantation is a novel technique for TAR. However, early outcomes of a TBSG implantation in older patients have not been reported. This study aimed to evaluate the early outcomes of the TBSG technique in older patients with ATAAD.

Methods

From February 2015 to December 2020, 640 patients who simultaneously underwent an emergent open aortic surgery and TBSG implantation for ATAAD were enrolled in this study. They were categorized into the younger (age ≤ 70 years old, n = 573) and older groups (age > 70 years, n = 67). Clinical data of all patients were retrospectively reviewed.

Result

The mean ages of the patients in the younger and older groups were 45.3 ± 9.6 years old and 73.5 ± 3.0 years old, respectively. Preoperative characteristics were similar between the two groups, except for weight and incidence of moderate or greater aortic regurgitation, which were lower in the older group than those in the younger group. Surgical procedure and duration (i.e., duration for cardiopulmonary bypass, aortic cross-clamp, selected cerebral perfusion, and total circulation arrest) were comparable between the two groups (p > 0.05). Patients in the older group had higher incidence of dialysis for acute kidney injury and longer ICU stay compared with those in the younger group. However, the incidences of 30-day mortality (5.1% in younger group vs. 7.5% in older group, p = 0.407) and other major complications (i.e., neurological adverse events) were similar between the two groups.

Conclusion

TBSG implantation for ATAAD resulted in an acceptable mortality rate in patients above 70 years old, thus, it could be a feasible surgical procedure to perform in older patients with ATAAD when a TAR is required.
Elevated circulating PCSK9 level is associated with 28-day mortality in patients with sepsis: a prospective cohort study
Authors: Shu Yuanlu , Deng Ziwei , Deng Ye , Zhou Jianliang , Wang Jin , Duan Zhenxing , Jiang Tao , Zhao Xiang , Shi Zhihua , Qiu Chengfeng
Published: October 2023

Objectives

Pro-protein convertase subtilisin/kexin 9 (PCSK9) decreases the clearance of the pathogenic lipids, supporting the potential role of PCSK9 in the prognosis of sepsis.

Methods

In this prospective cohort study, patients with sepsis were consecutively recruited from 1 to 2020 to 30 September 2021 at the First People’s Hospital of Huaihua, China. All the eligible patients were categorized into low-PCSK9 and high-PCSK9 groups, based on their PCSK9 levels at admission. Time-dependent receiver operating characteristic curves and Cox proportional hazards regression were used to evaluate the association between PCSK9 level and 28-day mortality of sepsis.

Results

Of the 203 enrolled patients, 56 (27.59%) died during the 28-day follow-up. The PCSK9 level was positively related to the C-reactive protein level. The cut-off point of PCSK9 levels for 28-day mortality risk was 370 ng/ml. Through comparison between high-PCSK9 (> 370 ng/ml) with low-PCSK9 (≤ 370 ng/ml) groups, the adjusted HR for mortality was 2.56 (95% CI: 1.25–5.23, p = 0.01).

Conclusions

The 28-day mortality of sepsis increased significantly as the baseline circulating PCSK9 level exceeded 370 ng/ml, indicating circulating PCSK9 levels may be a potential biomarker to predict the prognosis of sepsis.
How to perform prespecified subgroup analyses when using propensity score methods in the case of imbalanced subgroups
Authors: Chatelet Florian , Verillaud Benjamin , Chevret Sylvie
Published: October 2023

Background

Looking for treatment-by-subset interaction on a right-censored outcome based on observational data using propensity-score (PS) modeling is of interest. However, there are still issues regarding its implementation, notably when the subsets are very imbalanced in terms of prognostic features and treatment prevalence.

Methods

We conducted a simulation study to compare two main PS estimation strategies, performed either once on the whole sample (“across subset”) or in each subset separately (“within subsets”). Several PS models and estimands are also investigated. We then illustrated those approaches on the motivating example, namely, evaluating the benefits of facial nerve resection in patients with parotid cancer in contact with the nerve, according to pretreatment facial palsy.

Results

Our simulation study demonstrated that both strategies provide close results in terms of bias and variance of the estimated treatment effect, with a slight advantage for the “across subsets” strategy in very small samples, provided that interaction terms between the subset variable and other covariates influencing the choice of treatment are incorporated. PS matching without replacement resulted in biased estimates and should be avoided in the case of very imbalanced subsets.

Conclusions

When assessing heterogeneity in the treatment effect in small samples, the “across subsets” strategy of PS estimation is preferred. Then, either a PS matching with replacement or a weighting method must be used to estimate the average treatment effect in the treated or in the overlap population. In contrast, PS matching without replacement should be avoided in this setting.
Impact of an INtervention to increase MOBility in older hospitalized medical patients (INTOMOB): Study protocol for a cluster randomized controlled trial
Authors: Mooser Blandine , Bergsma Dominique , Liechti Fabian D. , Baumgartner Christine , Gentizon Jenny , Méan Marie , Wertli Maria M. , Mancinetti Marco , Schmidt-Leuenberger Joachim , Aubert Carole E.
Published: October 2023

Background

Low mobility during an acute hospitalization is frequent and associated with adverse effects, including persistent functional decline, institutionalization and death. However, we lack effective interventions to improve mobility that are scalable in everyday practice. The INTOMOB trial – INtervention to increase MOBility in older hospitalized medical patients – will test the effect of a multilevel intervention to improve mobility of older hospitalized patients on functional mobility.

Methods

The INTOMOB multicenter superiority parallel cluster randomized controlled trial will enroll in total 274 patients in Swiss hospitals. Community-dwelling adults aged ≥ 60 years, admitted to a general internal medicine ward with an anticipated length of hospital stay of ≥ 3 days, will be eligible for participation. Unit of randomization will be the wards. A multilevel mobility intervention will be compared to standard of care and target the patients (information and exercise booklets, mobility diary, iPad with exercise videos), healthcare professionals (e-learning, oral presentation, mobility checklist), and environment (posters and pictures on the wards). The primary outcome will be life-space level, measured by the University of Alabama at Birmingham Study of Aging Life-Space Assessment (LSA), at 30 days after enrollment. The LSA is a measure of functional mobility, i.e., how far participants move from bedroom to outside town. Secondary outcomes include, among others, LSA at 180 days, mobility and falls during hospitalization, muscle strength at discharge, and falls, emergency room visits, readmissions, and death within 180 days.

Discussion

This study has the potential to improve outcomes of older hospitalized patients through an intervention that should be scalable in clinical practice because it fosters patient empowerment and does not require additional resources. The tools provided to the patients can help them implement better mobility practices after discharge, which can contribute to better functional outcomes. The choice of a functional patient-reported outcome measure as primary outcome (rather than a “simple” objective mobility measure) reinforces the patient-centeredness of the study.

Trial registration

clinicaltrials.gov (NCT05639231, released on December 19 2022); Swiss National Clinical Trial Portal (SNCTP000005259, released on November 28 2022).
Association between chronic pain and acute coronary syndrome in the older population: a nationwide population-based cohort study
Authors: Liu Yu-Chang , Ho Chung-Han , Chen Yi-Chen , Hsu Chien-Chin , Lin Hung-Jung , Wang Chia-Ti , Huang Chien-Cheng
Published: October 2023

Background

Chronic pain (CP) may increase the risk of acute coronary syndrome (ACS); however, this issue in the older population remains unclear. Therefore, this study was conducted to clarify it.

Methods

We used the Taiwan National Health Insurance Research Database to identify older patients with CP between 2001 and 2005 as the study cohort. Comparison cohort was the older patients without CP by matching age, sex, and index date at 1:1 ratio with the study cohort in the same period. We also included common underlying comorbidities in the analyses. The risk of ACS was compared between the two cohorts by following up until 2015.

Results

A total of 17241 older patients with CP and 17241 older patients without CP were included in this study. In both cohorts, the mean age (± standard deviation) and female percentage were 73.5 (± 5.7) years and 55.4%, respectively. Spinal disorders (31.9%) and osteoarthritis (27.0%) were the most common causes of CP. Older patients with CP had an increased risk for ACS compared to those without CP after adjusting for all underlying comorbidities (adjusted sub-distribution hazard ratio [sHR] 1.18; 95% confidence interval: 1.07–1.30). The increasement of risk of ACS was more when the follow-up period was longer (adjusted sHR of < 3 years: 1.8 vs. <2 years: 1.75 vs. <1 year: 1.55).

Conclusions

CP was associated with an increased risk of ACS in the older population, and the association was more prominent when the follow-up period was longer. Early detection and intervention for CP are suggested in this population.
Psychometric evaluation of the Protection Motivation Theory scale in assessing fall protection motivation among older adults to reduce fall risk
Authors: Ong Mei Fong , Soh Kim Lam , Saimon Rosalia , Tiong Ing Khieng , Saidi Hasni Idayu , Mortell Manfred
Published: October 2023

Background

Protection Motivation Theory could be another potential and good framework that addresses essential elements in a behavioural change leading to positive fall protective behaviours. The positive behavioural change could reduce the risk of falls and improve the quality of life of the older community. The study aims to evaluate the reliability and validity of the culturally adapted Protection Motivation Theory scale for older adults' fall protection motivation or protective behaviours to reduce fall risk.

Methods

A cross-sectional study was conducted to establish a psychometric instrument validation. A total of 389 participants aged 55 years and above were included. The study was conducted in Sarawak, Malaysia, from November 2021 to January 2022 in two phases, translation of the PMT Scale, cross-cultural adaptation, face validation and pre-testing of the PMT Scale. The participants were selected using multistage random sampling in a primary healthcare clinic. Data entry and statistical analysis were performed using IBM SPSS version 26 for exploratory factor analysis and SmartPLS version 3.3.7 for confirmatory factor analysis using partial least square structural equation modelling.

Results

The Kaiser–Meyer–Olkin value was 0.760, Bartlett's sphericity test was significant and the total variance explained was 61%. It identified 31 items within eight dimensions of the Protection Motivation Theory scale. The Higher Order Constructs' measurement model indicates that the convergent and discriminant validity were established (Cronbach's alpha and composite reliability: ≥ 0.740; average variance extracted: 0.619 to 0.935 and Henseler's Heterotrait-Monotrait criterion for all constructs' discriminant validity: < 0.9). Test–retest for the intraclass correlation coefficient was 0.745. The model's coefficient of determination demonstrated R2 = 0.375.

Conclusion

Overall, the Protection Motivation Theory Scale has established its reliability and validity for assisting older adults in the community. The Protection Motivation Theory Scale could be used in fall prevention interventions by promoting fall protective behaviours to reduce fall risk among community-dwelling older adults. The scale could assist healthcare providers in assessing the intention of older adults to use fall protective behaviours to reduce fall risk and serve as an alternative reference in developing fall prevention education in a fall prevention strategy.
Assessing the COVID-19 vaccination program during the Omicron variant (B.1.1.529) epidemic in early 2022, Tokyo
Authors: Kayano Taishi , Nishiura Hiroshi
Published: October 2023

Background

Many countries, including high-income nations, struggled to control epidemic waves caused by the Omicron variant (B.1.1.529), which had an antigenically distinct evolution. Evaluating the direct and indirect effects of vaccination during the Omicron waves is essential to assess virus control policies. The present study assessed the population impacts of a vaccination program during the sixth wave caused by BA.1 and BA.2 from January to May 2022, in Tokyo.

Methods

We analyzed the primary series and booster vaccination coverages and the confirmed cases stratified by vaccination history. We estimated the number of COVID-19 cases that were directly and indirectly prevented by vaccination. To estimate the direct impact, we used a statistical model that compared risks between unvaccinated and vaccinated individuals. A transmission model employing the renewal process was devised to quantify the total effect, given as the sum of the direct and indirect effects.

Results

Assuming that the reporting coverage of cases was 25%, mass vaccination programs, including primary and booster immunizations, directly averted 640,000 COVID-19 cases (95% confidence interval: 624–655). Furthermore, these programs directly and indirectly prevented 8.5 million infections (95% confidence interval: 8.4–8.6). Hypothetical scenarios indicated that we could have expected a 19% or 7% relative reduction in the number of infections, respectively, compared with the observed number of infections, if the booster coverage had been equivalent to that of the second dose or if coverage among people aged 10–49 years had been 10% higher. If the third dose coverage was smaller and comparable to that of the fourth dose, the total number of infections would have increased by 52% compared with the observed number of infections.

Conclusions

The population benefit of vaccination via direct and indirect effects was substantial, with an estimated 65% reduction in the number of SARS-CoV-2 infections compared with counterfactual (without vaccination) in Tokyo during the sixth wave caused by BA.1 and BA.2.
A case of acute kidney injury due to native kidney BK polyomavirus-associated nephropathy in a human T-lymphotropic virus type 1 carrier
Authors: Takae Keita , Ueno Yuki , Shojima Masumi , Nagae Hiroshi , Nakano Takako , Takata Shohei , Katafuchi Ritsuko , Masutani Kosuke , Nakano Toshiaki , Kuroki Yusuke
Published: October 2023

Background

BK polyomavirus-associated nephropathy (BKPyVAN) has become a major cause of kidney dysfunction and graft loss in kidney transplant recipients. On rare occasion, polyomavirus has also been known to affect native kidneys of immunocompromised individuals. Only a small number of opportunistic infections have been reported in the carrier phase of human T-lymphotropic virus type 1 (HTLV-1). This is the first reported case of BKPyVAN in native kidneys of an HTLV-1 carrier.

Case presentation

A 61-year-old man was referred to our hospital from a primary care physician for work-up and treatment of pneumonia. He was diagnosed with Pneumocystis pneumonia and identified as a HTLV-1 carrier who had not yet developed adult T-cell leukemia (ATL). The pneumonia was successfully treated with sulfamethoxazole-trimethoprim. He had never been diagnosed with any kind of kidney dysfunction. Laboratory investigations showed a serum creatinine of 5.3 mg/dL, and urinary sediment showed cells with nuclear enlargement and inclusion bodies suggesting viral infection. The urinary Papanicolaou stain showed inclusions in swollen, ground-glass nuclei, typical of “decoy cells”. Renal biopsy showed degeneration of tubules with epithelial enlargement, vacuolar degeneration, nuclear inclusion bodies, and detachment from the tubular basement membrane. Tubular nuclei showed positive staining positive for simian virus 40 large-T antigen. Polymerase chain reaction tests for BK polyomavirus DNA of both urine and plasma were positive. These findings confirmed a diagnosis of BKPyVAN. Intravenous immunoglobulin therapy did not improve renal function, necessitating maintenance hemodialysis therapy.

Conclusions

BKPyVAN should be considered when acute kidney injury occurs with opportunistic infection. HTLV-1 carriers can develop opportunistic infections even before the onset of ATL.
Changes in electrophysiological findings of spinal muscular atrophy type I after the administration of nusinersen and onasemnogene abeparvovec: two case reports
Authors: Mizuno Tomoko , Kanouchi Tadashi , Tamura Yumie , Hirata Ko , Emoto Runa , Suzuki Tomonori , Kashimada Kenichi , Morio Tomohiro
Published: October 2023

Background

Recently, there have been significant advances in the treatment of spinal muscular atrophy (SMA). Although clinical improvement in patients with SMA after the treatment has been reported, changes in electrophysiological findings, especially needle electromyography (EMG), have rarely been reported. Herein, we report the posttreatment changes in EMG and nerve conduction study findings over time in two patients with SMA type I.

Case presentation

Patient 1: A 2.5-year-old girl was diagnosed with SMA type I at 1 month of age. She received nusinersen four times and onasemnogene abeparvovec (OA) was administered at 6 months of age. The compound muscle action potential (CMAP) amplitudes of the median and tibial nerves increased over time. The needle EMG after the treatment showed high-amplitude motor unit potentials (MUPs) suggestive of reinnervation during voluntary contraction, which were not seen before the treatment. However, fibrillation potentials at rest were still seen after the treatment. Patient 2: A 2-year-old girl was diagnosed with SMA type I at 6 months of age. She had received nusinersen two times and OA was administered at 7 months of age. The CMAP amplitudes and the MUPs presented similar changes as presented in Case 1.

Conclusion

This is the first report on the changes in needle EMG findings after treatment in patients with SMA type I. These findings suggested that peripheral nerve reinnervation occurred after the treatment, although active denervation was still present. The accumulation of these findings will be important for evaluating the effectiveness of treatment for SMA in the future.
Survival outcomes including salvage therapy of adult head and neck para-meningeal rhabdomyosarcoma: a multicenter retrospective study from Japan
Authors: Tsuchihashi Kenji , Ito Mamoru , Arita Shuji , Kusaba Hitoshi , Kusano Wataru , Matsumura Takashi , Kitazono Takafumi , Ueno Shohei , Taguchi Ryosuke , Yoshihiro Tomoyasu , Doi Yasuhiro , Arimizu Kohei , Ohmura Hirofumi , Kajitani Tatsuhiro , Nio Kenta , Nakano Michitaka , Oshima Kotoe , Tamura Shingo , Shirakawa Tsuyoshi , Shimokawa Hozumi , Uchino Keita , Hanamura Fumiyasu , Okumura Yuta , Komoda Masato , Isobe Taichi , Ariyama Hiroshi , Esaki Taito , Hashimoto Kazuki , Komune Noritaka , Matsuo Mioko , Matsumoto Keiji , Asai Kaori , Yoshitake Tadamasa , Yamamoto Hidetaka , Oda Yoshinao , Akashi Koichi , Baba Eishi
Published: October 2023

Background

Rhabdomyosarcoma is the most common soft tissue sarcoma in children, but rare in adults. Para-meningeal rhabdomyosarcoma in head and neck (PM-HNRMS) is less applicable for surgery due to the anatomic reason. PM-HNRMS has a poor prognosis in children. However, its clinical outcomes remain unclear in adults due to the rarity. Further, there is almost no detailed data about salvage therapy.

Methods

We retrospectively examined the adult patients with PM-HNRMS treated at institutions belonging to the Kyushu Medical Oncology Group from 2009 to 2022. We evaluated the overall survival (OS) and progression-free survival (PFS) of the patients who received a first-line therapy. We also reviewed the clinical outcomes of patients who progressed against a first-line therapy and received salvage therapy.

Results

Total 11 patients of PM-HNRMS received a first-line therapy. The characteristics were as follows: median age: 38 years (range 25 – 63 years), histology (alveolar/spindle): 10/1, and risk group (intermediate/high): 7/4. As a first-line therapy, VAC and ARST0431-based regimen was performed in 10 and 1 patients, respectively. During a first-line therapy, definitive radiation for all lesions were performed in seven patients. The median PFS was 14.2 months (95%CI: 6.0 – 25.8 months): 17.1 months (95%CI: 6.0 – not reached (NR)) for patients with stage I-III and 8.5 months (95%CI: 5.2 – 25.8 months) for patients with stage IV. The 1-year and 3-year PFS rates were 54.5% and 11.3% for all patients. Median OS in all patients was 40.8 months (95%CI: 12.1 months–NR): 40.8 months (95%CI: 12.1 – NR) for patients with stage I-III and NR for patients with stage IV. The 5-year OS rate was 48.5% for all patients. Among seven patients who received salvage therapy, three are still alive, two of whom remain disease-free for over 4 years after completion of the last therapy. Those two patients received multi-modal therapy including local therapy for all detected lesions.

Conclusion

The cure rate of adult PM-HNRMS is low in spite of a first-line therapy in this study. Salvage therapy might prolong the survival in patients who received the multi-modal therapy including local therapy for all detected lesions.
Comprehensive interventions to reduce occupational hazards among medical staff in the pathology department of five primary hospitals
Authors: Wang Hui , Feng Dao , He Yong , Jin Xunhua , Fu Shui
Published: October 2023

Objective

To explore comprehensive interventions to reduce occupational hazards among medical staff in the pathology department of five primary hospitals.

Methods

The indoor air quality in the pathology department of five primary hospitals and the health status of staff were investigated and analyzed. Formaldehyde and benzene concentrations in the technical and diagnostic rooms of the pathology departments were analyzed before and after comprehensive interventions. The Environmental Protection Agency risk assessment paradigm was used to assess the health risks from occupational exposure to benzene and formaldehyde. Consequently, considering the local environment, targeted comprehensive intervention measures were developed, including optimizing management, raising awareness, updating equipment, and replacing reagents.

Results

Eye discomfort was higher among technicians in the pathology department than among clinical medical staff (P < 0.05). Before comprehensive interventions, formaldehyde concentrations were higher in the technical room than in the diagnostic room at the five primary hospitals (P < 0.05). However, compared to before interventions, formaldehyde and benzene concentrations in both rooms were significantly lower after comprehensive interventions. Furthermore, although medium risks of occupational exposure to benzene and formaldehyde remained in both rooms before and after comprehensive interventions, the risk values before interventions were higher than after comprehensive interventions. The staff of the technical rooms showed higher risk values that those of the diagnostic rooms before and after comprehensive interventions. Similarly, although hazard quotient (HQ) values for occupational exposure to benzene and formaldehyde were < 1 in both the technical and diagnostic rooms before and after comprehensive interventions, with lower noncarcinogenic risks, the values were higher before than after comprehensive interventions. Moreover, staff in the technical room had higher HQ values before and after comprehensive interventions than those in the diagnostic room. The use of environmentally friendly reagents for the preparation of frozen sections was effective.

Conclusion

Comprehensive interventions significantly reduced occupational hazards among staff at the pathology department of five primary hospitals, which is of great practical significance to protect the health of staff.
Understanding the economic burden of chronic cough: a systematic literature review
Authors: Bali Vishal , Adriano Ada , Byrne Aidan , Akers Katherine G. , Frederickson Andrew , Schelfhout Jonathan
Published: October 2023

Chronic cough (CC) is associated with high healthcare resource utilization (HCRU) due to challenges in diagnosis and treatment and is anticipated to have a substantial economic impact. This systematic literature review (SLR) sought to identify evidence on the cost-effectiveness of treatments and the economic burden associated with CC. Electronic database searches were supplemented with searches of conference proceedings and health technology assessment body websites. Two independent reviewers assessed all citations for inclusion based on predefined inclusion/exclusion criteria. Key inclusion criteria were patient population with CC, and outcomes related to cost-effectiveness and HCRU and costs. After screening, one cost-effectiveness analysis was identified, alongside eight studies reporting HCRU and costs related to CC. Though evidence was limited, studies suggest that patients with CC incur higher costs and use more resources than those with acute cough. Types of resource use reported included healthcare contacts and prescriptions, diagnostic tests, referrals and specialist evaluations, and treatment use. There is a paucity of literature on HCRU and costs in CC, and very limited cost-effectiveness analyses. The economic burden appears higher in these patients however, without direct comparison to the general population it is difficult to determine the total impact. The increased burden is expected to be a result of the challenges with diagnosis and lack of approved treatments. However, limited conclusions can be drawn in the absence of further data. Future studies should endeavor to quantify the HCRU and cost attributable to patients with CC.