bluuebunny/crossref_metadata_2025 huggingface dataset:
A phase 2 multicenter trial of ruxolitinib to treat bronchiolitis obliterans syndrome after allogeneic HCT
Authors: DeFilipp Zachariah , Kim Haesook T. , Cheng Guang-Shing , Hamilton Betty K. , Chhabra Saurabh , Hamadani Mehdi , Sandhu Karamjeet S. , Perez Lia , Lee Catherine J. , Brennan Timothy L. , Garrelts Cassandra , Brown Bergin M. , Gallagher Kathleen , Newcomb Richard A. , El-Jawahri Areej , Chen Yi-Bin
Published: October 2024

Bronchiolitis obliterans syndrome (BOS) occurring after allogeneic hematopoietic cell transplantation (HCT) is a high-risk manifestation of chronic graft-versus-host disease. In this prospective, multicenter phase 2 trial, adult participants with BOS were treated with ruxolitinib 10 mg twice daily, continuously in 28-day cycles for up to 12 cycles. Participants enrolled into newly diagnosed (<6 months since BOS diagnosis, cohort A) or established (≥6 months since BOS diagnosis, cohort B) disease cohorts. The primary objective was to evaluate the early treatment effect of ruxolitinib, assessed by the change in forced expiratory volume in 1 second (FEV1) at 3 months compared with enrollment. The primary end point differed according to cohort (cohort A, improvement, defined as ≥10% increase in FEV1; cohort B, stabilization, defined as an absence of ≥10% decrease in FEV1). Between 2019 and 2022, 49 participants meeting the criteria for BOS were enrolled and treated (cohort A, n = 36; cohort B, n = 13). The primary end point was achieved by 27.8% of participants with new BOS and 92.3% of participants with established BOS. According to the 2014 National Institutes of Health Consensus Criteria, the best lung-specific overall response rate on ruxoltinib for the 49 participants was 34.7% (16.3% complete response and 18.4% partial response), with most responses occurring in mild or moderate disease. Noninfectious severe (grade ≥3) treatment-emergent adverse events were infrequent. Nine severe infectious events occurred and were largely respiratory in nature. These results support the use of ruxolitinib in the management of BOS after allogeneic HCT. This trial was registered at www.ClinicalTrials.gov as #NCT03674047.
Post-viral lung diseases: the microbiota as a key player
Authors: Stadler Sabine V , von Garnier Christophe , Ubags Niki D
Published: October 2024

Viral infections of the respiratory tract can lead to chronic lung injury through immunopathological mechanisms that remain unclear. Communities of commensal bacteria colonizing the respiratory tract, known as the respiratory tract microbiota, are altered in viral infections, which can contribute to inflammation, lung epithelial damage and subsequent development of lung disease. Emerging evidence on post-viral lung injury suggests an interplay between viral infections, immune responses and airway microbiota composition in the development of viral-induced lung diseases. In this review, we present the clinical characteristics of post-viral lung injury, along with the underlying immunopathological mechanisms and host-bacteria interactions, with a focus on influenza virus, respiratory syncytial virus and coronaviruses. Additionally, considering the important role of the airway microbiota in viral-induced pulmonary sequelae, we suggest key areas for future research on respiratory microbiota involvement in the development of post-viral lung diseases.
Estimation of mass and moisture content of flat square lumber in a stack during air-drying process by the vibration method with additional mass
Authors: Kubojima Yoshitaka , Sonoda Satomi , Kato Hideo
Published: October 2024

A vibration test to measure the mass of a specimen without weighing it using the difference between the resonance frequency with an additional mass and that without it (vibration method with additional mass, VAM) was applied to Japanese cedar flat square lumber with dimensions of 210 mm × 135 mm × 3000 mm both with and without a pith in the process of air-drying. The longitudinal and bending vibration tests were performed on the specimens with and without an additional mass. The accuracy of VAM that was expressed by the estimated mass by VAM to the measured mass (MVAM/M0) was sufficiently high throughout the air-drying process. The accuracy of VAM for the longitudinal vibration was higher than that for the bending vibration. The moisture content based on the estimated mass by VAM was in the expected range.
Large right middle cerebral artery stroke with hemorrhagic transformation
Authors: Niles Jack , Bhasin Garv , Ganti Latha
Published: October 2024

The authors present a case of an acute right middle cerebral artery infarct in a 65-year-old male with a history of diabetes, hypertension, and cardiovascular disease. The timeline of treatment and the evolution of the stroke is described. This case highlights the significant burden of right-sided cerebral artery stroke, even when intervention is swift.
The power of deep learning in simplifying feature selection for hepatocellular carcinoma: a review
Authors: Mostafa Ghada , Mahmoud Hamdi , Abd El-Hafeez Tarek , E.ElAraby Mohamed
Published: October 2024

Background

Hepatocellular Carcinoma (HCC) is a highly aggressive, prevalent, and deadly type of liver cancer. With the advent of deep learning techniques, significant advancements have been made in simplifying and optimizing the feature selection process.

Objective

Our scoping review presents an overview of the various deep learning models and algorithms utilized to address feature selection for HCC. The paper highlights the strengths and limitations of each approach, along with their potential applications in clinical practice. Additionally, it discusses the benefits of using deep learning to identify relevant features and their impact on the accuracy and efficiency of diagnosis, prognosis, and treatment of HCC.

Design

The review encompasses a comprehensive analysis of the research conducted in the past few years, focusing on the methodologies, datasets, and evaluation metrics adopted by different studies. The paper aims to identify the key trends and advancements in the field, shedding light on the promising areas for future research and development.

Results

The findings of this review indicate that deep learning techniques have shown promising results in simplifying feature selection for HCC. By leveraging large-scale datasets and advanced neural network architectures, these methods have demonstrated improved accuracy and robustness in identifying predictive features.

Conclusions

We analyze published studies to reveal the state-of-the-art HCC prediction and showcase how deep learning can boost accuracy and decrease false positives. But we also acknowledge the challenges that remain in translating this potential into clinical reality.
A multifaceted analysis of decreasing trust in health institutions in the EU during the COVID-19 pandemic
Authors: Yaddanapudi Lahari , Hahn Julia , Ladikas Miltos
Published: October 2024

Background

Public trust is crucial during health crises, such as the COVID-19 pandemic, for the effective implementation of scientific and policy interventions. This study investigates factors contributing to the decline in trust in the health sector within the European Union during the pandemic.

Methods

Using the publicly available 2020–2022 Standard Eurobarometer dataset, we employed a "geography of trust" approach. We applied equal quantile mapping to visualise high and low trust countries and Local Spatial Autocorrelation (LISA) to identify statistically significant clusters. Using a series of one-way ANOVA, we found associations between socio-economic and other variables available in the same dataset with trust.

Results

Trust in health institutions and medical staff declined in 20 of 27 EU countries from 2020 to 2022. Clear geographical clusters of Western and Central Europe as the high-trust countries and Eastern Europe as the low-trust countries emerged through mapping. One-way ANOVA revealed that contrary to several studies, age, gender, and most demographics did not vary with trust, but trust was directly associated with the satisfaction with measures taken to fight the COVID-19 pandemic, and individual perceptions about their life and national affairs (p < 0.001).

Conclusion

High-trust Western European countries share characteristics in health systems, governance, and pandemic responses. Understanding this interplay could inform trust-building strategies. The persistent low trust in Eastern Europe may stem from slow government responses and requires nuanced approaches considering unique contexts. The decline in traditionally high-trust countries highlights challenges even in established social contexts. This study provides valuable insights for policymakers aiming to foster trust during health crises.
Digital communication between mothers and community health workers to support neonatal health (CHV-NEO): study protocol for a randomized controlled trial
Authors: Ronen Keshet , Pothan Lincoln C. , Apondi Violet , Otieno Felix A. , Mwakanema Daniel , Otieno Felix O. , Osborn Lusi , Dettinger Julia C. , Shrestha Priyanka , Manguerra Helena , Mukumbang Ferdinand , Masinde Millicent , Waweru Evelyn , Amulele Mercy , Were Christine , Wasunna Beatrice , John-Stewart Grace , Weiner Bryan , Means Arianna Rubin , Richardson Barbra A. , Hedstrom Anna B. , Unger Jennifer A. , Kinuthia John
Published: October 2024

Background

Provision of essential newborn care at home, rapid identification of illness, and care-seeking by caregivers can prevent neonatal mortality. Mobile technology can connect caregivers with information and healthcare worker advice more rapidly and frequently than healthcare visits. Community health workers (CHWs) are well-suited to deliver such interventions. We developed an interactive short message service (SMS) intervention for neonatal health in Kenya, named CHV-NEO. CHV-NEO sends automated, theory-based, actionable, messages throughout the peripartum period that guide mothers to evaluate maternal and neonatal danger signs and facilitate real-time dialogue with a CHW via SMS. We integrated this intervention into Kenya’s national electronic community health information system (eCHIS), which is currently used at scale to support CHW workflow.

Methods

The effect of CHV-NEO on clinical and implementation outcomes will be evaluated through a non-blinded cluster randomized controlled trial. Twenty sites across Kisumu County in Western Kenya were randomized 1:1 to provide either the national eCHIS with integrated CHV-NEO messaging (intervention) or standard of care using eCHIS without CHV-NEO (control). We will compare neonatal mortality between arms based on abstracted eCHIS data from 7200 pregnant women. Secondary outcomes include self-reported provision of essential newborn care (appropriate cord care, thermal care, and timely initiation of breastfeeding), knowledge of neonatal danger signs, and care-seeking for neonatal illness, compared between arms based on questionnaires with a subgroup of 2000 women attending study visits at enrollment in pregnancy and 6 weeks postpartum. We will also determine CHV-NEO’s effect on CHW workflows and evaluate determinants of intervention acceptability, adoption, and fidelity of use through questionnaires, individual interviews, and messaging data.

Discussion

We hypothesize that the CHV-NEO direct-to-client communication strategy can be successfully integrated within existing CHW workflows and infrastructure, improve the provision of at-home essential newborn care, increase timely referral of neonatal illness to facilities, and reduce neonatal mortality. The intervention’s integration into the national eCHIS tool will facilitate rapid scale-up if it is clinically effective and successfully implemented.

Trial registration

ClinicalTrials.gov, NCT05187897. The CHV-NEO study was registered on January 12, 2022.
Terminal differentiation precedes functional circuit integration in the peduncle neurons in regenerating Hydra vulgaris
Authors: Escobar Alondra , Kim Soonyoung , Primack Abby S. , Duret Guillaume , Juliano Celina E. , Robinson Jacob T.
Published: October 2024

Understanding how neural circuits are regenerated following injury is a fundamental question in neuroscience. Hydra is a powerful model for studying this process because it has a simple neural circuit structure, significant and reproducible regenerative abilities, and established methods for creating transgenics with cell-type-specific expression. While Hydra is a long-standing model for regeneration and development, little is known about how neural activity and behavior is restored following significant injury. In this study, we ask if regenerating neurons terminally differentiate prior to reforming functional neural circuits, or if neural circuits regenerate first and then guide the constituent naive cells toward their terminal fate. To address this question, we developed a dual-expression transgenic Hydra line that expresses a cell-type-specific red fluorescent protein (tdTomato) in ec5 peduncle neurons, and a calcium indicator (GCaMP7s) in all neurons. With this transgenic line, we can simultaneously record neural activity and track the reappearance of the terminally-differentiated ec5 neurons. Using SCAPE (Swept Confocally Aligned Planar Excitation) microscopy, we monitored both calcium activity and expression of tdTomato-positive neurons in 3D with single-cell resolution during regeneration of Hydra’s aboral end. The synchronized neural activity associated with a regenerated neural circuit was observed approximately 4 to 8 hours after expression of tdTomato in ec5 neurons. These data suggest that regenerating ec5 neurons undergo terminal differentiation prior to re-establishing their functional role in the nervous system. The combination of dynamic imaging of neural activity and gene expression during regeneration make Hydra a powerful model system for understanding the key molecular and functional processes involved in neural regeneration following injury.
A multivariate approach to assessing landscape structure effects on wildlife crossing structure use
Authors: Yamashita Thomas J. , Perotto-Baldivieso Humberto L. , Wester David B. , Ryer Kevin W. , Kline Richard J. , Tewes Michael E. , Young John H. , Lombardi Jason V.
Published: October 2024

Background

Complexity in landscape structure is often assessed using individual metrics related to ecological processes. However, this rarely incorporates important relationships among metrics and may miss landscape structure effects. Multivariate statistics provide techniques for assessing overall landscape structure effects. We assessed how multivariate statistics could be used to connect landscape structure with an ecological process [bobcat (Lynx rufus) wildlife crossing structure (WCS) use]. We tested how landscape structure at WCS sites compared to the surrounding landscape and how structure affected detections at WCS sites. Our study was conducted in Cameron County, Texas, USA where WCSs are in various stages of construction and monitoring. We used a classified land use/land cover map and aerial LiDAR to calculate configuration and density metrics at WCS and random sites. We created indices for configuration and density using principal components analysis to assess landscape structure effects on camera trap detections at WCSs.

Results

Landscape structure at WCSs did not differ from random locations. Wildlife crossing structure use increased with greater woody cover and decreased with increasing vegetation density. Our indices allowed identification of differences in how configuration and density impacted WCS use. Ordination methods helped identify individual contributions of landscape metrics to the overall landscape structure effect.

Conclusions

Wildlife crossing structures are permanent fixtures on landscapes, so selecting appropriate locations using broad-scale landscape structure likely increases target species use. Using indices of landscape structure provides planners with a more holistic approach to WCS placement and provides a more comprehensive picture of landscape pattern and process relationships.
Growth of sulfate-reducing Desulfobacterota and Bacillota at periodic oxygen stress of 50% air-O2 saturation
Authors: Dyksma Stefan , Pester Michael
Published: October 2024

Background

Sulfate-reducing bacteria (SRB) are frequently encountered in anoxic-to-oxic transition zones, where they are transiently exposed to microoxic or even oxic conditions on a regular basis. This can be marine tidal sediments, microbial mats, and freshwater wetlands like peatlands. In the latter, a cryptic but highly active sulfur cycle supports their anaerobic activity. Here, we aimed for a better understanding of how SRB responds to periodically fluctuating redox regimes.

Results

To mimic these fluctuating redox conditions, a bioreactor was inoculated with peat soil supporting cryptic sulfur cycling and consecutively exposed to oxic (one week) and anoxic (four weeks) phases over a period of > 200 days. SRB affiliated to the genus Desulfosporosinus (Bacillota) and the families Syntrophobacteraceae, Desulfomonilaceae, Desulfocapsaceae, and Desulfovibrionaceae (Desulfobacterota) successively established growing populations (up to 2.9% relative abundance) despite weekly periods of oxygen exposures at 133 µM (50% air saturation). Adaptation mechanisms were analyzed by genome-centric metatranscriptomics. Despite a global drop in gene expression during oxic phases, the perpetuation of gene expression for energy metabolism was observed for all SRBs. The transcriptional response pattern for oxygen resistance was differentiated across individual SRBs, indicating different adaptation strategies. Most SRB transcribed differing sets of genes for oxygen consumption, reactive oxygen species detoxification, and repair of oxidized proteins as a response to the periodical redox switch from anoxic to oxic conditions. Noteworthy, a Desulfosporosinus, a Desulfovibrionaceaea, and a Desulfocapsaceaea representative maintained high transcript levels of genes encoding oxygen defense proteins even under anoxic conditions, while representing dominant SRB populations after half a year of bioreactor operation.

Conclusions

In situ-relevant peatland SRB established large populations despite periodic one-week oxygen levels that are one order of magnitude higher than known to be tolerated by pure cultures of SRB. The observed decrease in gene expression regulation may be key to withstand periodically occurring changes in redox regimes in these otherwise strictly anaerobic microorganisms. Our study provides important insights into the stress response of SRB that drives sulfur cycling at oxic-anoxic interphases.
Intraoperative indocyanine green fluorescence for precise resection of nonocclusive mesenteric ischemia: a case report and diagnostic considerations based on pathology findings
Authors: Mizukami Akihito , Furuya Shinji , Takiguchi Koichi , Shiraishi Kensuke , Nakata Yuki , Akaike Hidenori , Kawaguchi Yoshihiko , Amemiya Hidetake , Kawaida Hiromichi , Ichikawa Daisuke
Published: October 2024

Background

Nonocclusive mesenteric ischemia (NOMI) is characterized by intestinal ischemia caused by spasms in the peripheral intestinal vessels without organic obstruction in the main mesenteric vessels. NOMI can be fatal in case of delayed diagnosis and treatment. Although the use of indocyanine green (ICG) fluorescence in assessing intestinal viability during NOMI surgery is well recognized, there is a paucity of reported cases using this technique. Herein, we present a case of NOMI that was successfully managed through accurate diagnosis and resection of the ischemic intestines guided by ICG fluorescence.

Case presentation

An 81-year-old man presented with abdominal pain. Contrast-enhanced computed tomography revealed intrahepatic portal vein gas, superior mesenteric vein gas, and terminal ileal edema. Considering these findings, the patient was diagnosed with NOMI and emergency surgery was performed. Intestinal edema was observed 30 cm upstream of the terminal ileum without serosal discoloration. ICG fluorescence revealed areas of normal perfusion as well as mild and moderate hypoperfusion. The small bowel, including the hypoperfusion area, was resected. As no clinical signs of residual bowel ischemia were observed during the postoperative course, a second-look operation was deemed unnecessary. Intraoperative ICG fluorescence and histopathological findings indicated mucosal edema in the mildly hypoperfused area and mucosal necrosis in the moderately hypoperfused area.

Conclusions

This case highlights the use of intraoperative ICG fluorescence in the disease. ICG fluorescence is invaluable in assessing the extent of bowel ischemia and guiding precise resection. Thus, future efforts should focus on identifying accumulation of cases and quantification of ICG fluorescence intensity to further improve diagnostic performance.
High-grade mucinous tubular and spindle cell carcinoma of the kidney in a patient on hemodialysis: a case report and literature review
Authors: Yamashita Kaori , Yoshida Keita , Sakamoto Tetsushi , Kubota Satoshi , Shiseki Takahiro , Nakazawa Tadao , Nagashima Yoji , Inui Masashi
Published: October 2024

Background

End-stage renal disease is a risk factor for renal cell carcinoma. However, mucinous tubular and spindle cell carcinoma of the kidney is rare. We report a patient on hemodialysis who had high-grade mucinous tubular and spindle cell carcinoma of the kidney.

Case presentation

A 62-year-old Japanese woman had end-stage renal disease and had been on hemodialysis for the previous 4 years. However, periodic imaging examinations to detect kidney cancer had not been conducted. The patient visited our department of urology complaining of general fatigue and dyspnea. Computed tomography with enhancement revealed a solid renal mass with a diameter of 66 mm. It had invaded the right psoas muscle and had multiple lymph node metastases. In addition, the patient had massive ascites and right-sided predominant pleural effusion. We drained the pleural effusion, but she died 11 days after admission. An autopsy was performed. Pathological examination revealed high-grade mucinous tubular and spindle cell carcinoma of the right kidney; multiple organ metastases to the bilateral lungs, liver, gall bladder, uterus, ovary, and inferior vena cava; cancerous pleuritis; and cancerous peritonitis. Our case indicates that high-grade mucinous tubular and spindle cell carcinoma emerging in end-stage kidney causes a detrimental clinical course.

Conclusion

High-grade mucinous tubular and spindle cell carcinoma of the kidney had a severe clinical course. We recommend periodic screening of patients with end-stage renal disease, using computed tomography or ultrasound.
Social conditions impact functional outcome in patients with hand osteoarthritis: the low-income hand osteoarthritis (LIHOA) cohort
Authors: de Azevedo Francisco Vileimar Andrade , Borges João Pedro Sobreira , de Souza Filho Antonio Matos , Junior José Carlos Godeiro Costa , Silveira Cláudio Régis Sampaio , Rocha Francisco Airton Castro
Published: October 2024

Background

Hand osteoarthritis (HOA) is a highly prevalent disease that may be impacted by social inequalities. Few studies in HOA are from underdeveloped regions. We intend to contribute to fill this gap presenting clinical characteristics of our low-income HOA cohort (LIHOA).

Methods

Data from 119 patients with a HOA diagnosis fulfilling ACR criteria seen between August 2019 and May 2023 in Fortaleza/Brazil. Evaluations included pain (VAS, visual analogue scale), X-ray (KL, Kellgren-Lawrence), grip and pinch strength (KgF), Cochin hand functional scale (CHFS), FIHOA, and SF-12 scores. Social data included monthly (<1, 1≥/<3, ≥3 MW) minimum wage earnings, occupation, and literacy [</≥ 9 school-years (SY)].

Results

107 out of the 119 patients were included. Mean age was 61.9 (±10.3) years with 94 (92%) women. Systemic arterial hypertension (48%), metabolic syndrome (42.8%), dyslipidemia (28.4%), and obesity (25%) were the most common comorbidities. Mean disease duration was 7.5 ± 7.1 years. Median VAS values at rest and activity were 3 (3–5) and 8 (5–9), respectively (p < 0.001). Fifty-seven (56.4%) patients had ≥4 symptomatic joints with a median of 4 (2–8) painful joints at activity. The 2nd distal interphalangeal (IF), joint was the most symptomatic (21; 23.3%) and most had >4 IF nodes. OA in other joints: 37 (36.2%) spine, 28 (29.4%) knee, 21 (20.5%) bunions. Functional impairment was mild [8 (5–14) median FIHOA]. Median serum CRP was 0.2 mg/dL (0.1–0.4) with 14 (20%) patients above reference value. Mean total KL score was 27.6 ± 13.6 with 21 (23%), 38 (41.7%), and 33 (36.2%) KL2, KL3, and KL4, respectively; 51 (54.8%) and 42 (45.2%) patients declared </≥3 MW earnings, respectively. Most declared >9SY including 37.2% with a university degree. Individuals earning <3 MW had lower pinch (p < 0.004) and grip strength (p < 0.01), and higher FIHOA scores (p < 0.007), as compared to ≥3 MW earning group. Literacy or occupation did not impact outcome. SYSADOA were used by 13 (12.7%), 6 used oral and 3 topical anti-inflammatory drugs and 2 used 5 mg/d prednisone.

Conclusion

Clinical characteristics in our LIHOA cohort mirror those reported in affluent regions. Socioeconomic disparities influenced functional outcome in LIHOA cohort.
Mitral valve repair and replacement in infectious endocarditis: a systematic review and meta-analysis of clinical outcome
Authors: Nuthalapati Umesh , Bathinapattla Manoj Reddy , Cardoso Rayner Peyser , Jesi Nusrat Jahan , Singh Kanwarmandeep , Moradi Iman , Gostomczyk Karol , Afzal Maham , Omer Moosa Bin , Mian Zorez Rashid , Patel Soham , Sachdeva Pratyush , Malik Muhammad Nauman , Abbas Mohammad , Singh Jugraj , Shafique Muhammad Ashir
Published: October 2024

Background

Infective endocarditis (IE) poses significant clinical challenges, often necessitating surgical intervention for improved patient outcomes. The choice between mitral valve repair (MVP) and mitral valve replacement (MVR) is crucial in managing IE. This systematic review and meta-analysis aims to compare the effectiveness of MVP and MVR in treating IE, focusing on outcomes such as postoperative bleeding, mortality, recurrent endocarditis, and stroke.

Main text

A comprehensive literature search was conducted following PRISMA guidelines. Studies directly comparing MVP and MVR in IE patients were included. Data extraction and quality assessment were performed, and meta-analysis was conducted using RevMan software. Thirty-two studies involving 82,123 patients were included. MVP was associated with significantly lower rates of postoperative bleeding (OR: 0.58, 95% CI: 0.40–0.84) and reduced long-term mortality (OR: 0.40, 95% CI: 0.32–0.51) compared to MVR. However, MVR showed lower rates of recurrent endocarditis. MVP was also associated with a decreased likelihood of postoperative stroke (OR: 0.52, 95% CI: 0.40–0.68).2, 4

Conclusions

MVP demonstrates advantages over MVR in reducing postoperative bleeding, long-term mortality, and stroke risk in IE patients. However, individual patient factors and surgical expertise must be considered in treatment decisions. Further research, including randomized controlled trials, is needed to validate these findings and refine treatment algorithms for IE management.
Copeptin as an inflammatory marker in diagnosis and prognosis of neonatal sepsis
Authors: Mabrouk Amna G. , Fahmey Sameh S. , Naguib Jhon B. , Abd-Elkareem Rehab M. , Mohamed Yasmen A.
Published: October 2024

Background

Copeptin is an immediate biomarker of individual stress response; many life-threatening diseases are causing a high elevation of its concentration in plasma, such as myocardial infarction and cardiovascular shock. Moreover, copeptin is a promising marker in sepsis. We aimed to evaluate copeptin as a diagnostic and prognostic marker in neonatal sepsis for the early initiation of appropriate therapy and the prediction of mortality. A prospective case-control study involved 237 neonates (165 cases had neonatal sepsis, and 72 served as controls). Cases were admitted to the neonatal intensive care unit (NICU) and followed up for symptoms and signs of sepsis confirmed by laboratory data: complete blood count (CBC), c-reactive protein (CRP), and cultures. Serum copeptin level by the enzyme-linked immunosorbent assay (ELISA) was measured for all included neonates. We observed that the copeptin level was significantly higher in cases than control (3.51 ± 1.4, 1.61 ± 0.51 pmol/liter, respectively). The cut-off value of copeptin at which we can discriminate between cases and controls was above 2.065 pmol/liter. Among cases, copeptin was higher in early-onset sepsis (EOS) than late-onset sepsis (LOS) neonates, and there was a significant correlation between its level and all the following: age at admission, birth weight, gestational age, history of perinatal asphyxia, maternal chorioamnionitis, and premature rupture of membrane (PROM). Also, copeptin was strongly associated with CRP level and the poor prognosis of patients. Copeptin can predict the death of cases at a cut-off value above 2.995 pmol/liter.

Conclusion

Serum copeptin level can be used as a diagnostic and prognostic marker in neonatal sepsis.
AQbD-novel strategy for analytical methods
Authors: Bairagi Amruta , Kothrukar Rutuja , Chikhale Hemant , Kosanam Sreya , Borse Laxmikant
Published: October 2024

Background

Analytical Quality by Design (AQbD) has emerged as a pivotal paradigm in the realm of analytical chemistry, revolutionizing the approach to method development and validation. This innovative strategy integrates principles of Quality by Design (QbD) into analytical procedures, aiming to ensure the quality and robustness of analytical methods. The traditional approach to method development often involves a trial-and-error process, where parameters are adjusted until satisfactory results are obtained. However, this approach can be time-consuming, resource-intensive, and may lack reproducibility. AQbD addresses these challenges by providing a systematic framework for method development that emphasizes understanding the relationship between critical process parameters (CPPs) and critical quality attributes (CQAs).

Discussion

Analytical Quality by design (AQbD) presents an innovative approach to creating and validating analytical procedures, aimed at achieving quality measurements within the method operable design region (MODR). The QbD approach to analytical development is proactive, methodical, and risk-based significantly helps in acquiring an in-depth knowledge of how critical process parameters (CPPs) affect analytical performances, measured by critical quality attributes (CQAs). Experiment design (DoE) is an essential part of QbD, functioning to carry out the response surface analysis and screening process, and ultimately to enable the definition of the multidimensional region of the successful operating ranges of the CPPs, known as the design space (DS). The purpose of this article is to offer a thorough description of the QbD approach's method development process and its implementation in analytical procedure validation, to produce high-quality output, employing statistical analysis in conjunction with other designing tools.

Conclusion

Analytical Quality by design (AQbD) offers a systematic and proactive approach to method development in analytical procedures. By focusing on method resilience and incorporating statistical analysis and experiment design (DoE), AQbD enables the production of high-quality outputs, while minimizing out of trend (OOT) and out of specification (OOS) results. This innovative strategy enhances the reliability and reproducibility of analytical methods, ultimately leading to improved outcomes across various industries.
Prevalence, bother, and impact on pelvic floor muscles of vaginal noise among middle-aged women
Authors: Hamoda Reham E. , Saad Esraa A. , Kamel Dalia M. , El-Shafei Manal A.
Published: October 2024

Background

Vaginal noise (VN) is a natural phenomenon that arises when air is forced into the vagina and then expelled as the vaginal wall muscles naturally contract. It has been described as involuntarily passing gas from the vagina. VN is a symptom of pelvic floor (PF) dysfunction and can cause social and psychological issues. Data on it is limited, and women rarely voluntarily report it. So, this study was conducted to determine the prevalence, bother, and relation between VN and PF muscle dysfunction.

Material and methods

It was a cross-sectional study that included females with age ranges from 30 to 60 years old, body mass index (BMI) ranges from 18 to 30 kg/m2, married, single, virgin, nulliparous, and multiparous women; those with previous one or more vaginal deliveries or cesarean sections (CS) or history of anterior and/or posterior vaginal wall prolapses; and those who had undergone medical interventions such as vaginal surgeries (e.g., pelvic floor reconstruction, hysterectomy), stress urinary incontinence, urge incontinence, and fecal incontinence. The Vaginal Wind Questionnaire, Pelvic Floor Impact Questionnaire-Short Form 7 (PFIQ-7), and Pelvic Floor Bother Questionnaire were used as methods of evaluating the VN prevalence and bother and its relation to PF dysfunction.

Results

It was noted that there was a 76.3% prevalence of VN and 75% bother among the study population. Eighty-eight percent of them did not seek any treatment, and VN occurred in 84.3% of females with pelvic floor muscle weakness.

Conclusion

VN is common in middle-aged Egyptian women, most frequently occurring with sexual intercourse, vaginal delivery, and pelvic floor muscle weakness.
A TBC1D24 gene variant coincides with STRC compound heterozygosity in a family with hearing loss: a case report
Authors: Schwarz Martin , Hanková Kamila , Havlovicová Markéta , Kremlíková Pourová Radka , Bouček Jan
Published: October 2024

Background

Hearing loss is a common inborn neurosensory condition. Hearing loss is very heterogeneous, and while screening programs exist for children, adolescents and adults with late-onset hearing loss often do not get referrals to geneticists.

Objective

To diagnose the cause of hearing impairment in two related late-onset hearing loss patients—father and son—on a molecular level. Both underwent audiological examinations, and both had moderate hearing loss.

Case presentation.

We used massive parallel sequencing, Sanger sequencing, MLPA, and standard audiological methods. We identified an inherited autosomal dominant likely causative variant in the TBC1D24 gene of both patients. They did not show any other TBC1D24 spectrum-related symptoms. Furthermore, the younger patient was found to be compound heterozygous for two variants in STRC gene.

Conclusions

Only a few dozen TBC1D24 hearing loss patients have been reported. On the contrary, STRC is a common hearing loss cause. We speculate that in the younger patient, the phenotype is caused by a combination of effects of both genes. The older patient’s phenotype is more likely caused only by the TBC1D24 variant. We believe that more attention should be paid to adolescent and adult-onset hearing loss patients, and more frequent referrals to geneticists are warranted.
Gender analysis of chickpea (
Cicer arietinum
) yield gap: the case of Ada’a, Ethiopia
Authors: Chiche Wubishet , Mojo Dagne , Abate Esubalew
Published: October 2024

One of the primary development challenges hindering poverty reduction in Africa is the existence of a yield gap between female and male farmers. However, previous studies conducted in Ethiopia have largely overlooked the role of gender-related factors in influencing this gap. This article aims to address this gap by examining the chickpea yield disparity between female and male farmers and identifying its determinants. Data were gathered from 325 respondents (163 male and 162 female farmers) in 2019, combining survey responses with qualitative insights from discussions in two women farmers' groups, two men farmers' groups, and four key informant interviews. T-tests and linear regression models were applied to quantify the extent of the yield gap and analyze the factors contributing to it. Additionally, thematic analysis of the qualitative data was conducted to complement the quantitative findings. The study revealed that female farmers produced 29% less chickpea yield in the 2019 production year compared to their male counterparts, and this difference was statistically significant. Factors such as land allocation for chickpea cultivation, soil fertility, labor availability, chickpea variety (improved or local), access to extension services, and participation in farmers' cooperatives were identified as significant contributors to the yield gap. Beyond these technical aspects, gender-related challenges like unequal treatment, restricted mobility, labor demands, and religious/cultural taboos were also factors impeding the productivity of women farmers. Addressing the yield gap necessitates an inclusive approach in all agricultural development endeavors, recognizing and rectifying gender-based disparities to enhance the productivity and livelihoods of female farmers.
Modeling, simulations, and Simulink developments in the analysis of optimal control of temperature and pH in a batch ethanol fermentation process
Authors: Asiedu Nana Yaw , Bamaalabong Peter Paul , Johnson Jesse Essuman , Bonsu Jude Kwaku , Addo Ahmad
Published: October 2024

Transfer of laboratory-scale experiments to production-scale ethanol fermentation is time-consuming and involves expensive prototype systems from complex experimental designs that determine optimal operating conditions for minimal substrate and product inhibitions. The study developed and validated a Simulink-based model for optimal pH and temperature control using fuzzy logic and PID controllers respectively and taking advantage of 2D and 1D substrate and product inhibition models from which suitable ethanol fermentation reaction rates models were selected. Temperature and pH levels and substrate, product, and biomass concentrations were measured. Selected inhibition models were linear-product, linear substrate-sudden stop product, and linear substrate for cassava, maize, and sorghum, respectively. Fuzzy logic controller ascertained optimal flow rate of acid and base as 0.000196 ml/s and 0.000204 ml/s, respectively, and pH error and rate of pH error as 0.00334 and 0.00368, respectively. F-test two-sample for variances showed no significant difference between model and experimental curves (cassava: F critical = 0.9704, F calculated = 0.1905; maize: F critical 0.9704, F calculated = 0.2149; sorghum: F critical = 0.9704, F calculated = 0.2488). PID logic controller showed model curves and experimental curves with good fit. F-test two-sample for variances showed no significant difference between model and experimental curves (cassava: F critical = 0.9704, F calculated = 0.1288; maize: F critical = 0.9704, F calculated = 0.2083; sorghum: F critical = 0.9704, F calculated = 0.2016). The study provided an improved approach as solution for optimal pH and temperature conditions in order to mitigate substrate and product inhibitions during ethanol fermentation. It illustrated that the application of artificial intelligence-based controllers provides satisfactory outcomes that are desirable for implementation in the industrial space.

Graphical Abstract
The paradox of medical dramas: global aspirations versus realities
Authors: Tedeschi Roberto
Published: October 2024

Medical dramas such as Grey's Anatomy influence young people's career aspirations, creating unrealistic expectations. This article examines the gap between these portrayals and the reality of medical practice, highlighting challenges such as rigorous training and high stress. Using Italy's ‘numero chiuso’ (‘closed number’) system as a case study, it addresses the global issue of intense competition in medical school admissions. The article advocates for realistic education and better support to prepare future healthcare professionals.
Evaluating a volunteer ‘Health Champions’ intervention supporting people with severe mental illness to manage their physical health: feasibility hybrid randomised controlled trial
Authors: Williams Julie , McGrath Ray , Ang Karen , Bakolis Ioannis , Healey Andy , Arias de la Torre Jorge , Mdudu Isabel , Gaughran Fiona , Sadler Euan , Pinto da Costa Mariana , Green Errol , Stepan Natalia , Tredget Gracie , Khadjesari Zarnie , Cross Sean , Sevdalis Nick
Published: October 2024

Background

People with severe mental illness (SMI) have worse physical health than the general population. There is evidence that support from volunteers can help the mental health of people with SMI, but little evidence regarding the support they can give for physical health.

Aims

To evaluate the feasibility of an intervention where volunteer ‘Health Champions’ support people with SMI in managing their physical health.

Method

A feasibility hybrid randomised controlled trial conducted in mental health teams with people with SMI. Volunteers delivered the Health Champions intervention. We collected data on the feasibility of delivering the intervention, and clinical and cost-effectiveness. Participants were randomised by a statistician independent of the research team, to either having a Health Champion or treatment as usual. Blinding was not done.

Results

We recruited 48 participants: 27 to the intervention group and 21 to the control group. Data were analysed for 34 participants. No changes were found in clinical effectiveness for either group. Implementation outcomes measures showed high acceptability, feasibility and appropriateness, but with low response rates. No adverse events were identified in either group. Interviews with participants found they identified changes they had made to their physical health. The cost of implementing the intervention was £312 per participant.

Conclusions

The Health Champion intervention was feasible to implement, but the implementation of the study measures was problematic. Participants found the intervention acceptable, feasible and appropriate, and it led them to make changes in their physical health. A larger trial is recommended, with tailored implementation outcome measures.
Assisted resolution and self-change: differences between healthcare systems
Authors: Hesse Morten , Brummer Julie , Nielsen Anette Søgaard
Published: October 2024

This editorial discusses a study by Day and colleagues, in which the authors investigated the prevalence of resolution of alcohol and other drug problems in the UK and compared people who resolved their problems with and without treatment.
Impact of COVID-19 on referrals to paediatric liaison psychiatry at Children's Health Ireland at Crumlin as the pandemic moved to endemic status
Authors: Sun B. , Adamis D. , McNicholas F.
Published: October 2024

Background

Rates of acute mental health presentations in youth were increasing pre-pandemic internationally. Longitudinal studies following COVID-19 attest to ongoing deterioration in youth mental health, recognising adverse unintended consequences following public health restrictions.

Aims

To examine whether the initial post-COVID-19 increase in mental health presentations persisted following the reclassification of COVID-19 to endemic status, accompanied by the removal of most restrictions.

Method

All referrals to paediatric liaison psychiatry (PLP) between January 2018 and December 2022 in a Dublin tertiary children's hospital were included in the study. An interrupted time series analysis with autoregressive integrated moving average models was conducted, examining referrals with respect to different phases of COVID-19 and application of public health restrictions.

Results

Some 1385 referrals to PLP were received over the 5-year study. There was a significant decrease in PLP referrals immediately post-COVID-19, followed by a significant and sustained increase as the pandemic progressed and moved to endemic status. Public health restriction phases had a unique effect on those presenting with suicidal ideation, with a significant increase in the number of referrals. There was no effect of restrictions on other clinical profiles.

Conclusions

Increased referrals for youth with mental health difficulties, reported during the COVID-19 pandemic, persisted into the early endemic stage, after COVID-19 public health restrictions ceased. Specific impacts of restrictions on suicidal ideation referrals require further study. Investment in child and adolescent mental health services remains a priority, and future pandemic response strategies need to examine unintended consequences of any enforced public health measure.
Evaluation and Surgical Management of Pediatric Cutaneous Melanoma and Atypical Spitz and Non-Spitz Melanocytic Tumors (Melanocytomas): A Report From Children's Oncology Group
Authors: Sargen Michael R. , Barnhill Raymond L. , Elder David E. , Swetter Susan M. , Prieto Victor G. , Ko Jennifer S. , Bahrami Armita , Gerami Pedram , Karunamurthy Arivarasan , Pappo Alberto S. , Schuchter Lynn M. , LeBoit Philip E. , Yeh Iwei , Kirkwood John M. , Jen Melinda , Dunkel Ira J. , Durham Megan M. , Christison-Lagay Emily R. , Austin Mary T. , Aldrink Jennifer H. , Mehrhoff Casey , Hawryluk Elena B. , Chu Emily Y. , Busam Klaus J. , Sondak Vernon , Messina Jane , Puig Susana , Colebatch Andrew J. , Coughlin Carrie C. , Berrebi Kristen G. , Laetsch Theodore W. , Mitchell Sarah G. , Seynnaeve Brittani
Published: October 2024

PURPOSE

The purpose of this study was to develop recommendations for the diagnostic evaluation and surgical management of cutaneous melanoma (CM) and atypical Spitz tumors (AST) and non-Spitz melanocytic tumors (melanocytomas) in pediatric (age 0-10 years) and adolescent (age 11-18 years) patients.

METHODS

A Children's Oncology Group–led panel with external, multidisciplinary CM specialists convened to develop recommendations on the basis of available data and expertise.

RESULTS

Thirty-three experts from multiple specialties (cutaneous/medical/surgical oncology, dermatology, and dermatopathology) established recommendations with supporting data from 87 peer-reviewed publications.

RECOMMENDATIONS

(1) Excisional biopsies with 1-3 mm margins should be performed when feasible for clinically suspicious melanocytic neoplasms. (2) Definitive surgical treatment for CM, including wide local excision and sentinel lymph node biopsy (SLNB), should follow National Comprehensive Cancer Network Guidelines in the absence of data from pediatric-specific surgery trials and/or cohort studies. (3) Accurate classification of ASTs as benign or malignant is more likely with immunohistochemistry and next-generation sequencing. (4) It may not be possible to classify some ASTs as likely/definitively benign or malignant after clinicopathologic and/or molecular correlation, and these Spitz tumors of uncertain malignant potential should be excised with 5 mm margins. (5) ASTs favored to be benign should be excised with 1- to 3-mm margins if transected on biopsy. (6) Re-excision is not necessary if the AST does not extend to the biopsy margin(s) when complete/excisional biopsy was performed. (7) SLNB should not be performed for Spitz tumors unless a diagnosis of CM is favored on clinicopathologic evaluation. (8) Non-Spitz melanocytomas have a presumed increased risk for progression to CM and should be excised with 1- to 3-mm margins if transected on biopsy. (9) Re-excision of non-Spitz melanocytomas is not necessary if the lesion is completely excised on biopsy.