bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardinality matching versus propensity score matching for addressing cluster-level residual confounding in implantable medical device and surgical epidemiology: a parametric and plasmode simulation study
Authors: Du Mike , Johnston Stephen , Coplan Paul M. , Strauss Victoria Y. , Khalid Sara , Prieto-Alhambra Daniel
Published: November 2024

Background

Rapid innovation and new regulations lead to an increased need for post-marketing surveillance of implantable devices. However, complex multi-level confounding related not only to patient-level but also to surgeon or hospital covariates hampers observational studies of risks and benefits. We conducted parametric and plasmode simulations to compare the performance of cardinality matching (CM) vs propensity score matching (PSM) to reduce confounding bias in the presence of cluster-level confounding.

Methods

Two Monte Carlo simulation studies were carried out: 1) Parametric simulations (1,000 iterations) with patients nested in clusters (ratio 10:1, 50:1, 100:1, 200:1, 500:1) and sample size n = 10,000 were conducted with patient and cluster level confounders; 2) Plasmode simulations generated from a cohort of 9981 patients admitted for pancreatectomy between 2015 to 2019 from a US hospital database. CM with 0.1 standardised mean different constraint threshold (SMD) for confounders and PSM were used to balance the confounders for within-cluster and cross-cluster matching. Treatment effects were then estimated using logistic regression as the outcome model on the obtained matched sample.

Results

CM yielded higher sample retention but more bias than PSM for cross-cluster matching in most scenarios. For instance, with ratio of 100:1, sample retention and relative bias were 97.1% and 26.5% for CM, compared to 82.5% and 12.2% for PSM. The results for plasmode simulation were similar.

Conclusions

CM offered better sample retention but higher bias in most scenarios compared to PSM. More research is needed to guide the use of CM particularly in constraint setting for confounders for medical device and surgical epidemiology.
Evaluating Senegal's COVID-19 surveillance system for early detection and response: lessons from the Keur Massar district, March 03, 2020 to May 31, 2022
Authors: Ba Amady , Loko Roka Jerlie , Ndiaye Mbouna , Ba Mamadou Sarifou , Diop Boly , Pasi Omer
Published: November 2024

Background

The COVID-19 pandemic highlights the importance of strong surveillance systems in detecting and responding to public health threats. We sought to evaluate attributes of Keur Massar district's existing COVID-19 surveillance system.

Method

A descriptive, cross-sectional study was conducted in June 2022; desk review covered data collected from March 03, 2020 to May 31, 2022 in 18 health posts. Data were collected using a standardized questionnaire completed during a face-to-face interview and a desk review of surveillance data gathered from different notification platforms (Excel, ODK, DHIS2 aggregated, and tracker). Study was conducted in Keur Massar department, in the Dakar region. We conducted face-to-face interviews with 18 nurses in June 2022. We utilized a standardized, semi-structured questionnaire adapted from CDC guidelines for surveillance evaluation.

Results

All 18 head nurses targeted, responded to the questionnaire, with an average age of 41.5 years and 63% aged between 30 and 44. The sex ratio (M/F) was 0.6, and respondents had an average of 15.1 years of experience. All nurses were involved in COVID-19 surveillance and had notified at least one suspected case.

While 39% conducted COVID-19 data analysis, 55.6% received feedback from the national level. The usefulness score for the surveillance system was 77.7, with the lowest score (72.9) related to describing the pandemic’s magnitude. Simplicity scored 63.3, with low scores for the availability of guidelines (0) but high scores for training and equipment (94.4). Acceptability scored 76.6, with strong support for COVID-19 surveillance but weak community involvement (48.6).

While no cases were reported through the DHIS2 aggregated platform, 1327 PCR-positive SARS-CoV-2 cases were reported through the national Excel sheet and 278 PCR-positive cases were reported through the COVID-19 DHIS2 tracker during the same period. Timeliness varied, averaging 3 days using ODK and 7 days with the national Excel sheet, with a combined average of 5 days across both systems.

Conclusion

The study highlights challenges in COVID-19 surveillance due to limited human resources, multiple data systems, and delays in notification. While most nurses were trained and equipped, gaps in data quality, timeliness, and community support emphasize the need for streamlined processes and increased workforce capacity.
Health literacy and self-care among adult immigrants with type 2 diabetes: a scoping review
Authors: Tørris Christine , Nortvedt Line
Published: November 2024

Introduction

There exists a gap in the health status of immigrants in comparison to the overall population, and health literacy has been shown to be a mediator for health outcomes and may predict their quality of life (QoL). We aimed to systematically map and synthesize research findings on adult immigrants’ health literacy in terms of their health beliefs, understanding, and self-management of Type 2 Diabetes Mellitus.

Methods

A scoping review guided by Arksey and O’Malley’s framework was conducted, based on systematic searches in the Embase, Ovid MEDLINE, and APA PsycInfo databases in June 2023. The retrieved articles were screened and assessed by the two authors independently.

Results

Of 568 identified studies, 16 (9 qualitative, 4 cross-sectional, 1 mixed-methods, and 2 experimental) were included in this review. Low/moderate health literacy levels with no sex-related differences were reported. Immigrants’ access to health information was limited by language barriers and a lack of culturally adapted information, especially from their physicians. Among women, access to health information was limited by patriarchal norms. Knowledge gaps were primarily related to understanding the necessity of medication and the importance of a healthy lifestyle. Healthcare professionals played an important role in motivating immigrants to adhere to treatment.

Conclusion

Few studies were found on this topic, and additional research is needed to enhance health literacy among immigrants. Limited health information, language barriers, and a shortage of culturally sensitive knowledge appear to hinder immigrants’ ability to access, understand, and apply health information. Cultural norms and personal factors further suppress these abilities, ultimately impacting their health outcomes. The findings of this study suggest that health literacy is a crucial component of healthcare professionals’ curricula, equipping them with the skills to identify and assist patients with low health literacy.
Reliability of the digital functionally generated path technique for assessing occlusal interferences and adjusting CAD-CAM zirconia crowns: an in vivo study
Authors: Saad Sherine Anwar , Shalaby Yousreya Atteya , Azer Amir Shoukry
Published: November 2024

Background

Designing the occlusal surface of a prosthesis to ensure optimal eccentric occlusion is challenging without precisely replicating the patient’s mandibular movements. During the CAD-CAM prosthesis delivery process, clinicians often need to make adjustments to the prosthesis to avoid occlusal interferences that may occur during lateral excursions. Recently, there have been developments in the field of mandibular motion tracking using optical devices. These approaches seek to incorporate an individual’s functional movement into the research field of occlusal morphology.

Aim

This study aimed to assess the accuracy of digitally replicating mandibular movements to identify and correct occlusal interferences in monolithic CAD-CAM zirconia crowns.

Methods

An intraoral scanner (IOS) was used to capture complete arch maxillary and mandibular teeth and record buccal and lateral interocclusal records of maxillary first premolar abutment teeth of thirteen participants. For each patient, two monolithic zirconia crowns were fabricated following the standard digital workflow. The crowns were categorized based on the virtual method used for adjusting occlusal interferences into two groups: Group I, where occlusal interferences in CAD-CAM zirconia crowns were adjusted using buccal interocclusal records, and Group II, where adjustments were made using both buccal and lateral interocclusal records. After crown fabrication following the manufacturer’s instructions, occlusion was analyzed using an electronic pressure analyzer. The mean, standard deviation and median values of the recorded data were measured. Paired t test and Wilcoxon Sign Rank test were executed for analyzing differences between groups (p value ≤ 0.05).

Results

Group I recorded higher maximum pressure at lateral mandibular movement with mean ± standard deviation value of 26.00 ± 4.95% than Group II with 20.62 ± 3.38%. Regarding pressure recorded at maximum intercuspation (MI) Group I showed higher results; 8.08 ± 1.50% compared to Group II with 7.23 ± 1.59% mean ± standard deviation value. The average value of crown volume for Group I was (160.36 ± 15.94) mm3, while for Group II was (157.63 ± 14.45) mm3.

Conclusions

The digital functionally generated path technique allows for identifying occlusal interferences and modifying CAD-CAM zirconia crown designs.
The effectiveness of online educational interventions on impostor syndrome and burnout among medical trainees: a systematic review
Authors: Hsu Chun-Lun , Liu Cheng-Heng , Huang Chih-Chung , Chen Huey-Ling , Chiu Yen-Lin , Yang Chih-Wei
Published: November 2024

Background

Impostor syndrome and burnout are highly prevalent among medical students and trainees, significantly impacting their mental health and professional development. The advent of online educational interventions provides a promising solution, offering accessibility and flexibility to tackle these issues. This systematic review aims to evaluate the effectiveness of online educational interventions in alleviating impostor syndrome and burnout among medical learners.

Methods

A comprehensive literature search was conducted across PubMed, Cochrane Library, Embase, Scopus and PsycInfo, identifying relevant studies published up to March 2024. Studies focusing on online interventions targeting impostor syndrome and burnout among medical students, residents, and fellows were included, and their quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI).

Results

Among the screened studies, six met our inclusion criteria, comprising four randomized controlled trials, one qualitative study, and one mixed-methods study. Their mean MERSQI score was 14.67 (SD 1.23), indicating a high methodological quality. The interventions adopted in these studies varied, including group coaching sessions, workshops, and provision of educational resources. Notably, two randomized trials demonstrated significant reductions in impostor syndrome symptoms after online interventions, compared with the control groups. On the other hand, results for burnout outcomes were equivocal, with some studies reporting improved emotional exhaustion scores and decreased burnout risk, while others found no significant differences.

Conclusions

Current evidence suggests that structured online educational interventions, particularly those incorporating coaching and cognitive reframing strategies, can effectively reduce impostor syndrome among medical trainees. However, the impact on burnout remains inconclusive. Further research is needed to optimize online program components and implementation strategies to comprehensively address both impostor syndrome and burnout in this population.

Clinical trial number

As this is a systematic review rather than a clinical trial, no clinical trial number is applicable. Nonetheless, this systematic review has been prospectively registered with PROSPERO (registration number: CRD42024541034), in line with best practice recommendations for systematic reviews.
A tailored intervention for the detection of patients with coronary heart disease and mental or cognitive comorbidities in the German primary care setting: qualitative evaluation of implementation success
Authors: Herrmann Christin , Werner Belinda , Wurster Florian , Karbach Ute , Leikert Charlotte , Nordmeyer Laura , Meixner Adriana , Sannemann Lena , Albus Christian , Jessen Frank , Kuntz Ludwig , Schulz-Nieswandt Frank , Pfaff Holger ,   on behalf of the Cologne Research and Development Network (CoRe-Net) Study Group, Meyer Ingo , Scholten Nadine , Stock Stephanie , Strupp Julia , Voltz Raymond
Published: November 2024

Background

Guidelines recommend the identification of potential mental and/or cognitive disorders (MCD) in patients with coronary heart disease (CHD). However, compliance with these guidelines appears to be lacking in primary care. A minimal invasive intervention was tailored with experts for the primary care setting to increase the identification of this patient group and ensure proper treatment. The intervention includes: A trigger question, screening tests and question prompt sheet for patients. Following the implementation of this intervention in primary care physician (PCP) offices, the aim of this study is to evaluate the implementation outcomes.

Methods

Semi-structured interviews were conducted with ten PCPs who tested the intervention for six months. The study was guided by Proctor’s Framework on Implementation Outcomes to understand the appropriateness, feasibility, acceptability, fidelity and sustainability of the intervention as proxies for implementation success.

Results

Relevance of the topic and the need for the intervention is recognised by all of the PCPs. All PCPs were willing to try the intervention and considered it generally appropriate and feasible. Additionally, supporting implementation resources were considered helpful in familiarising with the intervention. Screening of patients with a first diagnosis of CHD, those who have had experienced a recent coronary event and those who have been hospitalised for CHD is considered practical and appropriate. Known barriers such as lack of knowledge, perceived relevance and awareness were successfully addressed. It was not possible to overcome barriers such as time pressure, forgetfulness, and patient reaction. Additionally, the paper format of the information materials was perceived as impractical, and integration into the physician information system was identified as a possible way to increase acceptance. Nevertheless, PCPs stated they will continue to be aware of the link between CHD and MCD and want to maintain their individualised approach.

Conclusions

The study provides important insights into the use of a minimal invasive intervention in primary care. Despite tailoring the intervention to the primary care setting, implementation success was suboptimal due to individual barriers in PCP offices. This highlights the need for tailored approaches at the level of individual PCP offices to better address context-specific barriers.
Associations of per- and polyfluoroalkyl substances and heavy metals with blood lipid profiles in a representative sample of Korean adolescents
Authors: Kim Youlim , Shin Sanghee , Choe Yunsoo , Cho Jaelim , Kim Changsoo , Kim Su Hwan , Kim Kyoung-Nam
Published: November 2024

Background

Previous studies on the associations of per- and polyfluoroalkyl substances (PFASs) and heavy metals with lipid profiles among adolescents have been scarce. We sought to investigate the associations of PFASs and heavy metals with blood lipid levels in a representative sample of Korean adolescents.

Methods

Data from the Korean National Environmental Health Survey (2018–2020) were used. Concentrations of PFASs [perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid, perfluorononanoic acid (PFNA), and perfluorodecanoic acid (PFDeA)], lead, and mercury were measured in serum, whole blood, and urine samples, respectively. Linear regression, Bayesian kernel machine regression (BKMR), and k-means clustering analyses were employed to evaluate the associations between pollutants and lipid levels.

Results

In the linear regression analyses, PFOA levels were associated with higher low-density lipoprotein cholesterol (LDL-C) levels; PFOS with higher total cholesterol (TC) levels; PFNA with higher TC, LDL-C, and non-high-density lipoprotein cholesterol (non-HDL-C) levels; PFDeA with higher TC, LDL-C, non-HDL-C, and high-density lipoprotein cholesterol levels; and mercury with higher TC and non-HDL-C levels. The BKMR analysis revealed that the PFAS and heavy metal mixture was associated with higher LDL-C levels (1.8% increase in LDL-C at the 75th percentile of all PFAS and heavy metal concentrations compared to their median values, 95% credible interval: 0.5, 3.1), primarily driven by the effect of PFDeA. Compared to individuals in the low pollutant exposure cluster (geometric mean levels of PFOA, PFOS, PFHxS, PFNA, PFDeA, lead, and mercury were 2.7 μg/L, 6.2 μg/L, 1.6 μg/L, 0.7 μg/L, 0.4 μg/L, 0.8 μg/dL, and 0.3 μg/L, respectively), those in the high pollutant exposure cluster (5.1 μg/L, 10.7 μg/L, 3.7 μg/L, 1.3 μg/L, 0.6 μg/L, 0.9 μg/dL, and 0.4 μg/L, respectively) demonstrated higher TC levels (2.5% increase in TC, 95% confidence interval: 0.1, 5.0) in the k-means clustering analysis.

Conclusion

Due to the limitations of this study, such as its cross-sectional design, these results should be interpreted cautiously and confirmed in future studies before drawing implications for public health strategies aimed at promoting health during adolescence and later in life.
Combatting cellular immortality in cancers by targeting the shelterin protein complex
Authors: Chakraborty Sohini , Banerjee Satarupa
Published: November 2024

Shelterin proteins (TERF1, TERF2, TPP1, TINF2, POT1) protect telomeres, prevent unwarranted repair activation, and regulate telomerase activity. Alterations in these proteins can lead to cancer progression. This study uses an in-silico approach to examine shelterin in tumour samples across various cancers, employing mutation plots, phylogenetic trees, and sequence alignments. Network pharmacology identified TERF1 as an essential shelterin protein and transcription factors RUNX1, CTCF, and KDM2B as potential biomarkers due to their interactions with miRNAs and shelterin proteins. We performed MCODE analysis to identify subnetworks of ncRNAs interacting with the shelterin proteins. Shelterin expression predicted patient survival in 24 cancer types, with TERF1, TERF2, TINF2, and POT1 significantly expressed in testicular, AML, prostate, breast and renal cancers, respectively, and TPP1 in AML and skin cancer. Spearman and Pearson's analyses showed significant correlations of TERF1 across cancers, with near-significant correlations for all five proteins in different cancer datasets like breast cancer, kidney renal papillary and lung squamous cell carcinoma, skin cutaneous melanoma, etc.,. Shelterin expression correlated with patient survival in breast, renal, lung, skin, uterine, and gastric cancers. Insights into TPP1-associated glycans highlighted glycosylated sites contributing to tumorigenesis. This study provides molecular signatures for further functional and therapeutic research on shelterin, highlighting its potential as a target for anti-cancer therapies and promising prospects for cancer prognosis and prediction.
Dietary contributions in the genetic variation of liver fibrosis: a genome-wide association study of fibrosis-4 index in the liver fibrosis development
Authors: Palupi Poppy Diah , Wei Chun-Yu , Chou Wan-Hsuan , Lin Min-Rou , Wan Yu-Jui Yvonne , Chang Wei-Chiao
Published: November 2024

Background

The fibrosis-4 (FIB-4) index is a non-invasive method to assess the severity of liver fibrosis. The development of liver fibrosis is influenced by genetic predisposition and dietary factors. However, the modulating effect of dietary factors on the genetic susceptibility of liver fibrosis remains unclear. The study aims to investigate the role of dietary factors in modulating the genetic susceptibility of liver fibrosis.

Methods

Here, we conducted a genome-wide association study (GWAS) of FIB-4 index-directed liver fibrosis risk, adjusted with diet, lifestyle factors, and hepatitis serological markers. The high (N = 1,476) and low (N = 36,735) liver fibrosis risk groups were defined with a FIB-4 > 2.67 and < 1.3, respectively.

Results

The age-related FIB-4 variation showed subjects with a FIB-4 > 2.67 (3.8%), indicating high fibrosis risk, occurred predominantly among individuals above 60 years old. The multivariable analysis showed that tea intake is significantly associated with a reduced risk of liver fibrosis. The GWAS adjusted for sex, age, age2, dietary factors (tea and coffee consumption, vegetarian preference), lifestyle (alcohol consumption, physical activity), hepatitis serological markers (anti-HCV, HBsAg, HBeAg), and the top ten principal components indicated 25 genome-wide significant signals (p < 5 × 10− 8). Two variants (rs56293029 and rs9389269) were previously associated with the FIB-4 index in alcohol-related cirrhosis, while the 23 SNPs remaining were novel. The rs9399136 (HBS1L) is a protective variant, and rs9274407 (HLA-DQB1) is a risk variant, both contributing to liver fibrosis development. Our results showed that genetic factors play a major role in liver fibrosis, while dietary factors have minor effects on disease progression. Pathway analysis suggested the potential of immune response and hematopoietic systems function in the pathogenesis of liver disease.

Conclusions

The studies not only revealed the protective role of rs9399136 (HBS1L) and the risk effect of rs9274407 (HLA-DQB1) toward liver fibrosis in a Taiwanese population, but also demonstrated that individual consumption patterns, such as tea uptake, have a minor impact on liver fibrosis prevention. The pathway analysis from GWAS variants further indicated the importance of immune responses in the pathogenesis of liver fibrosis.
Creep rates of the Philippine fault on Leyte Island based on offset cultural features
Authors: Tsutsumi Hiroyuki , Perez Jeffrey S.
Published: November 2024

Recent space–geodetic analyses revealed that the central Philippine fault on Leyte Island creeps aseismically. We obtained the first verifiable evidence of surface creep on the northernmost and central Leyte Island based on surveys of offset cultural features (e.g., roads, buildings, and curbs). The creep rates derived from offset cultural features in the past 10–35 years are 20.9 ± 4.3 mm/year for northernmost Leyte and ~ 15 mm/year for central Leyte. These rates are comparable with the lower bound of the rates obtained from GNSS and InSAR analyses and are in good agreement with the geologic fault slip rates. On 15 January 2023, a moderate earthquake (Mw 4.7) ruptured the creeping section on the northernmost Leyte Island, where we measured ~ 20 mm/year creep rate. The left-lateral motion of the Philippine fault in the northernmost Leyte appears to be mainly accommodated by creeping with relatively little contributions from coseismic displacement related to a small locked patch on the fault plane. The observed fault behavior, aseismic creeping with moderate surface-rupturing earthquakes, is similar to that observed on Masbate Island. Surface creeping has been identified for the Philippine fault from Masbate Island to northern Mindanao Island, and it is essential to estimate the creep rate and the ratio between creep and coseismic displacement to better characterize the fault mechanics and seismic hazards of the Philippine fault.
Neural phase picker trained on the Japan meteorological agency unified earthquake catalog
Authors: Naoi Makoto , Tamaribuchi Koji , Shimojo Kengo , Katoh Shinya , Ohyanagi Shukei
Published: November 2024

As Japan is one of the most seismically active countries, seismic data from various institutions are shared in real time and made accessible via the Web to promote research. The Japan Meteorological Agency (JMA), in collaboration with the Ministry of Education, Culture, Sports, Science, and Technology, processes these data to compile a 'unified earthquake catalog' for use in the development of strategies for disaster prevention and public safety. Based on manual arrival-time measurements provided by the JMA, we retrained PhaseNet, the deep-learning phase picker, known as neural phase picker that has gained prominence in recent years, to promote the development of high-quality seismic catalogs in Japan. We utilized the PhaseNet architecture for our model and trained it using 6.1 million three-component seismic waveforms collected in 2014–2021. The performance of the original PhaseNet model, trained with data from California, was suboptimal when applied to routine Japanese data, particularly ocean-bottom seismometer records. Retraining the model with the JMA unified catalog and corresponding waveforms significantly enhanced its performance in picking the arrival times of regular and low-frequency earthquakes. Compared with the original PhaseNet, the dependency of the model on the type of seismic station was reduced by retraining and its performance for waveforms was improved even from stations not included in the training data set. The model performance varied with earthquake magnitude, highlighting the reliance on extensive data for small events in the training set. Compared with the conventional procedure, the model identified numerous events, particularly smaller ones with undetermined magnitudes when integrated into the routine automatic processing of the JMA. Furthermore, leveraging approximately ten times more training data than the California data set, we developed and trained PhaseNetWC, doubling the number of filter channels in each convolutional layer in comparison with those of the original PhaseNet. This modified phase picker surpassed the performance of its predecessor. The dissemination of these models is anticipated to enhance the analysis of routine observational data sets in Japan.

Graphical Abstract
A reliable NLOS error identification method based on LightGBM driven by multiple features of GNSS signals
Authors: Zhang Xiaohong , Wang Xinyu , Liu Wanke , Tao Xianlu , Gu Yupeng , Jia Hailu , Zhang Chuanming
Published: November 2024

In complicated urban environments, Global Navigation Satellite System (GNSS) signals are frequently affected by building reflection or refraction, resulting in Non-Line-of-Sight (NLOS) errors. In severe cases, NLOS errors can cause a ranging error of hundreds of meters, which has a substantial impact on the precision and dependability of GNSS positioning. To address this problem, we propose a reliable NLOS error identification method based on the Light Gradient Boosting Machine (LightGBM), which is driven by multiple features of GNSS signals. The sample data are first labeled using a fisheye camera to classify the signals from visible satellites as Line-of-Sight (LOS) or NLOS signals. We then analyzed the sample data to determine the correlation among multiple features, such as the signal-to-noise ratio, elevation angle, pseudorange consistency, phase consistency, Code Minus Carrier, and Multi-Path combined observations. Finally, we introduce the LightGBM model to establish an effective correlation between signal features and satellite visibility and adopt a multifeature-driven scheme to achieve reliable identification of NLOSs. The test results show that the proposed method is superior to other methods such as Extreme Gradient Boosting (XGBoost), in terms of accuracy and usability. The model demonstrates a potential classification accuracy of approximately 90% with minimal time consumption. Furthermore, the Standard Point Positioning results after excluding NLOSs show the Root Mean Squares are improved by 47.82%, 56.68%, and 36.68% in the east, north, and up directions, respectively, and the overall positioning performance is significantly improved.
In-hospital and long-term clinical outcomes of spontaneous coronary artery dissection (SCAD): a meta-analysis of conservative versus revascularization approaches
Authors: Pitliya Anmol , Pitliya Aakanksha , Vasudevan Srivatsa Surya , Yadav Kumari Priya , Shabbir Muhammad Bilal , Zahoor Shaghaf , Shabbir Aisha , Ibrahim Abdulgafar Dare , Jeswani Bijay Mukesh , Jonnala Ramya Reddy , Singla Ramit
Published: November 2024

Background

The ideal treatment strategy for spontaneous coronary artery dissection (SCAD) remains unclear, with patients potentially treated with either conservative medical care or a revascularization approach.

Methods

We performed a systematic review and meta-analysis adhering to PRISMA 2020 guidelines. Inclusion criteria involved studies with confirmed SCAD diagnosis, reporting initial management strategies, and original research with ≥ 10 participants. Random-effect models were applied for insignificant heterogeneity with significance at p ≤ 0.05. Sensitivity analysis and funnel plots assessed potential publication bias.

Results

Our analysis found no significant differences in major adverse cardiac events (MACE) (OR = 0.61, p = 0.49), unstable angina pectoris (UAP) (OR = 1.04, p = 0.93), non-ST segment elevation myocardial infarction (NSTEMI) (OR = 1.16, p = 0.82), recurrent myocardial infarction (MI) (OR = 0.78, p = 0.56), stroke (OR = 0.35, p = 0.07), heart failure (OR = 0.41, p = 0.24), in-hospital mortality (OR = 0.35, p = 0.09), post-discharge mortality (OR = 1.66, p = 0.27), or ST segment elevation myocardial infarction (STEMI) (OR = 0.45, p = 0.23) between conservative management and revascularization procedures. However, sensitivity analysis reveals significant decreases in odds of inferior wall STEMI (OR = 0.41 [95% CI 0.17–0.97], p = 0.04) and heart failure (OR = 0.18 [95% CI 0.06–0.54], p = 0.002) in conservative treatment compared to revascularization group.

Conclusion

Conservative therapy significantly decreased inferior wall STEMI and heart failure as compared to revascularization in SCAD. Although no significant differences in cardiovascular outcomes, sensitivity analysis highlights potential benefits of conservative management.
Integrating machine learning and sentiment analysis in movie recommendation systems
Authors: Sarhan Amany M. , Ayman Hager , Wagdi Mariam , Ali Bassant , Adel Aliaa , Osama Rahf
Published: November 2024

The fast growth of the film business, along with an ever-increasing number of movie options, has highlighted the need for better recommendation algorithms. This study investigates the application of sentiment analysis in a movie recommendation system with the goal of improving the user experience. The importance of this sector stems from its ability to bridge the gap between user interests and the vast number of cinematic products, addressing individual emotional states and preferences. Researchers choose to generate movie recommendations based on the sentiments conveyed by viewers’ reviews of the movies. Sentiment-based movie recommendation system research employs techniques such as natural language processing and hybrid models with the goal of increasing user satisfaction. To this purpose, the integration of advanced machine learning algorithms such as cosine similarity, support vector machine, and Naive Bayes improves recommendation systems with sentiment analysis. Cosine similarity improves movie recommendations by recognizing minor user preferences, while support vector machines and Naive Bayes enhance sentiment analysis by offering a nuanced interpretation of textual attitudes. Through trials, the proposed system employs two public datasets for sentiment analysis, namely the TMDB5k dataset and the Reviews dataset, and makes predictions (positive, negative, or neutral) based on the content of the review through conducting sentiment analysis on the text using the Viscous Accretion Disk Evolution Resource (VADER) approach. The findings, based on users’ feedback, are more accurate and informative regarding movie quality, where SVM accuracy is 99.28% and Naïve Bayes accuracy is 96.60% when used with VADER sentiment analysis.
A study of comparing between auditory manifestations in post-COVID 2019 and 2023
Authors: Abd El Hady Heba Tallah sherif , Kolkaila Enaas Ahmad
Published: November 2024

Background

It’s known that COVID-19 affects the audio-vestibular system, while its variant is not studied yet. Accordingly, this work was designed to study the effect of COVID-19 and its variant on audio-vestibular system and to compare between symptoms and effects of these two.

Methods

A case- control study was conducted, with each case and control group consisting of 75 people who were age and gender matched. Their age ranged from 18 to 45 years. They were splited into three groups as follows: Study group 1 (post-COVID-19), it consisted of 25 post recovery adults, Study group 2 (post- COVID-23) consisted of 25 post recovery adults. Finally, a control group (group 3) consisted of 25 healthy people. PTA and tympanometry were used to evaluate hearing while VNG was used to evaluate vestibular system in all subjects included.

Results

Regarding the SNHL there was a statistically significant difference between post-COVID-19 and controls while no statistically significant difference was reported between post-COVID-19 and post-COVID-23 or between post-COVID-23 and controls. Regarding conductive hearing loss there was statistically significant difference between post-COVID-23 and controls with no statistically significant differences between post-COVID-19 and post-COVID-23 or between post-COVID-23 and controls. Regarding the vestibular examination, Statistical analysis revealed significant difference in caloric test results between post-COVID-19 and controls with no statistically significant difference between the post-COVID-19 and post-COVID-23 or between post-COVID-23 and controls.

Conclusions

SNHL was more than CHL in post-COVID 2019. On the other hand, in post COVID-2023 cases CHL was more than SNHL. Also, the severity of symptom decreased from 2019 to 2023. We recommend that COVID patients should proceed with an audio-vestibular evaluation. So that early affection could be detected and managed properly accordingly.
Using Machine Learning Models to Predict Pathologic Complete Response to Neoadjuvant Chemotherapy in Breast Cancer
Authors: Rahadian Rayhan Erlangga , Tan Hong Qi , Ho Bryan Shihan , Kumaran Arjunan , Villanueva Andre , Sng Joy , Tan Ryan Shea Ying Cong , Tan Tira Jing Ying , Tan Veronique Kiak Mien , Tan Benita Kiat Tee , Lim Geok Hoon , Cai Yiyu , Nei Wen Long , Wong Fuh Yong
Published: November 2024

PURPOSE

Neoadjuvant chemotherapy (NAC) is increasingly used in breast cancer. Predictive modeling is useful in predicting pathologic complete response (pCR) to NAC. We test machine learning (ML) models to predict pCR in breast cancer and explore methods of handling missing data.

METHODS

Four hundred and ninety-nine patients with breast cancer treated with NAC in two centers in Singapore (National Cancer Centre Singapore [NCCS] and KK Hospital) between January 2014 and December 2017 were included. Eleven clinical features were used to train five different ML models. Listwise deletion and imputation were evaluated on handling missing data. Model performance was evaluated by AUC and calibration (Brier score). Feature importance from the best performing model in the external testing data set was calculated using Shapley additive explanations.

RESULTS

Seventy-two (24.6%), 18 (24.7%), and 31 (24.8%) patients attained pCR in NCCS training, NCCS testing, and KK Women's and Children's Hospital (KKH) testing data sets, respectively. The random forest (RF) base and imputed models have the highest AUCs in the KKH cohort of 0.794 (95% CI, 0.709 to 0.873) and 0.795 (95% CI, 0.706 to 0.871), respectively, and were the best calibrated with the lowest Brier score. No statistically significant difference was noted between AUCs of the base and imputed models in all data sets. The imputed model had a larger positive predictive value (PPV; 98.2%
v
95.1%) and negative predictive value (NPV; 96.7%
v
90.0%) than the base model in the KKH data set. Estrogen receptor intensity, human epidermal growth factor 2 intensity, and age at diagnosis were the three most important predictors.

CONCLUSION

ML, particularly RF, demonstrates reasonable accuracy in pCR prediction after NAC. Imputing missing fields in the data can improve the PPV and NPV of the pCR prediction model.
MBX 2109, A Once-Weekly Parathyroid Hormone Replacement Therapy Prodrug: Phase 1, First-In-Human, Randomized Trial
Authors: Carney Patricia , Cutler Gordon B , Schneider Kristi , Zhang Fa , DiMarchi Richard
Published: November 2024

Context

Hypoparathyroidism denotes parathyroid hormone (PTH) deficiency and impaired mineral metabolism. MBX 2109, a novel prodrug yielding a biologically active PTH peptide agonist (PTH[1-32], extended by a fatty acylated Lys33), is being developed as a long-acting, once-weekly PTH replacement therapy.

Objective

Here, we report the safety, pharmacokinetics (PK), and pharmacodynamics (PD) of MBX 2109 in healthy volunteers.

Methods

This phase 1, randomized, double-blind, placebo-controlled, multiple ascending-dose study (NCT05158335) enrolled healthy adults, who were randomly assigned 4:1 to receive MBX 2109 (200, 400, 600, and 900 μg; n = 8) or placebo (n = 2) by subcutaneous administration once weekly for 4 doses (days 1, 8, 15, and 22). The primary end point was safety and tolerability. Key secondary end points were PK and PD.

Results

Overall, 40 participants (MBX 2109 n = 32, placebo n = 8) were randomly assigned (mean age, 43.3 years; 22.5% female). Treatment-emergent adverse events (TEAEs) occurred in 50% to 88% of MBX 2109 groups and in 25% of placebo participants. In the MBX 2109 groups, no severe or serious TEAEs were observed. Injection-site reaction was the most common treatment-related TEAE. The half-lives were 79 to 95 hours for MBX 2109 and 184 to 213 hours for the fatty-acylated biologically active PTH peptide, which showed dose- and time-dependent exposure increases.

Conclusion

The sustained-action PTH prodrug MBX 2109 was well tolerated with no unexpected, off-target safety issues. The long half-life and flat exposure profile of MBX 2109's biologically active PTH agonist supports once-weekly administration. MBX 2109 doses were identified for future studies.
Social Determinants of Health for Cardiovascular-Kidney-Metabolic Syndrome Among Patients With Diabetes
Authors: Belay Kibret Enyew , Feleke Yeweyenhareg , Alemneh Theodros Aberra , Haile Asteway Mulat , Abebe Dawit Girma
Published: November 2024

Context

Cardiovascular-kidney-metabolic (CKM) syndrome is a recently introduced term that is a complex disease consisting of cardiovascular disease, renal disease, obesity, and diabetes. The association of social determinants of health (SDOH) with CKM syndrome is not fully known.

Objective

We aimed to assess SDOH affecting CKM syndrome among adult patients with diabetes at follow-up at a tertiary hospital in Ethiopia.

Methods

A cross-sectional hospital-based study was used. Data were collected using a Kobo toolbox and entered into SPSS version 29 for further analysis.

Results

A total of 422 adult patients with diabetes were included in this study. The mean ± SD age of the patients was 54.14 ± 13.74 years. Fifty-two percent of the patients were male. In this study, 52.4% had cardiovascular kidney metabolic syndrome. Male patients (AOR: 1.73; 95% CI, 1.01-2.94), lost to follow-up for more than a year due to lack of money (AOR: 2.69; 95% CI, 1.01-7.22), missed an appointment due to lack of transportation in the past 1 year (AOR: 2.98; 95% CI, 1.21-7.33), were patients with disability (AOR: 1.97; 95% CI, 1.12-3.48), had hypertension (AOR: 3.12; 95% CI, 1.85-5.28), had obesity (AOR: 2.27, 95% CI, 1.17, 4.40), and were in retirement (AOR: 2.12; 95% CI, 1.04-4.30) these being more significantly associated with CKM syndrome.

Conclusion

More than half of patients had CKM syndrome. More attention should be given to SDOH, including male sex, financial constraints, transportation issues, disability, and retirement.
Survival Outcomes and Genetic Characteristics of Resected Pancreatic Acinar Cell Carcinoma
Authors: Blair Alex B. , Radomski Shannon N. , Chou Joanne , Liu Mengyuan , Howell Thomas Clark , Park Wungki , O’Reilly Eileen M. , Zheng Lei , Balachandran Vinod P. , Wei Alice C. , Kingham T. Peter , D’Angelica Michael I. , Drebin Jeffrey , Zani Sabino , Blazer Dan G. , Burkhart Richard A. , Burns William R. , Lafaro Kelly J. , Allen Peter J. , Jarnagin William R. , Lidsky Michael E. , He Jin , Soares Kevin C.
Published: November 2024

Background

Pancreatic acinar cell carcinoma (pACC) is a rare neoplasm of the exocrine pancreas. There is a dearth of information about tumor characteristics and patient outcomes. This study describes the clinical characteristics, genetic alterations, and survival outcomes of resected pACC.

Patients and Methods

Consecutive patients undergoing pancreatectomy for pathologically confirmed pACC from 1999 to 2022 across three high-volume pancreas surgery centers were analyzed. Patient demographics, tumor characteristics, treatment data, and genetic sequencing were obtained through retrospective abstraction.

Results

A total of 61 patients with resected pACC were identified. Median overall survival (OS) was 73 months and median recurrence free survival was 22 months. Nine patients underwent resection for oligometastatic disease; median OS was not reached after a median follow-up of 31 months from date of metastasectomy. Adjuvant chemotherapy was administered in 67% of patients with FOLFOX/FOLFIRINOX (5-fluorouracil, leucovorin, oxaliplatin, ± irinotecan) the most common regimen (58%). Sequencing data were obtained in 47 (77%) patients. A mutation in at least one of three core genes associated with the homologous recombination repair (HRR) pathway (BRCA1, BRCA2, or PALB2) occurred in 26% (n = 12) with BRCA2 the most frequently identified. A mutation in any other “non-core” gene associated with DNA damage repair or the HRR pathway was identified in 45% (n = 21) with a high tumor mutational burden of > 10 mutations per megabase in 13%.

Conclusions

Resection of pACC is associated with favorable survival outcomes, even in the setting of oligometastatic disease. Mutations in the HRR pathway are common, providing opportunities for potential targeted therapeutic options.
Laparoscopic Subtotal Splenectomy: A Feasible Option in the Treatment of Splenic Metastasis
Authors: Izquierdo Cristina , García-Picazo Alberto , Rodríguez Juan Pablo , Navarro Anna , Donisi Greta , Luque Eduardo , Ielpo Benedetto , Burdío Fernando , Sánchez-Velázquez Patricia
Published: November 2024

Introduction

Laparoscopic subtotal splenectomy (LSS) is a procedure that helps avoid the consequences of asplenia. Given the spleen’s importance and functionality, there may be specific indications and patient conditions in which partial splenectomy is beneficial. This case report aims to clarify the indications for LSS and outline the surgical technique.

Methods

This multimedia article provides a comprehensive overview of the surgical procedure, emphasizing key steps to avoid postoperative bleeding and complications.

Results

The patient was hospitalized for 3 days without any complications observed. Postoperative hemoglobin levels were 11.2 g/dL, with no signs of anemia. The patient was discharged with a follow-up visit after 2 weeks, showing no evidence of postoperative complications. The anatomopathological study revealed a nodular area with extensive tumoral necrosis.

Discussion

LSS is a safe surgical option that might help to mitigate the consequences of total splenectomy. Innovative technology in hemostasis, such as COOLINGBIS© (a monopolar electrosurgical electrode designed for hemostatic sealing and coagulation) can help manage this risk. Identifying the vascular pedicle via computed tomography scan is crucial to prevent unexpected bleeding.

Conclusions

In selected cases, LSS is a feasible and safe procedure when performed with appropriate laparoscopic equipment and by experienced surgeons.
Mobile applications (apps) for tobacco cessation: Behaviour change potential and heuristic analysis using the Mobile Application Rating Scale (MARS)
Authors: Bhat Bhargav , Nayak Prajna Pramod , Vasthare Ramprasad , Singhal Deepak Kumar
Published: November 2024

Background Given the high prevalence of tobacco use, India presents a significant challenge in tobacco control. Yet, the support received for tobacco cessation is suboptimal. Hence, the aim of this narrative review was to identify and heuristically evaluate ‘high-quality’ and ‘engaging’ tobacco cessation mobile apps using the Mobile Application Rating Scale (MARS). Also, to categorize and analyse their features with respect to engagement, functionality, aesthetics, and information quality. Methods A systematic search of tobacco cessation apps was done within app stores of prominent smartphone platforms developed by Apple and Android. The following search terms: ‘quit smoking,’ ‘smoking cessation, ‘stop smoking,’ ‘smoking therapy,’ ‘quit tobacco,’ ‘cigarette cessation,’ ‘cold turkey,’ and ‘quit cigarette.’ Pearson’s correlations were used to analyse correlations between app scores (Total score app-quality/mean score) and downloads/ratings and number of downloads with the overall MARS score. A Chi-square test was performed to analyse any association between app focus and app release dates. Results Total MARS scores ranged from 3.1 to 4.9. Quitsure app (4.9), Craving to Quit! app (4.8) and Stop Tobacco Mobile Trainer: Quit Smoking App (4.74) were ranked the highest according to the MARS overall mean score. Older apps focussed more on mere goal setting or substance use, as compared to behaviour change; whereas, recently developed apps are now focussing more on behaviour change. Conclusions The content and functionality of behaviour change-focused apps were of higher quality than those of other app categories. These recently developed mHealth apps can effectively supersede the traditional smoking cessation methods.
Human placental cells are resistant to SARS-CoV-2 infection and replication
Authors: Yoshida Nagisa , Thomas Jake R. , Appios Anna , Brember Matthew P. , Aye Irving L.M.H. , Edgar James R. , Firth Andrew E. , Chung Betty Y.W. , McGovern Naomi , Stewart Hazel
Published: November 2024

Background Infection during pregnancy with SARS-CoV-2 can have a serious impact on both maternal and foetal health. Clinical studies have shown that SARS-CoV-2 transmission from the mother to the foetus typically does not occur. However, there is evidence that SARS-CoV-2 can infect the placenta in utero. Here we sought to quantify the permissiveness of placental cells to SARS-CoV-2 infection and to determine if they support viral release. Methods By using publicly available single-cell RNA sequencing (scRNAseq) data sets and confocal microscopy we compared ACE2 transcript and protein expression across human first trimester and term placental cells. We also used in vitro infection assays to quantify the infection rates of a range of placenta-derived cells. Finally, we quantified the viral egress from these cells. Results ACE2 transcripts are found in a range of placental cell types across gestation, including trophoblast. However, ACE2 protein expression does not significantly change across placental cell types from first trimester to term. We find that 0.5±0.15 % of term trophoblast cells can be infected with SARS-CoV-2 while primary placental fibroblasts and macrophages, and JEG-3, JAR and HUVEC cell lines are resistant to infection. Furthermore, primary trophoblast cells poorly support viral release while JEG-3 cells allow relatively high levels of viral release. Conclusions The low level of viral release by primary placental cells provides insight into how the virus is impaired from crossing the placenta to the foetus.