bluuebunny/crossref_metadata_2025 huggingface dataset:
Hospital Discharge Opioid Prescribing Trends in a Multistate Institution Following the Introduction of Opioid Prescribing Guidelines and Key Metrics Dashboard
Authors: Lai Benjamin , O’Keefe Nancy , Cunningham Julie
Published: May 2024

Background

Despite the introduction of the Centers for Disease Control and Prevention's opioid prescribing guidelines, studies indicate that a significant proportion of opioids prescribed at hospital discharge remains unused. Little is known if improved provider awareness of guidelines and metrics would facilitate rightsizing opioid prescriptions at hospital discharge. Our institution created opioid prescribing guidelines and a key metrics dashboard and subsequently disseminated these tools to our institution's leadership and prescribers. We aim to evaluate the effectiveness of these efforts in reducing hospital discharge opioid prescriptions, especially those for acute pain exceeding 100 morphine milligram equivalents (MME).

Methods

Following the development of practice-specific opioid prescribing guidelines in 2017, a key metrics dashboard was created in 2021 to display the percentage of hospital discharges with opioids prescribed and the percentage of discharges with opioids prescribed for acute pain exceeding 100 MME. These metrics were broken down into calendar years between 2018 and 2022, and by the 7 major practice regions across our institution spanning 5 U.S. States.

Results

From 2018 to 2022, all regions showed a decline in the percentage of hospital discharges with opioids prescribed (range 2.7%-9.4%). In the same period, 5 of 7 regions showed a decline in discharge opioid prescriptions exceeding 100 MME for acute pain (range 8.8%-23.2%). Two sites showed an increase of 2.4% and 2.7%.

Conclusion

Downward trends in hospital discharge opioid prescriptions were observed for most practice regions following the introduction of our institution's opioid prescribing guidelines and key metrics dashboard.
What Faculty and Students Value When Evaluating Human Digital Anatomy Platforms: A Mixed-Methods Study
Authors: Lee Jason Wen Yau , Susanto Johan , Lai Siang Hui , Cheow Peng Chung , Low Li Xiang Tessa , Bello Fernando
Published: May 2024

OBJECTIVES

There is an increasing availability of digital technologies for teaching and learning of human anatomy. Studies have shown that such applications allow for better spatial awareness than traditional methods. These digital human anatomy platforms offer users myriad features, such as the ability to manipulate 3D models, conduct prosection, investigate anatomical regions through virtual reality, or perform knowledge tests on themselves. This study examined what faculty members’ value when using digital human anatomy platforms for teaching and what students value when using these platforms for learning.

METHODS

Six anatomy faculty members and 21 students were selected to participate in this study. After using the three digital anatomy platforms for at least 1 week, a survey was conducted to record their feedback in 4 categories: usability, interactive features, level of detail, and learning support. Respondents’ Qualitative feedback within each category was also analyzed to strengthen the study's findings.

RESULTS

The study's findings showed that faculty members and students have different priorities when evaluating digital anatomy platforms. Faculty members valued platforms that provided better accuracy and detailed anatomical structures, while students prioritized usability above the rest of the features.

CONCLUSION

Given that faculty and students have different preferences when selecting digital anatomy platforms, this article proposed that educators maximize the specific affordances offered by the technology by having a clear pedagogy and strategy on how the technology will be incorporated into the curriculum to help students achieve the desired learning outcomes.
Incidence and predictors of intracranial hemorrhage after intravenous thrombolysis with tenecteplase
Authors: Marnat Gaultier , Gerschenfeld Gaspard , Olindo Stephane , Sibon Igor , Seners Pierre , Clarençon Frederic , Smadja Didier , Chausson Nicolas , Ben Hassen Wagih , Piotin Michel , Caroff Jildaz , Alamowitch Sonia , Turc Guillaume
Published: May 2024

Background:

Despite its increasing use, there are limited data on the risk of intracranial hemorrhage (ICH) after intravenous thrombolysis with tenecteplase in the setting of acute ischemic stroke. Our aim was to investigate the incidence and predictors of ICH after tenecteplase administration.

Methods:

We reviewed data from the prospective ongoing multicenter TETRIS (Tenecteplase Treatment in Ischemic Stroke) registry. Patients with available day-1 imaging were included in this study. Clinical, imaging and biological variables were collected. Follow-up imaging performed 24 h after IVT was locally reviewed by senior neuroradiologists and neurologists. The incidence of parenchymal hematoma (PH) and any ICH were investigated. Potential predictors of PH and any ICH were assessed in multivariable logistic regressions. Subgroup analyses focusing on patients intended for endovascular treatment were performed.

Results:

PH and any ICH occurred in 126/1321 (incidence rate: 9.5%, 95% CI 8.1–11.2) and 521/1321 (39.4%, 95% CI 36.8–42.1) patients, respectively. Symptomatic ICH was observed in 77/1321 (5.8%; 95% CI 4.7–7.2). PH occurrence was significantly associated with poorer functional outcomes ( p < 0.0001) and death ( p < 0.0001) after 3 months. Older age (aOR = 1.03; 95% CI 1.01–1.05), male gender (aOR = 2.07; 95% CI 1.28–3.36), a history of hypertension (aOR = 2.08; 95% CI 1.19–3.62), a higher baseline NIHSS (aOR = 1.07; 95% CI 1.03–1.10) and higher admission blood glucose level (aOR = 1.12; 95% CI 1.05–1.19) were independently associated with PH occurrence. Similar associations were observed in the subgroup of patients intended for endovascular treatment.

Conclusion:

We quantified the incidence of ICH after IVT with tenecteplase in a real-life prospective registry and determined independent predictors of ICH. These findings allow to identify patients at high risk of ICH.
Real-World Outcomes of the 0.19 mg Fluocinolone Acetonide Intravitreal Implant for Diabetic Macular Edema
Authors: Morozova Christine , Humayun Lucas L. , Kasper Jonathan , Morozov Andy , Tabandeh Homayoun , Boyer David S. , Dayani Pouya N. , Rahhal Firas M.
Published: May 2024

Purpose: To evaluate the real-world clinical and safety outcomes of a 0.19 mg fluocinolone acetonide intravitreal implant to treat diabetic macular edema (DME). Methods: This retrospective analysis comprised patients treated with a single fluocinolone acetonide intravitreal implant for the clinical indication of ME secondary to diabetic retinopathy. Primary outcomes included changes in best-corrected visual acuity (BCVA), central subfield thickness (CST), and the frequency of DME-related treatments 12 months before and up to 36 months after fluocinolone acetonide administration. Safety outcomes were also assessed. Results: One hundred forty-eight eyes (115 patients) were followed for a mean (±SD) of 12.3 ± 4.2 months before and 29.4 ± 14.5 months after fluocinolone acetonide administration. A 0.8-letter decrease (Early Treatment Diabetic Retinopathy Study) in the mean BCVA was observed at month 24. The BCVA was 70 letters (20/40 Snellen equivalent) or more in 20.6% of eyes at baseline and in 23.7% of eyes 24 months after implant administration. The mean CST was 379.9 μm and 323.7 μm, respectively. The CST was 300 μm or less in 58.7% of eyes at month 24 ( P < .001). The mean frequency of intravitreal antivascular endothelial growth factor injections or laser photocoagulation decreased from 4.9 to 1.5 per year after fluocinolone acetonide administration ( P < .001). Implant migration to the anterior chamber occurred in 3 eyes, 2 of which were vitrectomized and later required removal. Conclusions: The 0.19 mg fluocinolone acetonide intravitreal implant provided long-term stabilization of VA and macular anatomy in patients with DME, despite a significant reduction in treatment frequency.
The 2012 Greek Retrofit and Borrowing Costs in the European Periphery
Authors: Bolton Patrick , Fu Xuewen , Gulati Mitu , Panizza Ugo
Published: May 2024

This article examines the impact of Greece retroactively, via legislation, changing the terms in hundreds of billions of euros worth of Greek government bonds governed by domestic Greek law. As the abrogation of gold clauses in US government bonds by the US Congress in 1933 had been, the Greek action was decried as violative of the rule of law and sure to negatively impact the future ability of Euro area sovereigns to borrow. We test whether the Greek action had negative spillovers on European government debt markets. We find no evidence of increased borrowing for even the most peripheral European economies from the Greek action.
Are We Underestimating the Crime Prevention Outcomes of Community Policing? The Importance of Crime Reporting Sensitivity Bias
Authors: Weisburd David , Wilson David B. , Gill Charlotte , Kuen Kiseong , Zastrow Taryn
Published: May 2024

One of the key policing innovations of the last three decades has been community-oriented policing. It is particularly important because it is one of the only proactive policing approaches that consistently improves citizen evaluations of the police. At the same time, a series of reviews have concluded that there is not persuasive evidence that community policing reduces crime. In this paper we argue that these conclusions are likely flawed because of what we term crime reporting sensitivity (CRS) bias. CRS bias occurs because community policing leads to more cooperation with the police and subsequently increased crime reporting. Such increased crime reporting bias adjusts crime prevention outcomes of community policing downward. We illustrate this process by reanalyzing data from the Brooklyn Park ACT Experiment (Weisburd et al., 2021). We begin by showing the specific crime categories that contribute most to CRS bias. We then use a difference-in-differences panel regression approach to assess whether the experimental intervention in Brooklyn Park led to significant CRS bias. Finally, we use bounded estimates from the Brooklyn Park Experiment to adjust meta-analytic results from prior community policing studies to examine whether the conclusion that community policing does not impact on crime would need to be revisited if CRS bias was accounted for. We find that adjusted estimates tell a very different, more positive, story about community policing, suggesting that future studies should recognize and adjust for CRS bias, or identify other measures not influenced by this mechanism.
Gendered Judicial Opinions
Authors: Livermore Michael A. , Varsava Nina , Carlson Keith , Rockmore Daniel N.
Published: May 2024

In this paper we investigate whether gender is associated with the content of judicial opinions in the U.S. courts of appeals. Using a topic model analysis, we find that gender is a significant predictor of the content of judicial opinions. Two causal pathways could explain this result: (1) men and women judges write differently about the same cases; (2) men and women judges write about different cases, either due to assignment or selection effects. To untangle these two pathways, we carry out three additional analyses. First, we examine whether the United States as a party is associated with judge gender. We next examine whether case codes are associated with judge gender. Finally, we examine the relationship between topic prevalence and gender, controlling for case codes. Our findings lend greater support to the second pathway than the first. This result raises the prospect that prior work on gender-based differences in judicial behavior may be confounded by assignment or selection effects. Our results also raise normative concerns about gender disparities in voice and influence in the U.S. courts.
Reconciling Legal and Empirical Conceptions of Disparate Impact: An Analysis of Police Stops Across California
Authors: Grossman Joshua , Nyarko Julian , Goel Sharad
Published: May 2024

We evaluate the statistical and conceptual foundations of empirical tests for disparate impact. We begin by considering a recent, popular proposal in the economics literature that seeks to assess disparate impact via a comparison of error rates for the majority and the minority group. Building on past work, we show that this approach suffers from what is colloquially known as “the problem of inframarginality”, in turn putting it in direct conflict with legal understandings of discrimination. We then analyze two alternative proposals that quantify disparate impact either in terms of risk-adjusted disparities or by comparing existing disparities to those under a statistically optimized decision policy. Both approaches have differing, context-specific strengths and weaknesses, and we discuss how they relate to the individual elements in the legal test for disparate impact. We then turn towards assessing disparate impact of search decisions among approximately 1.5 million police stops recorded across California in 2022 pursuant to its Racial Identity and Profiling Act (RIPA). The results are suggestive of disparate impact against Black and Hispanic drivers for several large law enforcement agencies. We further propose alternative search strategies that more efficiently recover contraband while also exerting fewer racial disparities.
Synthetic Marijuana: Assessment of Usage, Motivation and Associated Risks in Adolescent Substance Users
Authors: Baweja Raman , Mills-Huffnagle Sara , Jernigan Amanda , Chongtham Nungshitombi , Waschbusch Daniel , Waxmonsky James G
Published: May 2024

Objectives:

Use of Synthetic and designer products, including synthetic marijuana (SM), among adolescents poses a major risk to public health. Little is known about the motivating factors of synthetic substance use in adolescents. This study examined the motivations, predictors, perceived risks and benefits, and differences with SM versus natural marijuana among adolescents.

Methods:

Between April 2016 and May 2018, a convenience sample of adolescents receiving substance use treatment from a local counseling center completed an anonymous survey to assess the use of natural and synthetic marijuana use, the Strengths and Difficulties Questionnaire to assess levels of current psychiatric symptoms and the Community Assessment of Psychic Experiences-Positive Scale to assess symptoms of psychosis.

Results:

A total of 80 adolescents (age range of 14-18 years; 71% male; 53% Caucasian) completed the study. Of these, 39 (49%) reported natural marijuana use (natural marijuana users) and 41 (51%) reported both synthetic and natural marijuana use (dual users). The most commonly reported reasons for using SM were its low cost and reduced risk of detection. Participants who were familiar with SM and reported a desire to avoid detection on drug tests were likelier to use SM (all P < .05). Dual users reported more benefits and risks associated with SM use when compared to natural marijuana users ( P ⩽ .05). The use of SM also heightened the perceived medical risks of natural marijuana, including seizures and respiratory issues ( P < .05), compared with natural marijuana users. While dual users self-reported more conduct ( P = .009) and externalizing problems ( P = .024) when compared to natural marijuana users, there were no group differences in psychotic symptoms, nor correlations with the frequency of synthetic or natural marijuana use and psychotic symptoms except that persecutory ideation correlated with the frequency of natural marijuana use during the past 12 months ( rp = 0.28, P = .04).

Conclusions:

These results suggest that reports of cost savings, and lack of detection on urine drug screens are common reasons for SM use in adolescents despite being aware of the risks of using SM. Perceived benefits of using synthetics and other novel substances appear diverse, and merit further exploration as a better understanding of what motivates adolescents to use specific novel substances may guide prevention and treatment efforts.
Unstructured Road Extraction in UAV Images based on Lightweight Model
Authors: Zhang Di , An Qichao , Feng Xiaoxue , Liu Ronghua , Han Jun , Pan Feng
Published: May 2024

There is no unified planning standard for unstructured roads, and the morphological structures of these roads are complex and varied. It is important to maintain a balance between accuracy and speed for unstructured road extraction models. Unstructured road extraction algorithms based on deep learning have problems such as high model complexity, high computational cost, and the inability to adapt to current edge computing devices. Therefore, it is best to use lightweight network models. Considering the need for lightweight models and the characteristics of unstructured roads with different pattern shapes, such as blocks and strips, a TMB (Triple Multi-Block) feature extraction module is proposed, and the overall structure of the TMBNet network is described. The TMB module was compared with SS-nbt, Non-bottleneck-1D, and other modules via experiments. The feasibility and effectiveness of the TMB module design were proven through experiments and visualizations. The comparison experiment, using multiple convolution kernel categories, proved that the TMB module can improve the segmentation accuracy of the network. The comparison with different semantic segmentation networks demonstrates that the TMBNet network has advantages in terms of unstructured road extraction.
Reinforcement Learning-Based Energy Management for Hybrid Power Systems: State-of-the-Art Survey, Review, and Perspectives
Authors: Tang Xiaolin , Chen Jiaxin , Qin Yechen , Liu Teng , Yang Kai , Khajepour Amir , Li Shen
Published: May 2024

The new energy vehicle plays a crucial role in green transportation, and the energy management strategy of hybrid power systems is essential for ensuring energy-efficient driving. This paper presents a state-of-the-art survey and review of reinforcement learning-based energy management strategies for hybrid power systems. Additionally, it envisions the outlook for autonomous intelligent hybrid electric vehicles, with reinforcement learning as the foundational technology. First of all, to provide a macro view of historical development, the brief history of deep learning, reinforcement learning, and deep reinforcement learning is presented in the form of a timeline. Then, the comprehensive survey and review are conducted by collecting papers from mainstream academic databases. Enumerating most of the contributions based on three main directions—algorithm innovation, powertrain innovation, and environment innovation—provides an objective review of the research status. Finally, to advance the application of reinforcement learning in autonomous intelligent hybrid electric vehicles, future research plans positioned as “Alpha HEV” are envisioned, integrating Autopilot and energy-saving control.
Geometric Error Identification of Gantry-Type CNC Machine Tool Based on Multi-Station Synchronization Laser Tracers
Authors: Zha Jun , Zhang Huijie
Published: May 2024

Laser tracers are a three-dimensional coordinate measurement system that are widely used in industrial measurement. We propose a geometric error identification method based on multi-station synchronization laser tracers to enable the rapid and high-precision measurement of geometric errors for gantry-type computer numerical control (CNC) machine tools. This method also improves on the existing measurement efficiency issues in the single-base station measurement method and multi-base station time-sharing measurement method. We consider a three-axis gantry-type CNC machine tool, and the geometric error mathematical model is derived and established based on the combination of screw theory and a topological analysis of the machine kinematic chain. The four-station laser tracers position and measurement points are realized based on the multi-point positioning principle. A self-calibration algorithm is proposed for the coordinate calibration process of a laser tracer using the Levenberg–Marquardt nonlinear least squares method, and the geometric error is solved using Taylor’s first-order linearization iteration. The experimental results show that the geometric error calculated based on this modeling method is comparable to the results from the Etalon laser tracer. For a volume of 800 mm × 1000 mm × 350 mm, the maximum differences of the linear, angular, and spatial position errors were 2.0 μm, 2.7 μrad, and 12.0 μm, respectively, which verifies the accuracy of the proposed algorithm. This research proposes a modeling method for the precise measurement of errors in machine tools, and the applied nature of this study also makes it relevant both to researchers and those in the industrial sector.
Simulating the effects of tax exemptions for plug-in electric vehicles in Norway
Authors: Pfaffenbichler Paul , Fearnley Nils , Figenbaum Erik , Emberger Günter
Published: May 2024

For many years Norway has been in the forefront of promoting electromobility. Today, Norway has the world’s highest per capita fleet of plug-in electric cars. In 2021, 1.6% of the cars in the EU fleet were plug-in electric vehicles, whereas their share was 21% in Norway. Part of the successful market take-up rate is due to wide-ranging tax exemptions. Increasing plug-in electric vehicles numbers causes tax revenue losses, making exemptions unsustainable. Norway has the ambitious goal that from 2025, all newly registered cars shall be zero-emission vehicles. Keeping tax exemptions in place might be crucial for this goal. The objective of this paper is to provide information to solve this dilemma. Tax exemption reduction and abolition paths which offer a compromise between minimal effects on the development of zero-emission vehicles and tax revenues have been identified. An updated and re-calibrated version of the stock-flow-model SERAPIS was used to simulate and assess different scenarios. Results show that a controlled tax phase-in allows Norway to reach its environmental targets of 100% zero emission vehicles by 2025 and a 55% decrease of CO2-emissions in 2030 relative to 2005 while simultaneously increasing public revenues significantly.
Genome-wide identification of GH28 family and insight into its contributions to pod shattering resistance in Brassica napus L.
Authors: Zhang Fugui , Liu Nian , Chen Tianhua , Xu Hong , Li Rui , Wang Liyan , Zhou Shuo , Cai Qing’ao , Hou Xinzhe , Wang Ling , Qian Xingzhi , Zhu Zonghe , Zhou Kejin
Published: May 2024

Rapeseed (Brassica napus L.), accounts for nearly 16% of vegetable oil, is the world’s second produced oilseed. However, pod shattering has caused significant yield loses in rapeseed production, particularly during mechanical harvesting. The GH28 genes can promote pod shattering by changing the structure of the pod cell wall in Arabidopsis. However, the role of the GH28 gene family in rapeseed was largely unknown. Therefore, a genome-wide comprehensive analysis was conducted to classify the role of GH28 gene family on rapeseed pod shattering. A total of 37 BnaGH28 genes in the rapeseed genome were identified. These BnaGH28s can be divided into five groups (Group A-E), based on phylogenetic and synteny analysis. Protein property, gene structure, conserved motif, cis-acting element, and gene expression profile of BnaGH28 genes in the same group were similar. Specially, the expression level of genes in group A-D was gradually decreased, but increased in group E with the development of silique. Among eleven higher expressed genes in group E, two BnaGH28 genes (BnaA07T0199500ZS and BnaC06T0206500ZS) were significantly regulated by IAA or GA treatment. And the significant effects of BnaA07T0199500ZS variation on pod shattering resistance were also demonstrated in present study. These results could open a new window for insight into the role of BnaGH28 genes on pod shattering resistance in rapeseed.
Measures during the COVID-19 pandemic in public primary health care in Greece: is there still a missing link to universal health coverage?
Authors: Tsampouri Efthalia , Kapetaniou Konstantina , Missiou Aristea , Bakola Maria , Willems Sara , Van Poel Esther , Tatsioni Athina
Published: May 2024

Background

The PRICOV-19 study aimed to assess the organization of primary health care (PHC) during the COVID-19 pandemic in 37 European countries and Israel; and its impact on different dimensions of quality of care. In this paper, we described measures taken by public PHC centers in Greece. Additionally, we explored potential differences between rural and non-rural settings.

Methods

The study population consisted of the 287 public PHC centers in Greece. A random sample of 100 PHC centers stratified by Health Region was created. The online questionnaire consisted of 53 items, covering six sections: general information on the PHC center, patient flow, infection prevention, information processing, communication to patients, collaboration, and collegiality.

Results

Seventy-eight PHC centers (78%) - 50 rural and 28 non-rural – responded to the survey. Certain measures were reported by few PHC centers. Specifically, the use of online messages about complaints that can be solved without a visit to the PHC center (21% rural; and 31% non-rural PHC centers), the use of video consultations with patients (12% rural; and 7% non-rural PHC centers), and the use of electronic medical records (EMRs) to systematically identify the list of patients with chronic conditions (5% rural; and 10% non-rural PHC centers) were scarcely reported. Very few PHC centers reported measures to support identifying and reaching out to vulnerable population, including patients that may have experienced domestic violence (8% rural; and 7% non-rural PHC centers), or financial problems (26% rural; and 7% non-rural PHC centers). Providing administrative documents to patients through postal mail (12% rural; and 21% non-rural PHC centers), or regular e-mail (11% rural; and 36% non-rural PHC centers), or through a secured server (8% rural; and 18% non-rural PHC centers) was rarely reported. Finally, providing information in multiple languages through a PHC website (12% rural PHC centers only), or an answering machine (6% rural PHC centers only), or leaflets (3% rural PHC centers only; and for leaflets specifically on COVID-19: 6% rural; and 8% non-rural PHC centers) were lacking in most PHC centers.

Conclusion

Our study captured measures implemented by few PHC centers suggesting potential priority areas of future improvement.
The impact of continuous and intermittent supportive counseling on self-efficacy and continuation of breastfeeding in lactating women affected by COVID-19: a quasi-experimental trial
Authors: Karimi Maryam , Maleki Azam , Rastegari Leila
Published: May 2024

Background

Promoting exclusive breastfeeding can have a great effect in reducing the complications and mortality rate of mother and child.

Objective

The study aimed to compare the effects of continuous and intermittent supportive counselling on the self-efficacy and continuity of breastfeeding among Lactating mothers with COVID-19.

Methods

The study was a semi-experimental research method and was conducted on 73 mothers with COVID-19 who were hospitalized in Ayatollah Mousavi Hospital in Zanjan, Iran from May 2021 to April 2022. In the continuous counselling group, counselling was provided daily for 14 days, while in the intermittent counselling group, counselling was provided once a week for four weeks. Breastfeeding continuity was assessed based on the World Health Organization’s classification, and breastfeeding self-efficacy was measured using Dennis’ standard breastfeeding self-efficacy questionnaire (BSE) up to four months after delivery. The data were analyzed using chi-square tests, independent t-tests, paired t-tests, analysis of variance with repeated measures, and survival analysis (Kaplan-Meier) with a 95% confidence level.

Results

The survival analysis revealed that the cessation of exclusive breastfeeding occurred in 17 cases within the continuous counselling group and in 22 cases within the intermittent counselling group. The rates of continuation for exclusive breastfeeding were 52.8% and 40.5% in the continuous and intermittent counselling group respectively. However, no statistically significant differences were observed in the continuation of breastfeeding and the trend of changes in the mean scores of breastfeeding self-efficacies between the continuous and intermittent counselling groups. Furthermore, comparing the change in breastfeeding self-efficacy scores between the one-month and four-month follow-ups within the continuous counselling group, a statistically significant increase was observed.

Conclusion

The results indicated no difference in the effectiveness of continuous and intermittent counseling methods in improving breastfeeding continuity in women with COVID-19. Further research is needed to explore the long-term effects of different counseling approaches on breastfeeding outcomes during crises.

Trial registration

The study was registered on the Iranian Registry of Clinical Trials website on 29/06/2021 with the registration code IRCT20150731023423N19. It can be accessed via this link: https://irct.behdasht.gov.ir/user/trial/55391/view.
The impact of loco-regional treatment modality on the outcomes in breast cancer patients younger than forty years of age
Authors: Boutrus Rimoun R. , Abdelazim Yasser A. , Mohammed Toka , Bayomy Mohammed , Ibraheem Maher H. , Hussein Alaadin , Sebaie Medhat El
Published: May 2024

Purpose

To determine the impact of the loco-regional treatment modality, on the loco-regional recurrence (LRR) rates and overall survival (OS) in breast cancer patients younger than 40 years.

Methods

Data of 623 breast cancer patients younger than 40 years of age were retrospectively reviewed. Patients were stratified according to the locoregional treatment approach into three groups: the mastectomy group (M), the mastectomy followed by radiation therapy group (MRX) and the breast conservative therapy group (BCT).

Results

Median follow-up was 72 months (range, 6-180). Two hundred and nine patients were treated with BCT, 86 with MRM and 328 with MRX. The 10-year rate LRR rates according to treatment modality were: 13.4% for BCT, 15.1% for MRM and 8.5% for MRX (p 0.106). On univariate analysis, T stage (p 0.009), AJCC stage (p 0.047) and Her 2 status (p 0.001) were associated with LRR. Ten-year overall survival (OS) was 72.7% (78.5% in the BCT group, 69.8% in the MRM group and 69.8% in the MRX group, p 0.072).

On Univariate analysis, age < 35 (p 0.032), grade III (p 0.001), N3 stage (p 0.001), AJCC stage III (p 0.005), ER negative status (0.04), Her 2-status positive (0.006) and lack of chemotherapy administration (p 0.02) were all predictors of increased mortality.

Conclusion

For patients younger than 40 years of age, similar LRR and overall survival outcomes were achieved using BCT, M or MRX. Young age at diagnosis should not be used alone in recommending one loco-regional treatment approach over the others.
Do not stumble over the same “stone” twice: a case series of endogenous endophthalmitis secondary to severe systemic diseases
Authors: He Ying , Zeng Weijuan , Shi Wenjian , Chen Xiaomin , Shen Yanru , Wang Shun , Cai Xiaojun , Liu Yang , Gao Yingying , Ke Min
Published: May 2024

Background

Endogenous endophthalmitis (EE) is a rare but highly destructive eye emergency secondary to systemic infection. Acute endophthalmitis can lead to irreversible vision impairment or even loss of the whole eye, unless being diagnosed and treated promptly.

Case presentation

This study reports three typical EE cases of endogenous endophthalmitis secondary to different severe systemic diseases. Patients were recruited from the Department of ophthalmology at Zhongnan hospital of Wuhan University and the Department of ophthalmology at the Second Affiliated Hospital of Fujian Medical University. Patients were followed up for up to 60 days. Among these cases, the eye symptoms is the initial manifestations while secondary to original different special systemic conditions. Patients have been treated under dynamically prompt response undergoing systemic treatment and eye treatment at the same time. Best corrected visual acuity were 20/40, 20/60 and light perception during follow-up evaluation.

Conclusions

Our observation suggest that prompt identification and treatment could save patients’ vision from EE.
Comparison of anxiety, pain, and quality of life in individuals with mild or moderate malocclusion between conventional fixed orthodontic treatment versus Invisalign: a randomised clinical trial
Authors: Tunca Yasemin , Kaya Yesim , Tunca Murat , Keskin Sıddık
Published: May 2024

Background

We evaluated anxiety, pain, and oral-health-related quality of life in individuals treated with conventional fixed appliances (Group A) and clear aligners (Group B) for moderate malocclusion during the initial phase of orthodontic treatment.

Methods

Sixty individuals, separated into Group A (n = 30) and Group B (n = 30), were included in the study. They completed the Anxiety Levels, Oral Health Impact Profile-14, and Oral Health Related Quality of Life - United Kingdom/Surveys after the application of attachments on days 0 (T1), 10 (T10), and 20 (T20). Their pain levels were evaluated with the Visual Analogue Scale on days 0, 2, and 6 in the 2nd and 6th hours and on the 1st, 3rd, 7th, 14th, and 21st days.

Results

Per the VAS questionnaire, pain levels in the 2nd hour, 6th hour, 1st day, and 3rd day were significantly lower in Group B than in Group A. In the OHIP-14 survey results, the comparison between Group A and Group B showed a significant difference only on the 1st day. The STAI and OHRQoL-UK survey results did not differ significantly between the groups.

Conclusions

We found no significant difference between the two groups in terms of anxiety levels, and pain among individuals in Group A was higher than in Group B only at the beginning of the treatment. No significant differences were observed in terms of individuals’ quality of life.

Trial registration

NCT06133296 (retrospectively registered)- Registration Date:15/11/2023.
JAM3 promotes cervical cancer metastasis by activating the HIF-1α/VEGFA pathway
Authors: Peng Jiali , Chen Yao , Yin Aijun
Published: May 2024

Cervical cancer is the fourth most common cancer and the leading cause of mortality among women worldwide. Tumor metastasis is an important cause of poor prognosis. Determining the exact mechanisms of metastasis and potential targeted therapies is urgently needed. Junctional adhesion molecule 3 (JAM3) is an important member of the TJ tight junction (TJ) family, and its biological function in cervical cancer needs to be further clarified. We found that JAM3 was highly expressed in cervical cancer patients with lymph node metastasis and that high expression of JAM3 promoted cervical cancer cell metastasis both in vitro and in vivo. In addition, overexpression of JAM3 induces epithelial–mesenchymal transition (EMT). Moreover, silencing JAM3 suppressed cervical cancer cell migration and invasion in vitro. Finally, JAM3 overexpression activated the HIF-1α/VEGFA pathway. In conclusion, our results suggested that JAM3 promotes cervical cancer cell migration and invasion by activating the HIF-1α/VEGFA pathway. JAM3 may be a promising biomarker and effective therapeutic target for cervical cancer.
Nursing practice of routine gastric aspiration in preterm infants and its link to necrotizing enterocolitis: is the practice still clinically relevant?
Authors: Elsayed Ramadan Osama Mohamed , Alruwaili Majed Mowanes , Alruwaili Abeer Nuwayfi , Elsharkawy Nadia Bassuoni , Abdelaziz Enas Mahrous , Zaky Mohammed Elsayed , shaban Marwa Mamdouh , Shaban Mostafa
Published: May 2024

The practice of routine gastric residual aspiration in preterm infants remains controversial, with conflicting evidence regarding its impact on necrotizing enterocolitis (NEC). As front-line caregivers, nurses play a vital role in gastric aspiration procedures and must be informed by evidence. This quasi-experimental nursing study aimed to assess whether gastric aspiration is clinically relevant in reducing the risk of NEC in preterm infants.

A total of 250 preterm infants from two NICUs in Egypt were allocated to the gastric aspiration (n = 125) and non-aspiration (n = 125) groups. Feeding practices, gastric residuals, and incidence/severity of NEC were compared between groups according to modified Bell’s criteria. Risk factors were analyzed using multivariate regression. There were no significant baseline differences between the groups. The gastric residual attributes and feeding outcomes did not differ substantially from aspiration. The overall incidence of NEC was 14–15%, with no significant differences in the odds of onset or progression of NEC by stage between the groups. Lower gestational age and birth weight emerged as stronger predictors of NEC. Routine gastric aspiration does not appear to directly prevent or reduce the severity of NEC in this population. Although gastric residuals retain clinical importance, study findings question assumptions that aspiration protects against NEC and informs nursing practice. Evidence-based feeding protocols must continually evolve through ongoing research on modifiable risk factors for this devastating intestinal disease in preterm infants.
Ensuring universal access to quality care for persons with presumed tuberculosis reaching the private sector: lessons from Kerala
Authors: Rakesh P. S. , Shannawaz Mohd
Published: May 2024

Background

More than half of the people with Tuberculosis (TB) symptoms in India seek care from the private sector. People with TB getting treatment from private sector in India are considered to be at a higher risk for receiving suboptimal quality of care in terms of incorrect diagnosis and treatment, lack of treatment adherence support with a high loss to follow-up rate that could eventually increase their risk of drug resistance. The current study aims at documenting the approach and efforts taken by the Kerala state to partner with the private health care delivery providers for ensuring quality TB care to the people with presumed TB reaching them.

Methods

A case study approach was adopted with review of all available literature followed by five Key Informant Interviews to understand the case through a primary descriptive exploration. Grounded theory approach was used to generating the single theory of the case itself that explains it.

Results

Kerala state has taken a variety of interventions to ensure universal access to TB care for citizens reaching the private sector with documented improvement in the quality of TB care. Key learnings from these initiatives were (i) patients need to be at the centre of partnerships, (ii) good governance is essential for ensuring Universal Health Coverage in a mixed health system, (iii) data intelligence is required to guide partnerships, (iv) identification of the correct ‘problems’ is crucial for effective design of partnerships and (v) a platform for meaningful dialogue of key stakeholders is needed.

Conclusion

Kerala experience demonstrated that if governments take a proactive role in engaging the private sector, in an informed and evidence-based way, they can leverage the advantages of the private sector while protecting the public health interest.
mPPTMP195 nanoparticles enhance fracture recovery through HDAC4 nuclear translocation inhibition
Authors: Chen Xinping , Li Chengwei , Zhao Jiyu , Liu Yunxiang , Zhao Zhizhong , Wang Zhenyu , Li Yue , Wang Yunfei , Guo Lixia , Li Lu , Chen Chongwei , Bai Bing , Wang Shaowei
Published: May 2024

Delayed repair of fractures seriously impacts patients’ health and significantly increases financial burdens. Consequently, there is a growing clinical demand for effective fracture treatment. While current materials used for fracture repair have partially addressed bone integrity issues, they still possess limitations. These challenges include issues associated with autologous material donor sites, intricate preparation procedures for artificial biomaterials, suboptimal biocompatibility, and extended degradation cycles, all of which are detrimental to bone regeneration. Hence, there is an urgent need to design a novel material with a straightforward preparation method that can substantially enhance bone regeneration. In this context, we developed a novel nanoparticle, mPPTMP195, to enhance the bioavailability of TMP195 for fracture treatment. Our results demonstrate that mPPTMP195 effectively promotes the differentiation of bone marrow mesenchymal stem cells into osteoblasts while inhibiting the differentiation of bone marrow mononuclear macrophages into osteoclasts. Moreover, in a mouse femur fracture model, mPPTMP195 nanoparticles exhibited superior therapeutic effects compared to free TMP195. Ultimately, our study highlights that mPPTMP195 accelerates fracture repair by preventing HDAC4 translocation from the cytoplasm to the nucleus, thereby activating the NRF2/HO-1 signaling pathway. In conclusion, our study not only proposes a new strategy for fracture treatment but also provides an efficient nano-delivery system for the widespread application of TMP195 in various other diseases.
Titanium dioxide nanoparticles alleviates polystyrene nanoplastics induced growth inhibition by modulating carbon and nitrogen metabolism via melatonin signaling in maize
Authors: Yang Xiaoxiao , Feng Ke , Wang Guo , Zhang Shifang , Zhao Juan , Yuan Xiangyang , Ren Jianhong
Published: May 2024

Background

Nanoplastics, are emerging pollutants, present a potential hazard to food security and human health. Titanium dioxide nanoparticles (Nano-TiO2), serving as nano-fertilizer in agriculture, may be important in alleviating polystyrene nanoplastics (PSNPs) toxicity.

Results

Here, we performed transcriptomic, metabolomic and physiological analyzes to identify the role of Nano-TiO2 in regulating the metabolic processes in PSNPs-stressed maize seedlings (Zea mays L.). The growth inhibition by PSNPs stress was partially relieved by Nano-TiO2. Furthermore, when considering the outcomes obtained from RNA-seq, enzyme activity, and metabolite content analyses, it becomes evident that Nano-TiO2 significantly enhance carbon and nitrogen metabolism levels in plants. In comparison to plants that were not subjected to Nano-TiO2, plants exposed to Nano-TiO2 exhibited enhanced capabilities in maintaining higher rates of photosynthesis, sucrose synthesis, nitrogen assimilation, and protein synthesis under stressful conditions. Meanwhile, Nano-TiO2 alleviated the oxidative damage by modulating the antioxidant systems. Interestingly, we also found that Nano-TiO2 significantly enhanced the endogenous melatonin levels in maize seedlings. P-chlorophenylalanine (p-CPA, a melatonin synthesis inhibitor) declined Nano-TiO2-induced PSNPs tolerance.

Conclusions

Taken together, our data show that melatonin is involved in Nano-TiO2-induced growth promotion in maize through the regulation of carbon and nitrogen metabolism.

Graphical Abstract
Revealing the pathogenesis of gastric intestinal metaplasia based on the mucosoid air-liquid interface
Authors: Liu Simeng , Wen Huijuan , Li Fazhan , Xue Xia , Sun Xiangdong , Li Fuhao , Hu Ruoyu , Xi Huayuan , Boccellato Francesco , Meyer Thomas F , Mi Yang , Zheng Pengyuan
Published: May 2024

Background

Gastric intestinal metaplasia (GIM) is an essential precancerous lesion. Although the reversal of GIM is challenging, it potentially brings a state-to-art strategy for gastric cancer therapeutics (GC). The lack of the appropriate in vitro model limits studies of GIM pathogenesis, which is the issue this work aims to address for further studies.

Method

The air-liquid interface (ALI) model was adopted for the long-term culture of GIM cells in the present work. This study conducted Immunofluorescence (IF), quantitative real-time polymerase chain reaction (qRT-PCR), transcriptomic sequencing, and mucoproteomic sequencing (MS) techniques to identify the pathways for differential expressed genes (DEGs) enrichment among different groups, furthermore, to verify novel biomarkers of GIM cells.

Result

Our study suggests that GIM-ALI model is analog to the innate GIM cells, which thus can be used for mucus collection and drug screening. We found genes MUC17, CDA, TRIM15, TBX3, FLVCR2, ONECUT2, ACY3, NMUR2, and MAL2 were highly expressed in GIM cells, while GLDN, SLC5A5, MAL, and MALAT1 showed down-regulated, which can be used as potential biomarkers for GIM cells. In parallel, these genes that highly expressed in GIM samples were mainly involved in cancer-related pathways, such as the MAPK signal pathway and oxidative phosphorylation signal pathway.

Conclusion

The ALI model is validated for the first time for the in vitro study of GIM. GIM-ALI model is a novel in vitro model that can mimic the tissue micro-environment in GIM patients and further provide an avenue for studying the characteristics of GIM mucus. Our study identified new markers of GIM as well as pathways associated with GIM, which provides outstanding insight for exploring GIM pathogenesis and potentially other related conditions.
Unravelling the clinical heterogeneity of undefined recurrent fever over time in the European registries on Autoinflammation
Authors: Vyzhga Y. , Wittkowski H. , Hentgen V. , Georgin-Lavialle S. , Theodoropoulou A. , Fuehner S. , Jesenak M. , Frenkel J. , Papadopoulou-Alataki E. , Anton Jordi , Olivieri A. Nunzia , Brunner J. , Sanchez J. , Koné-Paut I. , Fingerhutova S. , Pillet P. , Meinzer U. , Khubchandani R. , Jansson A. , Haas J.-P. , Berendes R. , Kallinich T. , Horneff G. , Lilienthal E. , Papa R. , Foell D. , Lainka E. , Caorsi R. , Gattorno M. , Hofer M. ,   AID-Net JIRcohortEurofever/PRINTO
Published: May 2024

Background

Systemic autoinflammatory disorders (SAIDs) represent a growing spectrum of diseases characterized by dysregulation of the innate immune system. The most common pediatric autoinflammatory fever syndrome, Periodic Fever, Aphthous Stomatitis, Pharyngitis, Adenitis (PFAPA), has well defined clinical diagnostic criteria, but there is a subset of patients who do not meet these criteria and are classified as undefined autoinflammatory diseases (uAID). This project, endorsed by PRES, supported by the EMERGE fellowship program, aimed to analyze the evolution of symptoms in recurrent fevers without molecular diagnosis in the context of undifferentiated AIDs, focusing on PFAPA and syndrome of undifferentiated recurrent fever (SURF), using data from European AID registries.

Methods

Data of patients with PFAPA, SURF and uSAID were collected from 3 registries including detailed epidemiological, demographic and clinical data, results of the genetic testing and additional laboratory investigations with retrospective application of the modified Marshall and PRINTO/Eurofever classification criteria on the cohort of PFAPA patients and preliminary SURF criteria on uSAID/SURF patients.

Results

Clinical presentation of PFAPA is variable and some patients did not fit the conventional PFAPA criteria and exhibit different symptoms. Some patients did not meet the criteria for either PFAPA or SURF, highlighting the heterogeneity within these groups. The study also explored potential overlaps between PFAPA and SURF/uAID, revealing that some patients exhibited symptoms characteristic of both conditions, emphasizing the need for more precise classification criteria.

Conclusions

Patients with recurrent fevers without molecular diagnoses represent a clinically heterogeneous group. Improved classification criteria are needed for both PFAPA and SURF/uAID to accurately identify and manage these patients, ultimately improving clinical outcomes.