bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and validation of a nomogram for decannulation in patients with neurological injury: A prognostic accuracy study
Authors: Wang Xi , Wang Lu , Wang Zeyu , Sun Yi , Liu Xingdong , Li Feng , Zheng Yu
Published: October 2022

Background

Tracheostomy is a lifesaving procedure provided for patients with severe neurological injury. However, there is a lack of clarity about whether patients can be decannulated within 6 months in those receiving tracheostomy and what factors can be detected as a predictor for decannulation.

Objective

The objective of this study was to explore predictive factors of decannulation in patients with neurological injury receiving tracheostomy within 6 months and construct a novel nomogram model for clinical diagnosis and treatment.

Methods

This retrospective observational study enrolled patients with neurological injury who were admitted to the ICU of neurosurgical department in the First Affiliated Hospital of Nanjing Medical University between January 2016 and March 2021. Patients were divided into decannulation group and cannulation group according to whether tracheostomy tube removal was performed within 6 months after tracheostomy. Multivariable logistic regression analysis was performed to determine associated risk factors with a bootstrap backward selection process. The nomogram to assess the probability of decannulation at 6 months was constructed based on the regression coefficients of the associated factors and validated by bootstrap resampling. Model performance was measured by examining discrimination (Harrell's C-index), calibration (calibration plots), and utility (Kaplan–Meier curves stratified by the tertile of the predicted probability calculated and subgroup analysis stratified by age and intervention).

Results

A total of 40.1% (147/367) of patients decannulated within 6 months. Significant variables in multivariable logistic regression analysis were age (odds ratio [OR], 0.972; 95% confidence interval [CI], 0.954–0.990), National Institutes of Health Stroke Scale (NIHSS) score (OR, 0.936; 95% CI, 0.911–0.963), early rehabilitation (OR, 5.062; 95% CI, 2.889–8.868), shock (OR, 0.175; 95% CI, 0.058–0.533), and secondary surgery (OR, 0.210; 95% CI, 0.078–0.566). The area under receiver operating characteristic curve estimated with these variables was of 0.793 (95% CI, 0.747–0.838; P < 0.001). A nomogram prediction model was constructed to predict the probability of decannulation in tracheostomized patients with a concordance index of 0.788 after internal validation.

Conclusion

We developed a nomogram that can predict the probability of decannulation within 6 months in tracheostomized neurological injury patients. The nomogram, including age, NIHSS scores, early rehabilitation, shock, and secondary surgery, may assist clinicians in estimating patients' prognosis.
Association of prenatal modifiable risk factors with attention-deficit hyperactivity disorder outcomes at age 10 and 15 in an extremely low gestational age cohort
Authors: Cochran David M. , Jensen Elizabeth T. , Frazier Jean A. , Jalnapurkar Isha , Kim Sohye , Roell Kyle R. , Joseph Robert M. , Hooper Stephen R. , Santos Hudson P. , Kuban Karl C. K. , Fry Rebecca C. , O’Shea T. Michael
Published: October 2022

Background

The increased risk of developing attention-deficit hyperactivity disorder (ADHD) in extremely preterm infants is well-documented. Better understanding of perinatal risk factors, particularly those that are modifiable, can inform prevention efforts.

Methods

We examined data from the Extremely Low Gestational Age Newborns (ELGAN) Study. Participants were screened for ADHD at age 10 with the Child Symptom Inventory-4 (N = 734) and assessed at age 15 with a structured diagnostic interview (MINI-KID) to evaluate for the diagnosis of ADHD (N = 575). We studied associations of pre-pregnancy maternal body mass index (BMI), pregestational and/or gestational diabetes, maternal smoking during pregnancy (MSDP), and hypertensive disorders of pregnancy (HDP) with 10-year and 15-year ADHD outcomes. Relative risks were calculated using Poisson regression models with robust error variance, adjusted for maternal age, maternal educational status, use of food stamps, public insurance status, marital status at birth, and family history of ADHD. We defined ADHD as a positive screen on the CSI-4 at age 10 and/or meeting DSM-5 criteria at age 15 on the MINI-KID. We evaluated the robustness of the associations to broadening or restricting the definition of ADHD. We limited the analysis to individuals with IQ ≥ 70 to decrease confounding by cognitive functioning. We evaluated interactions between maternal BMI and diabetes status. We assessed for mediation of risk increase by alterations in inflammatory or neurotrophic protein levels in the first week of life.

Results

Elevated maternal BMI and maternal diabetes were each associated with a 55–65% increase in risk of ADHD, with evidence of both additive and multiplicative interactions between the two exposures. MSDP and HDP were not associated with the risk of ADHD outcomes. There was some evidence for association of ADHD outcomes with high levels of inflammatory proteins or moderate levels of neurotrophic proteins, but there was no evidence that these mediated the risk associated with maternal BMI or diabetes.

Conclusion

Contrary to previous population-based studies, MSDP and HDP did not predict ADHD outcomes in this extremely preterm cohort, but elevated maternal pre-pregnancy BMI, maternal diabetes, and perinatal inflammatory markers were associated with increased risk of ADHD at age 10 and/or 15, with positive interaction between pre-pregnancy BMI and maternal diabetes.
Risk decision: The self-charity discrepancies in electrophysiological responses to outcome evaluation
Authors: Tan Min , Li Mei , Li Jin , Li Huie , You Chang , Zhang Guanfei , Zhong Yiping
Published: October 2022

Previous studies have examined the outcome evaluation related to the self and other, and recent research has explored the outcome evaluation of the self and other with pro-social implications. However, the evaluation processing of outcomes in the group in need remains unclear. This study has examined the neural mechanisms of evaluative processing by gambling for the self and charity, respectively. At the behavioral level, when participants make decisions for themselves, they made riskier decisions following the gain than loss in small outcomes and engage in more risky behaviors following the loss than gain in large outcomes. However, magnitude and valence did not affect the next risky behavior when participants made decisions for the charity. At the neurophysiological level, the results found that the FRN was larger for the charity outcome than for the self-outcome. For FRN, the valence difference of small outcomes was smaller than that of large outcomes. The P3 response was larger for the self-outcome than for the charity outcome. Meanwhile, compared with the small outcome, the self-charity discrepancies have a significant difference in large outcomes. In addition, the FRN amplitude for self in large outcomes was negatively correlated with the upcoming risky choices, regardless of outcome valence. The behavioral results suggest that people are more likely to optimize strategies for themselves than for the charity. The ERP findings indicated that people focus more on charity outcome than self-outcome in the early stage. In the middle and late stages, people turn attention to their outcomes, and the difference between self’s and charity’s outcome varies with the magnitude. Specifically, it is only in large outcomes that people engage more emotional attention or motivation in their outcomes, but self and charity outcomes had a similar emotional engagement in small outcomes.
Multisensory benefits for speech recognition in noisy environments
Authors: Oh Yonghee , Schwalm Meg , Kalpin Nicole
Published: October 2022

A series of our previous studies explored the use of an abstract visual representation of the amplitude envelope cues from target sentences to benefit speech perception in complex listening environments. The purpose of this study was to expand this auditory-visual speech perception to the tactile domain. Twenty adults participated in speech recognition measurements in four different sensory modalities (AO, auditory-only; AV, auditory-visual; AT, auditory-tactile; AVT, auditory-visual-tactile). The target sentences were fixed at 65 dB sound pressure level and embedded within a simultaneous speech-shaped noise masker of varying degrees of signal-to-noise ratios (−7, −5, −3, −1, and 1 dB SNR). The amplitudes of both abstract visual and vibrotactile stimuli were temporally synchronized with the target speech envelope for comparison. Average results showed that adding temporally-synchronized multimodal cues to the auditory signal did provide significant improvements in word recognition performance across all three multimodal stimulus conditions (AV, AT, and AVT), especially at the lower SNR levels of −7, −5, and −3 dB for both male (8–20% improvement) and female (5–25% improvement) talkers. The greatest improvement in word recognition performance (15–19% improvement for males and 14–25% improvement for females) was observed when both visual and tactile cues were integrated (AVT). Another interesting finding in this study is that temporally synchronized abstract visual and vibrotactile stimuli additively stack in their influence on speech recognition performance. Our findings suggest that a multisensory integration process in speech perception requires salient temporal cues to enhance speech recognition ability in noisy environments.
Global trends in research of glutamate in epilepsy during past two decades: A bibliometric analysis
Authors: Wang Wei , Gao Runshi , Ren Zhiwei , Yang Dongju , Sun Ke , Li Xiaoling , Yan Suying
Published: October 2022

Epilepsy affects more than 70 million people in the world. It is characterized by recurrent spontaneous seizures, and it is related to many neurological, cognitive, and psychosocial consequences. Glutamate neurotransmitter dysfunction has essential functions in the pathophysiology of epilepsy. In this work, bibliometric analysis was conducted to explore the trends, frontiers, and hotspots of the global scientific output of glutamate in epilepsy research in the past 20 years. The Science Citation Index Expanded of the Web of Science Core Collection (WoSCC) was searched to obtain information on publications and records published between 2002 and 2021. VOSviewer and CiteSpace were used to conduct bibliometric and visual analyses on the overall distribution of annual output, major countries, active institutions, journals, authors, commonly cited literature, and keywords. The impact and quality of the papers were assessed using the global citation score (GCS). Four thousand eight hundred ninety-one publications were retrieved in total. During the past two decades, the number of publications (Np) associated with glutamate in epilepsy has risen yearly. The United States has published the most papers; its H-index and number of citations are also the highest. The League of European Research Universities (LERU) was the most productive institution. In 2016, the total score of the paper written by Zhang Y was 854, ranking first. The keywords that appear most frequently are “epilepsy,” “glutamate,” “temporal lobe epilepsy (TLE),” “hippocampus,” and “seizures.” This study showed that although the publications related to epileptic glutamate fluctuated slightly, the Np increased overall. The United States is a great creator and influential country in this field. The first three authors are Eid, T., Aronica, E., and Smolders, I. “spectrum,” “animal model,” “inflammation,” “mutation,” “dysfunction,” and “prefrontal cortex” are increasing research hotspots. By recognizing the most critical indicators (researchers, countries, research institutes, and journals of glutamate release in epilepsy research), the research hotspot of glutamate in epilepsy could help countries, scholars, and policymakers in this field enhance their understanding of the role of glutamate in epilepsy and make decisions.
Brain cortical alterations in COVID-19 patients with neurological symptoms
Authors: Sanabria-Diaz Gretel , Etter Manina Maja , Melie-Garcia Lester , Lieb Johanna M. , Psychogios Marios-Nikos , Hutter Gregor , Granziera Cristina
Published: October 2022

Background

Growing evidence suggests that the central nervous system is affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), since infected patients suffer from acute and long-term neurological sequelae. Nevertheless, it is currently unknown whether the virus affects the brain cortex. The purpose of this study was to assess the cortical gray matter volume, the cortical thickness, and the cortical surface area in a group of SARS-CoV-2 infected patients with neurological symptoms compared to healthy control subjects. Additionally, we analyzed the cortical features and the association with inflammatory biomarkers in the cerebrospinal fluid (CSF) and plasma.

Materials and methods

Thirty-three patients were selected from a prospective cross-sectional study cohort during the ongoing pandemic (August 2020–April 2021) at the university hospitals of Basel and Zurich (Switzerland). The group included patients with different neurological symptom severity (Class I: nearly asymptomatic/mild symptoms, II: moderate symptoms, III: severe symptoms). Thirty-three healthy age and sex-matched subjects that underwent the same MRI protocol served as controls. For each anatomical T1w MPRAGE image, regional cortical gray matter volume, thickness, and surface area were computed with FreeSurfer. Using a linear regression model, cortical measures were compared between groups (patients vs. controls; Class I vs. II–III), with age, sex, MRI magnetic field strength, and total intracranial volume/mean thickness/total surface area as covariates. In a subgroup of patients, the association between cortical features and clinical parameters was assessed using partial correlation adjusting for the same covariates. P-values were corrected using a false discovery rate (FDR).

Results

Our findings revealed a lower cortical volume in COVID-19 patients’ orbitofrontal, frontal, and cingulate regions than in controls (p < 0.05). Regional gray matter volume and thickness decreases were negatively associated with CSF total protein levels, the CSF/blood-albumin ratio, and CSF EN-RAGE levels.

Conclusion

Our data suggest that viral-triggered inflammation leads to neurotoxic damage in some cortical areas during the acute phase of a COVID-19 infection in patients with neurological symptoms.
Acute unilateral vestibular neuritis contributes to alterations in vestibular function modulating circumvention around obstacles: A pilot study suggesting a role for vestibular signals in the spatial perception of orientation during circumvention
Authors: Allum John , Rust Heiko Mario , Honegger Flurin
Published: October 2022

Background

Walking among crowds avoiding colliding with people is described by patients with vestibular disorders as vertigo-inducing. Accurate body motion while circumventing an impeding obstacle in the gait pathway is dependent on an integration of multimodal sensory cues. However, a direct role of vestibular signals in spatial perception of distance or orientation during obstacle circumvention has not been investigated to date.

Materials and methods

We examined trunk yaw motion during circumvention in patients with acute unilateral vestibular loss (aUVL) and compared their results with age-matched healthy controls (HCs). Subjects performed five gait tasks with eyes open two times: walk 6 m in total, but after 3 m, circumvent to the left or right, as closely as possible, a cylindrical obstacle representing a person, and then veer back to the original path; walk 6 m, but after left and right circumvention at 3 m, veer, respectively, to the right, and left 45 deg; and walk 6 m without circumvention. Trunk yaw angular velocities (YAVs) were measured using a gyroscope system.

Results

Yaw angular velocity peak amplitudes approaching to, and departing from, the circumvented object were always greater for patients with aUVL compared to HCs, regardless of whether passing was to the aUVLs’ deficit or normal side. The departing peak YAV was always greater, circa 52 and 87%, than the approaching YAV for HCs when going straight and veering 45 deg (p ≤ 0.0006), respectively. For patients with aUVL, departing velocities were marginally greater (12%) than approaching YAVs when going straight (p < 0.05) and were only 40% greater when veering 45 deg (p = 0.05). The differences in departing YAVs resulted in significantly lower trajectory-end yaw angles for veering trials to the deficit side in patients with aUVL (34 vs. 43 degs in HCs).

Conclusion

The results demonstrate the effects of vestibular loss on yaw velocity control during the three phases of circumvention. First, approaching an obstacle, a greater YAV is found in patients with aUVL. Second, the departing YAV is found to be less than in HCs with respect to the approaching velocity, resulting in larger deficit side passing yaw angles. Third, patients with UVLs show yaw errors returning to the desired trajectory. These results could provide a basis for rehabilitation protocols helping to avoid collisions while walking in crowded spaces.
A fuzzy-oscillatory model of medial prefrontal cortex control function in spatial memory retrieval in human navigation function
Authors: Moghadam Maryam , Towhidkhah Farzad , Gharibzadeh Shahriar
Published: October 2022

Navigation can be broadly defined as the process of moving from an origin to a destination through path-planning. Previous research has shown that navigation is mainly related to the function of the medial temporal lobe (MTL), including the hippocampus (HPC), and medial prefrontal cortex (mPFC), which controls retrieval of the spatial memories from this region. In this study, we suggested a cognitive and computational model of human navigation with a focus on mutual interactions between the hippocampus (HPC) and the mPFC using the concept of synchrony. The Van-der-pol oscillator was used to model the synchronous process of receiving and processing “what stream” information. A fuzzy lookup table system was applied for modeling the controlling function of the mPFC in retrieving spatial information from the HPC. The effect of attention level was also included and simulated. The performance of the model was evaluated using information reported in previous experimental research. Due to the inherent stability of the proposed fuzzy-oscillatory model, it is less sensitive to the exact values of the initial conditions, and therefore, it is shown that it is consistent with the actual human performance in real environments. Analyzing the proposed cognitive and fuzzy-oscillatory computational model demonstrates that the model is able to reproduce certain cognitive and functional disturbances in navigation in related diseases such as Alzheimer’s disease (AD). We have shown that an increase in the bifurcation parameter of the Van-der-pol equation represents an increase in the low-frequency spectral power density and a decrease in the high-frequency spectral power as occurs in AD due to an increase in the amyloid plaques in the brain. These changes in the frequency characteristics of neuronal activity, in turn, lead to impaired recall and retrieval of landmarks information and learned routes upon encountering them. As a result, and because of the wrong frequency code being transmitted, the relevant set of rules in the mPFC is not activated, or another unrelated set will be activated, which leads to forgetfulness and erroneous decisions in routing and eventually losing the route in Alzheimer’s patients.
Multimodal parameter spaces of a complex multi-channel neuron model
Authors: Wang Y. Curtis , Rudi Johann , Velasco James , Sinha Nirvik , Idumah Gideon , Powers Randall K. , Heckman Charles J. , Chardon Matthieu K.
Published: October 2022

One of the most common types of models that helps us to understand neuron behavior is based on the Hodgkin–Huxley ion channel formulation (HH model). A major challenge with inferring parameters in HH models is non-uniqueness: many different sets of ion channel parameter values produce similar outputs for the same input stimulus. Such phenomena result in an objective function that exhibits multiple modes (i.e., multiple local minima). This non-uniqueness of local optimality poses challenges for parameter estimation with many algorithmic optimization techniques. HH models additionally have severe non-linearities resulting in further challenges for inferring parameters in an algorithmic fashion. To address these challenges with a tractable method in high-dimensional parameter spaces, we propose using a particular Markov chain Monte Carlo (MCMC) algorithm, which has the advantage of inferring parameters in a Bayesian framework. The Bayesian approach is designed to be suitable for multimodal solutions to inverse problems. We introduce and demonstrate the method using a three-channel HH model. We then focus on the inference of nine parameters in an eight-channel HH model, which we analyze in detail. We explore how the MCMC algorithm can uncover complex relationships between inferred parameters using five injected current levels. The MCMC method provides as a result a nine-dimensional posterior distribution, which we analyze visually with solution maps or landscapes of the possible parameter sets. The visualized solution maps show new complex structures of the multimodal posteriors, and they allow for selection of locally and globally optimal value sets, and they visually expose parameter sensitivities and regions of higher model robustness. We envision these solution maps as enabling experimentalists to improve the design of future experiments, increase scientific productivity and improve on model structure and ideation when the MCMC algorithm is applied to experimental data.
Obesity, rather than high fat diet, exacerbates the outcome of influenza virus infection in influenza-sensitized mice
Authors: Guo Weimin , Wu Dayong , Li Lijun , Ding Samuel , Meydani Simin Nikbin
Published: October 2022

Introduction

Obesity is associated with impaired immune function and increased susceptibility to infection. High fat (HF) diet-induced obesity is a commonly used animal model. However, HF diet itself is known to affect immune function and infection. Thus, it is not discernable which one, HF diet or adiposity, is the major contributor to the observed impairment in immunity and susceptibility to infection in HF diet-induced obesity. We hypothesized that obesity is a major contributor to impaired immune function.

Methods and results

Weight-matched outbred female CD-1 mice (1-mo) were randomly assigned to either a HF (45%) or a low fat (LF, 10%) diet group. Ten week after feeding their respective diets, weight gain in the mice fed the HF diet varied greatly. Thus, based on the average body weight, mice in HF diet group were divided into two sub-groups: HF lean (HF-L) and HF obese (HF-O). After 25-week, mice were immunized with an influenza A/Puerto Rico/8/34 vaccine and boosted 3-week later. Five week after the booster, mice were infected with influenza A/Puerto Rico/8/34 virus, and body weight was recorded daily for 1 month. HF-O mice exhibited significant weight loss after influenza virus challenge compared to LF and HF-L mice while LF and HF-L mice largely maintained their weight to a similar extent.

Conclusion

Our findings suggest that obesity, rather than HF diet, per se, may impair the efficacy of influenza vaccination.
Effects of the COVID-19 pandemic on diet and physical activity and the possible influence factors among Saudi in Riyadh
Authors: Almousa Lujain Abdulaziz , Alagal Reham Ibrahim
Published: October 2022

Background/Aim

The COVID-19 pandemic has been spreading throughout the world, having a significant impact on people’s lifestyles and health through social isolation and home confinement. The purpose of this study is to look into the impact of COVID-19 on diet and physical activity, as well as the possible influence factors, among ≥ 13-year-olds in Riyadh, Saudi Arabia.

Materials and methods

In the present study data were collected from 2,649 participants via an online survey. The Google online questionnaire was available from April 23 to May 6, 2020. During the COVID-19 lockdown, the survey asked respondents about their demographic characteristics (gender, age, education, economic income, and occupation), anthropometric data, physical activity, and diet habits.

Results

The study included 2,649 respondents, with 23.3% being male and 76.7% female. The majority of them were in good health and ranged in age from 21 to 29 years. 31% of those polled were overweight, and 14.3% were obese. The majority of respondents have a bachelor’s degree, diploma, or the equivalent, and a monthly family income of ≤ 25.000 SR. Those who were following a healthy diet (32.3%) were unable to maintain it during confinement, with males being affected more than females (42.7%, 29.3%, respectively, P = 0.004), and those most impacted were aged 21–29 years (38.0%, P = 0.046). Furthermore, 59.5% of males significantly failed to continue exercising during confinement compared to females who exercised consistently (P = 0.01). In terms of age, females aged less than 40 increased their exercise rate by about 23.4%, while males aged 40 and up decreased their exercise rate by 25.7% (P = 0.000). Moreover, 40.5% of the subjects’ weight increased, according to the findings. However, there was no significant effect on body mass index, despite the fact that 51% of participants were overweight or obese.

Conclusion

The data showed that the COVID-19 lockdown had a negative impact on maintaining a healthy diet (p = 0.023*) and physical activity (p = 0.000**).
Real world outcomes with alpelisib in metastatic hormone receptor-positive breast cancer patients: A single institution experience
Authors: Alaklabi Sabah , Roy Arya Mariam , Attwood Kristopher , George Anthony , O’Connor Tracey , Early Amy , Levine Ellis G. , Gandhi Shipra
Published: October 2022

Background

It is critically important to study the real-world data of FDA-approved medications to understand the response rates and toxicities observed in the real-world population not represented in the clinical trials.

Methods

We reviewed charts of patients diagnosed with metastatic, hormone receptor-positive, human epidermal growth factor receptor 2 negative, PIK3CA-mutated breast cancer treated with alpelisib from May 2019 to January 2022. Clinical characteristics and treatment outcomes were collected. The association of clinical characteristics with responses and adverse events (AEs) was evaluated using the logistic regression model.

Results

27 patients were included. Median age at alpelisib initiation 67 years (range: 44, 77 years). Majority of patients had excellent performance status at time of alpelisib initiation. Most patients had chronic comorbidities, notably; 2 patients had controlled type 2 diabetes mellitus at time of alpelisib initiation. Majority had a median of three lines of therapy (range: 1, 7) before alpelisib. Clinical responses were determined using RECIST v1.1. 3/27 (11.11%) patients discontinued therapy before response assessment due to grade 3 AEs. Overall response rate was 12.5% (3/24), with all partial responses (PR). The median duration of response was 5.77 months (range: 5.54, 8.98). 14/27 (51.9%) of patients required dose interruption/reduction. Overall, 23/27 (85.19%) patients discontinued alpelisib of which 11 (47.83%) discontinued alpelisib due to AEs. Median duration of treatment was 2 months in patients who had grade 3 AEs (range: <1.00, 8.30) and 6.28 (1.15, 10.43) in those who did not. Any grade AEs were reported in 24/27 (88.9%) patients, namely, hyperglycemia 16/27 (59.3%), nausea 11/27 (40.7%), diarrhea 10/27 (37.0%), fatigue 7/27 (25.9%) and rash 6/27 (22.2%). Grade 3 AEs were reported in 13/27 patients (50%), namely, hyperglycemia in 7/27 (53.8%) patients followed by skin rash 4/27 (30.8%), GI side effects 3/27 (23.1%). Those with progressive disease as best response to alpelisib, had more non-metabolic comorbidities, higher number of liver metastases, PIK3CA E545K mutations, and shorter duration on therapy compared to those with PR and stable disease.

Conclusion

Patients should be counseled about the toxicity and modest benefit observed with alpelisib in real-world clinical practice when used in later lines of therapy.
Contrast-enhanced ultrasonography for differential diagnosis of adnexal masses
Authors: Shentu Weihui , Zhang Yin , Gu Jiaojiao , Wang Fa , Zhao Wei , Liu Chunmei , Lin Zimei , Wang Yao , Liu Chen , Chen Yunyu , Fan Qiyun , Wang Hongying
Published: October 2022

Background

Quantitative contrast-enhanced ultrasonography parameters are affected by various factors. We evaluated corrected quantitative contrast enhanced ultrasonography in differentiating benign adnexal tumors from malignant tumors.

Methods

Patients with adnexal masses who underwent conventional and contrast-enhanced ultrasonography were included. Contrast-enhanced ultrasonography parameters such as base intensity, arrival time, peak intensity, time to peak intensity, ascending slope, and descending slope were measured. Corrected (time to peak intensity − arrival time) mass/(time to peak intensity − arrival time) uterus and (peak intensity − base intensity) mass/(peak intensity − base intensity) uterus were calculated. Lesions were confirmed by pathologic examination of surgical specimens.

Results

This study included 31 patients with 35 adnexal lesions including 20 (57.10%) benign and 15 (42.90%) malignant lesions. The corrected contrast-enhanced ultrasonography quantitative parameters in lesions were statistically different between malignant and benign groups (P<0.05). The optimal cut-off value for (time to peak intensity − arrival time) mass/(time to peak intensity − arrival time) uterus, ascending slope, and (peak intensity − base intensity) mass/(peak intensity − base intensity) uterus, and descending slope for differentiating malignant adnexal masses from benign tumors were 1.05 (area under curve: 0.93, P<0.05), 1.11 (area under curve: 0.83, P<0.05), 0.82 (area under curve: 0.73, P<0.05), and −0.27 (area under curve: 0.66, P=0.16), with sensitivity and specificity of 93.33% and 85.00%, 86.67% and 75.00%, 86.67% and 60.00%, and 54.55% and 66.67%, respectively.

Conclusions

Corrected contrast-enhanced ultrasonography parameters provide practical differential diagnosis value of adnexal lesions with high reliability for sonologists.
Tumor microenvironment and exosomes in brain metastasis: Molecular mechanisms and clinical application
Authors: Aili Yirizhati , Maimaitiming Nuersimanguli , Qin Hu , Ji Wenyu , Fan Guofeng , Wang Zengliang , Wang Yongxin
Published: October 2022

Metastasis is one of the important biological features of malignant tumors and one of the main factors responsible for poor prognosis. Although the widespread application of newer clinical technologies and their continuous development have significantly improved survival in patients with brain metastases, there is no uniform standard of care. More effective therapeutic measures are therefore needed to improve prognosis. Understanding the mechanisms of tumor cell colonization, growth, and invasion in the central nervous system is of particular importance for the prevention and treatment of brain metastases. This process can be plausibly explained by the “seed and soil” hypothesis, which essentially states that tumor cells can interact with various components of the central nervous system microenvironment to produce adaptive changes; it is this interaction that determines the development of brain metastases. As a novel form of intercellular communication, exosomes play a key role in the brain metastasis microenvironment and carry various bioactive molecules that regulate receptor cell activity. In this paper, we review the roles and prospects of brain metastatic tumor cells, the brain metastatic tumor microenvironment, and exosomes in the development and clinical management of brain metastases.
Tissue concentration of vascular endothelial growth factor is not related to the depth of trophoblastic invasion in ampullary pregnancies—A pilot study
Authors: Teshima Décio Roberto Kamio , Pereira Pedro Paulo , Francisco Rossana Pulcineli Vieira , De Oliveira Matheus Abelo , Schulz Regina , Antonângelo Leila , Cabar Fábio Roberto
Published: October 2022

Introduction: The factors that modulate trophoblastic invasion into the tubal wall remain uncertain. Moreover, it is known that the concentration of vascular endothelial growth factor (VEGF) is increased in cases of deeper trophoblastic invasion in the fallopian tubes.

Objective: This study aimed to assess if there is a correlation between VEGF tissue expression and the depth of trophoblastic infiltration into the tubal wall in patients with ampullary pregnancy.

Methods: A cross-sectional study was conducted in patients with a diagnosis of tubal pregnancy in the ampullary region who underwent salpingectomy. Inclusion criteria were spontaneously conceived singleton pregnancies, diagnosis of tubal pregnancy in the ampullary region, and radical surgical treatment. A lack of agreement regarding the location of the tubal pregnancy and impossibility of either anatomopathological or tissue VEGF analysis were the exclusion criteria. Histologically, trophoblastic invasion into the tubal wall was classified as grade I when limited to the tubal mucosa, grade II when it reached the muscle layer, and grade III when it comprised the full thickness of the tubal wall. A total of 42 patients fulfilled the inclusion criteria and were selected to participate in the study. Eight patients were excluded. After surgery, tissue VEGF expression was measured by immunohistochemistry and the point counting technique.

Results: Histological analysis revealed that eight patients had stage I tubal infiltration, seven had stage II, and 19 had stage III. The difference between the percentage of VEGF expression in the trophoblastic tissue was not significant in relation to the degree of trophoblastic invasion (p = 0.621) (ANOVA). Trophoblastic tissue VEGF showed no statistical difference for prediction of both degrees of trophoblastic invasion (univariate multinomial regression).

Conclusion: The depth of trophoblastic penetration into the tubal wall in ampullary pregnancies is not associated with tissue VEGF expression.
Serum high-sensitive C-reactive protein is a simple indicator for all-cause among individuals with MAFLD
Authors: Huang Jiaofeng , Wang Mingfang , Wu Yinlian , Kumar Rahul , Lin Su
Published: October 2022

High-sensitive C-reactive protein (hs-CRP) is one of the diagnostic components for metabolic (-dysfunction) associated fatty liver disease (MAFLD). This study aimed to explore the relationship between hs-CRP level and 25-year mortality in patients with MAFLD. The study data were from the Third National Health and Nutrition Examination Survey 1988–1994. All participants were followed up until December 2015 and the outcome of each participant was ascertained from National Death Index records. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence interval (CI) of all-cause mortality, cardiovascular-related mortality, and malignancy-related mortality. A total of 4,145 participants with MAFLD were included in final analysis. The median follow-up period was 22.3 years (interquartile range 16.9–24.2). There were 1,610 (38.8%) all-cause deaths. The leading cause of death was malignant neoplasms (365/1,610, 22.7%), followed by cardiovascular diseases (342/1,610, 21.2%). Of the 4,145 patients with MAFLD, 1,293 (31.2%) had an hs-CRP level greater than 0.5 mg/dl. Those with hs-CRP > 0.5 mg/dl were older, more likely to be female and had greater derangements of metabolic profiles than those with lower hs-CRP. The results of Cox regression analysis showed that hs-CRP ≥ 0.5 mg/dl was an independent risk factor for all-cause mortality (HR = 1.394, 95% CI 1.253–1.551), cardiovascular mortality (HR = 1.497, 95% CI 1.190–1.885) and malignant neoplasms related mortality (HR = 1.290, 95% CI 1.030–1.615) after adjusting for risk factors. This study confirms that hs-CRP is an independent predictive factor of poor prognosis in patients with MAFLD.
Polyamine pathways interconnect with GABA metabolic processes to mediate the low-temperature response in plants
Authors: Xu Mengyun , Yang Qinwen , Bai Genxiang , Li Ping , Yan Jian
Published: October 2022

Low temperatures are among the most commonly encountered environmental conditions that adversely affect plant growth and development, leading to substantial reductions in crop productivity. Plants have accordingly evolved coordinated mechanisms that confer low-temperature adaptation and resistance. The plant metabolic network, including polyamines (PAs) and γ-aminobutyric acid (GABA) is reprogrammed to ensure that essential metabolic homeostasis is maintained in response to cold stress conditions. Additionally, GABA might serve as a central molecule in the defense system during low-temperature tolerance in plants. However, our understanding of how these metabolites function in conferring cold tolerance is still far from complete. Here, we summarized how PAs and GABA function in conferring cold tolerance, and describe the crucial role of GABA in the mitigation of ROS during cold stress in plants.
Soybean resilience to drought is supported by partial recovery of photosynthetic traits
Authors: Elsalahy Heba H. , Reckling Moritz
Published: October 2022

Climate change affects precipitation dynamics and the variability of drought frequency, intensity, timing, and duration. This represents a high risk in spring-sown grain legumes such as soybean. Yet, under European conditions, no evidence supports the potential recovery and resilience of drought-tolerant soybean cultivars after episodic drought, at different growth stages. A field experiment was conducted using a representative drought-tolerant cultivar of soybean (cv. Acardia), in 2020 and 2021, on sandy soils in Germany, applying four water regimes (irrigated, rainfed, early-drought, and late-drought stress). Drought stress was simulated by covering the plots during the event of rain with 6 × 6 m rainout shelters, at the vegetative (V-stage) and flowering (Fl-stage) stages. Drought response was quantified on plant height, chlorophyll fluorescence ratio (ChlF ratio), chlorophyll content (Chlc), and leaf surface temperature (LST), at different intervals after simulating drought until pod filling. Grain yield and yield components were quantified at the end of the growing season. Compared to rainfed conditions, a drought at V-stage and Fl-stage reduced significantly plant height, ChlF ratio, and Chlc by 20%, 11%, and 7%, respectively, but increased LST by 21% during the recovery phase. There was no recovery from drought except for Chlc after V-stage in 2021, that significantly recovered by 40% at the end of the growing season, signifying a partial recovery of the photochemical apparatus. Especially, there was no recovery observed in LST, implying the inability of soybean to restore LST within the physiological functional range (Graphical abstract). Under rainfed conditions, the grain yield reached 2.9 t ha-1 in 2020 and 5.2 t ha-1 in 2021. However, the episodic drought reduced the yield at V-stage and Fl-stage, by 63% and 25% in 2020, and 21% and 36% in 2021, respectively. To conclude, the timing of drought was less relevant for soybean resilience; however, pre- and post-drought soil moisture, drought intensity, and drought duration were likely more important. A drought-tolerant soybean cultivar may partially be drought-resilient due to the recovery of photosynthetic traits, but not the leaf thermal traits. Overall, these findings will accelerate future efforts by plant breeders, aimed at improving soybean drought resilience.
The effectiveness of ICT-supported flipped learning in an EFL context: A case of northern Iraq
Authors: Mahmood Abubakir Muhammad , Mohammadzadeh Behbood
Published: October 2022

Flipped Learning (FL) is a pedagogical model that leverages technology-enhanced instruction inside and outside of class time to maximize student engagement and learning during class time. This study investigated the effectiveness of ICT-supported Flipped learning in an EFL context in Northern Iraq to contribute to sustainable personalized language learning. The participants were EFL students and teachers of a primary school in Raniyah. The study employed an experimental method to collect student data and a teacher questionnaire. The results indicated that Flipped learning had statistically significant effects on the students’ academic performance and achievement. The mean scores of the post-tests scored higher than that of the pre-test. The mean scores of the EG with (M = 89.15) for the fifth grade and (M = 81.40) for the sixth grade were much higher than those of the CGs (M = 70.40) for the fifth grade and (M = 67.40) for the sixth grade which indicated that FL had a statistically great impact on the students’ academic performance and their product improvement. Besides, the results of the t-test showed a significant difference in performance between students in both EGs and CGs; the participants outstripped statistically significant on the post-test (p < 0.05) compared to the pre-test. The majority of the participants’ attitudes were positive toward Flipped learning, and they remarked that it had a significant role in learning compared to the conventional classes. The participant teachers quoted positive views on Flipped learning over traditional classes.
Examining the protective influence of posttraumatic growth on interpersonal suicide risk factors in a 6-week longitudinal study
Authors: Yasdiman Meryem Betul , Townsend Ellen , Blackie Laura E. R.
Published: October 2022

Research has found an inverse relationship between posttraumatic growth (PTG) and suicidal ideation in military and community samples that holds when controlling for other suicide risk factors. However, further research is needed into the underlying mechanisms to clarify how PTG protects against the formation of suicidal ideation. The current two-wave longitudinal study examined whether perceiving PTG from recent adverse circumstances while in a national lockdown during the COVID-19 pandemic attenuated the positive relationship of two interpersonal suicide risk factors – perceived burdensomeness (PB) and thwarted belonginess (TB)–over 6 weeks. Participants (n = 170) were recruited online from Prolific from income-deprived areas in the United Kingdom (mean age = 37.65; SD = 12.50; 53.5% female). Post-hoc power analyses indicated we had insufficient power to examine the hypothesised mediation for TB. We examined whether PTG mediated the relationship between PB at wave 1 and wave 2 while controlling for depression and anxiety in a sample of individuals at-risk for suicidal ideation. PTG did significantly and partially mediate the positive relationship between PB at wave 1 and 2. We discuss the theoretical and clinical implications that could result if future research successfully replicates these initial exploratory findings.
Readiness assessments for gender-affirming surgical treatments: A systematic scoping review of historical practices and changing ethical considerations
Authors: Amengual Travis , Kunstman Kaitlyn , Lloyd R. Brett , Janssen Aron , Wescott Annie B.
Published: October 2022

Transgender and gender diverse (TGD) are terms that refer to individuals whose gender identity differs from sex assigned at birth. TGD individuals may choose any variety of modifications to their gender expression including, but not limited to changing their name, clothing, or hairstyle, starting hormones, or undergoing surgery. Starting in the 1950s, surgeons and endocrinologists began treating what was then known as transsexualism with cross sex hormones and a variety of surgical procedures collectively known as sex reassignment surgery (SRS). Soon after, Harry Benjamin began work to develop standards of care that could be applied to these patients with some uniformity. These guidelines, published by the World Professional Association for Transgender Health (WPATH), are in their 8th iteration. Through each iteration there has been a requirement that patients requesting gender-affirming hormones (GAH) or gender-affirming surgery (GAS) undergo one or more detailed evaluations by a mental health provider through which they must obtain a “letter of readiness,” placing mental health providers in the role of gatekeeper. WPATH specifies eligibility criteria for gender-affirming treatments and general guidelines for the content of letters, but does not include specific details about what must be included, leading to a lack of uniformity in how mental health providers approach performing evaluations and writing letters. This manuscript aims to review practices related to evaluations and letters of readiness for GAS in adults over time as the standards of care have evolvedviaa scoping review of the literature. We will place a particular emphasis on changing ethical considerations over time and the evolution of the model of care from gatekeeping to informed consent. To this end, we did an extensive review of the literature. We identified a trend across successive iterations of the guidelines in both reducing stigma against TGD individuals and shift in ethical considerations from “do no harm” to the core principle of patient autonomy. This has helped reduce barriers to care and connect more people who desire it to gender affirming care (GAC), but in these authors’ opinions does not go far enough in reducing barriers.
The psychological impact of esophageal cancer screening on anxiety and depression in China
Authors: Zhu Juan , Ma Shanrui , Chen Ru , Liu Zhaorui , Liu Zhengkui , Wei Wenqiang
Published: October 2022

Objective

The psychological impact of screening is unclear and has been ignored. This study aimed to evaluate the psychological impact of esophageal cancer (EC) screening on anxiety and depression in China.

Materials and methods

A multicenter, population-based study in five high-risk regions of EC was conducted from 2019 to 2020. Residents were recruited and underwent endoscopic screening and then were diagnosed with normal, esophagitis, low-grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia (HGIN) and EC. Subjects who did not participate in the screening were referred to as the control group. We surveyed their anxiety and depression levels at baseline and after endoscopy and informed them of different pathological results to evaluate the psychological impact of the screening process.

Results

A total of 2,337 subjects completed all surveys in the screening process (normal: 355, esophagitis: 1,713, LGIN: 213, HGIN: 43 and EC: 13), with 63 controls. The levels of anxiety and depression of screeners were significantly higher than those of controls (P < 0.001). The fluctuation of anxiety and depression showed a “V” pattern in the screening process. The prevalence of anxiety symptoms at baseline, after endoscopy and after knowing the pathological results was 5.6, 0.3, and 3.2%, respectively (P < 0.001), and the corresponding prevalence of depression was 3.6, 0.2, and 2.1%, respectively (P < 0.001). With the aggravation of pathological results, the levels of anxiety and depression increased significantly (P < 0.001), especially in patients informed of HGIN (16.3 and 9.3%) and EC (23.1 and 30.8%).

Conclusion

Participation in endoscopic screening may bring short-term adverse psychological effects, especially at baseline and knowing the pathological results. More attention should be given to participants waiting for endoscopic screening. The method of informing the screening results of HGIN and EC should be improved. Further precise screening is needed to concentrate on high-risk groups to reduce the psychological impact of screening.