bluuebunny/crossref_metadata_2025 huggingface dataset:
Naturally-derived hydrogels for 3D pancreatic tumor models: A short review
Authors: Piłat Edyta , Kurdyn Agnieszka , Kucińska-Lipka Justyna
Published: September 2023

Statistics suggest a high proportion of mortality rate by pancreatic cancer, which is a solid tumor characterized by high heterogeneity and the presence of a complex extracellular matrix. The very low effectiveness of pancreatic cancer treatment roots in the high metastatic potential and drug resistance of this tumor. Therefore, the quest for efficient cellular models enabling precise mimicking in vivo conditions, and anticancer drug development is emerging as a priority. Routinely used 2D culture models offer an initial evaluation of the therapeutic potential of a compound against tumors, while scaffold-free and next-generation scaffold-based 3D hydrogel-based models are found to be promising for appropriate mimicking of the tumor environment and cell interactions. Over the last few years, attention was paid to the use of naturally-derived hydrogel as 3D models for pancreatic tumor modeling. Herein we first overview scaffold-free and scaffold-based 3D tumor models as advanced approaches, followed by placing the focus on naturally-derived hydrogels applied as scaffolds in pancreatic cancer modeling. This short review emphasizes that sustainable hydrogels can almost precisely imitate the complex in vivo microenvironment of pancreatic tumor, thereby hydrogel-based scaffold tumor models may be a breakthrough in pancreatic cancer studies and, in result, significantly improve the poor pancreatic tumor survivability prognosis. Nevertheless, anticancer drug development might be overshadowed by using this family of biomaterials.
A neonatal case of vascular ring with Alagille syndrome
Authors: Lee Pei-Shan , Silva Sepulveda Jose A , Del Campo Miguel , Leibel Sandra L , Hildreth Amber , Marc-Aurele Krishelle L
Published: September 2023

A female infant, born at 37 week 5 days to a mother via induced vaginal delivery for preeclampsia, was prenatally diagnosed with a right aortic arch with vascular ring. On the third day of life, the infant exhibited a bronze-gray coloration, and a direct bilirubin of 1.7 mg/dL was detected. The abdominal ultrasound did not visualize the gallbladder. Clinically, the infant displayed features consistent with Alagille syndrome, including unusual facial appearance, butterfly vertebrae, cardiovascular defects, and cholestasis. The geneticist noted that the mother of the patient also exhibited similar features. Both the infant and the mother were diagnosed with Alagille syndrome, both having the same heterozygous JAG1 gene (NM_000214.2) variant (c.1890_1893del, p.Ile630Metfs*112). We believe that the vascular ring observed in our patient is the first reported instance of a vascular ring associated with Alagille syndrome.
Frontal cutaneous leiomyosarcoma: A case report and review of the literature
Authors: Walid Bouaicha , Farah Ben Hafdhallah , Sbei Feten , Samar Ben Mrad , Mohamed Ali Sbai
Published: September 2023

Sarcomas are a heterogeneous group of mesenchymal tumours that can affect the skin. They are dominated by Kaposi’s sarcoma and dermatofibrosarcoma. Cutaneous leiomyosarcoma is a very rare entity. We report the case of a 78-year-old patient who presented with a primary frontal cutaneous leiomyosarcoma treated surgically with a good outcome at the last follow-up. The objective of this work is to identify the epidemiological, clinical, anatomopathological, therapeutic and prognostic particularities of this pathology through a review of the literature.
The Experiences of School Counselors Providing Virtual Services During COVID-19: A Phenomenological Investigation
Authors: Roberts Allison , Goodman-Scott Emily , Edirmanasinghe Natalie
Published: September 2023

In response to the lack of literature, we conducted a phenomenological study of 10 school counselors in four states and nine school districts exploring their experiences providing virtual school counseling services during the beginning stages of the COVID-19 pandemic, when many K–12 schools were closed. Results of this study indicated that overall, school counselors found the experience of providing virtual services during the initial stages of the pandemic to be negative, with their stated experiences centering around three themes: (a) difficulty meeting with students in virtual settings (i.e., feeling frustration and grief due to challenges meeting with students virtually), (b) abrupt adjustment (i.e., sudden changes and the need to pivot quickly, due to the pandemic), and (c) the challenge of addressing mental health complexities (i.e., difficulty in meeting nuanced mental health needs). We provide implications for practice, preparation, school/district policy, and research surrounding virtual school counseling during times of crisis and recovery, such as the COVID-19 pandemic. Last, we discuss implications for virtual school counseling within the future of school counseling.
Hedging Dynamic Fund Protection: A Static Versus Dynamic Comparison
Authors: Ray Bipasha , Ramprasath L
Published: September 2023

The static nature of the downside protection offered by a standard Put option can motivate investors to use exotic option contracts like dynamic fund protection (DFP), which protects the underlying asset value throughout its life. DFP has a path-dependent payoff structure with its terminal payoff depending on the terminal asset price, the strike price and the minimum price level attained by the asset over the contract tenor. This makes DFP a contract strikingly similar to a Lookback Call option. In this article, we try to borrow the respective strengths from a dynamic and a static hedging strategy, formulate a semi-static hedging procedure for DFP and compare the hedging effectiveness of this procedure with a standard delta hedging strategy. Given the payoff resemblance between a DFP and a Lookback Call, we also seek to verify Tompkins (2002, Journal of Risk Finance, 3(4), 6–34) conclusion, which objectively shows that a dynamic procedure performs better in hedging a Lookback Call option both with and without transaction cost. Using simulated underlying price paths, we perform the delta hedging on DFP based on the closed-form pricing formula given by Gerber and Pafumi (2000, North American Actuarial Journal, 4(2), 28–37) and compare the hedge performance results with its static hedge counterpart.
Impact of caregiver demands on growing family capabilities provide home care for dementia-affected seniors
Authors: Sya’diyah Hidayatus , Efendi Ferry , Mahmudah  , Saidah Qori’ Ila , Poddar Sandeep
Published: September 2023

Background:

The elderly with dementia occur cognitive decline and they are considered normal by the family, and then causing the need for care from elderly. This is not following the ability of home care by the family as an informal caregiver for the elderly with dementia. The purpose of this study was to analyze the effect of caregiver demands on the ability of families to do home care for elderly dementia.

Design and methods:

An analytical observational study with a cross-sectional design. The sample size is 100 respondents with a cluster random sampling technique. Data were collected by questionnaire and analyzed using SEM-PLS.

Results:

Caregiver demands have a direct effect on increasing the family’s ability to do home care for elderly dementia with a p-value = 0.011 ( p ≤ 0.05), t statistic value of 2.557 (≥1.96). Caregiver demands have four indicators, including care receiver impairment, caregiving activities, competency of caregivers, and caregiver/family relationship with elderly dementia. The condition of the elderly who experience various changes supports the increasing need for care to receive care and recovery as well as special attention from the family.

Conclusion:

The higher the need for care, the higher the family’s ability to do home care. This research implies that the family has a duty in the health sector to provide care for the elderly at home/home care, which strengthens the need for care, this supports caregiver empowerment and increases the independence of the elderly with dementia.
Comparisons of Psycho-Behavioral Factors, Body Composition, and Clinical Outcomes in Adults With Type 2 Diabetes by Perceived Hypoglycemia
Authors: Cha EunSeok , Joung Kyong Hye , Shin Yun-A , Son Nak-Hoon , Kim Hyun Jin , Faulkner Melissa Spezia
Published: September 2023

Purpose:

The purpose of the study was to examine the associations between perceived hypoglycemia and psycho-behavioral and clinical factors in persons with type 2 diabetes (T2D).

Methods:

Adults with T2D were recruited from outpatient clinics in a university hospital in Korea. Sociodemographics, psycho-behavioral and clinical factors, and body composition were assessed. The participants were divided into 2 groups reporting perceived hypoglycemia or not in the previous month based on an item of the Control Problem Scale. Group differences were compared at α = .05 using SPSS (version 26.0).

Results:

Of 177 participants, approximately one-third (n = 67) perceived hypoglycemia. The hypoglycemia group reported poor health-related quality of life, frequent blood monitoring and foot care, and sleep difficulties. However, no differences between groups were identified for diet, exercise, or glycosylated hemoglobin. The hypoglycemia group had a lower body mass index and a trend toward a lower skeletal muscle mass and fat free mass.

Conclusions:

Perceived hypoglycemia was associated with psycho-behavioral factors and body composition. Importantly, some persons on oral antidiabetic medications that do not cause hypoglycemia still perceived hypoglycemia. Further investigation is warranted to examine the efficacy of strategies to minimize hypoglycemia and inappropriate fear of hypoglycemia. In addition, clinicians should be aware of the potential risk of hypoglycemia in persons with lower muscle mass.
Target trial emulation with multi-state model analysis to assess treatment effectiveness using clinical COVID-19 data
Authors: Martinuka Oksana , Hazard Derek , Marateb Hamid Reza , Maringe Camille , Mansourian Marjan , Rubio-Rivas Manuel , Wolkewitz Martin
Published: September 2023

Background

Real-world observational data are an important source of evidence on the treatment effectiveness for patients hospitalized with coronavirus disease 2019 (COVID-19). However, observational studies evaluating treatment effectiveness based on longitudinal data are often prone to methodological biases such as immortal time bias, confounding bias, and competing risks.

Methods

For exemplary target trial emulation, we used a cohort of patients hospitalized with COVID-19 (n = 501) in a single centre. We described the methodology for evaluating the effectiveness of a single-dose treatment, emulated a trial using real-world data, and drafted a hypothetical study protocol describing the main components. To avoid immortal time and time-fixed confounding biases, we applied the clone-censor-weight technique. We set a 5-day grace period as a period of time when treatment could be initiated. We used the inverse probability of censoring weights to account for the selection bias introduced by artificial censoring. To estimate the treatment effects, we took the multi-state model approach. We considered a multi-state model with five states. The primary endpoint was defined as clinical severity status, assessed by a 5-point ordinal scale on day 30. Differences between the treatment group and standard of care treatment group were calculated using a proportional odds model and shown as odds ratios. Additionally, the weighted cause-specific hazards and transition probabilities for each treatment arm were presented.

Results

Our study demonstrates that trial emulation with a multi-state model analysis is a suitable approach to address observational data limitations, evaluate treatment effects on clinically heterogeneous in-hospital death and discharge alive endpoints, and consider the intermediate state of admission to ICU. The multi-state model analysis allows us to summarize results using stacked probability plots that make it easier to interpret results.

Conclusions

Extending the emulated target trial approach to multi-state model analysis complements treatment effectiveness analysis by gaining information on competing events. Combining two methodologies offers an option to address immortal time bias, confounding bias, and competing risk events. This methodological approach can provide additional insight for decision-making, particularly when data from randomized controlled trials (RCTs) are unavailable.
A scoping review of risk factors for urinary incontinence in older men
Authors: Olagundoye Olawunmi , Odusanya Benjamin , Kung Janice Y. , Gibson William , Wagg Adrian
Published: September 2023

Background

Most epidemiological studies have not systematically identified or categorized risk factors for urinary incontinence (UI) in older men, despite a higher prevalence than in younger men. Considering the burden of UI, an understanding of risk factors can inform cost-effective prevention/treatment programs. This scoping review aimed to identify and categorise risk factors for UI in older men, identify gaps in the evidence, and opportunities for future research.

Methods

The Joanna Briggs Institute (JBI) method for scoping reviews guided the conduct and reporting of this review alongside the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews checklist. JBI’s Population, Concept, and Context approach framed the inclusion criteria (all evidence sources on UI risk factors that included older men [65 +]). We employed JBI’s three-step search strategy, which included a limited initial search in Ovid MEDLINE, a detailed comprehensive database search, and a search of reference lists of included studies, Google Scholar and grey literature. There were no restrictions on language, study type, or publication date. Two independent reviewers screened, selected, and extracted eligible studies. Data were analyzed using descriptive statistics and qualitative content analysis.

Results

Forty-seven articles that met the inclusion criteria identified 98 risk factors across six categories. Behavioural risk factors, reported by only two studies, were the least investigated of all the categories, whereas medical factors/diseases were the most investigated. No genetic factors were documented. The top five risk factors were increasing age/advanced age (n = 12), Benign Prostatic Hyperplasia (n = 11), Diabetes Mellitus (n = 11), Detrusor overactivity (n = 10), limitation in physical function/ADL disability (n = 10), increased Body Mass Index (BMI)/overweight/obesity (n = 8), Dementia (n = 8), and Parkinson’s disease (n = 7).

Conclusion

There is a dearth of evidence to describe the role behavioural risk factors have in UI in older men. These factors may play a role in health promotion and disease prevention in this area.

Registration

A protocol detailing the methods was developed and published, and is registered in the Open Science Framework [Feb 07 2023; https://osf.io/xsrge/].
Prediction of conversion to dementia disorders based on timed up and go dual-task test verbal and motor outcomes: a five-year prospective memory-clinic-based study
Authors: Åberg Anna Cristina , Petersson Johanna R. , Giedraitis Vilmantas , McKee Kevin J. , Rosendahl Erik , Halvorsen Kjartan , Berglund Lars
Published: September 2023

Background

While assessment tools can increase the detection of cognitive impairment, there is currently insufficient evidence regarding clinical outcomes based on screening for cognitive impairment in older adults.

Methods

The study purpose was to investigate whether Timed Up and Go dual-task test (TUGdt) results, based on TUG combined with two different verbal tasks (name different animals, TUGdt-NA, and recite months in reverse order, TUGdt-MB), predicted dementia incidence over a period of five years among patients (N = 186, mean = 70.7 years; 45.7% female) diagnosed with Subjective Cognitive Impairment (SCI) and Mild Cognitive Impairment (MCI) following assessment at two memory clinics. Associations between TUG parameters and dementia incidence were examined in Cox regression models.

Results

During follow-up time (median (range) 3.7 (0.1–6.1) years) 98 participants converted to dementia. Novel findings indicated that the TUGdt parameter words/time, after adjustment for age, gender, and education, can be used for the prediction of conversion to dementia in participants with SCI or MCI over a period of five years. Among the TUG-related parameters investigated, words/time showed the best predictive capacity, while time scores of TUG and TUGdt as well as TUGdt cost did not produce significant predictive results. Results further showed that the step parameter step length during TUGdt predicts conversion to dementia before adjustment for age, gender, and education. Optimal TUGdt cutoffs for predicting dementia at 2- and 4-year follow-up based on words/time were calculated. The sensitivity of the TUGdt cutoffs was high at 2-year follow-up: TUGdt-NA words/time, 0.79; TUGdt-MB words/time, 0.71; reducing respectively to 0.64 and 0.65 at 4-year follow-up.

Conclusions

TUGdt words/time parameters have potential as cost-efficient tools for conversion-to-dementia risk assessment, useful for research and clinical purposes. These parameters may be able to bridge the gap of insufficient evidence for such clinical outcomes.

Trial registration

ClinicalTrials.gov Identifier: NCT05893524: https://www.clinicaltrials.gov/study/NCT05893524?id=NCT05893524&rank=1.
Cost-effectiveness analysis of liver transplantation in biliary atresia according to the severity of end-stage liver disease
Authors: Sihaklang Boonyanurak , Getsuwan Songpon , Pattanaprateep Oraluck , Butsriphum Napapat , Lertudomphonwanit Chatmanee , Tanpowpong Pornthep , Thirapattaraphan Chollasak , Treepongkaruna Suporn
Published: September 2023

Background

Timing for liver transplantation (LT) in biliary atresia (BA) children with end-stage liver disease (ESLD) is associated with all-cause mortality. The cut-off value of pediatric end-stage liver disease (PELD) score for LT consideration varies across institutions. We aimed to determine the cost-effectiveness of LT to prevent death among BA children registered on the waiting list with different severities of ESLD.

Methods

Subjects were BA children aged < 12 years at a transplant center between 2010 and 2021. A decision tree was developed for cost-effectiveness analysis from a hospital perspective to compare all-cause death between patients initially registered with a low PELD score (< 15) and a high PELD score (≥ 15). Each patient’s direct medical cost was retrieved from the beginning of registration until 5 years after LT, adjusted with an inflation rate to 2022 Thai Baht (THB).

Results

Among 176 children, 138 (78.4%) were initially registered with the high PELD score. The cost and mortality rate of the low PELD score group (THB1,413,424 or USD41,904 per patient and 31.6% mortality) were less than the high PELD score group (THB1,781,180 or USD52,807 per patient and 47.9% mortality), demonstrating the incremental cost-effectiveness ratio (ICER) of THB2,259,717 or USD66,994 per death prevented. The cost of early post-operative admission had the highest effect on the ICER. Considering the break-even analysis, cost among children initially registered at the low PELD score was also less expensive over time.

Conclusions

Registration for LT at PELD score < 15 was more cost-effective to prevent death among BA children with ESLD.
Psychometric and structural properties of the Karolinska Exhaustion Disorder Scale: a 1,072-patient study
Authors: Lindsäter Elin , van de Leur Jakob Clason , Rück Christian , Hedman-Lagerlöf Erik , Bianchi Renzo
Published: September 2023

Objective

Exhaustion disorder is a stress-related diagnosis that was introduced in 2005 to the Swedish version of the International Statistical Classification of Diseases and Related Health Problems, 10th edition (ICD-10). The Karolinska Exhaustion Disorder Scale (KEDS) was developed to assess exhaustion disorder symptomatology. While the KEDS is intended to reflect a single construct and be used based on its total score, the instrument's characteristics have received limited attention. This study investigated the KEDS’s psychometric and structural properties in a large clinical sample.

Methods

The study relied on data from 1,072 patients diagnosed with exhaustion disorder that were included in two clinical trials in Sweden. We investigated the dimensionality, homogeneity, and reliability of the KEDS using advanced statistical techniques, including exploratory structural equation modeling (ESEM) bifactor analysis.

Results

A one-factor confirmatory analytic model exhibited a poor fit, suggesting at least a degree of multidimensionality. The ESEM bifactor analysis found the general factor to explain about 72% of the common variance extracted, with an omega hierarchical coefficient of 0.680. Thus, the ESEM bifactor analysis did not clearly support the scale’s essential unidimensionality. A homogeneity analysis revealed a scale-level H of only 0.296, suggesting that KEDS’s total scores do not accurately rank individuals on the latent continuum assumed to underlie the measure. The KEDS’s reliability was modest, signaling considerable measurement error.

Conclusion

Findings reveal important limitations to the KEDS with possible implications for the status of exhaustion disorder as a nosological category.

Trial registration

This study was pre-registered on Open Science Framework (osf.io) on April 24, 2022 (https://osf.io/p34sq/).
Drowning rates among children and adolescents (aged 7–17) in Israel during the years 2008–2018
Authors: Abihasira Sigalit , Moran Daniel S. , Orr Daniela , Eliyahu Uri
Published: September 2023

Objective

Drowning is one of the leading causes of death among children and youth worldwide. This study aims to examine differences in the rates of drowning (fatal and non-fatal drowning) among children and youth in Israel stratified by age, sex, sector, place of drowning, and the drowning outcome. In addition, we compared the results of studies reported in other countries in specific age groups based on statistics of about 100,000 drowning cases.

Method

A statistical analysis of 474 drownings between 2008 and 2018 was conducted. All cases refer to youngsters aged 7–17 in the State of Israel. Statistical analysis was performed on data obtained from the Beterem – Safe Kids Israel organization and from the Israel Central Bureau of Statistics. Disparities between groups within the examined population were analyzed based on gender, sector (Jewish versus non-Jewish), and drowning site.

Results

Of the 474 drownings that occurred during 2008–2018, 38.4% ended in death. 79% of the cases occurred in pools. The Arab minority sector (21.1% of the general population) accounted for 25.1% of all drownings, males accounted for 70.5% of the drowning cases, and the age group with the most drownings (48.5%) was that of 15–17 years. The Jewish population was involved in more than 75% of drownings in places designated for bathing and in more than 83% of all disaster scenarios, whereas the Arab minority was involved in more than 61% of drownings in places not designated for bathing.

Conclusions

The results are comparable to those of other studies worldwide. Boys drown twice as much as girls, mainly in the age group of 15–17. This may be explained by overconfidence in boys and a tendency to overestimate their actual swimming abilities. Most drownings occur in pools. Drowning among the Jewish population occurs mainly in designated bathing sites.

Practical applications

The findings can and, in fact, must be used to inform and educate the younger generation as to the potential dangers involving bathing in designated bathing sites.
Characterizing neck injuries in the national football league: a descriptive epidemiology study
Authors: Dow Bobby , Doucet Dakota , Vemu Sree M. , Boddapati Venkat , Marco Rex A. W. , Hirase Takashi
Published: September 2023

Background

Neck injury is a common and often debilitating injury among athletes participating in American football. Limited data exists regarding neck injuries among elite athletes in the National Football League (NFL). To characterize the epidemiology of non-season ending, season-ending, and career-ending neck injuries in the NFL from 2016 through 2021.

Methods

Athletes who sustained neck injuries were identified using the NFL’s injured reserve (IR) list between the 2016 and 2021 seasons. Demographics and return to sport (RTS) data were collected. Available game footages were reviewed to identify the mechanism of injury (MOI). Injury incidence rates were calculated based on per team play basis.

Results

During the 6-year study period, 464 players (mean age 26.8 ± 3.2 years) were placed on the injury reserve list due to neck injuries. There were 285 defensive players and 179 offensive players injured (61.4 vs 38.6%, respectively, p < 0.001). Defensive back was the most common position to sustain a neck injury (111 players, 23.9%). 407 players (87.7%) sustained non-season-ending injuries with a mean RTS at 9.2 ± 11.3 days. 36 players (7.8%) sustained season-ending injuries with a mean RTS at 378.6 ± 162.0 days. 21 players (4.5%) sustained career-ending injuries. The overall incidence of neck injuries was 23.5 per 10,000 team plays. The incidence of season-ending injuries and career-ending injuries were 1.82 and 1.06 per 10,000 team plays, respectively. There were 38 injuries with available footages for MOI assessment (23 non-season-ending, 9 season-ending, 6 career-ending). Head-to-head contact was seen in 15 injuries (39.5%), head-down tackling in 11 injuries (28.9%), direct extremity-to-head contact in 7 injuries (18.4%), and head-to-ground contact in 5 injuries (13.2%). There was no significant difference in age, position, or MOI among players sustaining non-season-ending, season-ending, and career-ending injuries.

Conclusion

There is a high incidence of neck injuries among NFL athletes with predictable MOIs including head-to-head contact, head-down tackling, direct extremity-to-head contact, and head-to-ground contact. Defensive players were more likely to sustain neck injuries compared to offensive players. Defensive back was the most common position to sustain a neck injury.

Level of evidence

III.
Causes of death after testicular cancer diagnosis: a US population-based analysis
Authors: Wang Zhongyuan , Li Baochao , Xing Jiajun , Gong Zixuan , Xu Aiming , Wang Zengjun
Published: September 2023

Background

After the introduction of cisplatin-based chemotherapy, the survival time of testicular cancer (TC) patients has improved dramatically. However, the overall risk of death in patients with TC remains significantly higher than in the general population. The aim of this study was to assess and quantify the causes of death after TC diagnosis.

Method

In total, 44,975 men with TC in the United States diagnosed and registered by the Surveillance, Epidemiology, and End Results (SEER) database during 2000 to 2018 were studied. In this study, standardized mortality rates (SMRs) were calculated for each cause of death in TC individuals and further analyzed in strata according to age and race.

Result

Of the included participants, 3,573 (7.94%) died during the follow-up period. The greatest proportion of deaths (38.20%) occurred within 1 to 5 years after diagnosis. Most deaths occurred from TC itself and other cancers. For non-malignant conditions, the most common causes of death within 1 years after diagnosis were accidents and adverse effects (53, 4.75%) followed by diseases of heart (45, 4.04%). However, > 1 years after diagnosis, the most common noncancer causes of death were heart diseases. Results of stratified analysis show that non-Hispanic White TC participants have a lower SMR (0.68, 95% CI, 33.39–38.67) from Cerebrovascular Diseases than the general U.S. population.

Conclusions

Although TC remains the most common cause of death after TC diagnosis, other non-TC causes of death represent a significant number of deaths among TC men. These findings help TC survivors understand the various health risks that may occur at different follow-up periods.
Depression score mediate the association between a body shape index and infertility in overweight and obesity females, NHANES 2013–2018
Authors: Pan Qiangwei , Shen Xiaolu , Li Hongfeng , Zhu Bo , Chen Dake , Pan Jiajia
Published: September 2023

Background

Overweight and obese females demonstrate a significantly increased risk of anovulatory infertility. This study aims to investigate whether depression score could mediate the association between a body shape index (ABSI) and infertility, especially in overweight and obese population.

Methods

We included 5431 adult female Americans from the National Health and Nutrition Examination Survey (NHANES, 2013–2018) database. ABSI manifested the body shape using waist circumference, weight, and height. Infertility or fertility status was defined by interviewing female participants aged ≥ 18 through the reproductive health questionnaires. Depression symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) with total scores between 0 and 27. To investigate the association of infertility with ABSI and other individual components, survey-weighted multivariable logistic regression was performed. Mediation analysis of PHQ-9 score was conducted to disentangle the pathways that link ABSI to infertility among the NHANES participants.

Results

596 (10.97%) females were categorized with having infertility among 5431 participants. Participants with infertility showed higher ABSI and PHQ-9 score, appearing greater population proportion with depression symptoms. In the multivariable logistic regression model, ABSI (adjusted odds ratio = 0.14, 95% CI: 0.04 to 0.50) and PHQ-9 (adjusted odds ratio = 1.04, 95% CI: 1.01 to 1.07) were positively associated with infertility. PHQ-9 score was estimated to mediate 0.2% (P = 0.03) of the link between ABSI and infertility in all individuals, but to mediate 13.5% (P < 0.01) of the ABSI-infertility association in overweight and obese adult females.

Conclusion

The association between ABSI and infertility seems to be mediated by depression symptoms scored by PHQ-9, especially in those adult females with overweigh and obesity. Future studies should be implemented to further explore this mediator in ABSI-infertility link.
Using intervention mapping to develop evidence-based toolkits that support workers on long-term sick leave and their managers
Authors: Varela-Mato Veronica , Blake Holly , Yarker Joanna , Godfree Kate , Daly Guy , Hassard Juliet , Meyer Caroline , Kershaw Charlotte , Marwaha Steven , Newman Kristina , Russell Sean , Thomson Louise , Munir Fehmidah
Published: September 2023

Background

Managing long-term sickness absence is challenging in countries where employers and managers have the main responsibility to provide return to work support, particularly for workers with poor mental health. Whilst long-term sick leave and return to work frameworks and guidance exist for employers, there are currently no structured return to work protocols for employers or for their workers encompassing best practice strategies to support a positive and timely return to work outcome.

Purpose

To utilise the intervention mapping (IM) protocol as a framework to develop return to work toolkits that are underpinned by relevant behaviour change theory targeting mental health to promote a positive return to work experiensce for workers on long-term sick leave.

Methods

This paper provides a worked example of intervention mapping (IM) to develop an intervention through a six-step process to combine theory and evidence in the development of two toolkits – one designed for managers and one to be used by workers on long-term sick leave. As part of this process, collaborative planning techniques were used to develop the intervention. A planning group was set up, through which researchers would work alongside employer, worker, and mental health professional representatives to develop the toolkits. Additionally, feedback on the toolkits were sought from the target populations of workers and managers and from wider employer stakeholders (e.g., human resource specialists). The implementation and evaluation of the toolkits as a workplace intervention were also planned.

Results

Two toolkits were designed following the six steps of intervention mapping. Feedback from the planning group (n = 5; psychologist, psychiatrist, person with previous experience of poor mental health, employer and charity worker) and participants (n = 14; employers = 3, wellbeing director = 1; human resources = 2, managers = 2, employees with previous experience of poor mental health = 5) target populations indicated that the toolkits were acceptable and much needed.

Conclusions

Using IM allowed the development of an evidence-based practical intervention, whilst incorporating the views of all the impacted stakeholder groups. The feasibility and acceptability of the toolkits and their supporting intervention components, implementation process and methods of assessment will be evaluated in a feasibility pilot randomised controlled trial.
Development of a burst wave lithotripsy system for noninvasive fragmentation of ureteroliths in pet cats
Authors: Maxwell Adam D. , Kim Ga Won , Furrow Eva , Lulich Jody P. , Torre Marissa , MacConaghy Brian , Lynch Elizabeth , Leotta Daniel F. , Wang Yak-Nam , Borofsky Michael S. , Bailey Michael R.
Published: September 2023

Background

Upper urinary tract stones are increasingly prevalent in pet cats and are difficult to manage. Surgical procedures to address obstructing ureteroliths have short- and long-term complications, and medical therapies (e.g., fluid diuresis and smooth muscle relaxants) are infrequently effective. Burst wave lithotripsy is a non-invasive, ultrasound-guided, handheld focused ultrasound technology to disintegrate urinary stones, which is now undergoing human clinical trials in awake unanesthetized subjects.

Results

In this study, we designed and performed in vitro testing of a modified burst wave lithotripsy system to noninvasively fragment stones in cats. The design accounted for differences in anatomic scale, acoustic window, skin-to-stone depth, and stone size. Prototypes were fabricated and tested in a benchtop model using 35 natural calcium oxalate monohydrate stones from cats. In an initial experiment, burst wave lithotripsy was performed using peak ultrasound pressures of 7.3 (n = 10), 8.0 (n = 5), or 8.9 MPa (n = 10) for up to 30 min. Fourteen of 25 stones fragmented to < 1 mm within the 30 min. In a second experiment, burst wave lithotripsy was performed using a second transducer and peak ultrasound pressure of 8.0 MPa (n = 10) for up to 50 min. In the second experiment, 9 of 10 stones fragmented to < 1 mm within the 50 min. Across both experiments, an average of 73–97% of stone mass could be reduced to fragments < 1 mm. A third experiment found negligible injury with in vivo exposure of kidneys and ureters in a porcine animal model.

Conclusions

These data support further evaluation of burst wave lithotripsy as a noninvasive intervention for obstructing ureteroliths in cats.
Causal associations between type 1 diabetes mellitus and cardiovascular diseases: a Mendelian randomization study
Authors: Liu Zirui , Wang Haocheng , Yang Zhengkai , Lu Yu , Zou Cao
Published: September 2023

Background

The presence of type 1 diabetes mellitus (T1DM) has been demonstrated to pose an increased risk for developing cardiovascular diseases (CVDs). However, the causal relationships between T1DM and CVDs remain unclear due to the uncontrolled confounding factors and reverse causation bias of the observational studies.

Methods

Summary statistics of T1DM and seven CVDs from the largest available genome-wide association studies (GWAS) of European ancestry and FinnGen biobank were extracted for the primary MR analysis, and the analysis was replicated using UK biobank (UKBB) for validation. Three complementary methods: inverse variance weighted (IVW), weighted median, and MR-Egger were used for the MR estimates. The potential pleiotropic effects were assessed by MR-Egger intercept and MR-PRESSO global test. Additionally, multivariable MR (MVMR) analysis was performed to examine whether T1DM has independent effects on CVDs with adjustment of potential confounding factors. Moreover, a two-step MR approach was used to assess the potential mediating effects of these factors on the causal effects between T1DM and CVDs.

Results

Causal effects of T1DM on peripheral atherosclerosis (odds ratio [OR] = 1.06, 95% confidence interval [CI]: 1.02–1.10; p = 0.002)] and coronary atherosclerosis (OR = 1.03, 95% CI: 1.01–1.05; p = 0.001) were found. The results were less likely to be biased by the horizontal pleiotropic effects (both p values of MR-Egger intercept and MR-PRESSO Global test > 0.05). In the following MVMR analysis, we found the causal effects of T1DM on peripheral atherosclerosis and coronary atherosclerosis remain significant after adjusting for a series of potential confounding factors. Moreover, we found that hypertension partly mediated the causal effects of T1DM on peripheral atherosclerosis (proportion of mediation effect in total effect: 11.47%, 95% CI: 3.23–19.71%) and coronary atherosclerosis (16.84%, 95% CI: 5.35–28.33%). We didn’t find significant causal relationships between T1DM and other CVDs, including heart failure (HF), coronary artery disease (CAD), atrial fibrillation (AF), myocardial infarction (MI) and stroke. For the reverse MR from CVD to T1DM, no significant causal relationships were identified.

Conclusion

This MR study provided evidence supporting the causal effect of T1DM on peripheral atherosclerosis and coronary atherosclerosis, with hypertension partly mediating this effect.
Angiogenesis modulated by CD93 and its natural ligands IGFBP7 and MMRN2: a new target to facilitate solid tumor therapy by vasculature normalization
Authors: Li Yang , Fu Lei , Wu Baokang , Guo Xingqi , Shi Yu , Lv Chao , Yu Yang , Zhang Yizhou , Liang Zhiyun , Zhong Chongli , Han Shukun , Xu Feng , Tian Yu
Published: September 2023

The tumor vasculature was different from the normal vasculature in both function and morphology, which caused hypoxia in the tumor microenvironment (TME). Previous anti-angiogenesis therapy had led to a modest improvement in cancer immunotherapy. However, antiangiogenic therapy only benefitted a few patients and caused many side effects. Therefore, there was still a need to develop a new approach to affect tumor vasculature formation. The CD93 receptor expressed on the surface of vascular endothelial cells (ECs) and its natural ligands, MMRN2 and IGFBP7, were now considered potential targets in the antiangiogenic treatment because recent studies had reported that anti-CD93 could normalize the tumor vasculature without impacting normal blood vessels. Here, we reviewed recent studies on the role of CD93, IGFBP7, and MMRN2 in angiogenesis. We focused on revealing the interaction between IGFBP7-CD93 and MMRN2-CD93 and the signaling cascaded impacted by CD93, IGFBP7, and MMRN2 during the angiogenesis process. We also reviewed retrospective studies on CD93, IGFBP7, and MMRN2 expression and their relationship with clinical factors. In conclusion, CD93 was a promising target for normalizing the tumor vasculature.
Efficiency and equity of bed utilization in China’s health institutions: based on the rank-sum ratio method
Authors: Zhang Hang , Shi Leiyu , Yang Junyan , Sun Gang
Published: September 2023

Objective

The study aimed to analyze the efficiency and equity of bed utilization in Please check if the section headings are assigned to appropriate levels.China’s healthcare institutions and to compare and analyze the overall health resource utilization efficiency in recent years and some specific utilization conditions in 2021, to provide empirical experience for the allocation of health care resources in epidemic China.

Methods

To compare and analyze the overall health resource utilization efficiency of the whole country with that of the East, middle, and West in 2021, and to analyze the bed utilization efficiency of different types of healthcare institutions in China and the bed utilization efficiency of various types of specialist hospitals in the country in 2021 by using the rank-sum ratio method.

Results

In 2021, the bed utilization rate of China’s health institutions was 69.82%, and the number of bed turnover times was 27.65 times; the bed utilization rate of hospitals was 74.6%, and the number of bed turnover times was 26.08 times. The number of hospital bed turnovers was highest in the western region, lowest in the central region, and close to the national average in the eastern region. The average length of stay for discharged patients was the highest in the central region, the lowest in the eastern region, and the same as the national average in the western region. The analysis of rank-sum ratio method shows that among different types of health institutions’ bed utilization efficiency (r = 0.935, P = 0.000), general hospitals and traditional Chinese medicine hospitals have the best bed utilization rate, and the bed utilization rate of community health service centers (stations) needs to be improved; while among various types of specialized hospitals’ bed utilization efficiency (r = 0.959, P = 0.000), oncology hospitals, thoracic hospitals, and hematology hospitals, children’s hospitals have high bed utilization efficiency; leprosy hospitals, cosmetic hospitals, and stomatology hospitals have low bed utilization efficiency. Health technicians per 1,000 population are highest in the western region, lowest in the central region, and lower in the eastern region than in the western region but slightly higher than the national average. The number of beds in health institutions per 1,000 population is the highest in the central region, the lowest in the eastern region, and slightly lower in the northwest than in the central region but higher than the national average.

Conclusion

China’s investment in health funding in the field of health care has been on the rise in recent years. However, there still exists the situation of uneven investment in health expenses and inconsistent medical efficiency among regions. And change such a status quo can be further improved in terms of government, capital, human resources, technology, information system, and so on.
Per- and polyfluoroalkyl substances, gestational weight gain, postpartum weight retention and body composition in the UPSIDE cohort
Authors: Kinkade Carolyn W. , Rivera-Núñez Zorimar , Thurston Sally W. , Kannan Kurunthachalam , Miller Richard K. , Brunner Jessica , Wong Eunyoung , Groth Susan , O’Connor Thomas G. , Barrett Emily S.
Published: September 2023

Background

Per- and polyfluoroalkyl substances (PFAS) are synthetic chemicals found in drinking water and consumer products, resulting in ubiquitous human exposure. PFAS have been linked to endocrine disruption and altered weight gain across the lifespan. A limited and inconsistent body of research suggests PFAS may impact gestational weight gain (GWG) and postpartum body mass index (BMI), which are important predictors of overall infant and maternal health, respectively.

Methods

In the Understanding Pregnancy Signals and Infant Development (UPSIDE/UPSIDE-MOMs) study (n = 243; Rochester, NY), we examined second trimester serum PFAS (PFOS: perfluorooctanesulfonic acid, PFOA: perfluorooctanoic acid, PFNA: perfluorononanoic acid, PFHxS: perfluorohexanesulfonic acid, PFDA: perfluorodecanoic acid) in relation to GWG (kg, and weekly rate of gain) and in the postpartum, weight retention (PPWR (kg) and total body fat percentage (measured by bioelectrical impedance)). We fit multivariable linear regression models examining these outcomes in relation to log-transformed PFAS in the whole cohort as well as stratified by maternal pre-pregnancy BMI (< 25 vs. =  > 25 kg/m2), adjusting for demographics and lifestyle factors. We used weighted quantile sum regression to find the combined influence of the 5 PFAS on GWG, PPWR, and body fat percentage.

Results

PFOA and PFHxS were inversely associated with total GWG (PFOA: ß = -1.54 kg, 95%CI: -2.79, -0.30; rate ß = -0.05 kg/week, 95%CI: -0.09, -0.01; PFHxS: ß = -1.59 kg, 95%CI: -3.39, 0.21; rate ß = -0.05 kg/week, 95%CI: -0.11, 0.01) and PPWR at 6 and 12 months (PFOA 6 months: ß = -2.39 kg, 95%CI: -4.17, -0.61; 12 months: ß = -4.02 kg, 95%CI: -6.58, -1.46; PFHxS 6 months: ß = -2.94 kg, 95%CI: -5.52, -0.35; 12 months: ß = -5.13 kg, 95%CI: -8.34, -1.93). PFOA was additionally associated with lower body fat percentage at 6 and 12 months (ß = -1.75, 95%CI: -3.17, -0.32; ß = -1.64, 95%CI: -3.43, 0.16, respectively) with stronger associations observed in participants with higher pre-pregnancy BMI. The PFAS mixture was inversely associated with weight retention at 12 months (ß = -2.030, 95%CI: -3.486, -0.573) amongst all participants.

Conclusion

PFAS, in particular PFOA and PFHxS, in pregnancy are associated with altered patterns of GWG and postpartum adiposity with potential implications for fetal development and long-term maternal cardiometabolic health.
Mistaken information can lead only to misguided conclusions and policies: a commentary regarding Schüz et al.’s response
Authors: Tsuda Toshihide , Miyano Yumiko , Yamamoto Eiji
Published: September 2023

Background

After reviewing selected scientific evidence, Schüz et al. made two recommendations in the 2018 International Agency for Research on Cancer (IARC) Technical Publication No. 46. Their first recommendation was against population thyroid screening after a nuclear accident, and the second was that consideration be given to offering a long-term thyroid monitoring program for higher-risk individuals (100–500 mGy or more radiation) after a nuclear accident. However, their review of the scientific evidence was inadequate and misrepresented the information from both Chernobyl and Fukushima. We wrote a review article published in Environmental Health in 2022 using the “Toolkit for detecting misused epidemiological methods.” Schüz et al. critiqued our 2022 review article in 2023; their critique, based also on their 2018 IARC Technical Publication No. 46, was so fraught with problems that we developed this response.

Main body

Schüz et al. suggest that hundreds of thyroid cancer cases in children and adolescents, detected through population thyroid examinations using ultrasound echo and conducted since October 2011 in Fukushima, were not caused by the 2011 Fukushima Daiichi Nuclear Power Plant accident. Schüz et al. compared thyroid cancers in Fukushima directly with those in Chernobyl after April 1986 and listed up to five reasons to deny a causal relationship between radiation and thyroid cancers in Fukushima; however, those reasons we dismiss based on available evidence. No new scientific evidence was presented in their response to our commentary in which we pointed out that misinformation and biased scientific evidence had formed the basis of their arguments. Their published article provided erroneous information on Fukushima. The article implied overdiagnosis in adults and suggested that overdiagnosis would apply to current Fukushima cases. The IARC report did not validate the secondary confirmatory examination in the program which obscures the fact that overdiagnosis may not have occurred as much in Fukushima. The report consequently precluded the provision of important information and measures.

Conclusion

Information provided in the IARC Technical Publication No. 46 was based on selected scientific evidence resulting in both public and policy-maker confusion regarding past and present nuclear accidents, especially in Japan. It should be withdrawn.