bluuebunny/crossref_metadata_2025 huggingface dataset:
Implementation of Project ECHO in a university health network: contrasting and comparing experiences across health conditions through a qualitative approach in a Canadian tertiary care centre
Authors: Develay Élise , Wartelle-Bladou Claire , Talbot Annie , Khemiri Rania , Parent Jocelyne , Boulanger Aline , Dubreucq Simon , Pagé M Gabrielle
Published: September 2024

Objectives

The objective of this study was to compare and contrast the experiences of interdisciplinary attendees (spokes) and experts (hub members) from three Extension for Community Healthcare Outcomes (ECHO) programmes: hepatitis C, chronic pain and concurrent mental health and substance use disorders.

Design

Prospective qualitative study.

Setting

Single-centre in tertiary care.

Participants

The team conducted 30 one-on-one interviews with spokes and 4 focus groups with hub members from three ECHO programmes.

Analyses

Three analysts were involved to perform a reflexive thematic analysis.

Results

Our results showed the benefits and limitations of the three ECHOs, varying according to specificities of targeted chronic conditions. Three overarching themes were identified from the data analysis: (1) perceived impacts of an interprofessional educational setting; (2) nature of disease and interprofessional interactions as determinants of clinical practice changes in diagnoses and treatments and (3) impacts on patient engagement and care pathways.

Conclusions

The extent to which a chronic disease relies on a biopsychosocial approach, the degree of interdisciplinary care required and the simplicity/complexity of treatment algorithms influence perceived benefits and barriers to participating in ECHO programmes. These points raised by our study are important in the understanding of the successes and limitations of implementing an ECHO programme. They are essential as they provide key information for tailoring Project ECHO to the chronic disease it addresses.
Adapting the WHO hand hygiene ‘reminders in the workplace’ to improve acceptability for healthcare workers in maternity settings worldwide: a mixed methods study
Authors: Dunlop Catherine Louise , Kilpatrick Claire , Jones Laura , Bonet Mercedes , Allegranzi Benedetta , Brizuela Vanessa , Graham Wendy , Thompson Amy , Cheshire James , Lissauer David
Published: September 2024

Introduction

Hand hygiene is key in preventing healthcare-associated infections, but it is challenging in maternity settings due to high patient turnover, frequent emergencies and volume of aseptic procedures. We sought to investigate if adaptions to the WHO hand hygiene reminders could improve their acceptability in maternity settings globally, and use these findings to develop new reminders specific to maternity settings.

Methods

Informed by Sekhonet al’s acceptability framework, we conducted an online survey, semi-structured interviews and a focus group examining the three WHO central hand hygiene reminders (‘your five moments of hand hygiene’, ‘how to hand wash’ and ‘how to hand rub’) and their acceptability in maternity settings. A convergent mixed-methods study design was followed. Findings were examined overall and by country income status. A WHO expert working group tested the integrated findings, further refined results and developed recommendations to improve acceptability for use in the global maternity community. Findings were used to inform the development of two novel and acceptable hand hygiene reminders for use in high-income country (HIC) and low- and middle-income country (LMIC) maternity settings.

Results

Participation in the survey (n=342), semi-structured interviews (n=12) and focus group (n=7) spanned 51 countries (14 HICs and 37 LMICs). The highest scoring acceptability constructs were clarity of the intervention (intervention coherence), confidence in performance (self-efficacy), and alignment with personal values (ethicality). The lowest performing were perceived difficulty (burden) and how the intervention made the participant feel (affective attitude). Overfamiliarity reduced acceptability in HICs (perceived effectiveness). In LMICs, resource availability was a barrier to implementation (opportunity cost). Two new reminders were developed based on the findings, using inclusive female images, and clinical examples from maternity settings.

Conclusion

Following methodologically robust adaptation, two novel and inclusive maternity-specific hand hygiene reminders have been developed for use in both HIC and LMICs.
Prehabilitation for frail patients undergoing hip and knee replacement in the UK: Joint PREP feasibility study for a randomised controlled trial
Authors: Khalid Tanzeela , Ben-Shlomo Yoav , Bertram Wendy , Culliford Lucy , Henderson Emily J , Jepson Marcus , Johnson Emma , Mitchell Alex , Palmer Shea , Evans Jonathan Thomas , Whitehouse Michael R , Wylde Vikki
Published: September 2024

Objective

To determine the feasibility of conducting a randomised controlled trial (RCT) to evaluate a prehabilitation programme for frail patients undergoing total hip replacement (THR) or total knee replacement (TKR).

Design

Randomised feasibility study with embedded qualitative work.

Setting

Three National Health Service hospitals.

Participants

Adults aged ≥65 years, frail and scheduled for primary THR or TKR.

Intervention

Appointment with a physiotherapist to individualise a home-based exercise programme. Participants were encouraged to do the home exercises daily for 12 weeks pre-operative and were provided with a daily protein supplement. Participants were supported by six telephone calls over the 12-week intervention period.

Outcome measures

Eligibility and recruitment rates, intervention adherence, data completion rates of patient-reported outcome measures, retention rates and acceptability of the trial and intervention. Qualitative interviews were conducted with participants and non-participants and analysed using thematic analysis.

Results

Between December 2022 and August 2023, 411 patients were sent a screening pack. Of the 168 patients who returned a screening questionnaire, 79 were eligible and consented to participate, and 64 were randomised. Of the 33 participants randomised to the intervention, 26 attended the intervention appointment. Eighteen participants (69%) received all six intervention follow-up telephone calls. Nineteen participants (73%) completed an intervention adherence log; 13 (68%) adhered to the exercise programme and 11 (58%) adhered to the protein supplementation. The overall retention rate was 86% (55/64 overall) at 12 weeks. The 12-week follow-up questionnaire was returned by 46 of the 55 participants (84%) who were sent a questionnaire. Interviews with 19 patients found that the trial processes and intervention were generally acceptable, but areas of potential improvements were identified.

Conclusions

This study demonstrated that a larger study is possible and has identified improvements to optimise the design of an RCT.

Trial registration number

ISRCTN11121506.
Scientific evidence of acupuncture for post-stroke motor impairment: protocol for an overview of systematic reviews and meta-analyses
Authors: Yu Pei , Liu Yaning , Wang Haorun , Peng Tangming
Published: September 2024

Introduction

Several systematic reviews and meta-analyses (SRs/MAs) of clinical trials showed the efficacy of acupuncture for post-stroke motor impairment. To systematically estimate and synthesise these results, we aimed to conduct an overview of SRs/MAs to summarise the evidence and evaluate the methodological quality regarding the effectiveness and safety of acupuncture for post-stroke motor impairment.

Methods and analysis

This is a protocol for an overview of SRs/MAs. A literature search will be conducted in PubMed, Embase, Web of Science and Cochrane Central Registry of Controlled Trials from the construction of the database to March 2024. SRs/MAs evaluating the efficacy of acupuncture in post-stroke motor impairment patients will be included. Two independent investigators will screen and evaluate related SRs/MAs back-to-back. We will extract data into a predefined form designed to summarise the key characteristics of each study. The evaluation of methodological quality of the included SRs/MAs will be assessed using AMSTAR-2, the PRISMA 2020 checklist and the GRADE grading system.

Ethics and dissemination

Ethics approval is not required for this overview as we will only analyse published literature. The results will be published in a peer-reviewed journal.

PROSPERO registration number

CRD42024502006.
Digital wound monitoring with artificial intelligence to prioritise surgical wounds in cardiac surgery patients for priority or standard review: protocol for a randomised feasibility trial (WISDOM)
Authors: Tanner Judith , Rochon Melissa , Harris Roy , Beckhelling Jacqueline , Jurkiewicz James , Mason Lara , Bouttell Janet , Bolton Sarah , Dummer Jon , Wilson Keith , Dhoonmoon Luxmi , Cariaga Karen
Published: September 2024

Introduction

Digital surgical wound monitoring for patients at home is becoming an increasingly common method of wound follow-up. This regular monitoring improves patient outcomes by detecting wound complications early and enabling treatment to start before complications worsen. However, reviewing the digital data creates a new and additional workload for staff. The aim of this study is to assess a surgical wound monitoring platform that uses artificial intelligence to assist clinicians to review patients’ wound images by prioritising concerning images for urgent review. This will manage staff time more effectively.

Methods and analysis

This is a feasibility study for a new artificial intelligence module with 120 cardiac surgery patients at two centres serving a range of patient ethnicities and urban, rural and coastal locations. Each patient will be randomly allocated using a 1:1 ratio with mixed block sizes to receive the platform with the new detection and prioritising module (for up to 30 days after surgery) plus standard postoperative wound care or standard postoperative wound care only. Assessment is through surveys, interviews, phone calls and platform review at 30 days and through medical notes review and patient phone calls at 60 days. Outcomes will assess safety, acceptability, feasibility and health economic endpoints. The decision to proceed to a definitive trial will be based on prespecified progression criteria.

Ethics and dissemination

Permission to conduct the study was granted by the North of Scotland Research Ethics Committee 1 (24/NS0005) and the MHRA (CI/2024/0004/GB). The results of this Wound Imaging Software Digital platfOrM (WISDOM) study will be reported in peer-reviewed open-access journals and shared with participants and stakeholders.

Trial registration numbers

ISRCTN16900119andNCT06475703.
Minimal Einstein-Aether theory
Authors: Gürses Metin , Şentürk Çetin , Tekin Bayram
Published: September 2024

We show that there is a phenomenologically and theoretically consistent limit of the generic Einstein-Aether theory in which the Einstein-Aether field equations reduce to Einstein field equations with a perfect fluid distribution sourced by the aether field. This limit is obtained by taking three of the coupling constants of the theory to be zero but keeping the expansion coupling constant to be nonzero. We then consider the further reduction of this limited version of Einstein-Aether theory by taking the expansion of the aether field to be constant (possibly zero), and thereby we introduce the Minimal Einstein-Aether theory that supports the Einstein metrics as solutions with a reduced cosmological constant. The square of the expansion of the unit-timelike aether field shifts the bare cosmological constant and thus provides, via local Lorentz symmetry breaking inherent in the Einstein-Aether theories, a novel mechanism for reconciling the observed, small cosmological constant (or dark energy) with the large theoretical prediction coming from quantum field theories. The crucial point here is that minimal Einstein-Aether theory does not modify the well-tested aspects of General Relativity such as solar system tests and black hole physics including gravitational waves.
Smart Cities and Smart Networks: AI Applications in Urban Geography and Industrial Communication
Authors: He Bowen , Bhatti Uzair Aslam
Published: September 2024

This review paper delves into the extensive research on urban forms, focusing on urban sprawl through both traditional and contemporary approaches within urban geography. The complexity of defining urban sprawl has hindered the development of reliable models, with debates among researchers complicating a unified understanding. This selective review emphasizes studies measuring sprawl based on physical costs, environmental impacts, and transportation-related effects. Historical approaches often lacked innovative methodologies, but modern techniques, such as cartography, allow for the collection and analysis of long-term data, revealing metropolitan changes over decades. Despite these advancements, challenges persist due to varying interpretations of sprawl and difficulties in finding single measures to effectively differentiate factors like car density and resident density. Additionally, the paper explores the impact of intelligent technologies on industrial communications, particularly in the context of heterogeneous industrial networks. Modern intelligent technologies facilitate the automatic adaptation of mixed protocols, ensuring seamless communication among diverse industrial equipment. This has implications for urban infrastructure, where integrated smart systems can enhance operational efficiency and reliability. This paper reviews both historical and contemporary studies, demonstrating that the primary issue in understanding urban sprawl lies in measurement. It asserts that urban expansion is best understood through a multi-faceted approach. Progress in smart city tech and embedded systems has fostered the development of smart infrastructure, improving urban planning and mitigating adverse effects. The study highlights the need to blend new technologies with traditional methods to build accurate, sustainable models and plans for urban growth, emphasizing the synergy between urban planning and advancements in industrial communication.
Bifurcation Analysis and Optimal Control of an SEIR Model with Limited Medical Resources and Media Impact on Heterogeneous Networks
Authors: Sun Zhongkui , Zhang Hanqi , Liu Yuanyuan
Published: September 2024

The spread of epidemic diseases is often considered to be bound up with human behavior. Both treatment and awareness-raising are seen as important preventive measures during an outbreak. In this paper, an SEIR model on heterogeneous network containing saturated treatment function with media information variable is constructed. Through mathematical analysis, the basic reproduction number and equilibriums of the system are derived. The global stability of disease-free equilibrium is further proved based on LaSalle’s invariant principle. It is also found that with a gradual increase of the delayed treatment parameter, the system exhibits a transition from forward bifurcation to backward bifurcation with the variation of the basic reproduction number. Finally, an optimal control problem is formulated with both treatment rate and media information dissemination rate as control variables and solved using the Pontryagin’s maximum principle. All the above results are verified by numerical experiments.
Turing–Hopf Bifurcation Coinduced by Diffusion and Delay in Gierer–Meinhardt Systems
Authors: Ma Xiangyi , Wang Jinliang , Zhu Yanhua , Wang Ziwei , Sun Ying
Published: September 2024

This paper investigates the impact of gene expression time delay and diffusion on the dynamic behavior of a class of Gierer–Meinhardt systems under Neumann boundary conditions. It provides necessary and sufficient conditions for the emergence of Hopf, Turing, and Turing–Hopf bifurcations. Utilizing the normal form of the Turing–Hopf bifurcation, the spatiotemporal dynamics close to the bifurcation point are categorized into six types, encompassing spatially inhomogeneous and homogeneous periodic solutions, as well as spatially homogeneous and inhomogeneous steady states, along with their transitions. Notably, it’s observed that the systems may lack stable spatially inhomogeneous periodic solutions under specific parameters, despite the emergence of Turing–Hopf bifurcation. These findings are supported by numerical simulations.
2D Generating Surfaces in a Quartic Hamiltonian System with Three Degrees of Freedom – I
Authors: Katsanikas Matthaios , Gonzalez Montoya Francisco , Wiggins Stephen
Published: September 2024

In previous studies, we developed two techniques aimed at expanding the scope of constructing a periodic orbit dividing surface within a Hamiltonian system with three or more degrees of freedom. Our approach involved extending a periodic orbit into a torus or cylinder, thereby elevating it into a higher-dimensional entity within the energy surface (see [ Katsanikas & Wiggins , 2021a , 2021b , 2023a , 2023b ]). Recently, we introduced two alternative methods for creating dividing surfaces, distinct from the utilization of periodic orbits, by employing 2D surfaces (geometric entities) or 3D surfaces within a Hamiltonian system with three degrees of freedom (refer to [ Katsanikas & Wiggins , 2024a , 2024b , 2024c ]). In these studies, we applied these surfaces in a quadratic normal form Hamiltonian system with three degrees of freedom. In this series of two papers, we extend our results to 2D generating surfaces for quartic Hamiltonian systems with three degrees of freedom. This paper presents the first method of constructing 2D generating surfaces.
Program Merge: What's Deep Learning Got to Do with It?
Authors: Lahiri Shuvendu , Svyatkovskiy Alexey , Bird Christian , Meijer Erik , Coatta Terry
Published: September 2024

If you regularly work with open-source code or produce software for a large organization, you're already familiar with many of the challenges posed by collaborative programming at scale. Some of the most vexing of these tend to surface as a consequence of the many independent alterations inevitably made to code, which, unsurprisingly, can lead to updates that don't synchronize. Difficult merges are nothing new, of course, but the scale of the problem has gotten much worse. This is what led a group of researchers at MSR (Microsoft Research) to take on the task of complicated merges as a grand program-repair challenge, one they believed might be addressed at least in part by machine learning.
Exploring Generative Adversarial Networks for Augmenting Network Intrusion Detection Tasks
Authors: Constantin Mihai Gabriel , Stanciu Dan-Cristian , Ştefan Liviu-Daniel , Dogariu Mihai , Mihăilescu Dan , Ciobanu George , Bergeron Matt , Liu Winston , Belov Konstantin , Radu Octavian , Ionescu Bogdan
Published: September 2024

The advent of generative networks and their adoption in numerous domains and communities have led to a wave of innovation and breakthroughs in AI and machine learning. Generative Adversarial Networks (GANs) have expanded the scope of what is possible with machine learning, allowing for new applications in areas such as computer vision, natural language processing, and creative AI. GANs, in particular, have been used for a wide range of tasks, including image and video generation, data augmentation, style transfer, and anomaly detection. They have also been used for medical imaging and drug discovery, where they can generate synthetic data to augment small datasets, reduce the need for expensive experiments, and lower the number of real patients that must be included in medical trials. Given these developments, we propose using the power of GANs to create and augment flow-based network traffic datasets. We evaluate a series of GAN architectures, including Wasserstein, conditional, energy-based, gradient penalty, and LSTM-GANs. We evaluate their performance on a set of flow-based network traffic data collected from 16 subjects who used their computers for home, work, and study purposes. The performance of these GAN architectures is described according to metrics that involve networking principles, data distribution among a collection of flows, and temporal data distribution. Given the tendency of network intrusion detection datasets to have a very imbalanced data distribution, i.e., a large number of samples in the “normal traffic” category and a comparatively low number of samples assigned to the “intrusion” categories, we test our GANs by augmenting the intrusion data and checking whether this helps intrusion detection neural networks in their task. We publish the resulting UPBFlow dataset and code on GitHub.

1
Graph and Sequential Neural Networks in Session-based Recommendation: A Survey
Authors: Li Zihao , Yang Chao , Chen Yakun , Wang Xianzhi , Chen Hongxu , Xu Guandong , Yao Lina , Sheng Michael
Published: September 2024

Recent years have witnessed the remarkable success of recommendation systems (RSs) in alleviating the information overload problem. As a new paradigm of RSs, session-based recommendation (SR) specializes in users’ short-term preferences and aims at providing a more dynamic and timely recommendation based on ongoing interactions. This survey presents a comprehensive overview of the recent works on SR. First, we clarify the key definitions within SR and compare the characteristics of SR against other recommendation tasks. Then, we summarize the existing methods in two categories: sequential neural network based methods and graph neural network (GNN) based methods. The relevant frameworks and technical details are further introduced. Finally, we discuss the challenges of SR and new research directions in this area.
Digital Twin Studies for Reverse Engineering the Origins of Visual Intelligence
Authors: Wood Justin N. , Pandey Lalit , Wood Samantha M.W.
Published: September 2024

What are the core learning algorithms in brains? Nativists propose that intelligence emerges from innate domain-specific knowledge systems, whereas empiricists propose that intelligence emerges from domain-general systems that learn domain-specific knowledge from experience. We address this debate by reviewing digital twin studies designed to reverse engineer the learning algorithms in newborn brains. In digital twin studies, newborn animals and artificial agents are raised in the same environments and tested with the same tasks, permitting direct comparison of their learning abilities. Supporting empiricism, digital twin studies show that domain-general algorithms learn animal-like object perception when trained on the first-person visual experiences of newborn animals. Supporting nativism, digital twin studies show that domain-general algorithms produce innate domain-specific knowledge when trained on prenatal experiences (retinal waves). We argue that learning across humans, animals, and machines can be explained by a universal principle, which we call space-time fitting. Space-time fitting explains both empiricist and nativist phenomena, providing a unified framework for understanding the origins of intelligence.
Using word cloud as a formative assessment classroom technique in physiology
Authors: J Keba , Nayak Vineetha K. Ramdas , N Sajitha , S Himiki
Published: September 2024

The current study was conducted to present a novel formative assessment classroom technique using Mentimeter. The benefit of this novel technique is that it is easy to implement, quick, anonymous, and strengthens student’s conceptual learning. It also gives the teacher an opportunity to give feedback and stress commonly committed mistakes.
Development and evaluation of the active learning game “Who Am I?—Cellular Signal Transduction Edition”: the positive impact on undergraduate education
Authors: de Oliveira Kênia M. , Fernandes Ana Clara de G. , Soares Gabriela M. , da Silva Joel Alves , Carneiro Everardo M. , Barbosa Helena C. L.
Published: September 2024

We developed “Who Am I?—Cellular Signal Transduction Edition” to assist students in comprehending concepts of cellular signal transduction. This simple and cost-effective tool is perfect for educational settings with limited resources, and it encourages active learning for both small and large groups. Pre- and posttests have shown that it effectively enhances knowledge of hormonal actions and cellular signaling. Positive feedback from students emphasizes its value in reinforcing understanding and improving classroom engagement, making it a promising educational tool.
Application of cognitive load theory in reading English academic articles on medical education among Chinese undergraduate medical students
Authors: Bian Hui , Fu Xinyao , Wang Yuanyuan , Xiong Sihai , Chen Feiyu , Yang Yufei , Gao Di
Published: September 2024

Many nonnative English-speaking undergraduates have a fear of reading English academic articles. This study was performed to explore whether cognitive load theory can be a useful guiding strategy to promote English article reading among Chinese medical undergraduates. The results showed that cognitive load theory can serve as the basis for an effective strategy to guide English medical education article reading activities among undergraduates in China, and students’ attitudes toward the reading activities were favorable.
Comparable glucagon-stimulated amino acid suppression in individuals with and without hepatic steatosis or steatohepatitis
Authors: Heebøll Sara , Wegener Gregers , Grønbæk Henning , Nielsen Søren
Published: September 2024

The purpose of the study was to investigate the concept of “glucagon resistance” in metabolic dysfunction-associated steatotic liver disease (MASLD) pathogenesis. We asked if a disruption of the glucagon-mediated suppression of hepatic amino acid (AA) catabolism is present in individuals with MASLD compared with individuals with obesity but no MASLD. Contrary to expectations, we found no disruption of the glucagon-stimulated suppression of plasma AA concentration, which disputes the hypothesis that MASLD causes resistance to glucagon.
Modulation of motor cortex inhibition during manual dexterity tasks: an adaptive threshold hunting study
Authors: Duval Laura , Stinear Cathy M. , Byblow Winston D.
Published: September 2024

Primary motor cortex intracortical inhibition was investigated during dexterous manual task performance using adaptive threshold hunting. Motor cortex intracortical inhibition was uniquely modulated during pinching versus grasping tasks.
Malignant Transformation of Normal Oral Tissue to Dysplasia and Early Oral Squamous Cell Carcinoma: An In Silico Transcriptomics Approach
Authors: Jamshidi Shokoofeh , Tavangar Matina , Shojaei Setareh , Taherkhani Amir
Published: September 2024

Background: Oral squamous cell carcinoma (OSCC) is a prevalent and aggressive form of head and neck cancer, often diagnosed at advanced stages. Elucidating the molecular mechanisms involved in the malignant transformation from normal oral tissue to oral preinvasive lesions (OPL) and primary OSCC could facilitate early diagnosis and improve therapeutic strategies.

Methods: Differentially expressed genes (DEGs) were identified from the GSE30784 dataset by comparing normal oral tissue, oral dysplasia, and primary OSCC samples. Cross‐validation was performed using an independent RNA‐seq dataset, GSE186775. Protein–protein interaction (PPI) network analysis, gene ontology annotation, and pathway enrichment analysis were conducted on the common DEGs. Hub genes were identified, and their prognostic significance was evaluated using survival analysis. Transcription factor (TF) enrichment analysis, cross‐validation, and immunohistochemistry analyses were also performed.

Results: A total of 226 proteins and 677 interactions were identified in the PPI network, with 34 hub genes, including FN1, SERPINE1, PLAUR, THBS1, and ITGA6. Pathways such as “Formation of the cornified envelope,” “Keratinization,” and “Developmental biology” were enriched. Overexpression of SERPINE1, PLAUR, THBS1, and ITGA6 correlated with poor prognosis, while upregulation of CALML5 and SPINK5 was associated with favorable outcomes. NFIB emerged as the most significant TF‐regulating hub genes. Immunohistochemistry validated ITGA6 overexpression in primary OSCC. Cross‐validation using the RNA‐seq dataset supported the involvement of critical genes in the malignant transformation process.

Conclusion: This study identified vital genes, pathways, and prognostic markers involved in the malignant transformation from normal oral tissue to OPL and primary OSCC, providing insights for early diagnosis and targeted therapy development. Cross‐validation with an independent RNA‐seq dataset and immunohistochemistry reinforced the findings, supporting the robustness of the identified molecular signatures.
Combination of Qi Benefiting and Blood Circulation Promoting Herbs with Dapagliflozin in the Treatment of Type 2 Diabetes Mellitus Combined with Heart Failure: A Systematic Evaluation and Meta-Analysis Based on a Randomized Controlled Trial
Authors: Liu Changxing , Guo Xinyi , Wang He , Zhou Yabin
Published: September 2024

Introduction: This systematic review examines the efficacy of a combination of Qi benefiting and blood circulation promoting herbs with Dapagliflozin in treating type 2 diabetes mellitus (T2DM) combined with heart failure (HF). Methods: Randomized controlled trials (RCTs) assessing the combination of Qi benefiting and blood circulation promoting herbs with Dapagliflozin for T2DM and CHF was conducted. The search, spanning from the database’s establishment to June 2023, included seven databases: China Knowledge Network (CNKI), Wanfang Database, VIP Database, PubMed, Embase, Cochrane Library, and the Chinese Biomedical Literature Database. Two researchers screened and extracted data based on inclusion and exclusion criteria. The Cochrane Handbook version 5.1 guided the quality assessment of studies, and the meta-analysis was performed using RevMan 5.4 software. Results: Eleven articles, encompassing a sample size of 1,192 cases, were included. Meta-analysis results indicated that combining Qi benefiting and blood circulation promoting herbs with Dapagliflozin improved the clinical efficacy rate (OR = 4.35, 95% confidence interval [CI; 2.98, 6.35], p < 0.00001). It reduced blood glucose levels, evidenced by decreased fasting blood glucose (FBG) (mean difference [MD] = −1.19, 95% CI [−1.30, −1.09], p < 0.00001), 2-h postprandial blood glucose (2hPG) (MD = −1.95, 95% CI [−2.09, −1.80], p < 0.00001), and glycosylated hemoglobin (HbA1c) (MD = −1.40, 95% CI [−1.49, −1.31], p < 0.00001). Inflammatory factors also reduced, including C-reactive protein (CRP) (MD = −4.93, 95% CI [−5.38, −4.48], p < 0.00001), tumor necrosis factor (TNF-α) (MD = −2.91, 95% CI [−3.32, −2.49], p < 0.00001), and interleukin-6 (IL-6) (MD = −11.10, 95% CI [−12.43, −9.43], p < 0.00001). Additionally, left ventricular end-diastolic diameter (LVEDD) (standardized mean difference [SMD] = −1.25, 95% CI [−1.45, −1.05], p < 0.00001), left ventricular end-systolic diameter (LVESD) (SMD = −1.34, 95% CI [−1.51, −1.13], p < 0.00001), and improved left ventricular ejection fraction (LVEF) (SMD = 2.92, 95% CI [2.65, 3.19], p < 0.00001), 6-min walk test (6MWT) (MD = 35.59, 95% CI [29.72, 41.47], p < 0.00001), and Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores (MD = 35.59, 95% CI [29.72, 41.47], p < 0.00001) were observed. The incidence of adverse events also decreased (RR = 0.25, 95% CI [0.11, 0.56], p = 0.0007). Conclusion: The combination of Qi benefiting and blood circulation promoting herbs with Dapagliflozin shows potential in treating patients with T2DM and HF, suggesting its use as adjunctive therapy in clinical practice. However, the limited number and quality of the included studies necessitate further high-quality research to confirm these findings.
Insulin-Induced Copeptin Response in Children and Adolescents to Diagnose Arginine Vasopressin Deficiency
Authors: Gippert Sebastian , Brune Maik , Choukair Daniela , Bettendorf Markus
Published: September 2024

Introduction: The diagnosis of arginine vasopressin deficiency (AVD, formerly central diabetes insipidus) remains a challenge. In recent years, stimulated copeptin has emerged as a promising tool to diagnose AVD. Methods: In this single centre retrospective study, we identified paediatric patients with suspected pituitary insufficiency who underwent standard insulin tolerance testing (ITT) previously. Patients with AVD and non-matched controls without polyuria-polydipsia syndrome were identified. Diagnosis of AVD was confirmed retrospectively using comprehensive clinical and diagnostic characteristics. Serum copeptin concentrations were measured using a commercially available automated immunofluorescence assay (B.R.A.H.M.S Copeptin-proAVP KRYPTOR®) in −20°C stored samples collected before and 30, 45, and 60 min after insulin injection. Cut-off analyses were performed using ROC curves. Results: Twenty-five patients with AVD and 43 non-matched controls were available for analysis. Median basal copeptin concentrations of 1.51 pmol/L (IQR: 0.91–1.95; serum osmolarity: 288.5 mmol/L, IQR: 282.3–293.5) increased at a median of 30 min to a maximum of 1.95 pmol/L (IQR: 1.31–2.39) in AVD patients (p = 0.113) and from 4.41 pmol/L (IQR: 3.36–6.68; serum osmolarity: 281.0 mmol/L, IQR: 274.0–286.0, p < 0.001) to a maximum of 8.39 pmol/L (IQR: 4.95–19.72, p < 0.001) in controls. ROC analysis resulted in a cut-off of 3.0 pmol/L for maximum copeptin (91.7% sensitivity, 94.1% specificity) for the diagnosis of AVD. Conclusion: Our results suggest that insulin-stimulated serum copeptin concentrations are a sensitive and specific diagnostic tool for AVD in paediatric patients, which allows us to test multiple pituitary hormone axes simultaneously in a single test.
The RNA from Pseudomonas aeruginosa Reduces Neutrophil Responses Favoring Bacterial Survival
Authors: Pittaluga Jose R. , Birnberg-Weiss Federico , Serafino Agustina , Castro Joselyn E. , Castillo Luis A. , Martire-Greco Daiana , Barrionuevo Paula , Fernández Gabriela C. , Landoni Verónica I.
Published: September 2024

Introduction: Epithelial and endothelial cells modulate innate immune responses in the lung, including the arrival of neutrophils (PMN), which are crucial cells for the antibacterial host defense. Cells are exposed to prokaryotic RNA (pRNA) during bacterial infections and different pRNA may promote or attenuate the inflammatory response on different immune cells. Pseudomonas aeruginosa (PAE) can cause severe pneumonia and has several immune-evading mechanisms. The aim of this study was to determine the effects of the RNA from PAE (RNAPAE) on lung epithelial, endothelial cells, and PMN, and its impact on bacterial elimination. Methods: Purified total RNAPAE was used as a stimulus on a human lung epithelial cell line (Calu-6), human microvascular endothelial cell line HMEC-1 and isolated healthy human PMN. Activation and cytokine secretion were evaluated. In addition, PMN elimination of live ECO or PAE was determined in the presence of RNAPAE. Results: We found that RNAPAE either induced a pro-inflammatory response on Calu-6 and HMEC-1 or PMN. Pre-stimulation of PMN with RNAPAE diminished activation and chemotaxis induced by live bacteria. Moreover, we found that RNAPAE reduced phagocytosis of live ECO. Finally, we also found that non-degraded fragments of small RNA (<200 bp) were responsible for the PMN microbicidal attenuation during PAE elimination. Conclusion: Our results indicated that short fragments of RNAPAE diminished the immune response of PMN favoring bacterial survival.
Head-Up Tilt Sleeping to Treat Orthostatic Intolerance in a Patient with Advanced Parkinson’s Disease: A Case Report
Authors: van der Stam Amber H. , Shmuely Sharon , de Vries Nienke M. , Thijs Roland D. , van Kesteren-Biegstraaten Mirjam , Bloem Bastiaan R.
Published: September 2024

Introduction: Orthostatic hypotension is common in people with Parkinson’s disease (PD) due to autonomic dysfunction and medication use and can have a significant negative impact on quality of life. Pharmacological treatment is often complicated due to complex blood pressure regulation problems. This case report presents a patient whose symptoms of orthostatic intolerance were successfully treated with the non-pharmacological method of head-up tilt sleeping (HUTS). Case Presentation: A 69-year-old man with PD and prominent autonomic failure received recommendation from the neurologist to use HUTS to battle orthostatic intolerance, of which complaints were worst in the early morning. The patient noted a marked improvement of the orthostatic intolerance after a period in which he slowly step-by-step inclined the bed to an angle just over 10°. When ceasing HUTS for a brief period, complaints of orthostatic intolerance immediately returned and the patient returned to tilted sleeping right away. After a follow-up of 3 months, the patient did not report orthostatic intolerance during a standing test. Conclusion: This case illuminates that, despite difficulties intrinsic to this method, whole-body HUTS can ameliorate orthostatic intolerance and improve the daily life of people with advanced movement disorders.
A Trial of Finerenone in a Patient with Primary Aldosteronism
Authors: Karanović Štambuk Sandra
Published: September 2024

Introduction: Primary aldosteronism (PA), a common secondary cause of arterial hypertension, is treated either surgically or pharmacologically with mineralocorticoid receptor antagonists (MRAs). These drugs, while effective, can cause allergic reactions and have side effects, including menstrual cycle disorders in women. Finerenone is a new, highly selective, nonsteroidal MRA with excellent side-effect profile, primarily intended to slow the progression of diabetic kidney disease and improve cardiovascular outcomes in these patients. No data are available so far on its effect on patients with PA. Case Presentation: A case of a female patient with confirmed primary aldosteronism, in whom adrenal vein sampling failed twice is presented. The patient developed a skin allergic reaction to spironolactone and experienced prolonged vaginal bleedings with eplerenone, which was attributed to the drug’s affinity for progesterone receptors. A trial of finerenone was initiated, resulting in mild increase in plasma renin activity and serum potassium, and somewhat control of blood pressure, but far from optimal blood pressure control, normokalemia, or unsuppression of plasma renin activity. Conclusion: This case highlights the challenges of managing PA and describes an attempt of treatment with finerenone to which this patient unfortunately did not adequately respond.
Bibliometric Insights into Research Hotspots and Trends in Obesity and Asthma from 2013 to 2023
Authors: Cao Peng , Li Jiake , Wang Guohui , Sun Xulong , Luo Zhi , Zhu Shaihong , Zhu Liyong
Published: September 2024

Introduction: Obesity and asthma are closely linked, but the current state of research on this topic and future research directions have yet to be comprehensively explored. This study aims to provide an up-to-date overview of the research landscape in the field of obesity and asthma. Methods: A bibliometric analysis was conducted using the Web of Science Core Collection database to identify papers published on obesity and asthma between 2013 and 2023. VOSviewer software was utilized for statistical analysis and visualization of collaborative networks, research trends, literature sources, citation analysis, co-citation analysis, and keyword analysis. Results: A total of 3,406 records from 1,010 journals authored by 17,347 researchers affiliated with 4,573 institutes across 117 countries and regions were retrieved. The number of publications and citations increased annually. The USA and China contributed the majority of records. Major nodes in the collaboration network map included Harvard Medical School, Johns Hopkins University, University of Newcastle, Karolinska Institution, University of Toronto, and Seoul National University. Prolific authors included Anne E. Dixon, Erick Forno, Lisa G. Wood, Deepa Rastogi, and Fernando Holguin. Research trends and hotspots focused on metabolism studies, Mendelian randomization, gut microbiome, inflammation response, gene, biomarker research, and comorbidities were identified as potential future research frontiers. Conclusion: This study provides a comprehensive overview of the current research status and trends in the field of obesity and asthma. Our findings highlight the importance of understanding collaboration patterns, research hotspots, and emerging frontiers to guide future research in this area.
Diagnostic Accuracy of the Second Edition of the Paris System for Reporting High-Grade Urothelial Carcinoma in Urinary Cytology
Authors: Singh Anu , Khan Adil Aziz , Ahluwalia Charanjeet , Ahuja Sana , Ranga Sunil
Published: September 2024

Background: Urinary cytology, a non-invasive screening tool, is essential for detecting high-grade urothelial neoplasms. The Paris System (TPS) standardizes reporting practices to improve diagnostic accuracy. TPS 2.0, introduced in 2022, categorizes samples into six diagnostic groups, emphasizing high-grade urothelial carcinoma (HGUC). Materials and Methods: This retrospective study analyzed urine cytology samples from June 2023 to May 2024, correlating with histopathology when available. Samples were classified under TPS 2.0 categories, and statistical metrics including sensitivity, specificity, positive predictive value (PPV), and negative predictive value were calculated for three groups based on malignancy criteria. Results: Out of 180 samples, the distribution was ND (3.9%), NHGUC (65.6%), AUC (10%), SHGUC (11.7%), and HGUC (8.9%). Histopathological correlation was available for 30.6% of cases. risk of malignancy values were: ND (33.3%), negative for HGUC (29.4%), AUC (66.7%), suspicious for HGUC (94.1%), and HGUC (100%). Group A showed the highest sensitivity (86.49%) and diagnostic accuracy (84.62%), while group C had 100% specificity and PPV. Conclusion: The study confirms TPS 2.0’s efficacy in improving diagnostic accuracy for HGUC, with high specificity and sensitivity. Compared to TPS 1.0, TPS 2.0 offers clearer diagnostic criteria, enhancing clinical decision-making and patient outcomes. The findings support the continued use of TPS 2.0 in clinical practice, ensuring reliable identification of HGUC.
Spinal Teratoma with Recurrent Epileptic Episodes in Adults: A Case Report
Authors: Wang Jinlong , Cao Bo
Published: September 2024

Introduction: Spinal teratomas are rare, accounting for nearly 0.2–0.5% of all spinal tumors and 2% of all teratomas. Teratomas at the conus medullaris location do not inherently lead to epilepsy. However, potential epileptic seizures are caused when teratoma ruptures and the chemical stimulation of teratoma components enter the dural sac. Case Presentation: A 31-year-old Asian male patient suffering from epileptic onset and poor antiepileptic treatment was demonstrated. The spinal imaging examination was performed, and the patient suffered a space-occupying lesion within the conus medullaris related to spinal deformity, spinal embolism, etc. The autoimmune encephalitis spectrum revealed mGluR5 antibody IgG (+) 1:10 response. The patient stabilized after treatment with hormones and human immunoglobulin. Some hair and lipid droplets could be observed in the dural sac intraoperatively, and more hair and lipid-like material were present in the spinal cord. Postoperative pathology established the diagnosis as a conus medullaris teratoma in adults. Epileptic seizures stopped after surgery, and no additional seizures were reported during the 33-month follow-up period. Conclusions: Conus medullaris teratoma rupture in adults rarely causes epileptic seizures. For spinal deformity patients with unexplained epileptic symptoms, spinal MRI can be helpful in early diagnosis, and more appropriate treatment improves disease prognosis.
Systolic Blood Pressure, Cardiovascular Health, and Neurocognition in Adolescents
Authors: Hooper Stephen R. , Lande Marc B. , Flynn Joseph T. , Hanevold Coral D. , Meyers Kevin E. , Samuels Joshua , Becker Richard C. , Daniels Stephen R. , Falkner Bonita E. , Ferguson Michael A. , Ingelfinger Julie R. , Martin Lisa J. , Mitsnefes Mark , Khoury Phillip , Seo Jangdong , Urbina Elaine M.
Published: September 2024

BACKGROUND:

We studied whether increased systolic blood pressure (SBP), as determined by auscultatory SBP, ambulatory SBP, and the number of cardiovascular health risk indicators, are associated with neurocognition in adolescents.

METHODS:

This cross-sectional study included 365 adolescents (mean age, 15.5 years) from 6 academic medical centers in the United States. The sample was 59.5% male, 52.6% White, with 23.9% of the caregivers having less than or equal to a high school degree. Primary exposures included the following: auscultatory SBP, ambulatory SBP, and the number of cardiovascular risk factors. Neurocognitive outcomes comprised nonverbal IQ, attention, and parent ratings of executive functions.

RESULTS:

After examining the models for the effects of targeted covariates (eg, maternal education), higher auscultatory SBP was associated with lower nonverbal IQ (β=−1.39;
P
<0.001) and verbal attention (β=−2.39;
P
<0.05); higher ambulatory 24 hours. SBP (β=−21.39;
P
<0.05) and wake SBP (β=−21.62;
P
<0.05) were related to verbal attention; and all 3 ambulatory blood pressure measures were related to sustained attention accounting for small to medium amounts of variance (adjusted R
2
=0.08–0.09). Higher ambulatory blood pressure sleep SBP also was significantly associated with parent ratings of behavior regulation (β=12.61;
P
<0.05). These associations remained stable after a sensitivity analysis removed cases with hypertension. Number of cardiovascular risk factors performed similarly, with more risk factors being associated with lower nonverbal IQ (β=−1.35;
P
<0.01), verbal attention (β=−1.23;
P
<0.01), and all parent ratings of executive functions.

CONCLUSIONS:

Elevated SBP, even below the hypertension range, and general cardiovascular health are associated with neurocognitive outcomes in adolescents. How these findings might guide clinical care is worthy of additional study.
Polygenic Interactions With Environmental Exposures in Blood Pressure Regulation: The HUNT Study
Authors: Øvretveit Karsten , Ingeström Emma M. L. , Spitieris Michail , Tragante Vinicius , Thomas Laurent F. , Steinsland Ingelin , Brumpton Ben M. , Gudbjartsson Daniel F. , Holm Hilma , Stefansson Kari , Wisløff Ulrik , Hveem Kristian
Published: September 2024

Background

The essential hypertension phenotype results from an interplay between genetic and environmental factors. The influence of lifestyle exposures such as excess adiposity, alcohol consumption, tobacco use, diet, and activity patterns on blood pressure (BP) is well established. Additionally, polygenic risk scores for BP traits are associated with clinically significant phenotypic variation. However, interactions between genetic and environmental risk factors in hypertension morbidity and mortality are poorly characterized.

Methods and Results

We used genotype and phenotype data from up to 49 234 participants from the HUNT (Trøndelag Health Study) to model gene–environment interactions between genome‐wide polygenic risk scores for systolic BP and diastolic BP and 125 environmental exposures. Among the 125 environmental exposures assessed, 108 and 100 were independently associated with SBP and DBP, respectively. Of these, 12 interactions were identified for genome‐wide PRSs for systolic BP and 4 for genome‐wide polygenic risk scores for diastolic BP, 2 of which were overlapping (
P
 < 2 × 10
−4
). We found evidence for gene‐dependent influence of lifestyle factors such as cardiorespiratory fitness, dietary patterns, and tobacco exposure, as well as biomarkers such as serum cholesterol, creatinine, and alkaline phosphatase on BP.

Conclusions

Individuals that are genetically susceptible to high BP may be more vulnerable to common acquired risk factors for hypertension, but these effects appear to be modifiable. The gene‐dependent influence of several common acquired risk factors indicates the potential of genetic data combined with lifestyle assessments in risk stratification, and gene–environment‐informed risk modeling in the prevention and management of hypertension.