bluuebunny/crossref_metadata_2025 huggingface dataset:
Aflibercept versus ranibizumab for diabetic macular edema: A meta-analysis
Authors: Chen Haiyan , Shi Xuehui , Zhang Wang , Han Qianqian
Published: May 2023

Objective

The purpose of this study was to compare the efficacy and safety of aflibercept (AFL) versus ranibizumab (RAN) for the treatment of diabetic macular edema (DME).

Methods

The PubMed, Embase, Cochrane Library, and CNKI databases were searched up to September 2022 to identify prospective randomized controlled trials (RCTs) comparing AFL with RAN for the treatment of DME. Review Manager 5.3 software was used for data analysis. We used the GRADE system to evaluate the quality of the evidence for each outcome.

Results

A total of 8 RCTs involving 1067 eyes (939 patients) were included; there were 526 eyes in the AFL group and 541 eyes in the RAN group. Meta-analysis revealed that there was no significant difference between RAN and AFL in the best-corrected visual acuity (BCVA) of DME patients at 6 months (WMD: −0.05, 95% CI  =  −0.12 to 0.01, moderate quality) and 12 months after injection (WMD: −0.02, 95% CI  =  −0.07 to 0.03, moderate quality). Additionally, there was no significant difference between RAN and AFL in the reduction of central macular thickness (CMT) at 6 months (WMD: −0.36, 95% CI  =  −24.99 to 24.26, very low quality) and 12 months after injection (WMD: −6.36, 95% CI  =  −16.30 to 3.59, low quality). Meta-analysis showed that the number of intravitreal injections (IVIs) for AFL was significantly lower than that for RAN (WMD: −0.47, 95% CI  =  −0.88 to −0.05, very low quality). There were fewer adverse reactions to AFL than to RAN, but the difference was not significant.

Conclusion

This study found that there was no difference in BCVA, CMT or adverse reactions between AFL and RAN at 6 and 12 months of follow-up, but AFL needed fewer IVIs than RAN.
Data like any other? Sexual and reproductive health, Big Data and the Sustainable Development Goals
Authors: Hammond Natalie , Moretti Angelo
Published: May 2023

This article examines the possibilities and pitfalls of using Big Data to address sexual and reproductive health concerns as related to the Sustainable Development Goals (SDGs), paying particular attention to contextual difference in development settings. The global datafication of sexual and reproductive life has taken place at great speed. However, evidential deficiencies and a lack of critical engagement of the specific issues around working with sexual and reproductive health Big Data in development contexts is apparent. Informed by critical data studies, and framed by a political economy perspective which calls attention to power structures, we seek to deepen our understanding of the role and challenges that Big Data around sexual and reproductive health in the Low and Middle-Income Countries can play in addressing the SDGs. First, we explore the ways in which sexual datafication processes produce Big Data. We then consider how such Big Data could directly contribute to addressing the SDGs beyond simply monitoring and evaluating. Next, we unpick how the sensitive and stigmatised nature of sexual and reproductive health can have ramifications in data-driven contexts where significant power asymmetries exist. By doing so, we provide a more nuanced articulation of the challenges of datafication by contextualising the stigma around sexual and reproductive in a datafied context. We argue that whilst Big Data in relation to sexual and reproductive health shows potential to support the SDGs, there are specificities that must be considered to ensure that the push for data-driven approaches does no harm.
Unlocking the self: Can microdosing psychedelics make one feel more authentic?
Authors: Pop Ioana , Dinkelacker Jannis
Published: May 2023

Background and aim: In the present study, we focus on the relationship between state authenticity – the experience of being true to oneself in a particular moment – and microdosing – a practice that implies repeatedly ingesting very small doses of psychedelics that do not reach the threshold for perceptual alterations. We propose that microdosing could increase state authenticity through influencing people's mood and the number and satisfaction with daily activities. Methods: We used self-assessments of state authenticity collected from 18 microdosers in the Netherlands across the period of 1 month for a total of 192 observations. Results: We found that on the microdosing day and the day thereafter, state authenticity was significantly higher. Furthermore, the number of activities and the satisfaction with them were higher on the day when participants microdosed, while the following day only the number of activities was higher. Both the number or activities and the satisfaction with them were positively related to state authenticity. Conclusion: We propose that feeling and behaving authentically could have a central role in explaining the positive effects of microdosing on health and wellbeing that are reported by current research.
The influence of the deliberative quality of user comments on the number and quality of their reply comments
Authors: Naab Teresa K , Ruess Hanna-Sophie , Küchler Constanze
Published: May 2023

Comment sections below news posts on social media pages of news outlets provide spaces for user engagement and public discussions. However, from the normative perspective of deliberative discussions, user comments often lack quality. We analyze how deliberative characteristics of Facebook user comments, namely, reciprocity, respect, rationality, and constructiveness, can influence the number and deliberative quality of the reply comments they receive. The manual content analysis shows that rationality in top comments increases the number of replies; additionally, respect, rationality, and constructiveness in top comments increase the occurrence of these characteristics in replies. The findings support assumptions about the involvement mechanisms in commenting behavior and the applicability of social norm theory in online discussions. They contribute to understanding spirals of deliberation as well as those of incivility.
Falling: An existential experience in early childhood
Authors: Blume Michael Friedrich Walter , Mikkelsen Anette Lindahl
Published: May 2023

In this article, falling is considered as an existential bodily experience of the youngest children, aged one to three. No toddler can avoid falling; it is simply a condition of being bodily situated in the world. Active toddlers are falling toddlers, but even though the struggle with gravity appears to play a crucial role in the everyday lives of young children, it has been only a limited subject in early childhood research. Therefore, the authors examine the phenomenon of falling on the basis of empirical material collected in a focused ethnographic study carried out in two Danish nurseries. The findings are presented as a kind of typology, which includes analyses of five different fallings situations that were observed and videotaped in planned physical education activities. From an existential point of view, falling can be characterized as a negative experience with which the toddler must reconcile as a consequence of participating in movement activities. Even though it often starts as negative, falling seems to develop productive qualities, such as increased body consciousness or basic wakefulness. Physical active toddlers soon become experienced fallers, and this expertise makes it possible to use falling as a motor skill in playing situations or as a tool for communication. The authors use an existential framework to highlight and discuss the productive qualities of falling with the purpose of making it explicit for work in early childhood education.
A novel layout to charge a single cylinder diesel engine using supercharging and impulse turbo-compounding
Authors: Ramkumar Jayaraman , Krishnasamy Anand , Ramesh A
Published: May 2023

The benefits of turbocharged internal combustion engines are well established in the literature and mass production. Despite the numerous advantages of turbocharging, commercial single-cylinder engines are generally not turbocharged. This is due to intermittent exhaust gas flow to the turbine, typical for a single-cylinder engine. The current work proposes a novel layout wherein a supercharger boosts the engine to reap the benefits of charging the single-cylinder engine. An impulse turbine salvages part of the exhaust energy from the pulsated flow. A one-dimensional simulation study of the novel supercharged and turbo-compounded single-cylinder engine was carried out, and critical parameters of an impulse turbine were designed. CFD simulation study was carried out to validate the performance of the impulse turbine and the novel layout. This study modified a light-duty naturally aspirated (NA) diesel engine currently in mass production into the supercharged version. A positive displacement supercharger was mechanically coupled to the base NA engine with a suitable belt drive, and steady-state experiments were performed with NA and supercharged versions. One-dimensional AVL boost simulation models were validated for the NA and supercharged engines for brake power, air flow rate and BSFC within a 3% deviation. Nozzles of varying exit diameters were employed at the exhaust pipe. One-dimensional simulations were conducted to predict the supercharged engine performance and the kinetic energy rate available at the exhaust nozzle exit. An optimal nozzle exit diameter was chosen. Base calculations for the impulse turbine were performed with the output from the 1D simulation tool to design the critical features of the blade and the power turbine. The designed impulse turbine was further simulated using a commercially available CFD simulation tool, CONVERGE. CFD results showed that the impulse turbine generated about 1.55 kW of power, equivalent to 39% turbine efficiency. Experimental analysis was conducted on the supercharged engine with the optimal nozzle and the simulated impulse turbine. Results showed significantly improved engine performance with the supercharged and impulse turbine compounded version compared to the base NA version. The brake power output and brake thermal efficiency increased by 34% and 3.8%, respectively. Soot and carbon monoxide (CO) emissions were 80% lower, while unburned hydrocarbon (HC) emissions were 45% lower. However, NOx emissions were 60% higher, which can be curtailed by established NOx reduction strategies. Thus, the proposed method of employing a supercharger and compounding an impulse turbine for a single-cylinder diesel engine proved beneficial with improved performance, reduced brake specific fuel consumption and reduced emissions except for NOx.
Reducing the Methodological Heterogeneity (“Noise”) in the Literature Predicting In-Prison Interpersonal Harm in Male Populations
Authors: Wolff Nancy , Aizpurua Eva , Peng Dan
Published: May 2023

Interpersonal harm is a preventable public health problem. A growing body of literature shows persistently elevated exposure rates to physical and sexual victimization during incarceration. Yet how to prevent interpersonal harm during incarceration has proven far more elusive. A public health approach to prevention offers promise. To develop effective prevention strategies, the public health approach begins with defining and measuring the problem, followed by identifying risk and protective factors for the problem. The dynamic literature on in-prison interpersonal harm includes both parts of the public health approach but theoretical and methodological “noise” in this literature limits its instrumental utility to build effective prevention strategies. Herein, we critically review this evidence base (15 peer-reviewed articles published since 2000 with samples of 1,000+) to isolate the noise and the substance. We, then, minimize the methodological noise by testing for risk factors using self-report data that is representative of an entire U.S. state prison system for men and best data collection practices. Multilevel logistic regression is used to predict four types of interpersonal harm using theoretically grounded individual and prison-level covariates that are supported by the empirical literature. We conclude with recommendations for building an evidence base from which to develop prevention strategies that would create and sustain custodial conditions for people to be safe and healthy while incarcerated.
Magnesium and Diabetic Foot Ulcers: A Mini Review
Authors: Karakousis Nikolaos D. , Pyrgioti Elisavet E. , Georgakopoulos Petros N. , Apergi Kyriaki , Papanas Nikolaos
Published: May 2023

There is accumulating evidence that magnesium, an important mineral having a pivotal role in many physiological functions, may be important in development and healing of diabetic foot ulcers (DFUs). In this non-systematic mini review, we discuss the role of magnesium in DFUs, as well as the effects of magnesium administration in DFUs. Reduced Mg levels appear to be associated with DFUs. Moreover, Mg administration may be beneficial for the outcome of DFUs. Further investigation is imperative in order to shed more light on these findings.
Radial versus dorsal plating for trapeziometacarpal arthrodesis: a comparative biomechanical study
Authors: Cho Jae-Yong , Lim Joon-Ryul , Oh Won-Taek , Koh Il-Hyun , Chun Yong-Min , Choi Yun-Rak
Published: May 2023

Trapeziometacarpal arthrodesis is used for the treatment of advanced arthritis. Insufficient stabilization of the joint may lead to nonunion or hardware problems after arthrodesis. The purpose of this study was to compare the biomechanical properties of dorsal versus radial plate fixation of the trapeziometacarpal joint in ten pairs of fresh-frozen cadaveric hands. The biomechanical performance of each group was measured for stiffness in extension and flexion and load to failure using cantilever bending tests. The stiffness in extension was lower in the dorsally positioned group than in the radially positioned group (12.1 versus 15.2 N/mm, respectively). Load to failure was comparable between both groups (53.9 versus 50.9 N, respectively). A radially positioned locking plate for trapeziometacarpal arthrodesis may be biomechanically advantageous.
The design and evaluation of a digital learning-based English chatbot as an online self-learning method
Authors: Wu CH , Lam HY , Kong A , Wong WLH
Published: May 2023

A majority of government and international organisations have chosen English as their official language since it is the only language in the world with the status of a global language and a world language. One of the key components of learning a language is oral communication; however, students frequently overlook the value of oral communication, which reduces the effectiveness of language acquisition. To enhance the motivation and effectiveness of non-native English speakers to learn and practise English, this study aims to develop an interactive self-learning and self-improvement approach. A well-designed and chatbot-assisted learning environment is designed, using a variety of concepts such as informal learning, language learning, mobile learning, and educational mobile application, and evaluated.
Participant Experiences of Low-Dose Empagliflozin Use as Adjunct Therapy to Hybrid Closed Loop: Findings From a Randomized Controlled Trial
Authors: Pasqua Melissa-Rosina , Odabassian Madison , Tsoukas Michael A. , Haidar Ahmad
Published: May 2023

Background:

Very few patient-reported outcomes have been published in regard to opinions of individuals with type 1 diabetes concerning adjunctive therapy. The aim of this subanalysis was to qualitatively and quantitatively assess the thoughts and experiences of participants with type 1 diabetes who have used low doses of empagliflozin as an adjunct to hybrid closed-loop therapy.

Methods:

Semi-structured interviews were performed with adult participants who completed a double-blinded, crossover, randomized controlled trial using low-dose empagliflozin as an adjunct to hybrid closed-loop therapy. Participant experiences were captured through qualitative and quantitative methods. A descriptive analysis was performed using a qualitative approach; attitudes toward relevant topics were extracted from interview transcripts.

Results:

Twenty-four participants were interviewed; 15 (63%) perceived differences between interventions despite blinding, due to glycemic control or side effects. Advantages that arose were better glycemic control, in particular postprandially, requiring less insulin, and ease of use. Disadvantages were thought to be adverse effects, increased incidence of hypoglycemia, and increased pill burden. Thirteen (54%) participants were interested in using low-dose empagliflozin beyond the study.

Conclusions:

Many participants had positive experiences with low-dose empagliflozin as an adjunct to the hybrid closed-loop therapy. A dedicated study with unblinding would be beneficial to better characterize patient-reported outcomes.
The effect of outsourcing and insourcing on Agile and DevOps
Authors: Langerman Josef , Leung Wai Sze
Published: May 2023

The Chief Information Officer of the Standard Bank Group, Brenda Niehaus, was contemplating her next steps. It is 2014 and she has just been appointed in her role and was burdened with a considerable set of challenges. Standard Bank Group’s IT costs were far above industry benchmarks, delivery was slow, staff was unhappy and there were a couple of large signature projects that were over time and budget by orders of magnitudes. Her predecessor has embarked on a large whole scale outsourcing journey and a decision needs to be made if that will continue. Dawie Olivier, her Head of Build, advocates something different: Agile and DevOps. The dream in this approach is to have many small cross-functional two-pizza teams that work together in close proximity and build software. The code created on a developer’s laptop will then seamlessly deploy to production automatically without the interference of pesky change control boards or some manual intervention. Should she continue with outsourcing or insource and focus on Agile? What she didn’t realise was that her successors will all face a similar situation and that answers will not be ready at hand. Many organisations face a similar dilemma of balancing outsourcing, Agile, DevOps and general constraints around skilled resources. We provide a rich narrative of the choices CIOs face in developing countries around these themes to help students understand the risks and opportunities these different approaches bring.
Money in the age of bits and bytes: Technology in reshaping finance
Authors: Dananjayan Madhava Priya , Gopakumar Sridevi , Narayanasamy Parthasarathi
Published: May 2023

In contemporary times, there has been a growing convergence between the finance and technology sectors. The emergence of FinTech has revolutionized the delivery of financial services and created new opportunities for innovation in the financial sector. The use of artificial intelligence, blockchain, and mobile banking are examples of how technology is reshaping the financial industry. This case explores the emergence of the Indian banking sector’s adoption of technology, starting with computerization in the late 1980’s and its growth through to the present day. Financial services have benefited from technology in the form of streamlined processes, lower costs, happier customers, and easier access to relevant data. In addition, by using technology, risk can be evaluated, superior investments can be made, and customer habits may be comprehended. Conversely, technology presents a set of difficulties such as cybersecurity risks, financial misconduct, prejudiced algorithms, and the marginalization of specific demographics from digital financial amenities. This case brings out the perspective that the future of financial services is expected to be shaped in large part by the effects of technological progress.
Cooking Class Travel in Thailand: An Investigation of Value Co-Creation Experiences
Authors: Qian Jianwei , Lin Pearl , Wei Jiewen , Liu Ting , Nuttavuthisit Krittinee
Published: May 2023

Cooking class travel (CCT) is a special form of food economy that is emerging worldwide, especially in Southeast Asian countries, such as Thailand. CCT is a touristic activity with strong value co-creation characteristics, but it is scarcely investigated on how tourists and hosts can work together to co-create the experience and value in CCT. Thus, based on value co-creation theory, this study adopts a rigorous content analysis approach to inspect the value co-creation mechanism of CCT in Thailand. Results reveal a value co-creation framework for CCT—from resources to practices to the final outcomes—offering academia and practitioners an in-depth insight into this fast-developing type of tourism economy and extending value co-creation theory to a new research area.
scMEB: a fast and clustering-independent method for detecting differentially expressed genes in single-cell RNA-seq data
Authors: Zhu Jiadi , Yang Youlong
Published: May 2023

Background

Cell clustering is a prerequisite for identifying differentially expressed genes (DEGs) in single-cell RNA sequencing (scRNA-seq) data. Obtaining a perfect clustering result is of central importance for subsequent analyses, but not easy. Additionally, the increase in cell throughput due to the advancement of scRNA-seq protocols exacerbates many computational issues, especially regarding method runtime. To address these difficulties, a new, accurate, and fast method for detecting DEGs in scRNA-seq data is needed.

Results

Here, we propose single-cell minimum enclosing ball (scMEB), a novel and fast method for detecting single-cell DEGs without prior cell clustering results. The proposed method utilizes a small part of known non-DEGs (stably expressed genes) to build a minimum enclosing ball and defines the DEGs based on the distance of a mapped gene to the center of the hypersphere in a feature space.

Conclusions

We compared scMEB to two different approaches that could be used to identify DEGs without cell clustering. The investigation of 11 real datasets revealed that scMEB outperformed rival methods in terms of cell clustering, predicting genes with biological functions, and identifying marker genes. Moreover, scMEB was much faster than the other methods, making it particularly effective for finding DEGs in high-throughput scRNA-seq data. We have developed a package scMEB for the proposed method, which could be available at https://github.com/FocusPaka/scMEB.
Detection of blaNDM−1,mcr-1 and MexB in multidrug resistant Pseudomonas aeruginosa isolated from clinical specimens in a tertiary care hospital of Nepal
Authors: Sharma Samikshya , Devkota Madhu Dixit , Pokhrel Bharat Mani , Banjara Megha Raj
Published: May 2023

Introduction

Pseudomonas aeruginosa is an opportunistic pathogen, which causes healthcare-associated infections in immunosuppressed patients. They exhibit resistance to multiple classes of antibiotics via various mechanisms such as the over-expression of efflux pumps, decreased production of the outer membrane protein (D2 porin), over-expression of the chromosomally encoded AmpC cephalosporinase, modification of drugs, and mutation(s) at the target site of the drug. The bacteria also develop antibiotic resistance through the acquisition of resistance genes carried on mobile genetic elements. Limited data on phenotypic as well as genotypic characterization of MDR P. aeruginosa in Nepal infers the needs for this study. This study was carried out to determine the prevalence rate of metallo-β-lactamase (MBL-producer) as well as colistin resistant multidrug resistant (MDR) P. aeruginosa in Nepal and also to detect MBL, colistin resistance, and efflux pump encoding genes i.e. blaNDM−1, mcr-1 and MexB respectively in MDR P. aeruginosa isolated from clinical samples.

Methods/methodology

A total of 36 clinical isolates of P. aeruginosa were collected. All bacterial isolates were phenotypically screened for antibiotic susceptibility using Kirby Bauer Disc Diffusion method. All the multidrug resistant P. aeruginosa were phenotypically screened for MBL producer by Imipenem-EDTA combined disc diffusion test (CDDT). Similarly, MIC value for colistin was also determined by broth microdilution method. Genes encoding carbapenemase (blaNDM−1), colistin resistant (mcr-1) and efflux pump activity (MexB) were assayed by PCR.

Results

Among 36 P. aeruginosa, 50% were found to be MDR among which 66.7% were found to be MBL producer and 11.2% were found to be colistin resistant. Among MDR P. aeruginosa, 16.7%, 11.2% and 94.4% were found to be harbouring blaNDM−1, mcr-1 and MexB genes respectively.

Conclusion

In our study, carbapenemase production (encoded by blaNDM−1), colistin resistant enzyme production (encoded by mcr-1), and expression of efflux pump (encoded by MexB) are found to be one of the major causes of antibiotic resistance in P. aeruginosa. Therefore, periodic phenotypic as well as genotypic study in Nepal on P. aeruginosa would provide the scenario of resistance pattern or mechanisms in P. aeruginosa. Furthermore, new policies or rules can be implemented in order to control the P. aeruginosa infections.
Preoptimisation in patients with acute obstructive colon cancer (PREOCC) – a prospective registration study protocol
Authors: Boeding Jeske R. E. , Gobardhan Paul D. , Rijken Arjen M. , Seerden Tom C. J. , Verhoef Cornelis , Schreinemakers Jennifer M. J.
Published: May 2023

Background

Postoperative mortality and morbidity rates are high in patients with obstructing colon cancer (OCC). Different treatment options have been evaluated over the years, mainly for left sided OCC. Optimising the preoperative health condition in elective colorectal cancer (CRC) treatment shows promising results. The aim of this study is to determine whether preoptimisation is feasible in patients with OCC, with a special interest/focus on right-sided OCC, and if, ultimately, optimisation reduces mortality and morbidity (stoma rates, major and minor complications) rates in OCC.

Methods

This is a prospective registration study including all patients presenting with OCC in our hospital. Patients with OCC, treated with curative intent, will be screened for eligibility to receive preoptimisation before surgery. The preoptimisation protocol includes; decompression of the small bowel with a NG-tube for right sided obstruction and SEMS or decompressing ileostomy or colostomy, proximal to the site of obstruction, for left sided colonic obstructions. For the additional work-up, additional nutrition by means of parenteral feeding (for patients who are dependent on a NG tube) or oral/enteral nutrition (in case the obstruction is relieved) is provided. Physiotherapy with attention to both cardio and muscle training prior surgical resection is provided. The primary endpoint is complication-free survival (CFS) at the 90 day period after hospitalisation. Secondary outcomes include pre- and postoperative complications, patient- and tumour characteristics, surgical procedures, total in hospital stay, creation of decompressing and/or permanent ileo- or colostomy and long-term (oncological) outcomes.

Discussion

Preoptimisation is expected to improve the preoperative health condition of patients and thereby reduce postoperative complications.

Trial registration

Trial Registry: NL8266 date of registration: 06-jan-2020.

Study status

Open for inclusion.
Oxidative balance score and dietary phytochemical index can reduce the risk of colorectal cancer in Iranian population
Authors: Bentyaghoob Shahrooz , Dehghani Fereshteh , Alimohammadi Arezoo , Shateri Zainab , Kahrizsangi Masoud Amini , Nejad Elham Tavassoli , Nouri Mehran , Rashidkhani Bahram
Published: May 2023

Background

No previous study has assessed the association between oxidative balance score (OBS) and dietary phytochemical index (DPI) with colorectal cancer (CRC) simultaneously. Therefore, this study investigated the association between OBS and DPI with the odds of CRC among the Iranian population.

Methods

This hospital-based age and sex-matched case–control study was conducted between September 2008 and January 2010 (142 controls and 71 cases were entered for analysis). New diagnosed CRC cases were selected from the Cancer Institute, Imam Khomeini Hospital of Tehran. Dietary intakes were determined by a semi-quantitative food frequency questionnaire (FFQ). Then, dietary indices were calculated by food items and nutrient intake. Logistic regression was utilized for assessing the tertiles of OBS and DPI.

Results

In multivariate analysis, OBS was associated with a 77% reduction in CRC odds in the last tertile than the first tertile (odds ratio (OR) = 0.23, confidence interval (CI): 0.07–0.72, Ptrend = 0.017). Also, we found a 64% reduction in CRC odds in the last tertile of DPI compared to the first tertile (OR = 0.36, CI: 0.15–0.86, Ptrend = 0.015).

Conclusions

A diet rich in phytochemicals and anti-oxidants, including fruits and vegetables (citrus fruits, colored berries, and dark-green leafy vegetables) and whole grains, may reduce the CRC odds.
Long term changes in thrombocytopenia and leucopenia after HCV eradication with direct-acting antivirals
Authors: Tajiri Kazuto , Okada Kazuhiko , Ito Hiroyuki , Kawai Kengo , Kashii Yoshiro , Tokimitsu Yoshiharu , Muraishi Nozomu , Murayama Aiko , Hayashi Yuka , Minemura Masami , Takahara Terumi , Shimizu Yukihiro , Yasuda Ichiro
Published: May 2023

Background

Thrombocytopenia due to hypersplenism is a major complication of hepatitis C virus (HCV)-associated cirrhosis. HCV eradication improves these complications in some patients, but the long-term effects of HCV eradication on these complications remain unclear, especially in patients treated with direct acting antivirals (DAAs). The aim was to evaluate long term changes in thrombocytopenia and leucopenia after HCV eradication with DAAs.

Methods

The present multicenter study retrospectively evaluated changes over 5 years in thrombocytopenia and leukocytopenia, as well as changes in liver fibrosis markers and spleen size, in 115 patients with HCV-cirrhosis treated with DAAs.

Results

Thrombocytopenia and leukocytopenia were improved 4 weeks after DAA administration, with thrombocytopenia show further gradual improvement over the next year. Fib-4 index was markedly reduced 1 year after DAA, followed by subsequent gradual reduction over the next 4 years. Spleen size showed gradual annual reductions, with patients experiencing spleen size reduction characterized at baseline by bilirubinemia.

Conclusions

Rapid DAA-associated HCV eradication might lead to rapid disappearance of liver inflammation and bone marrow suppression due to HCV infection. HCV eradication may gradually improve portal hypertension, reducing spleen size.
Brain‐oscillation-synchronized stimulation to enhance motor recovery in early subacute stroke: a randomized controlled double‐blind three‐ arm parallel‐group exploratory trial comparing personalized, non‐ personalized and sham repetitive transcranial magnetic stimulation (Acronym: BOSS-STROKE)
Authors: Lieb Anne , Zrenner Brigitte , Zrenner Christoph , Kozák Gábor , Martus Peter , Grefkes Christian , Ziemann Ulf
Published: May 2023

Background

Stroke is a major cause of death and the most frequent cause of permanent disability in western countries. Repetitive transcranial brain stimulation (rTMS) has been used to enhance neuronal plasticity after stroke, yet with only moderate effect sizes. Here we will apply a highly innovative technology that synchronizes rTMS to specific brain states identified by real-time analysis of electroencephalography.

Methods

One hundred forty-four patients with early subacute ischemic motor stroke will be included in a multicenter 3-arm parallel, randomized, double-blind, standard rTMS and sham rTMS-controlled exploratory trial in Germany. In the experimental condition, rTMS will be synchronized to the trough of the sensorimotor µ-oscillation, a high-excitability state, over ipsilesional motor cortex. In the standard rTMS control condition the identical protocol will be applied, but non-synchronized to the ongoing µ-oscillation. In the sham condition, the same µ-oscillation-synchronized protocol as in experimental condition will be applied, but with ineffective rTMS, using the sham side of an active/placebo TMS coil. The treatment will be performed over five consecutive work days (1,200 pulses per day, 6,000 pulses total). The primary endpoint will be motor performance after the last treatment session as measured by the Fugl-Meyer Assessment Upper Extremity.

Discussion

This study investigates, for the first time, the therapeutic efficacy of personalized, brain-state-dependent rTMS. We hypothesize that synchronization of rTMS with a high-excitability state will lead to significantly stronger improvement of paretic upper extremity motor function than standard or sham rTMS. Positive results may catalyze a paradigm-shift towards personalized brain-state-dependent stimulation therapies.

Trial registration

This study was registered at ClinicalTrials.gov (NCT05600374) on 10–21-2022.
The relationship between personality traits and individual factors with perinatal depressive symptoms: a cross-sectional study
Authors: Serra Riccardo , Giacchetti Nicoletta , Bersani Francesco Saverio , Cappannini Gaia , Martucci Melania , Panfili Matteo , Sogos Carla , Aceti Franca
Published: May 2023

Background

Pregnancy is a crucial transition moment exposing women to potential mental health problems, especially depressive disturbances. Sociodemographic, pregnancy-related, and psychological factors have been related to depressive symptoms in the perinatal period. This study aims at (1) exploring personality and individual factors related with perinatal depressive symptoms, and (2) testing the mediating role of personality in the relation between characteristics of the woman’s family of origin and depressive symptoms.

Methods

Women in the perinatal period admitted to the gynecology unit for motherhood-related routine assessments (n = 241) were included in the study. A survey on individual sociodemographic, clinical, and pregnancy-related factors was administered, also including the Edinburgh Postnatal Depression Scale (EPDS) and the BIG-5 personality test.

Results

Couple conflict and neuroticism were independent and directly correlated with EPDS total score (respectively: B = 2.337; p = .017; B = 0.303; p < .001). Neuroticism was a significant mediator of the relation between the presence of a psychiatric disorder diagnosis in participant’s parents and the EPDS total score (indirect b = 0.969; BCCI95%=0.366—1.607).

Conclusions

Couple relation and neuroticism traits are individual factors related to depressive symptoms in the perinatal period. The family of origin also plays an indirect role on perinatal depressive symptoms. Screening of these factors could lead to early recognition and more tailored treatments, ultimately leading to better outcome for the entire family.
CT radiomics features of meso-esophageal fat in predicting overall survival of patients with locally advanced esophageal squamous cell carcinoma treated by definitive chemoradiotherapy
Authors: Yan Shuo , Li Fei-Ping , Jian Lian , Zhu Hai-Tao , Zhao Bo , Li Xiao-Ting , Shi Yan-Jie , Sun Ying-Shi
Published: May 2023

Objective

To investigate the value of CT radiomics features of meso-esophageal fat in the overall survival (OS) prediction of patients with locally advanced esophageal squamous cell carcinoma (ESCC).

Methods

A total of 166 patients with locally advanced ESCC in two medical centers were retrospectively analyzed. The volume of interest (VOI) of meso-esophageal fat and tumor were manually delineated on enhanced chest CT using ITK-SNAP. Radiomics features were extracted from the VOIs by Pyradiomics and then selected using the t-test, the Cox regression analysis, and the least absolute shrinkage and selection operator. The radiomics scores of meso-esophageal fat and tumors for OS were constructed by a linear combination of the selected radiomic features. The performance of both models was evaluated and compared by the C-index. Time-dependent receiver operating characteristic (ROC) analysis was employed to analyze the prognostic value of the meso-esophageal fat-based model. A combined model for risk evaluation was constructed based on multivariate analysis.

Results

The CT radiomic model of meso-esophageal fat showed valuable performance for survival analysis, with C-indexes of 0.688, 0.708, and 0.660 in the training, internal, and external validation cohorts, respectively. The 1-year, 2-year, and 3-year ROC curves showed AUCs of 0.640–0.793 in the cohorts. The model performed equivalently compared to the tumor-based radiomic model and performed better compared to the CT features-based model. Multivariate analysis showed that meso-rad-score was the only factor associated with OS.

Conclusions

A baseline CT radiomic model based on the meso-esophagus provide valuable prognostic information for ESCC patients treated with dCRT.
Dual-stage cognitive assessment: a two-stage screening for cognitive impairment in primary care
Authors: Cui Liang , Zhang Zhen , Huang Lin , Li Qinjie , Guo Yi-Han , Guo Qi-Hao
Published: May 2023

Background

Aging population has led to an increased proportion of older adults and cognitively impaired. We designed a brief and flexible two-stage cognitive screening scale, the Dual-Stage Cognitive Assessment (DuCA), for cognitive screening in primary care settings.

Method

In total, 1,772 community-dwelling participants were recruited, including those with normal cognition (NC, n = 1,008), mild cognitive impairment (MCI, n = 633), and Alzheimer’s disease (AD, n = 131), and administered a neuropsychological test battery and the DuCA. To improve performance, the DuCA combines visual and auditory memory tests for an enhanced memory function test.

Results

The correlation coefficient between DuCA-part 1 and DuCA-total was 0.84 (P < 0.001). The correlation coefficients of DuCA-part 1 with Addenbrooke’s Cognitive Examination III (ACE-III) and Montreal Cognitive Assessment Basic (MoCA-B) were 0.66 (P < 0.001) and 0.85 (P < 0.001), respectively. The correlation coefficients of DuCA-total with ACE-III and MoCA-B were 0.78 (P < 0.001) and 0.83 (P < 0.001), respectively. DuCA-Part 1 showed a similar discrimination ability for MCI from NC (area under curve [AUC] = 0.87, 95%CI 0.848–0.883) as ACE III (AUC = 0.86, 95%CI 0.838–0.874) and MoCA-B (AUC = 0.85, 95%CI 0.830–0.868). DuCA-total had a higher AUC (0.93, 95%CI: 0.917–0.942). At different education levels, the AUC was 0.83–0.84 for DuCA-part 1, and 0.89–0.94 for DuCA-total. DuCA-part 1 and DuCA-total’s ability to discriminate AD from MCI was 0.84 and 0.93, respectively.

Conclusion

DuCA-Part 1 would aid rapid screening and supplemented with the second part for a complete assessment. DuCA is suited for large-scale cognitive screening in primary care, saving time and eliminating the need for extensively training assessors.
Combined pituitary hormone deficiency harboring CHD7 gene missense mutation without CHARGE syndrome: a case report
Authors: Obata Yoshinari , Takayama Kana , Nishikubo Hideyuki , Tobimatsu Aoki , Matsuda Izumi , Uehara Yuhei , Maruo Yumiko , Sho Hiroyuki , Kosugi Motohiro , Yasuda Tetsuyuki
Published: May 2023

Background

Heterozygous loss-of-function mutations in the chromodomain helicase DNA-binding protein 7 (CHD7) gene cause CHARGE syndrome characterized by various congenital anomalies. A majority of patients with CHARGE syndrome present with congenital hypogonadotropic hypogonadism (HH), and combined pituitary hormone deficiency (CPHD) can also be present. Whereas CHD7 mutations have been identified in some patients with isolated HH without a diagnosis of CHARGE syndrome, it remains unclear whether CHD7 mutations can be identified in patients with CPHD who do not fulfill the criteria for CHARGE syndrome.

Case presentation

A 33-year-old woman was admitted to our hospital. She had primary amenorrhea and was at Tanner stage 2 for both pubic hair and breast development. She was diagnosed with CPHD (HH, growth hormone deficiency, and central hypothyroidism), and a heterozygous rare missense mutation (c.6745G > A, p.Asp2249Asn) in the CHD7 gene was identified. Our conservation analysis and numerous in silico analyses suggested that this mutation had pathogenic potential. She had mild intellectual disability, a minor feature of CHARGE syndrome, but did not fulfill the criteria for CHARGE syndrome.

Conclusions

We report a rare case of CPHD harboring CHD7 mutation without CHARGE syndrome. This case provides valuable insights into phenotypes caused by CHD7 mutations. CHD7 mutations can have a continuous phenotypic spectrum depending on the severity of hypopituitarism and CHARGE features. Therefore, we would like to propose a novel concept of CHD7-associated syndrome.
Favorable cervical cancer mortality-to-incidence ratios of countries with good human development index rankings and high health expenditures
Authors: Shen Tzu-Tsen , Long Cheng-Yu , Wu Ming-Ping
Published: May 2023

Background

Cervical cancer is highly preventable. The mortality-to-incidence ratio (MIR) is a marker that reflects the available screening interventions and clinical outcomes of cancer treatments. The association between the MIR for cervical cancer and cancer screening disparities among countries is an interesting issue but rarely investigated. The present study sought to understand the association between the cervical cancer MIR and the Human Development Index (HDI).

Methods

Cancer incidence and mortality rates were obtained from the GLOBOCAN database. The MIR was defined as the ratio of the crude mortality rate to the incidence rate. We used linear regression to analyze the correlation of MIRs with the HDI and current health expenditure (CHE) in 61 countries selected based on data quality.

Results

The results showed lower incidence and mortality rates and MIRs in more developed regions. In terms of regional categories, Africa had the highest incidence and mortality rates and MIRs. The incidence and mortality rates and MIRs were lowest in North America. Furthermore, favorable MIRs were correlated with a good HDI and high CHE as a percentage of gross domestic product (CHE/GDP) (both p < 0.0001).

Conclusions

The MIR variation for cervical cancer is associated with the ranking of the health system and health expenditure, which further supports the role of cancer screening and treatment disparities in clinical outcomes. The promotion of cancer screening programs can reduce the cervical cancer global incidence and mortality rates and MIRs.
The severity of menopause and associated factors among middle-aged women residing in Arba Minch, DHSS, Ethiopia, 2022
Authors: Misiker Begosew , Kashala Kefita , Misker Direslgne
Published: May 2023

Background

Menopause is a common practice in women, and it is recognized as a complete pause of menses for more than twelve months. A decrease in sex hormone levels particularly estrogen in the blood is associated with different types of menopausal symptoms. Those symptoms include different psychological, vasomotor, physical, and sexual symptoms. They are among the major public health problems of middle-aged women. Particularly severe forms of menopausal symptoms are bothersome for middle-aged women. However, little is known about the severity status and associated factors of menopausal symptoms among middle-aged women in the study area.

Objective

The main aim of the present study was to assess the severity of menopausal symptoms and associated factors among middle-aged women residing in Arba Minch DHSS.

Methods and materials

Community-based crossectional study was employed. A single population proportion formula was used to determine the sample size. A total of 423 study participants were recruited to conduct the study. A simple random sampling technique was used to employ study participants. Proportional sample size allocation formula was used to allocate study participants in each Kebele of Arba Minch DHSS (demographic and health surveillance site). A menopausal rating scale was used to assess the severity status of Menopausal symptoms. The collected data were analyzed by using SPSS version 20. A descriptive analysis was made to describe the Sociodemographic characteristics of the study participants. Moreover, binary and ordinal logistic regressions were used to identify the factors associated with the severity of menopausal symptoms among middle-aged women. On binary logistic regression variables with p-value < 0.25 were eligible for ordinal logistic regression. Variables with a p-value < 0.05 were considered statistically significant.

Result

The present study revealed that the prevalence of menopausal symptoms was 88.7%. According to the Menopausal rating scale, 91.7% of the study participants were Asymptomatic, 6.6% of them were mild in severity, 1.4% of them were moderate and the remaining 0.23% individuals were severe menopausal symptoms. The most severe menopausal symptom was the sexual problem. The factors that have a significant association with the severity of menopausal symptoms were Age with [AOR = 1.46(95%CI: 1.27–1.64)] and history of chronic disease with [AOR = 2.56(95%CI: 1.78–3.4)] and p < 0.001.

Conclusion and recommendation

Generally, menopausal symptoms among middle-aged women were common. Asymptomatic and mild forms are the dominant severity forms of menopausal symptoms. Age and history of chronic diseases have statistically significant associations with the severity of menopausal symptoms. The ministry of health, researchers, and different stakeholders are recommended to be concerned about this neglected issue.
Meningeal immunity and neurological diseases: new approaches, new insights
Authors: Su Yun , Zheng Huimin , Shi Changhe , Li Xinwei , Zhang Shuyu , Guo Guangyu , Yu Wenkai , Zhang Shuo , Hu Zhengwei , Yang Jing , Xia Zongping , Mao Chengyuan , Xu Yuming
Published: May 2023

The meninges, membranes surrounding the central nervous system (CNS) boundary, harbor a diverse array of immunocompetent immune cells, and therefore, serve as an immunologically active site. Meningeal immunity has emerged as a key factor in modulating proper brain function and social behavior, performing constant immune surveillance of the CNS, and participating in several neurological diseases. However, it remains to be determined how meningeal immunity contributes to CNS physiology and pathophysiology. With the advances in single-cell omics, new approaches, such as single-cell technologies, unveiled the details of cellular and molecular mechanisms underlying meningeal immunity in CNS homeostasis and dysfunction. These new findings contradict some previous dogmas and shed new light on new possible therapeutic targets. In this review, we focus on the complicated multi-components, powerful meningeal immunosurveillance capability, and its crucial involvement in physiological and neuropathological conditions, as recently revealed by single-cell technologies.