bluuebunny/crossref_metadata_2025 huggingface dataset:
A Critical Discourse Problematization Framework (CDPF) analysis of “Double Reduction” policy in China
Authors: Zhao Chenyi
Published: January 2024

This paper examines the “Double Reduction” policy issued by the Chinese government in 2021 by using a Critical Discourse Problematization Framework (CDPF) that combines Critical Discourse Analysis (CDA) and what’s the problem represented to be (WPR) approach. The study points out that the changing discourse of equality and equity in China is crucial for understanding the assumptions and presuppositions that lie behind and shape the “Double Reduction” policy. The analysis of the policy text conveys that the government views the privatization of education in China as being responsible for the lowered quality of public education, the competitive learning environment, and financial and mental pressure on families and parents. However, this study reveals the silent part of the “Double Reduction” policy through the WPR approach, which demonstrates that privatization of education is not the root cause of educational inequality/injustice in China. The work of this critical policy analysis aims to better understand the dilemma of education in China and provide insights to the policymakers, educators, and related stakeholders from the perspective of changing policy discourse.
Combination of Palbociclib and Endocrine Therapy in Hormone Receptor-Positive and Human Epidermal Growth Factor Receptor 2-Negative Metastatic Breast Cancer With or Without Brain Metastases
Authors: Zhang Qiuyi , Lan Xiaofeng , Huang Jiayi , Xie Xiaofeng , Chen Liping , Song Lin , Bai Xue , Chen Xuelian , Jing Haiman , Du Caiwen
Published: January 2024

Objective

This real-world study aimed to investigate the efficacy and safety of palbociclib plus endocrine therapy in patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative metastatic breast cancer in the real world in a Chinese population.

Methods

The clinical data of consecutively enrolled patients from the Cancer Hospital Chinese Academy of Medical Sciences, Shenzhen Center, and the University of Hong Kong - Shenzhen Hospital were collected. Progression-free survival curves were generated using log-rank tests with the Kaplan-Meier method. Univariate and multivariate logistic regression analyses were performed to identify the factors affecting progression-free survival.

Results

In total, 118 patients were enrolled, including 6 patients with brain metastases. At the last follow-up date, the median progression-free survival was 16.8 months (95% confidence interval, 11.1-22.5), with the 6-month and 12-month progression-free survival rates of 77.1% and 57.6%, respectively. The disease control rate and the intracranial disease control rate were 82.2% and 50%, respectively. A longer progression-free survival was observed for patients with the following characteristics: treatment-naive; without hepatic metastasis; sensitive to previous endocrine therapy and harboring fewer metastatic sites. The multivariate logistic regression analysis demonstrated that treatment lines and exposure to palliative chemotherapy were independent influencing factors of progression-free survival.

Conclusions

Palbociclib plus endocrine therapy in patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative metastatic breast cancer was effective and well-tolerated, even in patients with brain metastases. More benefits were observed in frontline therapy, chemotherapy-naive, and endocrine therapy–sensitive patients with fewer metastatic sites.
Prediction Model of Ocular Metastases in Gastric Adenocarcinoma: Machine Learning-Based Development and Interpretation Study
Authors: Zou Jie , Shen Yan-Kun , Wu Shi-Nan , Wei Hong , Li Qing-Jian , Xu San Hua , Ling Qian , Kang Min , Liu Zhao-Lin , Huang Hui , Chen Xu , Wang Yi-Xin , Liao Xu-Lin , Tan Gang , Shao Yi
Published: January 2024

Background: Although gastric adenocarcinoma (GA) related ocular metastasis (OM) is rare, its occurrence indicates a more severe disease. We aimed to utilize machine learning (ML) to analyze the risk factors of GA-related OM and predict its risks. Methods: This is a retrospective cohort study. The clinical data of 3532 GA patients were collected and randomly classified into training and validation sets in a ratio of 7:3. Those with or without OM were classified into OM and non-OM (NOM) groups. Univariate and multivariate logistic regression analyses and least absolute shrinkage and selection operator were conducted. We integrated the variables identified through feature importance ranking and further refined the selection process using forward sequential feature selection based on random forest (RF) algorithm before incorporating them into the ML model. We applied six ML algorithms to construct the predictive GA model. The area under the receiver operating characteristic (ROC) curve indicated the model's predictive ability. Also, we established a network risk calculator based on the best performance model. We used Shapley additive interpretation (SHAP) to identify risk factors and to confirm the interpretability of the black box model. We have de-identified all patient details. Results: The ML model, consisting of 13 variables, achieved an optimal predictive performance using the gradient boosting machine (GBM) model, with an impressive area under the curve (AUC) of 0.997 in the test set. Utilizing the SHAP method, we identified crucial factors for OM in GA patients, including LDL, CA724, CEA, AFP, CA125, Hb, CA153, and Ca2+. Additionally, we validated the model's reliability through an analysis of two patient cases and developed a functional online web prediction calculator based on the GBM model. Conclusion: We used the ML method to establish a risk prediction model for GA-related OM and showed that GBM performed best among the six ML models. The model may identify patients with GA-related OM to provide early and timely treatment.
A Randomized, Placebo-controlled, Double-blind Clinical Trial of Bacteriophage Cocktails in Chronic Wound Infections
Authors: Karn Subhash Lal , Bhartiya Satyanam Kumar , Pratap Arvind , Saroj Sanjay Kumar , Kumar Rajesh , Sahu Minakshi , Gangwar Mayank , Nath Gopal
Published: January 2024

Background

Chronic wounds are prevalent globally at endemic proportions. The common features associated with chronic wounds are prolonged inflammatory phase, infection with multidrug-resistant (MDR) bacteria, and subsequent biofilm formation. The present randomized-controlled trial (RCT) study was undertaken on chronic wounds of ≥6 weeks longer duration using customized phages to evaluate the efficacy and safety of bacteriophage therapy.

Methods

The study was conducted from December 2021 to August 2023. Thirty patients in each of the arms (placebo and bacteriophage) were recruited with chronic wounds. The patients, both arms, received the conventional treatment of wound debridement, local antiseptics, and local and systemic antibiotics at the discretion of the treating surgeon. However, before applying the customized bacteriophage cocktail or placebo, the wound surface was thoroughly washed to remove the residual antiseptics. The phage cocktails or placebo were applied on alternate days. The wounds were evaluated using the Bates-Jensen Wound Assessment Tool for the progress of wound healing.

Results

A total of 93.3% of the wound became sterile in 39 days (median sterility time), followed by complete healing by the end of 90 days in the phage group. Contrary to this, 83.3% of those on placebo therapy remained colonized by original bacteria or additional new bacteria without healing for up to 90 days.

Conclusion

With the well-designed RCT, we could conclude that customized bacteriophage therapy using bacteriophage cocktails will definitely cure the chronic wound, irrespective of age, sex, diabetes status, and infection by MDR bacteria.
Identifying Playfulness: An Empirical Study on How Adults Recognize and Define Playfulness Across Culture
Authors: Masek Leland
Published: January 2024

Playfulness is a critical concept for the study of games, play, and adult well-being. Empirical and theoretical works have argued for the major influence it has in adult lives around the globe. Despite these affirmations, one of the most commonly described barriers for further work is that there remains little clarity on how playfulness can be identified in diverse contexts. Most definitions are created for narrow applications with little evidence that they apply to other contexts. The inability to identify playfulness, especially across culture, thus remains a major gap for modern researchers. This work addresses this gap with 50 interviews by adults from 38 countries around the world on how they identify playfulness in their own life. Adults across culture identify playfulness with four characteristics: Active Behavior, Emotional Reinforcement, Social Sharing, and Non-Serious Framing. This four-part framework creates a clarifying and innovative vocabulary for future works on playfulness.
The best of times, the worst of times: Continuities in school leaders' work in uncertain times
Authors: Thomson Pat , Greany Toby
Published: January 2024

The COVID 19 pandemic created new challenges for school leaders. They worked very long hours in difficult circumstances. Improvising and responding quickly to poorly timed central guidelines had an adverse effect on their health and wellbeing. Our mixed methods studies show that leaders’ pandemic work was largely directed to establishing new management routines as well as dealing with people. Henri Lefebvre's rhythmanalysis allows us to see that leaders managed their pre-, during and post-pandemic work by working ‘after hours’. The analysis suggests that tackling wellbeing and workload and developing more sustainable leadership careers requires a fundamental redesign of the ways in which leaders’ work is carried out.
Genetic and phenotypic analyses of PRRT2 positive and negative paroxysmal kinesigenic dyskinesia
Authors: Zhang Yingying , Ren Jiechuan , Yang Tianhua , Xiong Weixi , Qin Linyuan , An Dongmei , Hu Fayun , Zhou Dong
Published: January 2024

Background:

Paroxysmal kinesigenic dyskinesia (PKD) is a rare neurological disorder, characterized by attacks of involuntary movements triggered by sudden action. Variants in proline-rich transmembrane protein 2 ( PRRT2) are the most common genetic cause of PKD.

Objective:

The objective was to investigate the clinical and genetic characteristics of PKD and to establish genotype–phenotype correlations.

Methods:

We enrolled 219 PKD patients, documented their clinical information and performed PRRT2 screening using Sanger sequencing. Whole exome sequencing was performed on 49 PKD probands without PRRT2 variants. Genotype–phenotype correlation analyses were conducted on the probands.

Results:

Among 219 PKD patients (99 cases from 39 families and 120 sporadic cases), 16 PRRT2 variants were identified. Nine variants (c.879+4A>G, c.879+5G>A, c.856G>A, c.955G>T, c.884G>C, c.649C>T, c.649dupC, c.649delC and c.696_697delCA) were previously known, while seven were novel (c.367_403del, c.347_348delAA, c.835C>T, c.116dupC, c.837_838insC, c.916_937del and c.902G>A). The mean interval from onset to diagnosis was 7.94 years. Compared to patients without PRRT2 variants, patients with the variants were more likely to have a positive family history, an earlier age of onset and a higher prevalence of falls during pre-treatment attacks (27.14% versus 8.99%, respectively). Patients with truncated PRRT2 variants tend to have bilateral attacks. We identified two transmembrane protein 151A ( TMEM151A) variants including a novel variant (c.368G>C) and a reported variant (c.203C>T) in two PRRT2-negative probands with PKD.

Conclusion:

These findings provide insights on the clinical characteristics, diagnostic timeline and treatment response of PKD patients. PKD patients with truncated PRRT2 variants may tend to have more severe paroxysmal symptoms. This study expands the spectrum of PRRT2 and TMEM151A variants. Carbamazepine and oxcarbazepine are both used as a first-line treatment choice for PKD patients.
Therapeutic potential of adiponectin in prediabetes: strategies, challenges, and future directions
Authors: Abdalla Mona Mohamed Ibrahim
Published: January 2024

Adiponectin, an adipose-derived hormone, plays a pivotal role in glucose regulation and lipid metabolism, with a decrease in circulating adiponectin levels being linked to insulin resistance and prediabetes. This review examines the therapeutic potential of adiponectin in managing prediabetes, elucidating on multiple aspects including its role in glucose and lipid metabolism, influence on insulin sensitivity, and anti-inflammatory properties. Moreover, the paper highlights the latest strategies to augment adiponectin levels, such as gene therapy, pharmacological interventions, dietary modifications, and lifestyle changes. It also addresses the challenges encountered in translating preclinical findings into clinical practice, primarily related to drug delivery, safety, and efficacy. Lastly, the review proposes future directions, underlining the need for large-scale human trials, novel adiponectin analogs, and personalized treatment strategies to harness adiponectin’s full therapeutic potential in preventing the transition from prediabetes to diabetes.
Metamorphosis of India’s electronic consumer device landscape: Case study of Asia’s most successful brand – boAt
Authors: Jain Akshat , Jain Prateek
Published: January 2024

boAt is an Indian-based consumer electronics business that sells earbuds, headphones stereos, portable chargers and luxury tough cables. It was founded in 2015. The co-founders Sameer Ashok Mehta and Aman Gupta founded Imagine Marketing Services Private Limited, in November 2013 which does business as boAt. The company has emerged as one of the prominent home-grown D2C brands that challenged market leaders in the earphones and wearable space. Overall, the company’s total annual profits surged nearly 61% to Rs 78.6 crore (INR 786 million) during FY21 from Rs 48.8 crore (INR 488 million) during FY20. The company’s success continued into FY22, where its revenue soared to 28.86 billion, accompanied by a profit (after tax) of ₹79 crore (INR 790 million). boAt’s remarkable performance in the consumer electronics market made it a notable player in the industry. In the fiscal year 2021–2022, boAt had set a revenue target of 500 crore (INR 5 billion). It was then the responsibility of the managing director, Aman Gupta, and his team to devise a strategic plan to achieve this goal. They faced the challenge of addressing potential issues anticipated by the team. Aman and his staff were particularly concerned with the corporate plan to offset the declining return on equity. They also had to formulate marketing strategies aimed at ensuring future sustainable growth for the company. This case study offered valuable insights into the changing landscape of India’s consumer device market and the strategies implemented by boAt’s management for successful navigation in the industry.
Prevalence and associated factors of needle stick and sharp injuries among nurses: A cross-sectional study
Authors: Abdo Almoliky Mokhtar , Elzilal Hala A. , Alzahrani Eman , Abo-Dief Hala M. , Saleh Khalil A. , Alkubati Sameer A. , Saad Mousa S. , Sultan Mujeeb A.
Published: January 2024

Objectives:

Workplace safety is essential to occupational health practices among healthcare providers, especially for nurses vulnerable to work-related hazards such as needle stick and sharp injuries. In Yemen, the underestimation and absence of reporting system and lack of health supplies in a collapsed health system exacerbated the needle stick and sharp injuries. This study aimed to identify the prevalence and associated factors of needle stick and sharp injuries among nurses in Taiz, Yemen.

Methods:

A cross-sectional study was conducted on a sample of 151 nurses working in three public hospitals in Taiz City. A semi-structured questionnaire was designed and delivered to the participants.

Results:

The prevalence of needle stick and sharp injuries among nurses was very high (95.36%), and around half were injured more than five times. Female nurses and those in an emergency department were more likely to be subjected to needle stick and sharp injuries ( p = 0.018 and 0.021, respectively). Needle stick was the most common cause of injury (62.77%), and the fingers were the most exposed injury site (79.17%). Non-reporting injuries were very high (73.61%), and only one-third (34.21%) of them proceeded in the process of management, and less than one-quarter (23.68%) had been vaccinated.

Conclusion:

The prevalence of needle stick and sharp injuries among nurses in Taiz was very high, and determined by gender and place of work. Post-injury reporting and precautions were poor, which may increase the prevalence of hospital-acquired infections among clients and healthcare providers.
Barriers and facilitators of health professionals in adopting digital health-related tools for medication appropriateness: A systematic review
Authors: Rodrigues Daniela A. , Roque Maria , Mateos-Campos Ramona , Figueiras Adolfo , Herdeiro Maria Teresa , Roque Fátima
Published: January 2024

Objective

Digital health is described as the use and development of all types of digital technologies to improve health outcomes. It could be used to prevent medication errors, a priority for health systems worldwide. However, the adoption of such tools remains slow. This study aims to identify factors (attitudes, knowledge and beliefs) acting as barriers and/or facilitators reported by healthcare professionals (HCPs) for the adoption of digital health-related tools for medication appropriateness.

Methods

A systematic review was performed by searching the literature in the MEDLINE PubMed, and EMBASE scientific databases for original articles regarding qualitative and quantitative data.

Results

Fifteen articles were included and a total of 125 barriers and 108 facilitators were identified, consolidated and categorized into technical (n = 48), organizational (n = 12), economical (n = 4), user-related (n = 34), and patient-related (n = 8) components. The most often reported barriers and facilitators were technical component-related ones concerning the need for additional training (n = 6), the time consumed (n = 6), and the easy way of using or learning how to use the tools (n = 9), respectively. Regarding setting analysis, agreement with clinical decision recommendations and impact on the doctor–patient relationship were more valued in primary care, while the user interface and system design were in the hospital.

Conclusions

The barriers and facilitators identified in this study provide relevant information to developers and it can be used as a starting point for the designing of successful digital health-related tools, specifically related to medication appropriateness. Future research includes economic evaluation-focused studies and in-depth case studies of specific barriers and facilitators.
Reliability of ChatGPT for performing triage task in the emergency department using the Korean Triage and Acuity Scale
Authors: Kim Jae Hyuk , Kim Sun Kyung , Choi Jongmyung , Lee Youngho
Published: January 2024

Background

Artificial intelligence (AI) technology can enable more efficient decision-making in healthcare settings. There is a growing interest in improving the speed and accuracy of AI systems in providing responses for given tasks in healthcare settings.

Objective

This study aimed to assess the reliability of ChatGPT in determining emergency department (ED) triage accuracy using the Korean Triage and Acuity Scale (KTAS).

Methods

Two hundred and two virtual patient cases were built. The gold standard triage classification for each case was established by an experienced ED physician. Three other human raters (ED paramedics) were involved and rated the virtual cases individually. The virtual cases were also rated by two different versions of the chat generative pre-trained transformer (ChatGPT, 3.5 and 4.0). Inter-rater reliability was examined using Fleiss’ kappa and intra-class correlation coefficient (ICC).

Results

The kappa values for the agreement between the four human raters and ChatGPTs were .523 (version 4.0) and .320 (version 3.5). Of the five levels, the performance was poor when rating patients at levels 1 and 5, as well as case scenarios with additional text descriptions. There were differences in the accuracy of the different versions of GPTs. The ICC between version 3.5 and the gold standard was .520, and that between version 4.0 and the gold standard was .802.

Conclusions

A substantial level of inter-rater reliability was revealed when GPTs were used as KTAS raters. The current study showed the potential of using GPT in emergency healthcare settings. Considering the shortage of experienced manpower, this AI method may help improve triaging accuracy.
Adverse Events After Isolated Posterior Cruciate Ligament Reconstruction: A National Database Study
Authors: Kammien Alexander J. , Price Ryan C. , McLaughlin William M. , Park Nancy , Richter Dustin L. , Schenck Robert C. , Grauer Jonathan N. , Medvecky Michael J.
Published: January 2024

Background:

Optimal management after posterior cruciate ligament (PCL) injury remains an active area of research, as reconstruction is technically challenging and poses unique risks in the posterior knee. Studies have reported variable rates of complications.

Purpose:

To describe the rates of readmission, emergency department (ED) visits, and postoperative complications within 90 days of isolated PCL reconstruction (PCLR) in a large, national cohort to better understand the perioperative variables that influence a practitioner's decision of whether to pursue operative versus nonoperative management.

Study Design:

Descriptive epidemiology study.

Methods:

PCLRs from January 1, 2010, through August 31, 2020, were identified in PearlDiver, a national administrative database. Patients with concomitant ligament surgery and those with fewer than 90 days of postoperative database activity were excluded. Deep vein thromboses, pulmonary embolisms, surgical site infections, compartment syndrome, and vascular events within 90 days of surgery were identified, as were 90-day readmissions and ED visits. Logistic regression models were built in PearlDiver to calculate odds ratios (ORs) for ED utilization.

Results:

The final cohort consisted of 1154 patients with isolated PCLR (mean age, 34 ± 16 years; 62% male). Most patients were located in the Southern United States (n = 417; 36.1%), and most had commercial insurance (n = 992; 86%). The 90-day rates of adverse events were as follows: deep vein thrombosis (13; 1.1%), pulmonary embolism (19; 1.6%), surgical site infection (<11; <1%), compartment syndrome (<11; <1%), vascular event (<11; <1%), readmission (13, 1.1%), and ED utilization (99; 8.6%). The majority of emergency department visits (52%) occurred in the first 2 weeks postoperatively. Predictive factors for ED utilization included Elixhauser Comorbidity Index score (OR = 1.31 per 2-point increase) and Medicaid insurance (OR = 2.03 relative to commercial insurance).

Conclusion:

The current study reported rates of adverse events after isolated PCLR in a large, national cohort. The results provide important context for decisions about optimal management of PCL injury.
A Severe Case of Streptococcus pneumoniae Meningoencephalitis in an Infant Resulting in Fatal Strokes
Authors: Goodman Michelle , Garcia Mekka R. , Wang Heidy , Borja Maria J. , Miller Claire , Segal Devorah
Published: January 2024

Streptococcus pneumoniae (S. Pneumoniae) is a common cause of bacterial meningitis in the pediatric population, but rarely causes complications such as encephalitis, abscess, and seizures with the prompt initiation of proper antimicrobial therapy. In this report, we present a rare and severe case of S. Pneumoniae meningoencephalitis in a full term 6-month-old which progressed to multiple cerebral and cerebellar infarcts with concomitant cerebellar tonsillar herniation and hypercarbic respiratory failure requiring intubation and mechanical ventilation despite early initiation of antibiotics. Given the patient's clinical status and poor neurological prognosis, the family eventually opted for palliative extubation.
Is the frequency of imaging markers still a predictor for revised intracerebral hemorrhage expansion?
Authors: Song Lei , Zhou Hang , Cheng Jun , Guo Wenmin , Ye Yu , Wang Rujia , Chen Jiao , Xiong Hui , Zhang Ji , Tang Dongfang , Zou Liwei , Kuang Lianghong , Qiu Xiaoming , Guo Tingting
Published: January 2024

Introduction:

Frequency of imaging markers (FIM) has been described as a novel predictor for hematoma expansion after intracerebral hemorrhage (ICH). A revised definition of hematoma expansion that incorporates intraventricular hemorrhage (IVH) growth, that is, revised hematoma expansion (RHE), has also been proposed. Nevertheless, the associations between FIM and IVH growth or RHE remains unexplored. The objective of this study was to assess the influence and performance of the FIM on two types.

Materials and Methods:

Patient selection and variables were based on our published protocol. FIM was defined as the ratio of the number of imaging markers to the onset-to-neuroimaging time. The association between FIM and two definitions was tested by multivariate analysis. The area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the FIM on two definitions were also evaluated.

Results:

There were 303 (20.36%) and 583 (39.18%) subjects in the IVH growth and RHE, respectively. Multivariate analysis demonstrated that FIM was associated with both IVH growth and RHE (odds ratio [OR] = 1.96, 95% confidence interval [CI] = 1.60–2.39; OR = 15.01, 95% CI = 10.51–21.43, respectively). The optimal cutoff points for FIM to predict IVH growth and RHE were 0.63 and 0.62, with AUC, sensitivity, specificity, PPV, and NPV of 0.66, 0.50, 0.78, 0.36, and 0.86 versus 0.80, 0.60, 0.93, 0.84, and 0.78, respectively.

Discussion and Conclusion:

FIM was not only a predictor of IVH growth, but also of RHE. These findings may have important clinical implications for decision-making based on risk stratification of patients with ICH.
Domestic/Intimate Partner Violence, Abuse, and Trauma During COVID-19 Lockdown: Gaslighting, Non-consensual Condom Removal, Grooming, Coercive Control, Power Dynamic, and Sexual Entitlement in Emotional and Psychological Abuse
Authors: Mukhtar Sonia
Published: January 2024

The COVID-19 outbreak has amplified psychosocial and emotional stressors for the more vulnerable segments of population. This article explored the drastic increase in emotional/psychological forms of abuse in intimate partner violence during COVID-19 lockdown period. Additionally, predisposing, precipitating, and perpetuating factors of gaslighting abuse, including non-consensual condom removal, grooming, love bombing, coercion, and power dynamics in controlling relationship, are discussed. Published articles on PubMed, Embase, Google Scholar, and Elsevier about psychological aspects of abuse in intimate partner violence during COVID-19 have been considered and reviewed. This article facilitates a solution-focused response for mental healthcare practitioners to support sustainable well-being through collective solidarity, empowerment, and resilience for survivors. This article introduced personal-collective growth process through humanistic-centered approaches for individuals to share their experiences, realign meaningfulness, create hope, and develop coping strategies.
Retrospective Analysis of Trends of Zygomaticomaxillary Complex Fractures in Patients Reporting to a Tertiary Health Center—Our Experience
Authors: Soni Dharang , Mahajan Amit , Dholabhai Pratesh , Panchal Krishna
Published: January 2024

Methods:

A six years retrospective observational study was conducted on 183 patients with Zygomaticomaxillary complex (ZMC) fractures. We analyzed prevalence of age, gender distribution, etiology, location and mode of treatment.

Results:

In our study, the mean age was 33±14.5, gender distribution 68% males and 32% females, etiology of ZMC fractures was 114 road traffic accident (RTA), 44 falls, 12 sports injuries, five interpersonal violence, four animal bites, and four work-related. Results show that the treatment options applied are 37 conservative management and 146 open reduction internal fixation.

Conclusion:

In this study, male predilection to ZMC fractures was seen, RTA being the most common etiology and the most common site of fracture was Zygomaticomaxillary buttress region. There are different treatment protocols for the management of ZMC fractures. In our study, two-point fixation was the most common (35%). Concluding upon our experience and the results derived from our study, various methods are used to stabilize zygomaticomaxillary complex fractures. Relying upon the characteristics of the fracture, open reduction and internal fixation with mini plates is the most reliable modality providing three-dimensional stability.
The association of self-perceived changes due to COVID-19 with mental and physical health among adult primary care patients with multiple chronic conditions: A US-based longitudinal study
Authors: Bonnell Levi N , Clifton Jessica , Natkin Lisa W , Hitt Juvena R , Littenberg Benjamin
Published: January 2024

Introduction

This study explores the association between self-perceived personal and community changes due to COVID-19 and health among vulnerable primary care patients experiencing multiple chronic conditions.

Methods

Between September 2017 and February 2021, we obtained data from 2,426 primary care patients managing multiple chronic conditions from across the United States. We assessed the relationship between self-perceived personal and community changes due to COVID-19 and change in health measured by the PROMIS-29 mental and physical health summary scores, GAD-7 (anxiety), andPHQ-9 (depression), and DASI (functional capacity) adjusting for relevant demographic, neighborhood characteristics, and county covariates.

Results

After adjustment, self-perceived personal and community changes due to COVID-19 were associated with significantly worse mental health summary scores (ß = -0.55; 95% Confidence Interval (CI) = -0.72, -0.37), anxiety (ß = 0.28; 95% CI = 0.16, 0.39), depression (ß = 0.35; 95% CI = 0.22, 0.47), and physical health summary scores (ß = -0.44; 95% CI = 0.88, 0.00). There was no association with functional capacity (ß = - 0.05; 95% CI = -0.16, 0.05).

Discussion

Among adults managing multiple chronic conditions, self-perceived personal and community changes due to COVID-19 were associated with health. This vulnerable population may be particularly susceptible to the negative effects of COVID-19. As we do not know the long-term health effects of COVID, this paper establishes a baseline of epidemiological data on COVID-19 burden and health among primary care patients with multiple chronic conditions.
Introduction to a How I Treat series on geriatric hematology
Authors: Ortel Thomas L.
Published: January 2024

Edited by Associate Editor Thomas L. Ortel, this How I Treat series focuses on geriatric hematology. Using illustrative cases, the authors present their approach to geriatric patients with von Willebrand disorders, anemia, thrombocytopenia, and multiple myeloma.
A phase 1-2 trial of DA-EPOCH-R plus ixazomib for MYC-aberrant lymphoid malignancies: the DACIPHOR regimen
Authors: Karmali Reem , Galvez Carlos , Hamadani Mehdi , Gordon Leo , Winter Jane , Ma Shuo , Nelson Valerie , Fenske Timothy S. , Shah Nirav N. , Jagadeesh Deepa , Klein Andreas , Helenowski Irene , Chen Ruohui , Mi Xinlei , Petrich Adam , Evens Andrew M. , Pro Barbara
Published: January 2024

MYC-aberrant non-Hodgkin lymphoma (NHL) is associated with poor outcomes with conventional chemotherapy. Ixazomib is an orally bioavailable proteasome inhibitor that targets drivers of MYC expression and has demonstrated preclinical activity in aggressive MYC-aberrant NHL. We conducted a phase 1/2 study evaluating the safety and efficacy of DA-EPOCH-R with adjunctive ixazomib in aggressive MYC-aberrant NHL. For induction, patients received 6 cycles of DA-EPOCH-R with ixazomib administered twice per 21-day cycle; responders continued weekly ixazomib maintenance for up to 1 year. Primary objectives were to determine the maximum tolerated dose in phase 1 and efficacy of DA-EPOCH-R with ixazomib as measured by 12-month progression-free survival (PFS) rate in phase 2. Thirty-six patients were evaluable for response. Median age was 63 years (range, 31-77) and 44% had double-hit lymphoma (DHL)/triple-hit lymphoma (THL). In phase 1, 3 mg of ixazomib was established as recommended phase 2 dose. Twenty-nine (76.3%) patients completed 6 cycles of DA-EPOCH-R and 25 (65.8%) underwent dose escalations. The ORR after induction was 97% (95% confidence interval, 81-100) with a CR rate of 69%. At median follow-up of 18.8 months, the 12-month PFS and overall survival (OS) rates were 78% and 86%, respectively. For DHL/THL vs dual expressor lymphomas (DEL), 12-month PFS rates were 53% vs 95% and 12-month OS rates were 65% vs 100%, respectively. Grade ≥3 toxicities were predominantly hematologic. Twenty-seven (75%) of patients experienced neuropathy, nearly all low-grade. DA-EPOCH-R induction with adjunctive ixazomib is feasible and appears effective in patients with DEL. This trial was registered at www.clinicaltrials.gov as #NCT02481310.
Novel GNE missense variants impair de novo sialylation and cause defective angiogenesis in the developing brain in mice
Authors: Huang Lulu , Kondo Yuji , Cao Lijuan , Han Jingjing , Li Tianyi , Zuo Bin , Yang Fei , Li Yun , Ma Zhenni , Bai Xia , Jiang Miao , Ruan Changgeng , Xia Lijun
Published: January 2024

Glucosamine (UDP-N-acetyl)-2-epimerase and N-acetylmannosamine (ManNAc) kinase (GNE) is a cytosolic enzyme in de novo sialic acid biosynthesis. Congenital deficiency of GNE causes an autosomal recessive genetic disorder associated with hereditary inclusion body myopathy and macrothrombocytopenia. Here, we report a pediatric patient with severe macrothrombocytopenia carrying 2 novel GNE missense variants, c.1781G>A (p.Cys594Tyr, hereafter, C594Y) and c.2204C>G (p.Pro735Arg, hereafter, P735R). To investigate the biological significance of these variants in vivo, we generated a mouse model carrying the P735R mutation. Mice with homozygous P735R mutations exhibited cerebral hemorrhages as early as embryonic day 11 (E11), which subsequently progressed to large hemorrhages in the brain and spinal cord, and died between E11.5 and E12.5. Defective angiogenesis such as distended vascular sprouts were found in neural tissues and embryonic megakaryocytes were abnormally accumulated in the perineural vascular plexus in mutant mouse embryos. Furthermore, our in vitro experiments indicated that both C594Y and P735R are loss-of-function mutations with respect to de novo sialic acid biosynthesis. Overall, this study reveals a novel role for GNE-mediated de novo sialic acid biosynthesis in mouse embryonic angiogenesis.
von Willebrand factor/factor VIII concentrate (Wilate) prophylaxis in children and adults with von Willebrand disease
Authors: Sidonio Robert F. , Boban Ana , Dubey Leonid , Inati Adlette , Kiss Csongor , Boda Zoltan , Lissitchkov Toshko , Nemes Laszlo , Novik Dzmitry , Peteva Elina , Taher Ali T. , Timofeeva Margarita Arkadevna , Vilchevska Kateryna V. , Vdovin Vladimir , Werner Sylvia , Knaub Sigurd , Djambas Khayat Claudia
Published: January 2024

Long-term prophylaxis with a von Willebrand factor (VWF) concentrate is recommended in patients with von Willebrand disease (VWD) who have a history of severe and frequent bleeds. However, data from prospective studies are scarce. WIL-31, a prospective, noncontrolled, international phase 3 trial, investigated the efficacy and safety of Wilate prophylaxis in severe patients with VWD. Male and female patients 6 years or older with VWD types 1, 2 (except 2N), or 3 who had completed a prospective, 6-month, on-demand, run-in study (WIL-29) were eligible to receive Wilate prophylaxis for 12 months. At baseline, patients (n = 33) had a median age of 18 years. Six (18%) patients had severe type 1, 5 (15%) had type 2, and 22 (67%) had type 3 VWD. The primary end point of a >50% reduction in mean total annualized bleeding rate (TABR) with Wilate prophylaxis vs prior on-demand treatment was met; mean TABR during prophylaxis was 5.2, representing an 84.4% reduction. The bleeding reduction was consistent across age, sex, and VWD types. The mean spontaneous ABR was 3.2, representing an 86.9% reduction vs on-demand treatment. During prophylaxis, 10 (30.3%) patients had 0 bleeding events and 15 (45.5%) patients had 0 spontaneous bleeding events. Of 173 BEs, 84.4% were minor and 69.9% treated. No serious adverse events related to study treatment and no thrombotic events were recorded. Overall, WIL-31 showed that Wilate prophylaxis was efficacious and well-tolerated in pediatric and adult patients with VWD of all types. The WIL-29 and WIL-31 trials were registered at www.ClinicalTrials.gov as #NCT04053699 and #NCT04052698, respectively.
PancrESS – a meta-analysis resource for understanding cell-type specific expression in the human pancreas
Authors: Sturgill David , Wang Li , Arda H. Efsun
Published: January 2024

Background

The human pancreas is composed of specialized cell types producing hormones and enzymes critical to human health. These specialized functions are the result of cell type-specific transcriptional programs which manifest in cell-specific gene expression. Understanding these programs is essential to developing therapies for pancreatic disorders. Transcription in the human pancreas has been widely studied by single-cell RNA technologies, however the diversity of protocols and analysis methods hinders their interpretability in the aggregate.

Results

In this work, we perform a meta-analysis of pancreatic single-cell RNA sequencing data. We present a database for reference transcriptome abundances and cell-type specificity metrics. This database facilitates the identification and definition of marker genes within the pancreas. Additionally, we introduce a versatile tool which is freely available as an R package, and should permit integration into existing workflows. Our tool accepts count data files generated by widely-used single-cell gene expression platforms in their original format, eliminating an additional pre-formatting step. Although we designed it to calculate expression specificity of pancreas cell types, our tool is agnostic to the biological source of count data, extending its applicability to other biological systems.

Conclusions

Our findings enhance the current understanding of expression specificity within the pancreas, surpassing previous work in terms of scope and detail. Furthermore, our database and tool enable researchers to perform similar calculations in diverse biological systems, expanding the applicability of marker gene identification and facilitating comparative analyses.
Node-adaptive graph Transformer with structural encoding for accurate and robust lncRNA-disease association prediction
Authors: Li Guanghui , Bai Peihao , Liang Cheng , Luo Jiawei
Published: January 2024

Background

Long noncoding RNAs (lncRNAs) are integral to a plethora of critical cellular biological processes, including the regulation of gene expression, cell differentiation, and the development of tumors and cancers. Predicting the relationships between lncRNAs and diseases can contribute to a better understanding of the pathogenic mechanisms of disease and provide strong support for the development of advanced treatment methods.

Results

Therefore, we present an innovative Node-Adaptive Graph Transformer model for predicting unknown LncRNA-Disease Associations, named NAGTLDA. First, we utilize the node-adaptive feature smoothing (NAFS) method to learn the local feature information of nodes and encode the structural information of the fusion similarity network of diseases and lncRNAs using Structural Deep Network Embedding (SDNE). Next, the Transformer module is used to capture potential association information between the network nodes. Finally, we employ a Transformer module with two multi-headed attention layers for learning global-level embedding fusion. Network structure coding is added as the structural inductive bias of the network to compensate for the missing message-passing mechanism in Transformer. NAGTLDA achieved an average AUC of 0.9531 and AUPR of 0.9537 significantly higher than state-of-the-art methods in 5-fold cross validation. We perform case studies on 4 diseases; 55 out of 60 associations between lncRNAs and diseases have been validated in the literatures. The results demonstrate the enormous potential of the graph Transformer structure to incorporate graph structural information for uncovering lncRNA-disease unknown correlations.

Conclusions

Our proposed NAGTLDA model can serve as a highly efficient computational method for predicting biological information associations.
Relationship between methylenetetrahydrofolate reductase C677T gene polymorphism and neutrophil gelatinase-associated lipocalin in early renal injury in H-type hypertension
Authors: Zhang Chi , Xin Qiu-Ping , Xie Yun-BO , Guo Xiang-Yu , Xing En-Hong , Dou Zhi-Jie , Zhao Cui
Published: January 2024

Objective

To analyse the relationship between the polymorphisms of the H-type hypertensive methylenetetrahydrofolate reductase (MTHFR) C677T gene and neutrophil gelatinase-associated lipocalin (NGAL) in early kidney injury.

Method

A total of 279 hospitalised patients with hypertension were selected and grouped according to their homocysteine (Hcy) level. If their blood Hcy level was ≥ 10 µmol/L they were assigned to the H-type hypertensive group, and if it was < 10 µmol/L they were assigned to the non-H-type hypertensive group. Blood lipid indexes, renal function indexes and blood glucose indexes were collected, and the differences between the two groups were compared. Furthermore, MTHFR C677T genotype distribution and allele frequency and Hcy level of MTHFR C677T genotype were compared, and logistic multiple regression analysis was conducted for the correlation of different genotypes of MTHFR C677T and the early kidney injury marker NGAL.

Results

In the non-H-type hypertensive group, the levels of Hcy and NGAL, cystatin, blood urea nitrogen, serum creatinine, uric acid, serum β2-microglobulin and urinary microalbumin-to-creatinine ratio increased significantly, and the glomerular filtration rate level decreased significantly, when compared with the H-type hypertensive group, with statistical differences (p < 0.05). The H-type hypertensive group and the non-H-type hypertensive group had significant differences in the CC, CT and TT genotypes and allele frequencies at the MTHFR C677T locus. The MTHFR C677T gene mutation rate of the H-type hypertensive group was significantly higher than that of the non-H-type hypertensive group. The H-type hypertensive group had higher levels of the TT genotype and CT genotype Hcy. There was a statistical difference (p < 0.05).

Conclusion

Methylenetetrahydrofolate reductase C677T polymorphism is correlated with the Hcy level, and its gene polymorphism will affect the Hcy level. Methylenetetrahydrofolate reductase C677T polymorphism has an interactive effect with NGAL. Screening NGAL and reducing Hcy levels are valuable methods for the prevention and treatment of early renal injury in patients with H-type hypertension and help improve the prognosis of patients and their quality of life.
A machine learning-based prediction model for postoperative delirium in cardiac valve surgery using electronic health records
Authors: Li Qiuying , Li Jiaxin , Chen Jiansong , Zhao Xu , Zhuang Jian , Zhong Guoping , Song Yamin , Lei Liming
Published: January 2024

Background

Previous models for predicting delirium after cardiac surgery remained inadequate. This study aimed to develop and validate a machine learning-based prediction model for postoperative delirium (POD) in cardiac valve surgery patients.

Methods

The electronic medical information of the cardiac surgical intensive care unit (CSICU) was extracted from a tertiary and major referral hospital in southern China over 1 year, from June 2019 to June 2020. A total of 507 patients admitted to the CSICU after cardiac valve surgery were included in this study. Seven classical machine learning algorithms (Random Forest Classifier, Logistic Regression, Support Vector Machine Classifier, K-nearest Neighbors Classifier, Gaussian Naive Bayes, Gradient Boosting Decision Tree, and Perceptron.) were used to develop delirium prediction models under full (q = 31) and selected (q = 19) feature sets, respectively.

Result

The Random Forest classifier performs exceptionally well in both feature datasets, with an Area Under the Curve (AUC) of 0.92 for the full feature dataset and an AUC of 0.86 for the selected feature dataset. Additionally, it achieves a relatively lower Expected Calibration Error (ECE) and the highest Average Precision (AP), with an AP of 0.80 for the full feature dataset and an AP of 0.73 for the selected feature dataset. To further evaluate the best-performing Random Forest classifier, SHAP (Shapley Additive Explanations) was used, and the importance matrix plot, scatter plots, and summary plots were generated.

Conclusions

We established machine learning-based prediction models to predict POD in patients undergoing cardiac valve surgery. The random forest model has the best predictive performance in prediction and can help improve the prognosis of patients with POD.
Willingness and influencing factors of old-age care mode selection among middle-aged and older adults in Henan Province, China
Authors: Ren Weicun , He Ruibo , Tarimo Clifford Silver , Sun Lei , Wu Jvxiao , Zhang Liang
Published: January 2024

Background

The choice of old-age care methods or places plays an important role in improving the quality of life and well-being of older adults. This study aimed to analyze the choices of various old-age care modes (OCMs) among middle-aged and older adults (MOA) aged 40 years and older in Henan Province, China, and to explore the influence of personal health status, perspectives on old-age (POA) and external support received on their choices.

Methods

This study analyzed the data from the previous survey which included 911 MOA. The mean comparison method was used to analyze the evaluation of MOA prior to selecting OCMs, and the effect of individual characteristics, external support received, and personal health status on the choice of OCM for MOA was assessed by Logistic regression (LR) and Concentration Index. The Mediation Effect Model was used to explore effect manner and scope of MOA’ POA in their choice of OCM.

Results

The overall scores for MOA on the choice of the home-based, community-family, retirement village, nursing homes OCM were 4.06 ± 0.81, 3.70 ± 0.88, 3.72 ± 0.90, 3.49 ± 0.97, respectively. The LR model indicated that education level, number of children, relationship between family members and the relationship with neighbors affected the choice of OCM for MOA (P < 0.05). Difference in OCM selection was relatively the largest based on the individual’s POA (Concentration index = -0.0895 ~ -0.0606), and it was shown to play a mediating role in other factors influencing the choice of OCM for MOA (Mediation effect = -0.002 ~ 0.013).

Conclusions

The evaluation of MOA on choosing a non-home OCM was generally, and the number of children and external support received were shown to have a relatively substantial impact on the choice of OCM among MOA, however, their power was affected by MOA’ POA. Policy makers could encourage the MOA’ selection of non-home OCM by improving the relationship among MOA persons while positively transforming their POA.