bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of leizumab on serum vascular endothelial growth factor, IL-6, MCP-1 inflammatory factors in neovascular glaucoma
Authors: Bian Junjie , Dai Weijia , Liu Dachuan
Published: February 2024

This study aimed to assess Leizumab's effect on serum endothelial growth factor, interleukin-6 (IL-6), monocyte chemotactic protein-1 (MCP-1), and inflammatory factors in neovascular glaucoma patients. 80 eligible patients treated between January 2021 and April 2023 were enrolled, randomly divided into control and study groups. The control group underwent vitrectomy while the study group received preoperative intravitreal rituximab injection. Measurements included serum and aqueous humor VEGF/PEDF, IL-6/MCP-1 levels, postoperative rebleeding/retinal detachment, and visual acuity changes over 6 weeks. After surgery, patients showed reduced serum VEGF/PEDF levels (P < 0.05), with decreased VEGF and increased PEDF in aqueous humor (P < 0.05). The study group had lower VEGF and higher PEDF levels than the control (P < 0.05). Serum IL-6/MCP-1 levels reduced post-surgery, with the study group lower than control (P < 0.05). Intraocular rebleeding was lower in the study group (P < 0.05), while retinal detachment rates were similar (P > 0.05). Visual acuity differed significantly from week 1 to 6 post-surgery (P < 0.05), with higher acuity in the study group during weeks 1–4 (P < 0.05). Weeks 5–6 follow-up showed no significant difference (P > 0.05). Pre-vitrectomy ranibizumab injection effectively reduced bleeding, VEGF/PEDF levels, inflammatory factors, and improved visual recovery.
A modified technique for arteriovenous fistula anastomosis: Preserving the surrounding tissue of the vein without the use of vascular clamps
Authors: Xiaohe Wang , Jie Li , Zhen Liu , Yuanyuan Zhang , Guocun Hou
Published: February 2024

Background:

This pilot study describes a new technique for creating an arteriovenous fistula (AVF) and presents the preliminary outcomes after 1 year of follow-up.

Methods:

The study included 19 patients (10 males, 9 females) with a mean age of 62 years (range 26–88 years). All patients received an AVF using a modified technique in which the surrounding tissues were not removed from the veins and no elastic loops or vascular clamps were used.

Results:

Immediate patency was obtained for all patients. The proportion of patients experiencing primary patency at 30 days and 6 months was 89.5% and 83.1%, respectively, and cumulative patency at 30 days and 6 months was 100%. At 1 year of follow-up, primary patency was 83.1% and cumulative patency was 100%.

Conclusions:

Complete preservation of the surrounding venous tissue in the absence of vascular clamps successfully established AVF, with a high surgical success rate.
Initial experience of thrombectomy using vascular snare with multiple loops for chronic organized thrombi in patients with thrombosed native hemodialysis fistulas
Authors: So Young Ho , Mo Hyejin , Kim Min Uk , Jung In Mok
Published: February 2024

Background:

Thrombi in native hemodialysis access frequently exhibit chronic organized feature because they have formed over a long period. Removal of these is quite difficult owing to relatively large volume, resilient feature, limitations of the introducer sheath size, etc. In this study, we report our experience using a vascular snare for the removal of these thrombi in native arteriovenous fistula (AVF).

Materials and methods:

The medical records of patients who underwent recanalization for thrombosed AVFs from January 2019 to August 2023 were reviewed. During the study period, a total of 29 native fistulas (19 brachiocephalic, nine radiocephalic, and one radiobasilic) in 25 patients were treated using a vascular snare with multiple loops (19 men and six women). Characteristics of the AVFs, endovascular procedures, technical and clinical results, and complications were evaluated.

Results:

Anatomic and clinical success rates were 96.6% and 100%, respectively. Total thrombosis was observed in 21 (72.4%) fistulas. Aneurysmal changes were found in 22 (75.9%) fistulas. The mean fistula age at the time of the procedure was 60.9 months (standard deviation, 52.2). Thrombectomy was initiated using a vascular snare in 14 fistulas. In 15 fistulas for which the procedures were initiated using a rotational percutaneous thrombectomy device (PTD), a vascular snare was subsequently used because recanalization failed or was insufficient due to chronic organizing thrombi. Additional aspiration and balloon angioplasty were performed in 27 (93.1%) and 28 (96.6%), respectively. Pharmacological thrombolysis was performed in one fistula for long segmental thrombosis combined with arterial thrombosis. The mean procedure time, excluding thrombolysis, was 91.9 min (standard deviation, 55.5). No complications related to the use of the vascular snare was observed.

Conclusion:

The use of a vascular snare with multiple loops was safe and highly effective for the removal of chronic organized thrombi in the recanalization of thrombosed AVFs.
The Absurdity of the Ordinary: The Fragile Affinity Between Imagination and Materiality in the Finnish Urban Periphery
Authors: Tuominen Pekka
Published: February 2024

This anthropological study focuses on spatially ordered dimensions of sociocultural life in Kontula, a suburban housing estate located at the urban margins of Helsinki, Finland. With a notorious reputation since its construction in the 1960s, it has come to represent the numerous ills of contemporary urbanity, from poverty and substance abuse to failed immigration policies. Its urban transformation is explored as the entanglement of imagination and materiality, a make-believe space that privileges neither the social constructionist nor the purely materialist perspective. I study the everyday life of its inhabitants as recurring and routinized episodes, occasionally interrupted by events that disturb its embodied flow and force inhabitants to reflect upon their spatially situated practices. I argue that the everyday encounters in rapidly transforming Kontula are simultaneously experienced as absurd and ordinary, and constitute the ordering principles of its affective geography.
The asymmetric effect of all-inclusive holiday service quality attributes on tourist satisfaction
Authors: Bui Hien Thu , Robinson Peter
Published: February 2024

All-inclusive holidays have regained popularity among budget-conscious holidaymakers amidst inflation and living cost crisis. Following the pandemic, tourists are now staying at the hotel more and venture out less, which further makes all-inclusive holidays more popular than ever. With the increasing popularity of all-inclusive holidays, knowledge expansion of this tourism segment is necessary. This study extends the under-developed all-inclusive holiday literature by exploring service quality attributes of all-inclusive holidays and evaluating their asymmetric effect on tourist satisfaction. Suggestions on prioritizing service quality attributes for improvement are expected to support industry practitioners in managing service quality and satisfaction strategically.
Unemployment protection for self-employed and platform workers in Belgium
Authors: De Becker Eleni , Bruynseraede Charlotte
Published: February 2024

This article analyses unemployment protection for platform workers and the self-employed in Belgium. In Belgium, the self-employed were traditionally not covered for unemployment, but since the 1990s, several steps have been taken to provide some protection. The scheme in place, now called the ‘bridging right’, has been regularly revised and extended, with the most recent reforms in 2022 and 2023. The Belgian legislator also took some initiatives to regulate platform work, by adopting, for example, legislation on the labour status of platform workers (2022). Platform workers are not treated as a separate category in Belgium with regard to unemployment, and they fall either under the scheme for employees or for the self-employed. In this paper, we will highlight the difficulties faced by platform workers in accessing unemployment protection, both under the scheme for employees and under the self-employed scheme. The analysis in this article shows that although important steps have been taken, several coverage gaps remain, in particular for platform workers, the solo (economically dependent) self-employed and persons who work in self-employment as a side activity.
Flagging as a silencing tool: Exploring the relationship between de-platforming of sex and online abuse on Instagram and TikTok
Authors: Are Carolina
Published: February 2024

This article investigates Instagram and TikTok’s approach to malicious flagging through users’ experience. Similar to liking, commenting and sharing, flagging is a reaction social media platforms allow users to highlight content that potentially violates community guidelines. However, flagging’s influence on moderation remains opaque: users who flag are largely unaware about the success of their reports; those who are de-platformed cannot be sure if or why their content has been reported, making them feel targeted not just by platforms’ processes, but by the retaliation of audiences themselves. Since the impact of de-platforming on users, and particularly on content creators who work through platforms, can be huge, this study provides scope to investigate flagging as an online abuse technique.
‘A pre-requisite of progress’? Prison modernisation and new prison building in England and Wales
Authors: Jones Robert , Hart Emily , Scott David
Published: February 2024

Drawing upon archival research and documentary analysis, this article offers the first in-depth critical account of the prison modernisation narrative in England and Wales. By closely examining the claims behind the UK Government's current prison building policy, the article reveals that prison modernisation is severely undermined by a lack of supporting evidence as well as arguments which indisputably serve to contradict the government's claims. In concluding that modernisation is a seductive and elusive concept which has been deployed to legitimate and support investment in the prison estate, the article offers new and important insights that contribute to critical research agendas around the endurance, survival, and growth of the prison, despite irrefutable and overwhelming evidence of its failure. The analysis presented here should encourage and embolden academics, policy makers, practitioners and politicians in England and Wales, as well as those in jurisdictions where modernisation is also used to legitimate prison expansion, to engage more critically with the claims behind prison modernisation.
Optimal tuning of three deep learning methods with signal processing and anomaly detection for multi-class damage detection of a large-scale bridge
Authors: Doroudi Rouzbeh , Lavassani Seyed Hossein Hosseini , Shahrouzi Mohsen
Published: February 2024

Long-span bridges play a crucial role in urbanization, connecting communities across vast obstacles. Structural health monitoring techniques have been deployed on these bridges, generate large amounts of data through sensor measurements, requiring data-driven approaches like deep learning (DL) for effective analysis. However, feature extraction from time-domain vibration response signals poses challenges for DL methods. To address this, the study proposes utilizing signal processing techniques such as the multivariate empirical mode decomposition (MEMD) and Wavelet transform (WT) to extract essential features for damage classification. The incorporation of MEMD and WT aims to overcome limitations and process nonstationary and nonlinear signals effectively. Three DL techniques, long-short-term memory (LSTM), one dimensional convolutional neural network (1D-CNN), multi-layer perceptron (MLP) are tuned and applied to Structural Health Monitoring of Tianjin Yonghe Bridge (located in China) as a real-world case study, in order to detect its condition by Deep signal anomaly detection and identify types of the damage. A powerful meta-heuristic algorithm called Observer-Teacher-Learner-Based Optimization, is used to optimize both hyperparameters and architecture of each DL models. The results demonstrate that the optimally tuned DLs are successful in identifying types of damage, as well as the condition of the structure, for the Tianjin Yonghe Bridge. The average accuracy values are obtained as 98.13, 97.96, and 97.79 for 1D-CNN, LSTM, and MLP, respectively. Such optimally tuned DLs are evaluated as effective solutions for detecting damage on large-scale bridges by extracting statistical time-domain and time–frequency domain features using the WT and MEMD.
Enhancing the understanding of bolt loosening and wave transmission in bolted lap-joint connections: a numerical and experimental study using guided Lamb waves
Authors: Kargar Gazkooh Hooman , Yousefi-Koma Aghil
Published: February 2024

Bolt loosening in bolted lap-joint connections can result in catastrophic failures in industrial settings. Therefore, it is crucial to investigate these connections thoroughly and implement preventative measures. However, examining such connections requires considering multiple influencing parameters. In this study, numerical simulations were conducted using three-dimensional finite element analysis in Abaqus software to evaluate these parameters in detail. The study employed a guided wave-based structural health monitoring approach and a precise ultrasonic-guided Lamb wave propagation method. Time signals were analyzed using phase shift and transmission coefficient (TC) factors as suitable indicators. Additionally, the S0 mode of the captured waves provided a highly informative wave packet for analysis due to its specific order. Initially, various simulations were carried out to determine the optimal length of the overlapping region that would result in the most effective transmission of waves. Increasing the bolt torque and the contact friction coefficient between the two plates in the overlapping region reduces the time for waves to reach the sensor and increases the TC of the passing waves. However, the saturation state does not cause any change in the received signals. Increasing the bolt torque is more effective in facilitating wave transmission through the connections than increasing the contact friction coefficient. Furthermore, variations in excitation voltage do not affect the arrival time or TC of the waves. The continuous wavelet transformation enabled a more detailed time-frequency analysis. The results demonstrate that changes in bolt torque do not impact the wave frequencies reaching the sensors, making the frequency insensitive to bolt loosening. Ultimately, the numerical simulation results were validated through experiments on a table-top laboratory sample. This research enhances researchers’ understanding of monitoring the health status of bolted lap-joint connections by investigating the impact of various parameters on guided Lamb wave transmission through these connections.
The multi-channel signals based tensor sparse representation classification method for fault diagnosis of high-speed train
Authors: Zhang Xingwu , Liu Biao , Ma Rui , Wan Hanyang , Wang Chenxi , Chen Xuefeng
Published: February 2024

The transmission system is a key component to ensure the stable operation of high-speed trains. Thus, it is significant to monitor its condition to ensure the operation safety. Nowadays sparse representation is widely used in fault diagnosis. However, as the number of sensors is increasing, the existing method destroys the internal structure of multi-channel signals and cannot effectively deal with the fault diagnosis of multi-channel signals in parallel. Therefore, this article extends the existing sparse representation method to tensor space to extract the coupling information between channels and realize the fault diagnosis of multi-channel. First, a tensor sparse representation model is proposed to achieve data-level multi-channel signal fusion and complete inter-channel fault feature extraction. Then, a multimodal dictionary learning algorithm is proposed to adaptively design the data-driven dictionary to achieve data-driven feature extraction. Finally, a tensor sparse representation classification method is proposed to achieve the purpose of intelligent diagnosis. Fault experiments verify the effectiveness and superiority of the method.
Composite encoder–decoder network for rapid bridge damage assessment using long-term monitoring acceleration data
Authors: Yessoufou Fadel , Yang Yibo , Zhu Jinsong
Published: February 2024

In recent years, the deployment of structural health monitoring (SHM) systems has become paramount for safeguarding critical infrastructures. Notwithstanding, the development of an unsupervised deep learning framework capable of learning from long-term sensor data remains a critical challenge, particularly in accurately assessing the exact damage location. This study addresses this gap by proposing a novel approach for rapid bridge damage assessment. The proposed method employed a deep overcomplete encoder–decoder network (DOEDN) to reconstruct the acceleration data acquired from each sensor node on the bridge. The reconstruction losses generated by the DOEDN framework are then used as damage-sensitive features. Additionally, a damage indicator based on Gaussian processes is introduced to assess the damage location and evaluate its severity. The performance and sensitivity of the proposed DOEDN framework are evaluated through long-term monitoring acceleration data from a numerical highway bridge model and the well-known full-scale Z24 bridge. Furthermore, comparative assessments against the regular deep undercomplete encoder–decoder network are conducted using metrics including mean absolute error, coefficient of determination ( R2), and mean intersection over union. The results show that the proposed DOEDN framework can reasonably assess the damage location and evaluate its severity across various structural scenarios in the bridge, even in the presence of temperature variations, thus providing a practical and effective solution for bridge health monitoring.
Structural health monitoring of a lenticular truss bridge: a comprehensive study
Authors: Enshaeian Alireza , Ghahremani Behzad , Rizzo Piervincenzo
Published: February 2024

The combined use of finite element modeling and structural health monitoring is becoming increasingly relevant in bridge maintenance. A growing number of new and old structures is instrumented with different kinds of sensors driven by dedicated hardware and software, while numerical models are used to simulate the response of the structures under various scenarios. This paper presents the monitoring of the Smithfield Street Bridge, one of the oldest and most iconic bridges in the city of Pittsburgh (Pennsylvania, USA). The bridge was instrumented by an independent party, not involved with the research presented here, with strain, displacement, and rotation wireless sensors. A detailed finite element model of one of the spans of the bridge was developed to calculate the strains induced by standardized trucks under pristine and simulated damage conditions. In addition, the model enabled to determine the sensitivity necessary to detect relevant structural changes in the bridge. The results of the numerical analyses were then compared with the results of a test in which a truck of known weight crossed the bridge multiple times. Finally, the data relative to 3 years of uninterrupted monitoring were processed and analyzed to identify eventual anomalies.
An adaptive reweighted-Kurtogram for bearing fault diagnosis under strong external impulse noise
Authors: Peng Jie , Zhao Yumeng , Zhang Xin , Wang Jiaxu , Wang Lei
Published: February 2024

In vibration-based fault diagnosis of rotating machinery, strong impulse noise constitutes a widely encountered source of external interference, thereby posing significant challenges to the effective extraction of diagnostic information. In this context, an adaptive reweighted-Kurtogram (ARKurtogram) method is proposed. The bearing transient fault signatures are accurately extracted through two aspects – that is, precise frequency band division and robust band selection indicator. Specifically, we use the dual-tree complex wavelet packet transform (DTCWPT) as the band division tool and propose the sub-bands rearranged and ensemble DTCWPT which addresses the band disorder problem, yields far richer band division patterns and maintains excellent performance of DTCWPT in signal decomposition. Meanwhile, we introduce a robust indicator characterizing periodic fault impulses to accurately select the fault band. In comparison with the classical kurtosis and the advanced reweighted-kurtosis, this indicator is insensitive to strong external impulse noise and its calculation process contains a sliding window averaging approach which makes the calculation entirely automated without human intervention. The validity of the ARKurtogram is investigated with the analysis of vibration signals measured from fault-injection experiments. The comparisons with the classical fast Kurtogram method and the advanced Autogram method highlight the advantages of the method in extracting bearing transient fault signatures from complex signals with strong external impulse noise. It shows high potential in the application of industrial bearing fault diagnosis.
Concomitant Tricuspid Valve Surgery Is Not Associated With Increased Operative Risk During Robotic Mitral Valve Surgery
Authors: Arslanhan Gökhan , Baştopçu Murat , Özcan Zeynep Sıla , Şenay Şahin , Koçyiğit Muharrem , Güllü Ahmet Ümit , Akyol Ahmet , Alhan Cem
Published: February 2024

Objective:

The aim of this study was to investigate the outcomes of robotic mitral valve surgery with and without concomitant tricuspid valve surgery.

Methods:

Patients who underwent robotic mitral surgery between March 2010 and September 2022 were included. Patients were grouped according to the presence of concomitant tricuspid interventions. The groups were compared for baseline factors, operative parameters, and early postoperative outcomes. Age- and gender-matched groups were also compared for outcomes.

Results:

The study included 285 robotic mitral surgery patients. There were 59 patients who underwent concomitant tricuspid interventions. In the concomitant tricuspid surgery group, cardiopulmonary bypass time (150.1 vs 128.4 min, P < 0.001) and cross-clamp time (99.2 vs 82.4 min, P < 0.001) were longer. Prolonged intubation was more frequent in the concomitant tricuspid intervention group (5.2% vs 0.5%, P = 0.029). The groups did not differ in terms of mortality, permanent pacemaker (PPM) requirement, or other morbidities. Perioperative outcomes were similar after matched group analysis.

Conclusions:

Operative mortality and early adverse outcomes did not increase with the addition of tricuspid intervention in our cohort of robotic mitral surgery patients. The robotic approach for mitral disease and coexisting tricuspid disease may offer safe results without an increased risk of postoperative PPM requirement.
Institutional thoughtlessness and the incarcerated pregnancy
Authors: Abbott Laura , Scott Tricia , Thomas Hilary
Published: February 2024

This article examines the unique experiences of pregnant women in prison, building on Sykes’ concept of the pains of imprisonment and Crawley’s notion of institutional thoughtlessness. Based on qualitative data from an ethnographic study of three English prisons, including interviews with 28 pregnant prisoners and 10 staff members and field observations, the study highlights the lack of basic provisions for pregnant women, such as adequate nutrition, fresh air and suitable bedding. The article argues that the lack of such rudimentary provisions leads to the unique experience of the pains of imprisonment for pregnant women. The article argues that the prison system needs to take a more considerate approach to prisoners who have specialist requirements, including pregnant women, rather than treating them as a homogenised group.
Lethality assessment protocol: Challenges and barriers of implementation for domestic violence victim advocates
Authors: Grant Tanya M , Cross-Denny Bronwyn
Published: February 2024

This exploratory qualitative research study examined the attitudes and barriers domestic violence victim advocates identified in successful implementation of the lethality assessment protocol, a collaborative intervention between police departments and domestic violence advocacy agencies in the state of Connecticut. Focus groups were conducted at four domestic violence agencies to ascertain advocates’ perceptions of the lethality assessment protocol. Advocates (N = 24) were recruited through an individual contact at each agency. Responses to focus group questions indicated both system-wide and individual agency and police department collaboration barriers. Results showed advocates generally support the protocol and believe it has beneficial intent and purpose. Challenges identified included lack of victim cooperation, variations in law enforcement officer attitude, and deficiencies in training. Implementation barriers and advocates’ attitudes are also discussed. Lethality assessment protocol is a useful tool, yet all stakeholders must actively engage in cooperative training, tackle personal biases toward domestic violence victims, and gain a better understanding of victim psychology.
Acute postoperative pain management techniques, their efficacy and complications after major gastrointestinal and hepato-pancreato-biliary cancer surgeries: An observational study
Authors: Ambulkar Reshma , Moharana Satya Kumar , Solanki Sohan Lal , Salunke Bindiya G , Agarwal Vandana
Published: February 2024

Background:

Patients undergoing major gastrointestinal (GI) surgery including hepato-pancreato-biliary (HPB) surgeries have large incisions, which cause severe acute postoperative pain that, if untreated, is associated with a higher incidence of postoperative morbidity and delayed recovery.

Methodology:

Our study included all patients who underwent elective major upper GI and HPB surgeries from 1 January 2018 to 31 December 2018. The patients were divided into two groups: the epidural and the non-epidural group. The average and worst pain scores at rest and movement were compared between both groups. We also studied the effect of pain relief in the two groups and associated postoperative outcomes, resumption of feeding, ambulation, hospital stay and intensive care unit stay.

Results:

A total of 566 patients were included in the study, out of which 490 received epidurals, and the rest, 76, belonged to the non-epidural group (transversus abdominis plane, rectus sheath block or no regional analgesia technique). The median average pain score at rest and movement was 2.0 and 3.0, respectively, in the epidural and non-epidural groups. The postoperative outcomes showed no statistical difference.

Conclusion:

The epidural group and the non-epidural group had similar pain scores, and the postoperative outcomes were also comparable.
Platform-based diffusion-proofing: Digitally mediated discursive practice and China’s prevention of protest spillover during Hong Kong’s Anti-Extradition Bill Movement
Authors: Huang Vincent Guangsheng , Xie Zhuoxiao
Published: February 2024

Based on the example of mainland China’s online diffusion-proofing practices against Hong Kong’s Anti-Extradition Bill Movement, we identify a platform-based tactic of diffusion-proofing. We argue that this tactic manifested the orchestration of top-down statist governance and bottom-up grassroots practices, as well as within-border and cross-border discursive dynamics. Facilitated by the technical affordances of social media platforms, a faction of netizens both from mainland China and Hong Kong followed the state and its agents online to co-construct discourses for preventing the potential spillover of the Movement to mainland China. We further suggest that this tactic was enabled by the hybridization of both technical logic and discursive logic. The platform affordances, especially different types of hashtags, allowed the state and its agents to practice digitally mediated discursive production, reacting to the momentum of the Movement. As a result, a discourse was constructed, which delegitimatized protest actions and ignited nationalistic sentiment for the purpose of diffusion-proofing.
Obesity-related maternal complications during the COVID-19 pandemic
Authors: Sgayer Inshirah , Fishman Tomer Yehuda , Lowenstein Lior , Wolf Maya Frank
Published: February 2024

Objectives

To compare gestational weight gain (GWG) during pregnancy and obesity-related maternal morbidity between three months of the first year of the COVID-19 pandemic and three months of the previous year.

Methods

A retrospective comparative study was conducted in a tertiary university-affiliated hospital. GWG, obesity rates and pregnancy complications were compared between the time periods.

Results

Among women with class I obesity, GWG was higher during the pandemic ( n = 1071) than the previous year ( n = 1194): 11.16 vs. 8.69 kg, p = 0.04. Women during the pandemic compared to the previous year were less likely to be diagnosed with gestational diabetes (odds ratio [OR] = 0.66, 95% confidence interval [CI] 0.47–0.91, p = 0.01) or hypertensive disorders of pregnancy (OR = 0.63, 95% CI 0.35–1.0, p = 0.05) after adjustment for parity, mode of conception and advanced maternal age.

Conclusions

Gestational weight gain increased during the pandemic, yet rates of obesity-related complications were notably fewer. This is likely attributed to decreased detection consequent to limited antenatal care.
Chronic primary pain: Navigating a new diagnostic entity
Authors: Blythe Dr Niamh
Published: February 2024

Historically, pain has been viewed as a symptom of disease, rather than a disease state itself. In 2018, the World Health Organization released the International Classification of Diseases, 11th Revision (ICD- 11), and for the first time a systematic coding system for chronic pain was incorporated. This new classification introduced the term chronic primary pain (CPP), defined as pain not better accounted for by an underlying condition and associated with significant functional impairment or distress. Now, for the first time CPP has been recognised by the National Institute for Health and Care Excellence as a condition in its own right. This article aims to explore the definitions, diagnosis, and management of CPP and how this may be translated into day-to-day primary care practice.
The impact of prognostic group classification on prostate cancer progression in intermediate-risk patients according to the European Association of Urology system: results in 479 patients treated with robot-assisted radical prostatectomy at a single tertiary referral center
Authors: Porcaro Antonio Benito , Bianchi Alberto , Panunzio Andrea , Gallina Sebastian , Tafuri Alessandro , Serafin Emanuele , Orlando Rossella , Mazzucato Giovanni , Vidiri Stefano , D’Aietti Damiano , Montanaro Francesca , Marafioti Patuzzo Giulia , Artoni Francesco , Baielli Alberto , Ditonno Francesco , Rizzetto Riccardo , Veccia Alessandro , Gozzo Alessandra , De Marco Vincenzo , Brunelli Matteo , Cerruto Maria Angela , Antonelli Alessandro
Published: February 2024

Background:

Treatment outcomes in intermediate-risk prostate cancer (PCa) may be impaired by adverse pathology misclassification including tumor upgrading and upstaging. Clinical predictors of disease progression need to be improved in this category of patients.

Objectives:

To identify PCa prognostic factors to define prognostic groups in intermediate-risk patients treated with robot-assisted radical prostatectomy (RARP).

Design:

Data from 1143 patients undergoing RARP from January 2013 to October 2020 were collected: 901 subjects had available follow-up, of whom 479 were at intermediate risk.

Methods:

PCa progression was defined as biochemical recurrence and/or local recurrence and/or distant metastases. Study endpoints were evaluated by statistical methods including Cox’s proportional hazards, Kaplan–Meyer survival curves, and binomial and multinomial logistic regression models.

Results:

After a median (interquartile range) of 35 months (15–57 months), 84 patients (17.5%) had disease progression, which was independently predicted by the percentage of biopsy-positive cores ⩾ 50% and the International Society of Urological Pathology (ISUP) grade group 3 for clinical factors and by ISUP > 2, positive surgical margins and pelvic lymph node invasion for pathological features. Patients were classified into clinical and pathological groups as favorable, unfavorable (one prognostic factor), and adverse (more than one prognostic factor). The risk of PCa progression increased with worsening prognosis through groups. A significant positive association was found between the two groups; consequently, as clinical prognosis worsened, the risk of detecting unfavorable and adverse pathological prognostic clusters increased in both unadjusted and adjusted models.

Conclusion:

The study identified factors predicting disease progression that allowed the computation of highly correlated prognostic groups. As the prognosis worsened, the risk of PCa progression increased. Intermediate-risk PCa needs more prognostic stratification for appropriate management.
Distinct clinical characteristics in stage III rectal cancer among different age groups and treatment outcomes after neoadjuvant chemoradiotherapy
Authors: Liu Baoqiu , Luo Huilong , Li Bin , Yu Haina , Sun Rui , Li Jibin , Gao Yuanhong , Ding Peirong , Wang Xicheng , Xiao Weiwei
Published: February 2024

Background:

There is a rapidly increasing incidence of early-onset colorectal cancer (EO-CRC) which threatens the survival of young people, while aging also represents a challenging clinical problem.

Objectives:

We aimed to investigate the differences in the clinical characteristics and prognosis in stage III rectal cancer (RC), to help optimize treatment strategies.

Design and methods:

This study included 757 patients with stage III RC, all of whom received neoadjuvant chemoradiotherapy and total mesorectal excision. The whole cohort was categorized as very early onset (VEO, ⩽30 years old), early onset (EO, >30 years old, ⩽50 years old), intermediate onset (IO, >50 years, ⩽70 years), or late onset (LO, >70 years old).

Results:

There were more female VEO patients than males, more mucinous adenocarcinoma, signet-ring cell carcinoma, pre-treatment cT4 stage, and higher pre-treatment serum carbohydrate antigen 19-9 compared with the other three groups. VEO patients had the worst survival with the highest RC-related mortality (34.5%), recurrence (13.8%), and metastasis (51.7%). LO patients had the highest non-RC-related mortality rate (16.6%). The Cox regression model showed VEO was a negative independent prognostic factor for disease-free survival [DFS, hazard ratio (HR): 2.830, 95% confidence interval (CI): 1.633–4.904, p < 0.001], distant metastasis-free survival (DMFS, HR: 2.969, 95% CI: 1.720–5.127, p < 0.001), overall survival (OS, HR: 2.164, 95% CI: 1.102–4.249, p = 0.025), and cancer-specific survival (CSS, HR: 2.321, 95% CI: 1.145–4.705, p = 0.020). LO was a negative independent factor on DFS (HR: 1.800, 95% CI: 1.113–2.911, p = 0.017), DMFS (HR: 1.903, 95% CI: 1.150–3.149, p = 0.012), OS (HR: 2.856, 95% CI: 1.745–4.583, p < 0.001), and CSS (HR: 2.248, 95% CI: 1.282–3.942, p = 0.005). VEO patients had better survival in the total neoadjuvant therapy-like (TNT-like) pattern on DFS ( p = 0.039). IO patients receiving TNT-like patterns had better survival on DFS, OS, and CSS ( p = 0.006, p = 0.018, p = 0.006, respectively).

Conclusion:

In stage III RC, VEO patients exhibited unique clinicopathological characteristics, with VEO a negative independent prognostic factor for DFS, DMFS, OS, and CSS. VEO and IO patients may benefit from a TNT-like treatment pattern.
Lethal Complications of Meningiomas: A Case Series
Authors: Feng Jeffrey J. , deJong Joyce L. , Douglas Elizabeth A. , Fisher-Hubbard Amanda O. , Prahlow Joseph A.
Published: February 2024

Background:

Meningiomas are the most prevalent type of primary intracranial tumor in adults, comprising nearly one-third of all intracranial tumors. They are typically benign, slow-growing, and asymptomatic but may cause neurological symptoms as they expand due to mass effect. Classification is determined by World Health Organization (WHO) grades 1 to 3 following pathological examination corresponding to benign, atypical, and anaplastic (malignant), respectively, reflecting their rate of growth and risk of recurrence. The vast majority are WHO grade 1 and their slow growth permits timely presentation for elective resection; however, meningiomas in vulnerable locations and coexisting morbidities can result in sudden death.

Objectives:

We present a series of four adult patients with meningiomas which resulted in death, including a case of fatal seizure, midline hemorrhagic meningioma, postresection meningitis, and compression of the cerebellum.

Research design:

Retrospective review of the authors’ cases was conducted. Available pathology, medical, and autopsy records including gross images were reviewed in each case. The inclusion criteria were adult patients (>18 years old) and that the cause of death had to include meningioma.

Subjects:

The four patients included a 61-year-old male, an 84-year-old female, a 62-year-old male, and a 37-year-old female.

Measures:

Qualitative; autopsy reports describing cause of death and pathology report findings including gross and microscopic analysis.

Conclusions:

Meningiomas are often benign in nature but can rarely result in death. Size and location of the tumor and risk factors are contributory. Autopsy examination can be instrumental in identifying the cause and mechanism of deaths associated with meningiomas.
Cerebral Venous Sinus Thrombosis Following Lumbar Puncture
Authors: Mierzwa Adam T. , Aladamat Nameer , Ali Imran , Kung Lisa
Published: February 2024

Cerebral venous sinus thrombosis (CVST) is a rare and potentially fatal condition. It is believed to be one of the rare complications of lumbar puncture (LP), however other causes and risk factors should be considered and ruled out. Diagnosis can be challenging after an LP as it can mimic low pressure or post dural puncture. We present a 23-year-old patient diagnosed with CVST following a diagnostic lumbar puncture, in the absence of other risk factors. The patient presented with a persistent headache that was initially attributed to low CSF pressure, as well as a transient episode of right hemi-body paresthesia. Neuroimaging including contrasted MRI with venography confirmed the diagnosis. The patient had negative hypercoagulable evaluation and was placed on anticoagulation on discharge. Our report highlights the importance of considering CVST in refractory headaches after LP and the value of neuroimaging when indicated.
The ‘temporariness’ of temporary agency work assignments
Authors: Kullmann Miriam
Published: February 2024

To prevent the misuse of the equal treatment principle and successive assignments designed to circumvent the TAW Directive's provisions, Member States have to take appropriate measures in accordance with national law and/or practice (Art. 5(5)). One such measure, as mentioned but not further defined by the TAW Directive itself (Art. 3(1)(b) to (e)), involves limiting the duration of assignments. Not limiting, in one way or the other, the maximum period during which a temporary agency worker may be assigned to a user undertaking then might be problematic for a Member State, and may result in the TAW Directive being transposed incorrectly. Yet, the failure of the TAW Directive itself to set a maximum duration, while also not providing criteria by which to establish whether an assignment leads to a circumvention of the provisions of the Directive (Art. 5(5)), may lead to legal uncertainty for Member States and for those making use of the legal rules on temporary agency work. Against this background, this article addresses the question of the extent to which limiting the duration of the assignment, from both a European and national perspective, can prevent the misuse and circumvention of the provisions of the TAW Directive.
Pedagogical practices in a gaming affinity space and the motivating sting of Elden Ring
Authors: von Gillern Sam , Robinson Brad , Czauderna André
Published: February 2024

This qualitative thematic analysis examines Reddit community members’ pedagogical practices in a discussion board related to Elden Ring, a notoriously difficult video game. Elden Ring is highly acclaimed by both critics and users for its excellent gameplay and tough-but-fair philosophy. A focal thread on Elden Ring was selected in which a novice player shared their difficulties in the game and community members replied to share advice, perspectives, and experiences on the game and gameplay success. Data analysis revealed two primary themes of pedagogical practices in this affinity space: instructional pedagogical practices and affective pedagogical practices. Instructional pedagogical practices included Explaining, Strategizing, and Questioning & Answering. Affective pedagogical practices included Encouraging and Empathizing. Collectively, these six pedagogical practices illustrate how dedicated fans of Elden Ring acted as a community of practice and supported one another’s learning experiences on this Reddit discussion board affinity space. Implications for education and directions for future research are discussed.
Consented maternal care and associated factors among mothers who gave birth at public health institutions in South Wollo Zone, Amhara region, Ethiopia 2022
Authors: Ferede Wassie Yazie , Erega Besfat Berihun , Sisay Fillorenes Ayalew , Ayalew Abeba Belay , Belachew Yismaw Yimam , Yimer Tigist Seid
Published: February 2024

Introduction:

Informed consent in healthcare services is a legal, ethical, and professional requirement on the part of all treating health providers and providing person-centered care. The methods of requesting consent during childbirth have not been extensively studied. In Ethiopia, there is not at all a single study done.

Objective:

The purpose of this study is to determine associated factors among mothers who gave birth at health institutions in the South Wollo Zone, Amhara region, Ethiopia in 2022.

Methods:

Mothers who gave birth at South Wollo Zone public health institutions, from 01 March to 30 April 2022 participated in a multi-center institutional-based cross-sectional study design. Systematic random sampling was used to select 423 study participants. A validated questionnaire was used for data collection, and the data were collected through face-to-face interviews. Data were entered into Epi-Data version 4.6 and exported to SPSS version 23 for analysis. A multivariable logistic regression analysis was performed to identify factors associated with the outcome variable. The level of significance was determined using an adjusted odds ratio with a 95% confidence interval.

Result:

The study had 416 participants in total, with a response rate of 98.3%. Out of the 416 respondents interviewed, 67.1% of the women received consented care. The age group of 30–34, complications during childbirth, intended pregnancy, merchant, and primary and referral hospital were significantly associated with consented care.

Conclusion:

The level of non-consented care during delivery was high compared with other literature reflecting substantial mistreatment. Therefore, stakeholders should strengthen monitoring and assessment systems to prevent abuse, and further study is required to look for practical ways to make improvements. Key elements of consented care have also been included in Basic and Emergency Obstetric Care training sessions and given to health providers.
Simultaneously combining a thulium fiber laser and holmium:YAG laser in vacuum-assisted mini-endoscopic combined intrarenal surgery on a complex renal calculus: A case report
Authors: Siantong Mookdarat , Ketsuwan Chinnakhet
Published: February 2024

Employing percutaneous nephrolithotomy to manage a complex renal calculus has always been challenging due to the blood transfusion requirement and the frequent necessity of using multiple access tracts. We report a novel treatment modality in the case of a 65-year-old male with a complex, large-volume renal calculus who was successfully treated by vacuum-assisted miniaturized endoscopic combined intrarenal surgery using the combination of a thulium fiber laser in retrograde fashion with a holmium:YAG laser in antegrade fashion. The kidney stone was entirely cleared, and the patient fully recovered with no adverse event.
Early Prevention of Critical Illness in Older Adults: Adaptation and Pilot Testing of an Electronic Risk Score and Checklist
Authors: Boswell Christopher L. , Minteer Sarah A. , Herasevich Svetlana , Garcia-Mendez Juan P. , Dong Yue , Gajic Ognjen , Barwise Amelia K.
Published: February 2024

Objective:

Given limited critical care resources and an aging population, early interventions to prevent critical illness are vital. In this work, we measured post-implementation outcomes after introducing a novel electronic scoring system (Elders Risk Assessment—ERA) and a risk-factor checklist, Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN), to detect older patients at high risk of critical illness in a primary care setting.

Methods:

The study was conducted at a family medicine clinic in Kasson, MN. The ADAPT-ITT framework was used to modify the CERTAIN checklist for primary care during 2 co-design workshops involving interdisciplinary clinicians, held in April 2023. The ERA score and modified CERTAIN checklist were implemented between May and July 2023 and identify and assess all patients age ≥60 years at risk of critical illness during their primary care visits. Implementation outcomes were evaluated at the end of the study via an anonymous survey and EHR data extraction.

Results:

Fourteen clinicians participated in 2 co-design workshops. A total of 19 clinicians participated in a post-pilot survey. All survey items were rated on a 5-point Likert type scale. Mean acceptability of the ERA score and checklist was rated 3.35 (SD = 0.75) and 3.09 (SD = 0.64), respectively. Appropriateness had a mean rating of 3.38 (SD = 0.82) for the ERA score and 3.19 (SD = 0.59) for the checklist. Mean feasibility was rated 3.38(SD = 0.85) and 2.92 (SD = 0.76) for the ERA score and checklist, respectively. The adoption rate was 50% (19/38) among clinicians, but the reach was low at 17% (49/289) of eligible patients.

Conclusions:

This pilot study evaluated the implementation of an intervention that introduced the ERA score and CERTAIN checklist into a primary care practice. Results indicate moderate acceptability, appropriateness, and feasibility of the ERA score, and similar ratings for the checklist, with slightly lower feasibility. While checklist adoption was moderate, reach was limited, indicating inconsistent use.

Recommendations:

We plan to use the open-ended resurvey responses to further modify the CERTAIN-FM checklist and implementation process. The ADAPT-ITT framework is a useful model for adapting the checklist to meet the primary care clinician needs.