bluuebunny/crossref_metadata_2025 huggingface dataset:
Intertwin discordance of aldosterone levels in amniotic fluid with placental anastomoses in monochorionic twins: Insight into the pathophysiology of twin‐to‐twin transfusion syndrome
Authors: Takano Mayumi , Tachihara Mayu , Kamiya Mio , Kotaki Hikari , Shimabukuro Makiko , Nagasaki Sumito , Nakata Masahiko
Published: June 2024

Introduction

Our objective was to investigate the association between the presence of placental anastomoses and intertwin differences in renin‐angiotensin‐aldosterone activation in monochorionic twins using amniotic fluid aldosterone (AF‐ALD) levels. In addition, this study also examined the association between AF‐ALD and the ALD levels in the umbilical cord blood (UCB‐ALD) in monochorionic twins.

Material and Methods

This prospective study included monochorionic diamniotic (MD) twin pregnancies that were not complicated by twin‐to‐twin transfusion syndrome (TTTS) at delivery. Amniotic fluid and umbilical cord vein blood samples were collected from each twin at delivery, and the ALD levels were measured subsequently. The MD twins were divided into two groups: those with placental anastomoses and those without anastomoses owing to fetoscopic laser surgery. The differences in the AF‐ALD levels between the larger and smaller twins were analyzed.

Results

The AF‐ALD levels showed a strong and significant positive correlation with UCB‐ALD levels in 131 MD twins (r = 0.804, p < 0.001). Intertwin differences were examined in 41 and 28 pairs of MD twins with and without placental anastomoses, respectively. The AF‐ALD levels in the smaller twins were significantly higher than those in the larger twins among the pairs of MD twins with placental anastomoses (p = 0.003); however, no statistically significant intertwin differences were observed among the twins without placental anastomoses (p > 0.05).

Conclusions

The AF‐ALD levels reflect the UCB‐ALD levels in MD twins. The presence of placental anastomoses led to intertwin discordance in the ALD levels in MD twins even uncomplicated with TTTS. It was considered that monochorionic twins have this clinical background, and it leads to the development of TTTS.
Atrial fibrillation and flutter and ocular diseases. The Ural eye and medical study and the Ural very old study
Authors: Bikbov Mukharram M. , Kazakbaeva Gyulli M. , Rakhimova Ellina M. , Panda‐Jonas Songhomitra , Fakhretdinova Albina A. , Tuliakova Azaliia M. , Rusakova Iulia A. , Jonas Jost B.
Published: June 2024

Purpose

To assess associations between atrial fibrillation/atrial flutter (AF) and ocular parameters and diseases.

Methods

The population‐based Ural Eye and Medical Study (UEMS) and the Ural Very Old Study (UVOS) included 4894 individuals (age: 40+ years) and 835 individuals (age: 85+ years), respectively.

Results

In the UEMS, AF prevalence (80/4894; 1.6%; 95% CI: 1.3, 2.0) increased from 1/1029 (0.1%) in the age group of 40 to <50 years to 29/619 (4.7%) and 12/159 (7.5%) in the age groups of 70 to <80 years and 80+ years, respectively. Higher AF prevalence correlated with older age (OR: 1.08; 95% CI: 1.04, 1.12; p < 0.001), urban region of habitation (OR: 1.08; 95% CI: 1.04, 1.12; p < 0.001), higher prevalence of cardiovascular disease/stroke (OR: 2.50; 95% CI: 1.32, 4.72; p < 0.001) and lower prevalence of neck pain (OR: 0.35; 95% CI: 0.14, 0.85; p = 0.02), higher serum concentration of bilirubin (OR: 1.03; 95% CI: 1.02, 1.05; p < 0.001) and lower prothrombin index (OR: 0.96; 95% CI: 0.93, 0.99; p = 0.003), higher stage of arterial hypertension (OR: 1.52; 95% CI: 1.01, 2.28; p = 0.04) and higher ankle‐brachial index (OR: 22.1; 95% CI: 4.45, 1.10; p < 0.001). In that model, AF prevalence was not associated with ocular parameters such as intraocular pressure (p = 0.52), retinal nerve fibre layer thickness (p = 0.70), refractive error (p = 0.13), axial length (p = 0.14), nuclear cataract degree (p = 0.50) and prevalence (p = 0.40), cortical cataract degree (p = 0.43) and presence (p = 0.17), lens pseudoexfoliation (p = 0.58), status after cataract surgery (p = 0.38), age‐related macular degeneration prevalence (p = 0.63), open‐angle glaucoma presence (p = 0.90) and stage (p = 0.55), angle‐closure glaucoma prevalence (p = 0.99) and stage (p = 0.99), diabetic retinopathy prevalence presence (p = 0.37) and stage (p = 0.32), and myopic macular degeneration (p = 0.98). In the UVOS, similar results were obtained.

Conclusions

In these multi‐ethnic populations from Russia, AF prevalence was not associated with any major ocular disease and may not play a major role in the pathogenesis of these disorders.
Considerable paediatric drug dispensing – A nationwide study of more than 2 million Swedish children
Authors: Dahlén Elin , Kimland Elin Eyfells
Published: June 2024

Aim

The aim of the nationwide study was to describe paediatric drug utilisation in Sweden.

Methods

Drug prescriptions dispensed to all children aged 0–17 years in 2019 were analysed using data from the Swedish National Prescribed Drug Register.

Results

We retrieved data on 2 180 508 unique children. Nearly 4.6 million prescriptions were dispensed to children aged 0–17 years, and 52% of these were to boys. Just under half of the children (47%) were dispensed at least one drug: 48% of girls and 45% of boys (p < 0.01). More than a third (34%) were dispensed three or more different drugs during 2019. The number of dispensed prescriptions per 1000 children was higher in boys than girls up to 12 years of age (p < 0.01), and the opposite trend was observed from 13 years and above, even when we excluded contraceptives (p < 0.01). The most common therapeutic areas were drugs for the respiratory tract (25%), namely antihistamines, antiasthmatics and cough medication. These were followed by psychoanaleptics and melatonin for the nervous system (19%) and dermatologicals (16%), namely cortisone creams and emollients.

Conclusion

Paediatric drug use was common, and a considerable proportion of children were dispensed multiple drugs.
ANXA1sp modulates the protective effect of Sirt3‐induced mitophagy against sepsis‐induced myocardial injury in mice
Authors: Ma Wanyu , Huang Zhijia , Miao Yanmei , Ma Xinglong , Zhang Zhiquan , Liu Wenjie , Xie Peng
Published: June 2024

Aim

Sepsis‐induced myocardial injury (SIMI) may be associated with insufficient mitophagy in cardiomyocytes, but the exact mechanism involved remains unknown. Sirtuin 3 (Sirt3) is mainly found in the mitochondrial matrix and is involved in repairing mitochondrial function through means such as the activation of autophagy. Previously, we demonstrated that the annexin‐A1 small peptide (ANXA1sp) can promote Sirt3 expression in mitochondria. In this study, we hypothesized that the activation of Sirt3 by ANXA1sp induces mitophagy, thereby providing a protective effect against SIMI in mice.

Methods

A mouse model of SIMI was established via cecal ligation and puncture. Intraperitoneal injections of ANXA1sp, 3TYP, and 3MA were administered prior to modeling. After successful modeling, IL‐6, TNF‐α, CK‐MB, and CTn‐I levels were measured; cardiac function was assessed using echocardiography; myocardial mitochondrial membrane potential, ROS, and ATP production were determined; myocardial mitochondrial ultrastructure was observed using transmission electron microscopy; and the expression levels of Sirt3 and autophagy‐related proteins were detected using western blotting.

Results

ANXA1sp significantly reduced serum IL‐6, TNF‐α, CK‐MB, and CTn‐I levels; decreased myocardial ROS production; increased mitochondrial membrane potential and ATP synthesis; and improved myocardial mitochondrial ultrastructure in septic mice. Furthermore, ANXA1sp promoted Sirt3 expression and activated the AMPK‐mTOR pathway to induce myocardial mitophagy. These protective effects of ANXA1sp were reversed upon treatment with the Sirt3 blocker, 3‐TYP.

Conclusion

ANXA1sp can reverse SIMI, and the underlying mechanism may be related to the activation of the AMPK‐mTOR pathway following upregulation of Sirt3 by ANXA1sp, which, in turn, induces autophagy.
Unveiling sustainability: Tech‐infused governance and ESG performance in textile industry
Authors: Zhu Naiping , Yang Jinlan , Agyemang Andrew Osei
Published: June 2024

We investigate the impact of corporate governance (CG) on environmental, social, and governance (ESG) performance in the textile industry in developing countries, taking into account the moderating role of technological innovation (TI). Based on institutional theory, we investigated the connection between CG, TI, and ESG performance. The study used secondary data from 197 textile firms in West Africa from 2010 to 2022. Our findings revealed a positive relationship between gender diversity and ESG performance. Similarly, a positive relationship was found between board independence and ESG performance. Contrarily, an inverse connection was found between board size and ESG performance, as well as CEO duality and ESG performance. The study adds to the academic literature on CG and ESG performance by emphasizing the necessity of balancing economic development with social responsibility and environmental preservation. In addition, the study highlights the need to stimulate technological innovation and create an effective governance structure conducive to implementing firms' ecological responsibilities. Lastly, policymakers can adopt the integrated ESG index in measuring firms' sustainability performance across all sectors and regions.
Surrogacy and the significance of gestation: Implications for law and policy
Authors: Mulligan Andrea
Published: June 2024

Gestational surrogacy is ethically complex, generating very different responses in law and policy worldwide. This paper argues that contemporary surrogacy law and policy, across many jurisdictions, fail to give sufficient attention to the significance of the relationship between the child and the gestational surrogate. This failure risks repeating the mistakes of historical, discredited approaches to adoption and donor‐assisted conception. This paper argues that proper recognition of the significance of gestation must be an organising principle in surrogacy law and policy. The paper begins by pointing to examples of surrogacy law and practice where the role of the gestator is unacceptably minimised, most notably the framing of the surrogate as a mere ‘carrier’. It goes on to examine the nature of gestation, including consideration of contemporary scholarship on the metaphysics of pregnancy and emerging work in epigenetics, and argues that current evidence supports the view that the gestational relationship must be taken more seriously than it currently is. The paper then draws analogies with parenthood in donor‐assisted conception and adoption to argue that approaches to parental status in novel family formations that fail to promote transparency and seek to deny the truth of familial relationships are doomed to fail. The paper concludes by suggesting some implications for law and policy that flow from placing sufficient emphasis on the gestational role. The overarching thesis of this paper is that gestational surrogacy is ethically permissible when these fundamental requirements are adhered to, and that surrogacy law should proceed on this basis.
Perspectives on technology: urethral slings in a post‐mesh world
Authors: Garcia Cindy , Homewood David , Gani Johan , O'Connell Helen E.
Published: June 2024

Objectives

To detail the history of synthetic mid‐urethral slings (SMUSs) and fascial slings, their efficacy, associated complications, and changes to practice that have occurred after the issuing of the 2011 US Food and Drug Administration (FDA) Safety Communication statement on transvaginal mesh (TVM), and to highlight the need for surgical registries and high‐quality randomised controlled data to guide recommendations for continence procedures, in view of current concerns regarding mesh.

Methods

A literature search was conducted in EMBASE, PubMed, and the Cochrane Database of systematic reviews to identify articles published from 2011 onward, following the FDA Safety Communication regarding TVM.

Results

Prior to the formal FDA Safety Communication in 2011, TVM was considered a safe option for the treatment of both pelvic organ prolapse (POP) and stress urinary incontinence (SUI). The 2011 FDA safety communications and ensuing widely publicised litigation against TVM manufacturers have shifted both surgeon and patient acceptance of mesh products. Several efforts by medical and government bodies have been made to establish ways to monitor the surgical outcomes and safety of mesh products. The Australasian Pelvic Floor Procedure Registry is one such example. Although SMUSs have a long and established safety profile, perceptions of mesh products for SUI have also been negatively affected. The extent of this, however, has yet to be adequately measured through qualitative and quantitative data. The available data suggest it has been difficult for patients and consumers to distinguish between TVM morbidity for POP vs SUI. Furthermore, there remains a lack of high‐quality randomised or real‐world registry data to definitively exclude the SMUS from the SUI treatment algorithm. Since SMUSs are a viable option for SUI treatment, the concept of a ‘post‐mesh world’ remains contentious.

Conclusion

Controversies surrounding SMUSs have changed the treatment landscape of SUI. Against the background of significant litigious action following the FDA warnings against mesh use, there has been significant reduction in the uptake of synthetic mesh products. Although there are ample data related to surgical outcomes and safety for both autologous fascial and retropubic SMUSs in carefully selected patients, informed consent and surgical training will be of paramount importance as newer synthetic materials reach clinical maturity.
Exploring the factors influencing the first singing date of a cicada, Graptopsaltria nigrofuscata: How will it be affected by climate change?
Authors: Tsujimoto Shohei G. , Koide Dai , Kumagai Naoki H. , Ikegami Makihiko , Nishihiro Jun
Published: June 2024

Climate change affects various scales of biotic interaction through phenological shifts. The emergence phenology of cicadas is ecologically important because these insects have large effects on the ecosystem as herbivores, as food resources, and in nutrient flux from subterranean resources. However, little is known about the weather factors affecting their emergence patterns in the field because their nymphal stages grow underground for several years.

Here, we used long‐term observation data on the first singing date (i.e. the first emergence of male individuals) of Graptopsaltria nigrofuscata, recorded by the Japan Meteorological Agency and citizen scientists throughout Japan, to (1) explore the most influential weather factors across a variety of time spans on the first singing date of G. nigrofuscata and (2) determine whether the temporal trend of the first singing date could be explained by temporal weather trends caused by climate change by using a state space model.

Our results indicated that higher temperatures from midsummer to early winter in the previous year are bringing the cicadas' emergence forward, and the annual increase in temperature is causing the advancement of emergence patterns. Other weather factors, such as precipitation and humidity, did not have a strong effect.

Our findings suggest that increased growth rates at the nymphal stage due to warming in the previous year influence cicada emergence timing. To understand the mechanisms of how rising temperatures are advancing cicada emergence, we need an approach based on the physiology and ecology of their nymphs.
Data science methods for response, incremental response and rate sensitivity to response modelling in banking
Authors: Arevalillo Jorge M.
Published: June 2024

This work provides a review of data science methods that can be used to address a wide variety of business problems in the banking sector. The paper examines three modelling paradigms: the response, incremental response and the rate sensitivity to response approaches, emphasising the role they play to address these problems. These paradigms and the methods they involve are presented in combination with real cases to illustrate their potential in extracting valuable business insights from data. It is enhanced their usefulness to help business experts like risk managers, commercial managers, financial directors and chief executive officers to plan their strategies and guide decision making on the basis of the insights given by their outcomes. The scope of the work is twofold: it presents a unified view of the methods and how the fit the aforementioned paradigms while, at the same time, it examines some business cases for their application. Both issues will be of interest for technical and managerial teams involved in running data science projects in banking.
Industrial collaborative agglomeration and green economic efficiency—Based on the intermediary effect of technical change
Authors: Yu Haichao , Dai Shangze , Ke Haiqian
Published: June 2024

Industry upgrading and structure transformation are important methods for the green and sustainable development. This paper utilizes urban panel data from China spanning the years 2009–2022 to investigate the impact of manufacturing and producer services collaborative agglomeration on green economy efficiency. Additionally, it examines the mediating effect of three modes of technical change: domestic technological stock, international technology transfer, and innovation absorptive capacity. The key findings are summarized as follows: (1) The impact of Industrial collaborative agglomeration (ICA) on green economy efficiency follows a U‐shaped curve relationship, when the degree of ICA is below the inflection point (1.4022), it negatively affects green economy efficiency. However, when the degree surpasses that point, it demonstrates a positive impact. (2) Domestic technological stock and international technology transfer act as mediating variables between ICA and green economy efficiency. Advancements in domestic technology innovation and increased international technology transfer contribute to a positive effect of ICA on green economic efficiency.
State‐led urbanization and technological innovation: A quasi‐natural experiment from county‐to‐district conversion in China
Authors: Wang Chong , Wang Lei
Published: June 2024

Different from the market‐led urbanization in western countries, China's urbanization process has the characteristics of being state‐led, in which county‐to‐district conversion (CTDC) policy plays a key role in promoting urbanization. Our study uses the data of 279 cities as a simple to explore the effect of the state‐led urbanization of CTDC on technological innovation. We find that CTDC significantly promote innovation, and this promoting effect is enhanced with the improvement of urban innovation ability. The mechanism test shows that financial expenditure on education and science, population agglomeration, information and communication technology industry are three channels for CTDC to boost technological innovation. We also find that this promotion effect is more obvious in eastern cities and the cities with higher administrative hierarchy, and is weakest in western cities, however, CTDC adjustment in northeastern cities significantly inhibited technological innovation. Further research shows that when the distance between merged county and city administrative center within 20 km, the effect is negative, after the distance is more than 20 km, with the increase of distance, the promoting effect of CTDC increases.
Competing against oneself and others? Competition as gendered technologies of the self
Authors: Carr Melissa , Kelan Elisabeth K.
Published: June 2024

This paper contributes to debates on gender and competition by drawing on a Foucauldian understanding of neoliberalism to explore how competition operates as gendered technologies of the self. Our findings are based on interviews and observations with women who work in a bank and a network marketing company. We unfold different modalities of competition that are in operation: competition has either an outward focus where women compete with other women or an inward focus where women compete with oneself. The study expands the theoretical understanding of gender and competition by exploring how different modalities of competition operate as gendered technologies of the self under neoliberalism. We conclude that while different modalities exist, they fulfill the same purpose in that they individualise women while making structural inequalities invisible.
The subjectivity load: Negotiating the internalization of “mother” and “creative worker” identities in creative industries
Authors: O’ Brien Anne
Published: June 2024

This paper explores how mothers who are creative workers articulate their subjectivities and examines how their interdependent identities as both mothers and creatives lead to a constant and unresolved negotiation of subjectivity. This constitutes an additional cognitive work burden or a “subjectivity load” for mother‐creatives. The study is based on a small‐scale qualitative study of 40 mothers working in Creative Industries in Ireland. Venn's framework on subjectivity is used to explore the attitudes, values, expectations, and dispositions that respondents articulated when questioned about how they saw the self in relation to the identities of mother and worker. Key findings note that mother workers held ambivalent attitudes about the combination of mothering with work. In terms of their values, respondents internalized a negative and irresolute sense of self if they did not live up to social values on motherhood. With regard to expectations of themselves, mothers felt that they were always having to choose between conflicting demands and that there was an internalized expectation that motherhood should be prioritized over work. Finally, in terms of their disposition, respondents explained they felt that society refused to understand mothers as artists and so they could not easily achieve a settled subjectivity in light of the invisibility of mothers who were also creative workers. Consequently, mother‐creatives are always engaged in a process of negotiation across identity contradictions to form their own subjectivities. This ongoing ambivalence creates another cognitive or subjectivity load around the making and remaking of the internalized self.
PUBLICSERV: Quality assessment scale for public services
Authors: Vieira Kelmara Mendes , Ravanello Renata Pase
Published: June 2024

The quality of public services is a recurrent theme; however, it lacks the structuring of valid measures. The objective of the study was to build and validate a quality assessment scale for public services (PUBLICSERV). A total of 55 items were developed on a 5‐point Likert scale. The instrument validation involved two phases. In the qualitative phase, the validation by specialists and the pre‐test were carried out. In the quantitative phase, a sample of 660 cases was used in the exploratory stage, and another sample of 1284 individuals, in the confirmatory validation. The result of the study is the construction and validation of a scale for assessing the quality of public services composed of 50 items distributed in seven dimensions (tangible aspects, reliability, relationship, public value, transparency, equality and legality, and satisfaction), which evaluates the quality of public services. A methodology for applying the scale was developed to facilitate its use by researchers, managers, and public policymakers, who may have feedback on the quality of the service provided, helping to identify gaps and prioritize needs, thus being able to develop strategies for improvements in public administration.
Revision for unsatisfactory outcomes of scalp micropigmentation
Authors: Park Jae Hyun , Kim Narae , Kim Dae Woo , Lee Injae
Published: June 2024

Background

Scalp micropigmentation (SMP) is becoming increasingly popular. Accordingly, complications of the procedure are on the rise. However, the results of improperly performed SMP are exceedingly challenging to rectify and ultimately lead to severe mental stress and feelings of inferiority in patients.

Aims

This retrospective study aimed to explore various aspects of unsatisfactory SMP outcomes and examine corrective measures available after the procedure.

Materials and methods

A total of 120 patients who underwent corrective surgery or procedures due to unsatisfactory outcomes after SMP were enrolled in the study. Their photographs and medical charts were reviewed retrospectively.

Results

Out of 120 participants, 76 were women and 43 men. In total, 107 patients (89.2%) had been treated at a tattooing or cosmetic facility at a beauty salon performing permanent makeup, 12 (10.0%) at another clinic, and one (0.8%) at an oriental medicine clinic. Of 120 patients, hair transplant surgery was performed on 74 patients (61.7%). Twenty‐five (20.8%) underwent both hair transplant surgery and complementary SMP. Sixteen (13.3%) patients received laser tattoo removal and underwent SMP anew. Five patients (4.2%) had a previous tattoo removed without additional treatment. Patients' subjective satisfaction scores averaged 4.5/5. The physician's objective satisfaction score was 4.6/5.

Conclusion

In cases where SMP is inadequately performed, satisfactory results can be achieved through appropriate revisions, such as tattoo removal, repeated SMP, or hair transplant surgery to conceal the tattoo by highly experienced medical professionals.

Level of evidence

IV.
Construction of the prediction model for multiple myeloma based on machine learning
Authors: Cai Jiangying , Liu Zhenhua , Wang Yingying , Yang Wanxia , Sun Zhipeng , You Chongge
Published: June 2024

Introduction

The global burden of multiple myeloma (MM) is increasing every year. Here, we have developed machine learning models to provide a reference for the early detection of MM.

Methods

A total of 465 patients and 150 healthy controls were enrolled in this retrospective study. Based on the variable screening strategy of least absolute shrinkage and selection operator (LASSO), three prediction models, logistic regression (LR), support vector machine (SVM), and random forest (RF), were established combining complete blood count (CBC) and cell population data (CPD) parameters in the training set (210 cases), and were verified in the validation set (90 cases) and test set (165 cases). The performance of each model was analyzed using receiver operating characteristic (ROC) curve, calibration curves, and decision curve analysis (DCA). Accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and area under the ROC curve (AUC) were applied to evaluate the models. Delong test was used to compare the AUC of the models.

Results

Six parameters including RBC (1012/L), RDW‐CV (%), IG (%), NE‐WZ, LY‐WX, and LY‐WZ were screened out by LASSO to construct the model. Among the three models, the AUC of RF model in the training set, validation set, and test set were 0.956, 0.892, and 0.875, which were higher than those of LR model (0.901, 0.849, and 0.858) and SVM model (0.929, 0.868, and 0.846). Delong test showed that there were significant differences among the models in the training set, no significant differences in the validation set, and significant differences only between SVM and RF models in the test set. The calibration curve and DCA showed that the three models had good validity and feasibility, and the RF model performed best.

Conclusion

The proposed RF model may be a useful auxiliary tool for rapid screening of MM patients.
Alleviating severity of limb trauma pain with coadministration of topical sesame oil and standard treatments: A GRADE‐assessed systematic review and meta‐analysis of randomised controlled trials
Authors: Razani Omolbanin , Nasiri Morteza , Yarahmadi Fatemeh , Zonoori Sahar , Shamsi Afzal , Abbasi Mohammad , Asadi Masoomeh
Published: June 2024

Recent randomised controlled trials (RCTs) have investigated the analgesic activity of sesame oil among patients with limb trauma; nevertheless, their findings are inconsistent. Hence, this review aimed to clarify the impact of topical administration of sesame oil on acute pain of adult outpatients with minor limb trauma. The online databases (e.g., Scopus, PubMed, Web of Science) were searched up to 31 January 2024. The RCTs were included if they compared the effect of applying standard treatments plus topical sesame oil to administering standard treatments alone or with a placebo/sham treatment. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) and the Cochrane Collaboration's risk of bias tool were applied to address the evidence quality and the study's methodological rigour, respectively. Four RCTs had the inclusion criteria, and their findings were pooled in a meta‐analysis employing a random‐effects approach. According to the pooled analysis, the reduction in mean change of the pain score from baseline to the second/third intervention day was significantly higher in favour of clients who received standard care plus daily massage of the trauma site with sesame oil compared to those who received a control condition (weighted mean difference: −1.10; 95% confidence interval [−1.62, −0.57]; p < 0.001). However, the evidence quality was moderate, and only two studies had good methodological rigour. Hence, more high‐quality studies are needed to make a solid evidence‐based conclusion about the favourable consequence of topical sesame oil on alleviating acute traumatic limb pain.
EuroGuiderm guideline on lichen sclerosus—Treatment of lichen sclerosus
Authors: Kirtschig G. , Kinberger M. , Kreuter A. , Simpson R. , Günthert A. , van Hees C. , Becker K. , Ramakers M. J. , Corazza M. , Müller S. , von Seitzberg S. , Boffa M. J. , Stein R. , Barbagli G. , Chi C. C. , Dauendorffer J. N. , Fischer B. , Gaskins M. , Hiltunen‐Back E. , Höfinger A. , Köllmann N. H. , Kühn H. , Larsen H. K. , Lazzeri M. , Mendling W. , Nikkels A. F. , Promm M. , Rall K. K. , Regauer S. , Sárdy M. , Sepp N. , Thune T. , Tsiogka A. , Vassileva S. , Voswinkel L. , Wölber L. , Werner R. N.
Published: June 2024

Introduction

Lichen sclerosus (LS) is an inflammatory skin disease affecting all ages. LS typically involves the anogenital site where it causes itching and soreness; it may lead to sexual and urinary dysfunction in females and males; however, it may be asymptomatic. First signs of LS are usually a whitening of the genital skin, sometimes preceded by redness and oedema; fissuring, scarring, shrinkage and fusion of structures may follow in its course. LS is associated with an increased risk of genital cancer. LS has a huge impact on the quality of life of affected patients, and it is important to raise more awareness of this not uncommon disease in order to diagnose and treat it early.

Objectives

The guideline intends to provide guidance on the diagnostic of LS (part 1), highlight important aspects in the care of LS patients, generate recommendations and treatment algorithms (part 2) on topical, interventional and surgical therapy, based on the latest evidence, provide guidance in the management of LS patients during pregnancy, provide guidance for the follow‐up of patients with LS and inform about new developments and potential research aspects.

Materials and Methods

The guideline was developed in accordance with the EuroGuiDerm Methods Manual v1.3 https://www.edf.one/de/home/Guidelines/EDF‐EuroGuiDerm.html. The wording of the recommendations was standardized (as suggested by the GRADE Working Group). The guideline development group is comprised of 34 experts from 16 countries, including 5 patient representatives.

Results

Ultrapotent or potent topical corticosteroids in females and males, adults and children remain gold standard of care for genital LS; co‐treatment with emollients is recommended. If standard treatment fails in males, a surgical intervention is recommended, complete circumcision may cure LS in males. UV light treatment is recommended for extragenital LS; however, there is limited scientific evidence. Topical calcineurin inhibitors are second line treatment. Laser treatment, using various wave lengths, is under investigation, and it can currently not be recommended for the treatment of LS. Treatment with biologics is only reported in single cases.

Conclusions

LS has to be diagnosed and treated as early as possible in order to minimize sequelae like scarring and cancer development. Topical potent and ultrapotent corticosteroids are the gold standard of care; genital LS is often a lifelong disease and needs to be treated long‐term.
Bit by bit toward the diversity of metopids: Description of the genus Pidimetopus n. gen. (Ciliophora: Armophorea)
Authors: Pomahač Ondřej , Méndez‐Sánchez Daniel , Čepička Ivan
Published: June 2024

While metopids (Armophorea: Metopida) represent the most species‐rich group of free‐living anaerobic ciliates thriving in hypoxic environments, our understanding of their true diversity remains incomplete. Most metopid species are still characterized only morphologically. Particularly, the so‐called IAC clade (named in the past after some of the taxa included, Idiometopus, Atopospira, and Clevelandellida), comprising free‐living members as well as the endosymbiotic ones (order Clevelandellida), is in serious need of revision. In our study, we establish a new free‐living genus in the IAC clade, Pidimetopus n. gen., with descriptions of two new species, P. nanus n. sp., and P. permonicus n. sp., using up‐to‐date molecular and morphologic methods. The genus is characterized by small cells (up to 75 μm long), not more than 10 adoral membranelles and eight somatic kineties, and usually, four long caudal cilia that can stiffen. In addition to morphologic and molecular characterizations, we also conducted a statistical morphotype analysis of the polymorphic species P. nanus n. sp. We discuss the relevance of the earlier morphologically described species Metopus minor as a putative collective taxon for several small metopids less than 50 μm long.
Changes in the cost‐effectiveness of pneumococcal vaccination and of programs to increase its uptake in U.S. older adults
Authors: Wateska Angela R. , Nowalk Mary Patricia , Altawalbeh Shoroq M. , Lin Chyongchiou J. , Harrison Lee H. , Schaffner William , Zimmerman Richard K. , Smith Kenneth J.
Published: June 2024

Background

Multiple factors, such as less complex U.S. adult pneumococcal recommendations that could increase vaccination rates, childhood pneumococcal vaccination indirect effects that decrease adult vaccination impact, and increased vaccine hesitancy (particularly in underserved minorities), could diminish the cost‐effectiveness of programs to increase pneumococcal vaccination in older adults. Prior analyses supported the economic favorability of these programs.

Methods

A Markov model compared no vaccination and current recommendations (either 20‐valent pneumococcal conjugate vaccine [PCV20] alone or 15‐valent pneumococcal conjugate vaccine plus the 23‐valent pneumococcal polysaccharide vaccine [PCV15/PPSV23]) without or with programs to increase vaccine uptake in Black and non‐Black 65‐year‐old cohorts. Pre‐pandemic population‐ and serotype‐specific pneumococcal disease risk and illness/vaccine costs came from U.S. databases. Program costs were $2.19 per vaccine‐eligible person and increased absolute vaccination likelihood by 7.5%. Delphi panel estimates and trial data informed vaccine effectiveness values. Analyses took a healthcare perspective, discounting at 3%/year over a lifetime time horizon.

Results

Uptake programs decreased pneumococcal disease overall. In Black cohorts, PCV20 without program cost $216,805 per quality‐adjusted life year (QALY) gained compared with no vaccination; incremental cost‐effectiveness was $245,546/QALY for PCV20 with program and $425,264/QALY for PCV15/PPSV23 with program. In non‐Black cohorts, all strategies cost >$200,000/QALY gained. When considering the potential indirect effects from childhood vaccination, all strategies became less economically attractive. Increased vaccination with less complex strategies had negligible effects. In probabilistic sensitivity analyses, current recommendations with or without programs were unlikely to be favored at thresholds <$200,000/QALY gained.

Conclusion

Current U.S. pneumococcal vaccination recommendations for older adults were unlikely to be economically reasonable with or without programs to increase vaccine uptake. Alternatives to current pneumococcal vaccines that include pneumococcal serotypes associated with adult disease should be considered.
Maternal immune activation with toll‐like receptor 7 agonist during mid‐gestation alters juvenile and adult developmental milestones and behavior
Authors: Sheng Julietta A. , Tobet Stuart A.
Published: June 2024

Infections during pregnancy are associated with increased risk for adult neuropsychiatric disease, such as major depressive disorder, schizophrenia, and autism spectrum disorder. In mouse models of maternal immune activation (MIA), different toll‐like receptors (TLRs) are stimulated to initiate inflammatory responses in mother and fetus. The goal of this study was to determine sex‐dependent aspects of MIA using a TLR7/8 agonist, Resiquimod (RQ), on neurodevelopment. RQ was administered to timed‐pregnant mice on embryonic day (E) 12.5. At E15, maternal/fetal plasma cytokines were measured by enzyme‐linked immunosorbent assay (ELISA). Maternal cytokines interleukin (IL)‐6 and IL‐10 were higher while tumor necrosis factor (TNF)‐α and IL‐17 were lower in pregnant dams exposed to RQ. Fetal cytokines (E15) were altered at the same timepoint with fetal plasma IL‐6 and IL‐17 greater after RQ compared to vehicle, while IL‐10 and TNF‐α were higher in male fetuses but not female. Other timed‐pregnant dams were allowed to give birth. MIA with RQ did not alter the female to male ratio of offspring born per litter. Body weights were reduced significantly in both sexes at birth, and over the next 5 weeks. Offspring from RQ‐injected mothers opened their eyes 5 days later than controls. Similarly, female offspring from RQ‐injected mothers exhibited pubertal delay based on vaginal opening 2–3 days later than control females. On the behavioral side, juvenile and adult male and female MIA offspring exhibited less social‐like behavior in a social interaction test. Anhedonia‐like behavior was greater in MIA adult female mice. This study provides support for sex‐dependent influences of fetal antecedents for altered brain development and behavioral outputs that could be indicative of increased susceptibility for adult disorders through immune mechanisms. Future studies are needed to determine neural cellular and molecular mechanisms for such programming effects.
An inclusive anatomical network analysis of human craniocerebral topology
Authors: Schuurman Tim , Bruner Emiliano
Published: June 2024

The human brain's complex morphology is spatially constrained by numerous intrinsic and extrinsic physical interactions. Spatial constraints help to identify the source of morphological variability and can be investigated by employing anatomical network analysis. Here, a model of human craniocerebral topology is presented, based on the bony elements of the skull at birth and a previously designed model of the brain. The goal was to investigate the topological components fundamental to the craniocerebral geometric balance, to identify underlying phenotypic patterns of spatial arrangement, and to understand how these patterns might have influenced the evolution of human brain morphology. Analysis of the craniocerebral network model revealed that the combined structure of the body and lesser wings of the sphenoid bone, the parahippocampal gyrus, and the parietal and ethmoid bones are susceptible to sustain and apply major spatial constraints that are likely to limit or channel their morphological evolution. The results also showcase a high level of global integration and efficient diffusion of biomechanical forces across the craniocerebral system, a fundamental aspect of morphological variability in terms of plasticity. Finally, community detection in the craniocerebral system highlights the concurrence of a longitudinal and a vertical modular partition. The former reflects the distinct morphogenetic environments of the three endocranial fossae, while the latter corresponds to those of the basicranium and calvaria.
The frequency of sepsis‐associated delirium in intensive care unit and its effect on nurse workload
Authors: Alıcı Şerife , Öztürk Birge Ayşegül
Published: June 2024

Aim

To determine the frequency of sepsis‐associated delirium (SAD) in the intensive care unit and its effect on nurse workload.

Design

A cross‐sectional and correlational design was used.

Methods

The study was conducted with 158 patients in the adult intensive care unit of a hospital between October 28 and July 28, 2022. Data analysis included frequency, chi‐squared/fisher's exact test, independent samples t‐test, correlation analysis, simple and multiple linear regression analyses. The study adhered to the STROBE guidelines.

Results

Sepsis was detected in 12.7% of the patients, delirium in 39.9%, and SAD in 10.1%. SAD was more common in males (19%) and 56.3% of the patients were admitted to the unit from the emergency department. Patients developing SAD had significantly higher age and mean sequential organ failure evaluation, acute physiology and chronic health evaluation II, and C‐reactive protein and lactate scores, but their Glasgow Coma Scale scores were significantly low. There was a moderate positive relationship between the patients' Sequential Organ Failure Assessment score and the presence of SAD. The most common source of infection in patients diagnosed with SAD was bloodstream infection (44.4%). SAD significantly increased nurse workload and average care time (1.8 h) and it explained 22.8% of the total variance in nurse workload. Additionally, the use of antibiotics, vasopressors and invasive mechanical ventilation significantly increased nurse workload.

Conclusion

In the study, in patients who developed SAD increased nurse workload and average care time significantly. Preventive nursing approaches and effective management of SAD can reduce the rate of development of SAD and nurse workload.

Implications for the profession and patient care

It is important to work with routine screening, prevention and patient–nurse ratio appropriate to the workload for SAD.
Listen to me, I really am sick! Patient and family narratives of clinical deterioration before and during rapid response system intervention
Authors: Bucknall Tracey K. , Guinane Jessica , McCormack Brendan , Jones Daryl , Buist Michael , Hutchinson Alison M.
Published: June 2024

Aim

To explore patient and family narratives about their recognition and response to clinical deterioration and their interactions with clinicians prior to and during Medical Emergency Team (MET) activations in hospital.

Background

Research on clinical deterioration has mostly focused on clinicians' roles. Although patients and families can identify subtle cues of early deterioration, little research has focused on their experience of recognising, speaking up and communicating with clinicians during this period of instability.

Design

A narrative inquiry.

Methods

Using narrative interviewing techniques, 33 adult patients and 14 family members of patients, who had received a MET call, in one private and one public academic teaching hospital in Melbourne, Australia were interviewed. Narrative analysis was conducted on the data.

Results

The core story of help seeking for recognition and response by clinicians to patient deterioration yielded four subplots: (1) identifying deterioration, recognition that something was not right and different from earlier; (2) voicing concerns to their nurse or by family members on their behalf; (3) being heard, desiring a response acknowledging the legitimacy of their concerns; and (4) once concerns were expressed, there was an expectation of and trust in clinicians to act on the concerns and manage the situation.

Conclusion

Clinical deterioration results in an additional burden for hospitalised patients and families to speak up, seek help and resolve their concerns. Educating patients and families on what to be concerned about and when to notify staff requires a close partnership with clinicians.

Implications for the Profession and/or Patient Care

Clinicians must create an environment that enables patients and families to speak up. They must be alert to both subjective and objective information, to acknowledge and to act on the information accordingly.

Reporting Method

The consolidated criteria for reporting qualitative research (COREQ) guidelines were used for reporting.

Patient or Public Contribution

The consumer researcher was involved in design, data analysis and publication preparation.
Telediagnosis as an effective tool for assessment temporomandibular disorders
Authors: Corelhano Amanda Rossi , Hilgenberg‐Sydney Priscila Brenner , Bonotto Daniel , Torres‐Pereira Cassius Carvalho
Published: June 2024

Background

The use of communication technologies has allowed a substantial improvement in telediagnosis.

Objectives

To evaluate the feasibility and diagnostic agreement of synchronous teleconsultation compared to physical standard examination for temporomandibular disorders (TMD) and orofacial pain.

Methods

Sixty‐one patients (50 women, 11 men) with a mean age of 46.07 years referred to the Orofacial Pain Ambulatory Service (SAMDOF —UFPR) were evaluated remotely. They were then examined in person by another evaluator, blinded for the first evaluation. Data on the experience and level of satisfaction with the teleconsultation were also collected.

Results

For each type and subtype of TMD, diagnostic agreement values, sensitivity, specificity, positive predictive values and negative predictive values were calculated with a 95% confidence interval. ‘Almost perfect’ agreement was found for Myalgia (k = 0.915), Arthralgia (k = 0.863), disc displacement without reduction without limited opening (k = 0.955) and no TMD (k = 1.00). ‘Substantial’ agreement for the subtypes headache attributed to TMD (k = 0.761), disc displacement without reduction with limited opening (k = 0.659) and subluxation (k = 7.82). The diagnoses of local myalgia (k = 0.573), myofascial pain with referral (k = 0.524) and disc displacement with reduction (k = 0.563) obtained ‘moderate’ agreement. Degenerative joint disease (k = 0.170) and disc displacement with reduction with intermittent locking (k = 0.000) obtained ‘weak’ and ‘no agreement’, respectively. More than 90% of the participants were satisfied and reported no discomfort during the assessment, agreeing to participate in another teleconsultation.

Conclusion

Synchronous teleconsultation proved to be feasible and presented adequate diagnostic agreement for the main painful TMDs, especially for the diagnosis of myalgia and arthralgia. This format was also well accepted among patients.