bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of breast cancer neoadjuvant chemotherapy on plasma and urine amino acid profile, plasma proteins and nitrogen metabolism
Authors: Dastych Milan , Holánek Miloš , Gottwaldová Jana , Čermáková Zdenka , Mikušková Alena
Published: August 2023

Purpose
This pilot observational prospective study examined the effect of neoadjuvant chemotherapy (NAC) using anthracycline + cyclophosphamide (AC) followed by paclitaxel (PTx) on a portfolio of 22 plasma and urinary amino acids, plasma proteins (albumin, prealbumin, transferrin), and products of nitrogen metabolism (urea, creatinine, uric acid) in plasma and urine.
Methods
Plasma and 24-hour urine samples were obtained from ten patients with early breast cancer (N1-3 N0-2 M0), at the following time points: before the start of NAC and during the AC/PTx treatment period (a total of 8 measurements at three-weekly intervals). Amino acids were analyzed using ion exchange chromatography.
Results
There were no significant differences in the measured parameters in plasma and urine between pre-NAC and during AC- and PTx-treatment. No trend was detected. A significant difference in the portfolio of plasma and urinary amino acids was found only in the pre-treatment period compared to the control group. Levels of eight plasma amino acids (8/22) were significantly reduced and those of 9 urine amino acids were increased (9/22). Nitrogenous catabolites in plasma and urine were not indicative of increased protein catabolism during the anthracycline and taxane treatment periods. A slightly positive nitrogen balance was accompanied by an average weight gain of 2.5 kg (range 0–5 kg).
Conclusion
The AC/PTx treatment regimen did not cause significant changes in the monitored laboratory parameters.
Barriers to proper maternal referral system of health facilities: a qualitative study in Eastern Ethiopia
Authors: Mengist Betelhem , Semahegn Agumasie , Yibabie Shegaye , Amsalu Bezabih , Tura Abera Kenay
Published: August 2023

Background
Appropriate referral system plays an essential role in curbing maternal mortality. Although the occurrence of obstetric complications is often unpredictable, addressing bottlenecks of the referral system is crucial to facilities the women have access to timely lifesaving interventions. Nonetheless, little is known about the barriers to maternal referral system in the eastern part of Ethiopia. Therefore, this study aimed to explore the barriers to maternal referral system at selected referral hospitals in eastern Ethiopia.
Methods
Key informant interviews and in-depth interviews were conducted among purposively selected respondents who had a role in the maternal referral processes. A total of 12 key informants that comprised of liaisons officers, healthcare providers and three in-depth interviews with referred women were conducted. Semi-structured interview guide was developed and used to facilitate the interviews. All the interviews were tape recorded, complemented by note taking. Then audio recorded interviews were transcribed as per verbatim of participants, and imported to NVivo for coding and merging. The data were thematically synthesized.
Results
The study identified a range of barriers that affect the maternal referral system in Eastern Ethiopia. The main barriers are grouped into three domains, such as: communication, transportation, and healthcare system. The most commonly reported barriers were lack of pre referral communication and feedback, using informal communication, incomplete referral communication, poor ambulance service including misuse of ambulances, lack of skilled healthcare, escort, and lack of medical equipment, at emergency, unnecessary self-referrals, poor referral skills, and limited number of health professions.
Conclusions
The maternal referral system is overwhelmingly affected by lack of skill, logistics (referral form), misuse of available ambulance, poor communication, and limited seeking of feedback. We suggest a regular consultative meeting with relevant stakeholders and uptake of feedbacks are crucial to improve referral communication, proper use of ambulance and building capacity of health workforce about referral, management that will improve the maternal referral system in the study area.
Establishing Dietary intake Behavior of children to prevent iron deficiency to sustain their growth, Oromiya region, Ethiopia: Community Cluster trial
Authors: Ferede Abebe , Belachew Tefera , Abera Muluemebet
Published: August 2023

Background: Distressing iron deficiency anemia (IDA) in young children requires an appropriate prevention strategy. This study aimed to determine how dietary intake behavior change (DIBC) could improve the effects of hemoglobin (Hb) concentration on children's growth from 6 to 59 months of age.
Methods: A cluster randomized controlled trial was conducted. The intervention and control groups were randomly assigned to the 16 lower community units (LCU). Children paired with their mothers were chosen from each LCU. At the starting point and finish line, Hb, anthropomorphic, and other variable data were collected. A t-test was used to analyze the mean variations. We determined significant parameters using a Generalized Estimating Equation (GEE).
Results: Approximately 1012 and 935 children were enrolled at the start and end of the study, respectively. At baseline, the mean Hb was 128.4 g/L + 15.6, and at the end, it was 141.3 g/L + 42.5. In contrast, in the control group, the incidence of iron deficiency anemia (IDA) was 15.2% (n = 77) at baseline. In the intervention group, IDA was 107 (21.1%) at baseline and 18 (3.6%) at the end line. At the time of completion, stunted growth in the intervention group decreased to 65 (12.8%) and climbed to 237 (55.2%) in the control group. Hb Mean differences between the groups in the baseline - end-line difference by height was 27.5g/L, p = 0.001. Children who were allocated to the intervention group by 12.6 cm (p = 0.001) in a month rated their height among the many tested parameters
Conclusions: Higher IDA and a very high prevalence of stunted growth were observed in both groups of children, but at the end line was radically reduced to low among the intervention group. Implementing healthy eating habits and dietary intake practices could essentially be improved among interventions, while the control group continued to experience negative effects. As a result, this type of intervention is more likely to have a widespread impact on the physical and nutritional well-being of children.
Clinical trial registration numbers: NCT04846062, Date: 15/04/2021
Posterior cruciate ligament repair in acute knee instabilities with internal bracing: midterm follow up for clinical and kinematic results
Authors: Martens Eike , Krackhardt Tilmann , Wicke Lino , Kratzenstein Stefan , Wegner Mathis , Lippross Sebastian
Published: August 2023

Background:
Injuries of the PCL are comparably rare. They occur with or without accompanying injuries of the knee and frequently occur in multi-ligament knee instability. Internal bracing is a recent treatment option for acute PCL tears. For low-grade instability, a conservative therapy is recommended while severe instability in multi-ligament injuries is mostly addressed by surgical reconstruction. Recent evaluations of internal bracing demonstrate good options for both isolated ligamentous and multiligamentous injuries.
The aim of this study was to assess general outcomes in joint function and stability as well as activity and quality of life by clinical examination and functional gait analysis.
Methods:
A total of 19 patients were examined after internal bracing of an acute II/III° PCL- injury between 2017 and 2021. Included were patients with MRI-proven unilateral PCL tear. In addition to clinical tests for mobility and posterior drawer test, a IMU based kinematic gait analysis was performed. Further IKDC-Score, TAS and Lysholm Score were examined. Regular stress radiographs of both knee joints were included for further evaluation.
Results:
Follow-up examination took place after 29.40 ± 10.47 months. The mean ROM of the injured knee showed 0.79° ± 1,9° for extension and 138,4° ± 3,4° for flexion. In gait and walking analysis, no significant movement restrictions for either knee joint remained. IKDC amounted to 53,2 ± 4,2% after injury and 91.7 ± 7,4% at follow-up. The Lysholm Score was 95.5% ± 8,3%. The TAS showed no significant difference (5,5 ± 1.30 pt pre-injury and 5,2 ± 1.2 pt at follow-up). The mean difference of posterior tibial translation reached 2,5 ± 1,5 mm in clinical examination and demonstrated significant difference to the healthy side. 1 patient needed revision surgery by complete PCL- reconstruction due to grade II-Instability postoperative but no other complications occurred.
Conclusions:
Internal bracing can offer good treatment for acute grade II and grade III PCL-instabilities, especially when further meniscal or ligamentous injuries require surgical repair. Despite the limited evidence-based results and applications to date, restoration of joint mobility and a minor residual posterior tibial translation can be confirmed. Results for everyday and sports activities are comparable with conservative and established surgical procedures.
Pneumococcus suppresses host inflammatory response through COMMD2 mediated NF-κB degradation by aggrephagy
Authors: Hamon Melanie , Connor Michael , Sanchez Lisa , Chevalier Christine , Carvalho Filipe , Eldridge Matthew , Chaze Thibault , Matondo Mariette , Weight Caroline , Dufour Sara , Impens Francis , Baumgarten Sebastian , Enninga Jost
Published: August 2023

NF-κB driven cellular immunity is essential for both pro- and anti-inflammatory responses to microbes, which makes it one of the most frequently targeted pathways by bacteria during pathogenesis. How NF-κB tunes the epithelial response to Streptococcus pneumoniae across the spectrum of commensal to pathogenic outcomes is not fully understood. In this study, we compare a commensal-like 6B ST90 strain to an invasive TIGR4 isolate and demonstrate that TIGR4 both blunts and antagonizes NF-κB activation. We identified, through comparative mass spectrometry of the p65 interactome, that the 6B ST90 isolate drives a non-canonical NF-κB RelB cascade, whereas TIGR4 induces p65 degradation though aggrephagy. Mechanistically, TIGR4 challenge triggers a novel interaction of COMMD2 with p65 and p62. This complex mediates export of p65 for degradation and is necessary for repressing host inflammatory transcription. With these results, we reveal for the first time a new bacterial pathogenesis mechanism to repress host inflammatory response though COMMD2 mediated turnover of p65, and present a paradigm for diverging NF-κB responses to pneumococcus.
Association of T-wave Changes and Type 2 diabetes: A cross-sectional sub-analysis of MASHAD cohort population using Minnesota coding system of Electrocardiogram
Authors: Soflaei Sara Saffar , Nazar Isa , Sahranavard Toktam , Fayedeh Farzad , Ghalibaf AmirAli Moodi , Ebrahimi Mahmoud , Alimi Hedieh , Shahri Bahram , Izadi-Moud Azadeh , Ferns Gordon A. , Ghodsi Alireza , Mehrabi Saeed , Tarhimi Milad , Esmaily Habibollah , Moohebati Mohsen , Ghayour-Mobarhan Majid
Published: August 2023

Background: Type 2 Diabetes Mellitus (T2DM) has become a major health concern with an increasing prevalence and is now one of the leading causes of death globally. T2DM and cardiovascular disease are strongly associated and T2DM is an important independent risk factor for ischemic heart disease. T-wave abnormalities (TWA) on electrocardiogram (ECG) can indicate several pathologies including ischemia. In this study, we aimed to investigate the association between T2DM and T-wave changes evaluated using the Minnesota coding system.
Methods: A cross-sectional study was conducted on the MASHAD cohort study population. All participants of the cohort population were enrolled in the study. 12-lead ECG and Minnesota coding system (codes 5-1 to 5-4) were utilized for T-wave observation and interpretation. Regression models were used for the final evaluation with a level of significance being considered at p<0.05.
Results: A total of 9035 participants aged 35-65 years old were included in the study, of whom 1273 were diabetic. The prevalence of code 5-2, 5-3, major and minor TWA were significantly higher in diabetics (p<0.05). Following adjustment for age, gender, and hypertension, no TWAs were significantly associated with T2DM (p>0.05). Whereas, hypertension, age, and body mass index were significantly associated with T2DM.
Conclusions: Although some T-wave abnormalities were more frequent in diabetics, none of them were statistically associated with T2DM in our study. Further research is needed to better understand the associations between T2DM and ischemic heart diseases.
Case Report: Anesthesia management of a patient that requires lung isolation with tracheal stenosis and an anterior airway
Authors: Raviv Abrar , Kessaris Christos P.
Published: August 2023

Background: Under general anesthesia, double lumen endotracheal tubes are frequently used in the surgical management of cases requiring lung isolation. However, a single lumen endotracheal tube with a bronchial blocker might be necessary in instances of tracheal stenosis or difficult airways.
Case Presentation: We describe a case of a 67-year-old female with a large lung cyst who showed signs of both tracheal stenosis and an anterior airway who underwent cyst removal. Under GlideScope videolaryngoscopy, a transition from a double lumen endotracheal tube to a single lumen endotracheal tube in conjunction with a bronchial blocker was required, which allowed for successful cyst removal from the patient with effective selective lung ventilation with uneventful recovery.
Conclusion: It is an original case report, which demonstrates the transition from a double lumen tube to a single lumen tube in conjunction with a bronchial blocker in the incident of both tracheal stenosis and an anterior airway under the guidance of the GlideScope.
Prevalence, determinants, intervention strategies and current gaps in addressing childhood malnutrition in Vietnam: a systematic review
Authors: Mondon Charlotte , Tan Pui Yee , Chan Chong Ling , Nga Thuy Tran , Gong Yun Yun
Published: August 2023

Background
Childhood malnutrition in all forms is a major public health issue worldwide. This review aimed to systematically examine the prevalence and determinants, and identify the potential interventions and current gap in addressing malnutrition including undernutrition, overnutrition and micronutrient deficiencies (MNDs) in Vietnamese children aged 0–18 years old.
Methods
Embase, Scopus, PubMed, and Web of Science were systematically searched through June 2022 to identify relevant articles published within the past 25 years. Study selection and data extraction were performed by one reviewer and checked for accuracy by the other two reviewers in accordance with PRISMA guideline. Risk of publication bias was assessed using American Dietetic Association Quality Criteria Checklist.
Results
81 studies that met the inclusion criteria were included. Undernutrition have been decreased over time but still 22.4%, 5.2% and 12.2% of children under 5 were stunted, wasted and underweight, respectively. Prevalence of MNDs varied by age, regions or socio-economic groups, with 11.4–89.9%, 11–90%, 23–87%, 11–58% and 8–20% of Vietnamese children were anaemic and iron, zinc, vitamin D and retinol deficient, respectively. Overweight and obesity is now on the rise (7.4–22%). The key determinants of undernutrition/MNDs included living in rural areas, children with low birth weight, and poor socio-economic status, whereas living in urban and affluent areas, having an inactive lifestyle and being a boy were associated with increased risk of overweight or obesity. Nutrition specific intervention studies including supplementation and food fortification consistently showed improvements in anthropometric indices and micronutrient biomarkers, and national nutrition sensitive programmes also provided nutritional benefits on child’s growth and eating behaviours, but lack of data on childhood overweight.
Conclusion
Stunting is still prevalent at 20% in Vietnamese children (< 5years) despite a significant reduction over the decade. MNDs remain to be a serious problem, whilst overweight and obesity are rapidly rising requiring attention and intervention. This finding highlights the needs for double duty actions to simultaneously and effectively address different forms of childhood malnutrition in Vietnam. However, evidence on the potential intervention strategies, especially on MNDs and overnutrition are still limited to inform policy decision, thus future researches are warranted.
Transversotrema patialense var. hafniensis infection in Poecilia reticulata by cercariae released from Melanoides tuberculata in Denmark: Implications for fish health and bioinvasion
Authors: Buchmann Kurt , Kania Per Walter
Published: August 2023

Background
Exotic and ornamental fish are highly popular companion animals in industrialized human societies resulting in a significant transcontinental trade of fish, invertebrates or aquatic plants. A major issue is the diseases associated with these organisms as they have a major impact on health of the fish in both public and private household aquaria. A secondary issue is the trade with these products, which potentially may expand the distribution area and spread a range of diseases to new habitats.
Results
We here describe how Poecilia reticulata Peters, 1859 (guppy), produced in a private household aquarium, were invaded by cercariae of an exotic trematode released by imported snails. The fish presented with severe clinical signs (tremor, flashing, scraping of body against objects). A standard parasitological examination and morphometric identification showed the disease to be caused by scale pocket infections with a species within the genus Transversotrema patialense (Soparkar, 1924), an exotic digenean trematode. Molecular identification by PCR, sequencing and BLAST analysis indicated that the parasite was an undescribed variant and the isolate was therefore named T. patialense var. hafniensis.
Conclusions
GenBank sequences for species within the genus Transversotrema are sparse and fragmented and we here present the entire 2646 bp sequence of encoding ribosomal RNA (partial 18S, ITS1, 5.8 S, ITS2, partial 28S) and a 1107 bp sequence of mitochondrial DNA (CO1). These are recommended for future diagnostics use and separation of sister species within T. patialense sensu lato. The fish were not purchased from a pet shop but produced in the home aquarium. This indicated that an infection pressure existed in the aquarium, where the source of infection was found to be exotic intermediate host snails Melanoides tuberculata (Müller, 1774), which originally were imported and purchased from a pet shop. They were recovered from the facility and shown to release infective cercariae, which infected naïve guppies. We frame that trade with infected snails may not only challenge the health of fish in aquaria but also represent a risk for spread of exotic fish diseases to new geographic regions where climate changes may facilitate their establishment.
Array-Based Statistical Analysis of the MK-3 Customizable Authenticated Encryption Algorithm
Authors: Bajorski Peter , Kaminsky Alan , Kurdziel Michael , Łukowiak Marcin , Radziszowski Stanisław
Published: August 2023

To provide security autonomy capability, such that different users can have independent variants of the encryption algorithm, MK-3 is designed to be customizable. Two levels of customization are supported, Factory Customization and Field Customization. Customization is done by modifying functions and function parameters in the algorithm to yield unique cipher functions while preserving the algorithm’s cryptographic security.
The main goal of this work is to present the results from the statistical analysis of the customizable MK-3 encryption cypher, focusing on field customized mixers. We recall the main components of the MK-3 algorithm and overview a subset of available factory and field customizations for MK-3. We test the main instances of the field customized versions and give a general argument for their desired statistical properties expected from an encryption cypher.
Driving Magnetosphere Convection through the ionosphere
Authors: Dai Lei , Zhu Minghui , Ren Yong , Wang Chi , Gonzales Walter , Samsonov Andrey , Escoubet Philippe , Tang Binbin , Zhang Jiaojiao , Branduardi-Raymont Graziella
Published: August 2023

The Dungey cycle is a fundamental concept in understanding magnetosphere convection in the presence of the interplanetary magnetic field (IMF). It explains that the convection within the closed part of the magnetosphere is primarily driven by magnetic reconnection in the nightside magnetospheric tail. Here we provide evidence that magnetospheric convection can also be driven solely by dayside magnetic reconnection, specifically through the ionosphere's two-cell convection. The enhanced convection progresses from the dayside to the nightside and responds rapidly, within 10-20 minutes, to a southward turning of the IMF. Uncovering this physical process provides new insights into the driving mechanisms behind planetary magnetosphere convection.
A qualitative study of the symptom management in patients with chemotherapy-induced hand-foot syndrome
Authors: Zhang Jie , Wang Chen , He Qian-Yun , Mao Dong-Liang , Huang Lei , Wang Mei , Zhang Jun
Published: August 2023

Purpose
To investigate the ability to self-manage symptoms in patients with chemotherapy-induced HFS and to provide guidance for developing a self-management plan that meets patient needs.
methods
From July 2022 to July 2023, 22 patients with chemotherapy-induced HFS were selected by objective sampling in the oncology department of a tertiary hospital in Shanghai. A semi-structured in-depth face-to-face interview was used to collect the case data, and the content analysis method was used for analysis, and the topic was refined.
Results
Twenty-two patients were interviewed. Three themes and six sub-themes emerged from the analytical interviews: the first theme was "Patient attitude and emotional response to symptoms," which consisted of patients gradually accepting the symptoms of HFS and adapting to some mild manifestations based on the following responses, showing different emotional responses to HFS, symptoms that affected their daily life. The patient feels guilty for his family and suffers from a self-image disorder. The second theme is "symptom experience," with symptoms that vary from patient to patient and have a different impact on the individual's life, including pain and itching. The third theme is "coping strategies," which include patients feeling the effects of limited social interaction and family relationships. The fourth topic, "Expectations for the future," includes gaining relevant knowledge through the website, doctors, and patients, changing habits, demonstrating symptom improvement, and meeting/exceeding the expectations of healthcare providers.
Conclusions
Healthcare providers should provide more education and emotional support to patients with chemotherapy-induced HFS to enable symptom management, elicit positive experiences.
Study Of Epilithic Cyanobacteria On The Walls Of Garh Palace And Abheda Mahal Of Kota, Rajasthan
Authors: Sharma Pooja , Shrivastava Neerja , Scholar Research
Published: August 2023

Cyanobacteria also called Blue Green Algae are gram negative, oxygenic photosynthetic prokaryotes. They show the ability of efficient nutrient uptake mechanism. Ancient monuments and temples are more exposed to sunlight and moisture of the environment and are the easiest sites for microbial colonization. Microbes are able to colonize on the walls of historical monument by forming biofilms or patinas. Biofilms of microbial cells degrade the asthetic value of ancient buildings and require lots of time and investment to eliminate them. The primary colonizers of stone monuments are seen as photosynthetic microorganisms (algae and Cyanobacteria). Many of the species of Cyanobacteria are able to tolerate climate extremes and hence require more attention to be study. It has been seen that Cyanobacteria need only light and water to grow and therefore can grow endolithically (4). They can tolerate extreme climate conditions. Cyanobacteria are able to survive on exposed surfaces of ancient walls and are greatly involved in biodeterioration of monuments (2). This makes more concern about the study of Cyanobacteria as they the agents of stone property degradation in future. Kota city is situated near the bank of river Chambal. Kota have semi-arid climate throughout the year. Garh Palace also known as City palace is a historic place since foundation laid in 1264 C.E by Prince Jait Singh of Bundi. It comprises number of architectural structures of ancient times. It has a huge museum which displays royal arms and ammunitions. Another ancient monument is Abheda Mahal situated near Chambal River, built by Ummed Maharaj. It is also rich in heritage with beautiful pond inside it. Total 12 species isolated from the walls of monuments generally belongs to genus Nostoc (1), of the genera Gloeocapsa (2), Gloeothece (2), Aphanothece (1), Chroocococcus (2), Chroococcidiopsis (1), Tolypothrix (1) and Aulosira (1) of Cyanophyta.
Identification of sialoylation-related genes as a new diagnostic biomarker of atherosclerosis by machine learning
Authors: Song Wei , Xue Jian-feng , Liu Ji-fang , Feng Yue , Yao Na , Yin Lu-hua , Yang Hong-Peng , Sun Hai-peng , Zhang Pu
Published: August 2023

Background:
Atherosclerosis (AS) is a pathological change based on the disorder of lipid metabolism, which is related to the inflammatory process of vascular wall and the high level of low-density lipoprotein. Sialoylation is a post-translational modification controlled by sialyltransferase, transporter and neuraminidase family. This process plays a key role in a variety of biological functions. Abnormal sialylation is related to a variety of diseases, including cancer, pathogen infection and cardiovascular disease (CVD). Therefore, this study aims to explore the role of sialylation related genes in AS.
Methods:
Two AS data sets were obtained from the gene expression comprehensive database (GEO). Based on the differentially expressed genes (DEGs) and the sialylation gene set, the differentially expressed sialylation-related genes (De-SRGs) were found. Then, machine learning method is used to find the core gene. The immune cell infiltration method was established to study the immune cell imbalance in AS. Subsequently, we explored two different subtypes based on core genes using 158 AS samples. Gene ontology (GO), Kyoto Encyclopedia of Genes and Genome (KEGG) pathway enrichment, gene set variation analysis (GSVA) and immunoinfiltration analysis are also used to evaluate the different roles of subtypes.
Results:
A total of 36 De-SRGs were identified. Through machine learning algorithm, 5 core genes were identified and 2 subtypes related to core genes were defined. The results of GSVA showed that type A inflammatory response related pathways were significantly enriched, while type B inflammatory response related pathways were significantly enriched.
Conclusion:
Through this study, we have revealed the relationship between Sialylation-related genes and AS, as well as the heterogeneity of AS patients with different Sialylation subtypes. Selecting a Sialylation-signature based on five genes as the best machine learning model can accurately evaluate the diagnosis of AS and control patients. Our research results reveal the progress of Sialylation in AS for the first time, and provide new insights for its potential pathogenesis and potential treatment strategies.
Association of postoperative adverse events with low skeletal muscle mass measured from the 12th thoracic vertebral skeletal muscle mass in oral cancer patients
Authors: Fujii Arisa , Suzuki Taiki , Sakai Katsuhiko , Matsuura Nobuyuki , Sugahara Keisuke , Katakura Akira , Nomura Takeshi
Published: August 2023

Background
Sarcopenia is characterized by a progressive and generalized loss of skeletal muscle mass and strength. The aim of this study was to investigate the impact of skeletal muscle mass on adverse events in free-flap reconstruction for defects after oral cancer resection.
Methods
The participants were a non-randomized retrospective cohort of 120 patients who underwent this procedure after preoperative diagnostic computed tomography. Cross-sectional areas (cm2) of skeletal muscles in the Th12 region were measured by manual outlining of computed tomography images. Subsequently, the skeletal muscle Cross-sectional areas at level L3 was estimated using the prediction rule described by Matsuyama et al. These areas were then normalized to height (cm2/m2) and defined as the skeletal muscle index.
Results
Recipient-site adverse events occurred in 56 patients (46.7%), and recipient-site surgical site infections occurred in 45 patients (37.5%). Skeletal muscle index was significantly associated with recipient site adverse events in univariate analysis (P < 0.05). Lower body mass index and skeletal muscle index were significantly associated with recipient site surgical site infection in univariate analysis (P < 0.05). In the multiple logistic regression model, a lower skeletal muscle index was a significant risk factor for recipient site adverse events and surgical site infections (adverse events odds ratio; 3.17/P = 0.04; surgical site infection odds ratio; 3.76/P = 0.02).
Conclusions
These results suggest that low skeletal muscle index in Th12 is particularly associated with adverse events and that it is a predictor of surgical site infections.
Random Informative Advertising with Vertically Differentiated Products
Authors: Lahmandi-Ayed Rim , Laussel Didier
Published: August 2023

We study a simple model in which two vertically differentiated firms compete in prices and mass advertising on an initially uninformed market. Consumers differ in their preference for quality. There is an upper bound on prices since consumers cannot spend more on the good than a fixed amount (say their income). Depending on this income and on the ratio between advertising cost and quality differential (relative advertising cost), either there is no equilibrium in pure strategies or there exists one of the following three types: 1) an Interior equilibrium where both firms have positive natural markets and charge prices lower than the consumer’s income; 2) a Constrained interior equilibrium where both firms have positive natural markets and the high-quality firm charges the consumer’s income or 3) a Corner equilibrium where the low-quality firm has no natural market selling only to uninformed customers. We show that no corner equilibrium exists in which the highquality firm would have a null natural market. At an equilibrium (whenever there exists one), the high-quality firm always advertises more, charges a higher price and makes a higher profit than the low-quality one. As the relative advertising cost goes to infinity, prices become equal and the advertising intensities converge to zero as well as the profits. Finally, the advertising intensities are, at least globally, increasing with the quality differential.
JEL classification: D83, L13, M37.
Expression of preference for the disclosure of secondary findings of comprehensive genomic profiling tests by cancer patients and relatives
Authors: Kimbara Shiro , Toyoda Masanori , Kiyota Naomi , Hanafusa Hiroaki , Niwa Yui , Tanaka Keiko , Uchida Megumi , Wada Yui , Komatsu Masato , Imamura Yoshinori , Funakoshi Yohei , Minami Hironobu
Published: August 2023

Background
Secondary findings (SFs) in comprehensive genomic profiling (CGP) testing can affect not only the healthcare of cancer patients but also their first-degree relatives. To date, however, the preferences of first-degree relatives concerning the disclosure of SFs have been not elucidated compared to that of cancer patients.
Methods
We retrospectively investigated the preferences of adult patients who underwent CGP tests and their adult first-degree relatives. Main outcomes were (i) the proportion of patients and first-degree relatives who expressed their preference before the results of CGP tests were disclosed; and (ii) the proportion of patients and first-degree relatives who opted for disclosure of SFs.
Results
Seventy-three patients and 252 first-degree relatives were included. All patients had expressed their preference, and all patients except one opted for disclosure. In contrast, only 41% of the 252 first-degree relatives expressed a preference prior to disclosure: 34% opted for disclosure and 7% refused disclosure. On multivariate analysis, the failure of first-degree relatives to express a preference was associated with old age and absence from pre-test explanatory sessions at the cancer genome clinic. All patients received a pre-test explanation from health professionals; in contrast, only 8% of first-degree relatives received an explanation from health professionals, while a further 35% of first-degree relatives received an explanation from the patient and 36% receive no pre-test explanation of SFs at all.
Conclusion
Our study highlights the difficulty of respecting the autonomy of individual first-degree relatives, particularly for those who do not attend pre-test explanatory sessions or are elderly.
Modified neoadjuvant rectal score as a novel prognostic model for rectal cancer patients who underwent chemoradiotherapy
Authors: Kawai Kazushige , Ozaki Kosuke , Nakano Daisuke , Dejima Akira , Ise Ichiro , Nakamori Sakiko , Kato Hiroki , Natsume Soichiro , Takao Misato , Yamaguchi Tatsuro , Ishihara Soichiro
Published: August 2023

Background: The neoadjuvant rectal score (NAR score) has recently been proposed as a better prognostic model than the conventional TNM classification for rectal cancer patients that have undergone neoadjuvant chemoradiotherapy. We recently developed an apoptosis-detection technique for assessing the viability of residual tumors in resected specimens after chemoradiotherapy. This study aimed to establish an improved prognostic classification by combining the NAR score and the assessment of the apoptosis of residual cancer cells.
Methods: We retrospectively enrolled 319 rectal cancer patients who underwent chemoradiotherapy followed by radical surgery. The recurrence-free survival and overall survival of the four models were compared: TNM stage, NAR score, modified TNM stage by re-staging according to cancer cell viability and modified NAR score also by re-staging.
Results: Down-staging of the ypT stage was observed in 15.5% of cases, whereas only 4.5% showed down-staging of ypN stage. C-index was highest for the modified NAR score (0.715), followed by the modified TNM, TNM, and NAR score. Similarly, Akaike’s information criterion was smallest in the modified NAR score (926.2), followed by modified TNM, TNM, and NAR score, suggesting that the modified NAR score was the best among these four models. The overall survival results were similar: c-index was the highest (0.767) and Akaike’s information criterion was the smallest (383.9) for the modified NAR score among the four models tested.
Conclusions: We established a novel prognostic model, for rectal cancer patients that have undergone neoadjuvant chemoradiotherapy, using a combination of apoptosis-detecting immunohistochemistry and neoadjuvant rectal scores.
Remote care instruction Via the WeChat platform for patients receiving subcutaneous anticoagulation during the COVID-19 pandemic: a retrospective analysis
Authors: Jiang Chao Yun , Li Ci Juan , Zhang Rong , Cai Tian Hong , Zhan Teng Hui
Published: August 2023

Objective
The purpose of this study was to investigate the effect of remote nursing guidance based on WeChat platform for patients receiving subcutaneous anticoagulation during the COVID-19 epidemic.
Methods
Retrospective analysis of clinical data, including demographic data and anticoagulation complications, of 126 patients who received subcutaneous anticoagulation therapy and received remote nursing guidance using WeChat platform in our hospital from January 2022 to December 2022. The Anti-Clot Treatment Scale (ACTS) and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) scale were used to evaluate patients' satisfaction with anticoagulation and quality of life at the beginning of anticoagulation, 2 weeks after anticoagulation, and at the end of anticoagulation.
Results
In total, 126 patients were involved in this study, all of them were female, 115 cases were natural pregnancy, 11 cases were assisted reproduction. This study including 7 cases of lower extremity deep vein thrombosis, 100 cases of hypercoagulable state, 10 cases of antiphospholipid syndrome, and 8 cases of protein S deficiency, 1 case of hyperhomocysteinemia. During the follow-up period, 4 patients (3.17%) had subcutaneous injection complications, including 3 cases of subcutaneous hemorrhage and 1 case of liquid leakage. 123 patients had completed the planned anticoagulation therapy or were receiving anticoagulation therapy as planned, and 3 patients did not receive anticoagulation therapy as planned (0 cases lost contact, 2 cases changed treatment units, and 1 case refused treatment). ACTS score (55.03 ± 1.73) and WHOQOL-BREF score (62.18 ± 3.17) after 3 months of anticoagulation, ACTS score (54.18 ± 1.20) and WHOQOL-BREF score(60.37 ± 2.25) after 2 weeks of anticoagulation was significantly higher than the ACTS score (47.81 ± 1.69) and WHOQOL-BREF score (55.25 ± 1.85) at the beginning of anticoagulation, and the difference was statistically significant (P value<0.01).
Conclusions
During the COVID-19 pandemic, remote nursing instruction via the WeChat platform for patients receiving subcutaneous anticoagulation can increase anticoagulation compliance, satisfaction, and quality of life.
BiGPICC: a graph-based approach to identifying carcinogenic gene combinations from mutation data
Authors: Oles Vladyslav , Dash Sajal , Anandakrishnan Ramu
Published: August 2023

Genome data from cancer patients encapsulates explicit and implicit relationships between the presence of a gene mutation and cancer occurrence in a patient. Different types of cancer in human are thought to be caused by combinations of two to nine gene mutations. Identifying these combinations through traditional exhaustive search requires the amount of computation that scales exponentially with the combination size and in most cases is intractable even for even cutting-edge supercomputers.
We propose a parameter-free heuristic approach that leverages the intrinsic topology of gene-patient mutations to identify carcinogenic combinations. The biological relevance of the identified combinations is measured by using them to predict the presence of tumor in previously unseen samples. The resulting classifiers for 16 cancer types perform on par with exhaustive search results, and score the average of 80.1% sensitivity and 91.6% specificity for the best choice of hit range per cancer type. Our approach is able to find higher-hit carcinogenic combinations targeting which would take years of computations using exhaustive search.
Blow-up and global existence of solutions to degenerate Kirchhoff equation with variable source
Authors: Zhang Jingjing , Li Xiaolei
Published: August 2023

In this paper, we mainly studies the classification of global existence and blow-up of solutions to degenerate Kirchhoff problems for the initial energy at different conditions. Firstly, under subcritical or critical conditions, we find two invariant sets and obtain the threshold results of global existence or blow-up in finite time. Furthermore, we apply $\omega$-limit to prove the existence of blow-up solutions for the supercritical initial energy case. Finally, we give two-sided estimates of asymptotic behavior when the source term is controlled by the diffusion term.
Mathematics Subject Classification (2010). Primary 35K55, 35B40; Secondary 35B44.
How stable are moral judgements? A longitudinal study of context dependency in attitudes towards patient responsibility
Authors: Bringedal Berit H , Rø Karin Isaksson
Published: August 2023

Background
Whether patients' life-style should involve lower priority for treatment is a controversial question in bioethics. Less is known about clinicians' views.
Methods
Surveys of doctors in Norway in 2008, 2014, 2021. Questionnaires included statements about patients' lifestyle's significance for priority to care, and vignettes of priority cases (only 2014). Focus group with six GPs in 2019. Data analysed by descriptive statistics, linear regression, and text analysis.
Results
Attitudes were fairly stable between 2008 and 2021. 17%/14% agreed that patients' lifestyle should count, while 19%/22% agreed that it should involve lower priority to scarce organs. 42/44% agreed that smokers should have lower priority. Substantially more agreed in 2014. Regression analyses showed that being male, working in hospital, and younger age increased the likelihood of agreeing. The focus group interview demonstrated that "lower priority" was unclear, and that attitudes changed from more to less positive to lowering priority due to lifestyle during discussion.
Conclusion
Many doctors agreed that lifestyle should be a priority criterion, contrary to Norwegian legislation and professional ethics. This might be explained by the unspecified meaning of priority, increased scarcity-awareness, or socio-cultural trends towards individualism. The 2014 results indicate a framing effect; the vignettes may have primed the respondents towards accepting lifestyle as a criterion. The interview demonstrated that moral views are changeable. Three lessons are drawn: Attitudes to normative questions are unstable and depend on context. The practical implication of "lower priority" should be specified. Many doctors are positive to deprioritizing patients allegedly responsible for their illness.
Clinical phenotypic characteristics of heart failure with preserved ejection fraction and its influence on prognosis
Authors: Xu Xia , Wang Yajiao , Li Yumeng , Zhang Bingxuan , song qingqiao
Published: August 2023

Background
Patients with heart failure with preserved ejection fraction are characterized by high morbidity and poor prognosis. Previous studies have shown that there are several different phenotypes of HFpEF, each with distinct clinical features, and we used k-means clustering to determine the clinical phenotypes of patients with HFpEF and to investigate their impact on prognosis.
Methods
We first screened 189 patients with HFpEF who met the inclusion criteria and stratified them using K-mean clustering according to clinical characteristics, routine blood and biochemical parameters, echocardiography, and comorbidities, and determined the optimal number of prime hearts using the error sum of squares. Kaplan-Meier survival curves were then used to assess the impact of each clinical phenotype on all-cause mortality; Cox regression risk models were used to estimate the correlation between each clinical phenotype and long-term prognosis.
Results
Four HFpEF phenotypes were identified: phenotype 1 was a young patient with poor cardiac function but preserved renal function; phenotype 2 was an older male patient with cardiac and renal insufficiency; phenotype 3 had preserved LA morphology and function, and all patients in this group had higher ejection fractions than the other three groups; phenotype 4 was an older female patient with preserved cardiac function but poor renal function. The Kaplan-Meier survival analysis found that patients with phenotype 2 had significantly lower survival rates than the other three groups, and the Cox proportional risk analysis also found that phenotype 2 showed the highest risk of all-cause mortality (HR = 4.6094; 95% CI: 2.0373, 10.4291).
Conclusion
K-means cluster analysis classified HFpEF patients into four clinical phenotypes, and the analysis revealed that old age and renal insufficiency were decisive factors affecting prognosis, so the staging and treatment of HFpEF patients should focus on age and renal function.
Argininosuccinate Lyase (ASL) Deficiency; Outcome of Patients with an Early Presentation at Johns Hopkins Aramco Healthcare (JHAH)
Authors: Alhaidar Atheer , AlSannaa Nouriya
Published: August 2023

Argininosuccinic aciduria (ASA) is an autosomal recessive inborn error of the urea disorder (UCD) cycle caused by mutation in the gene encoding argininosuccinate lyase (ASL). Here, we describe long-term complications and outcome of twelve Saudi Arab patients originated from four unrelated families diagnosed with ASA from January 1st 1983 to December 31st 2022 within Johns Hopkins Aramco Healthcare (JHAH). The age distribution was from 1 to 29 years with an average of 11.9. All patients manifested the classic severe neonatal phenotype. Despite of an early diagnosis, immediate medical intervention and good metabolic control, all the patients displayed variable degrees of cognitive impairment and neurologic dysfunction. Developmental delay and seizures disorder were seen in all of the affected patients. Other observed neuropsychiatric disorders were attention deficit hyperactivity and sleeping disorders. The previously recognized c.1060C > Tp(Q354X) genotype in Saudi Arab population was found to be associated with intractable seizures and psychomotor regression. This cohort study supports the former reports of high rate of neurologic complication in Argininosuccinate lyase deficiency contrasting with a lower rate of hyperammonemia.
The Impact of Digital Inequities on Esophageal Cancer Disparities in the US
Authors: Fei-Zhang David J. , Edwards Evan R. , Asthana Shravan , Chelius Daniel C , Sheyn Anthony M. , Rastatter Jeffrey C.
Published: August 2023

Objectives: To develop and implement a novel, comprehensive tool called the Digital Inequity Index (DII) that quantifiably measures modern technology access in the US and to assess the impact of digital inequity on esophageal cancer (EC) care nationwide.
Methods: A total of15,656 EC patients from 2013-2017 in SEER were assessed for significant regression trends in long-term follow-up, survival, prognosis, and treatment with increasing overall digital inequity, as measured by the DII. The DII was calculated based on 17 censustract-level variables derived from the American Community Survey and Federal Communications Commission. Variables were categorized as infrastructure-access (i.e., electronic device ownership, type of broadband, internet provider availability, income-broadband subscription ratio) or sociodemographic (i.e.,education, income, disability status), ranked and then averaged into a composite score.
Results: With increasing overall digital inequity, significant decreases in the length of long-term follow-up (p<0.001) and survival (p<0.001) for EC patients were observed. EC patients showed decreased odds of receivingthe indicated surgical resection (OR 0.90, 95% CI 0.84-96; OR 0.97; 95% CI0.95-1.00, respectively) with increasing digital inequity. They also showed increased odds of advanced preliminary staging (OR 1.02, 95% CI 1.00-1.05) and decreased odds of receiving the indicated chemotherapy (OR 0.97; 95% CI 0.95-99).
Conclusions: Digital inequities meaningfully contribute to detrimental trends in EC patient care in the US, allowing discourse for targeted means of alleviating disparities while contextualizing national, sociodemographic trends of the impact of online access on informed care.
Level of Evidence: III