bluuebunny/crossref_metadata_2025 huggingface dataset:
Children hospitalized with community-acquired pneumonia complicated by effusion: a single-centre retrospective cohort study
Authors: Alemayheu Gelila , Lee Claire S. J. , Erdman Laura K. , Wong Jacqueline , Rutherford Candy , Smieja Marek , Khan Sarah , Pernica Jeffrey M.
Published: April 2023

Objectives

To describe children hospitalized with community-acquired pneumonia complicated by effusion (cCAP).

Design

Retrospective cohort study.

Setting

A Canadian children’s hospital.

Participants

Children without significant medical comorbidities aged < 18 years admitted from January 2015-December 2019 to either the Paediatric Medicine or Paediatric General Surgery services with any pneumonia discharge code who were documented to have an effusion/empyaema using ultrasound.

Outcome measures

Length of stay; admission to the paediatric intensive care unit; microbiologic diagnosis; antibiotic use.

Results

There were 109 children without significant medical comorbidities hospitalized for confirmed cCAP during the study period. Their median length of stay was 9 days (Q1-Q3 6–11 days) and 35/109 (32%) were admitted to the paediatric intensive care unit. Most (89/109, 74%) underwent procedural drainage. Length of stay was not associated with effusion size but was associated with time to drainage (0.60 days longer stay per day delay in drainage, 95%CI 0.19-1.0 days). Microbiologic diagnosis was more often made via molecular testing of pleural fluids (43/59, 73%) than via blood culture (12/109, 11%); the main aetiologic pathogens wereS. pneumoniae(40/109, 37%),S. pyogenes(15/109, 14%), andS. aureus(7/109, 6%). Discharge on a narrow spectrum antibiotic (i.e. amoxicillin) was much more common when the cCAP pathogen was identified as compared to when it was not (68% vs. 24%, p < 0.001).

Conclusions

Children with cCAP were commonly hospitalized for prolonged periods. Prompt procedural drainage was associated with shorter hospital stays. Pleural fluid testing often facilitated microbiologic diagnosis, which itself was associated with more appropriate antibiotic therapy.
Health-related quality of life of men with primary osteoporosis and its changes after bisphosphonates treatment
Authors: Zhao Di-chen , Lin Xiao-yun , Hu Jing , Zhou Bing-na , Zhang Qian , Wang Ou , Jiang Yan , Xia Wei-bo , Xing Xiao-ping , Li Mei
Published: April 2023

Introduction

Osteoporosis leads to more serious consequences in men than in women, but less is known about its impacts on health-related quality of life (HRQoL) of men, and whether the anti-osteoporosis treatment can improve HRQoL of men with osteopenia/osteoprosis.

Methods

We enrolled men with primary osteoporosis and age-matched healthy controls. We collected medical history, serum levels of carboxyl-terminal type I collagen telopeptide, procollagen type I propeptides, and bone mineral density of patients. All patients and controls completed the short-form 36 (SF-36) questionnaires. Changes in HRQoL of osteopenia/osteoporosis men were prospectively evaluated after alendronate or zoledronic acid treatment.

Results

A total of 100 men with primary osteoporosis or osteopenia and 100 healthy men were included. The patients were divided into three subgroups: osteopenia (n = 35), osteoporosis (n = 39) and severe osteoporosis (n = 26). Men with osteoporosis or severe osteoporosis had impaired HRQoL in domains of physical health compared to healthy controls. HRQoL scores in physical health related domains of patients with severe osteoporosis were significantly lower compared to healthy controls, and were the poorest among the three subgroups of patients. Fragility fracture history was correlated with lower SF-36 scores about physical health. In 34 men with newly diagnosed osteoporosis receiving bisphosphonates treatment, HRQoL scores were significantly improved in domains of physical health after treatments.

Conclusions

The HRQoL is significantly impaired in men with osteoporosis, and the more severe the osteoporosis, the poorer the HRQoL. Fragility fracture is an important influencing factor of deteriorated HRQoL. Bisphosphonates treatment is beneficial to improve HRQoL of osteopenia/osteoporosis men.
Death place and palliative outcome indicators in patients under palliative home care service: an observational study
Authors: Chang Pei-Jung , Lin Cheng-Fu , Juang Ya-Huei , Chiu Jui-Yu , Lee Lung-Chun , Lin Shih-Yi , Huang Yu-Hui
Published: April 2023

Background

Dying at home accompanied by loved-ones is regarded favorably and brings good luck in Taiwan. This study aimed to examine the relevant factors affecting whether an individual dies at home or not in a group of terminal patients receiving palliative home care service.

Methods

The patients who were admitted to a palliative home care service at a hospital-affiliated home health care agency were consecutively enrolled between March 1, 2021 and March 31, 2022. During the period of care, the instruments of the palliative care outcomes collaboration was used to assess patients in each home visit twice a week, including symptom assessment scale, palliative care problem severity score, Australia-modified Karnofsky performance status, resource utilization groups-activities of daily living, and palliative care phase.

Results

There were 56 participants (53.6% female) with a median age of 73.0 years (interquartile range (IQR) 61.3–80.3 y/o), of whom 51 (91.1%) patients were diagnosed with cancer and 49 (96.1%) had metastasis. The number of home visits was 3.5 (IQR 2.0–5.0) and the average number of days under palliative home care service was 31 (IQR 16.3–51.5) before their death. After the end of the study, there was a significant deterioration of sleeping, appetite, and breathing problems in the home-death group, and appetite problems in the non-home death patients. However, physician-reported psychological/spiritual problems improved in the home-death group, and pain improved in the non-home death patients. Physical performance deteriorated in both groups, and more resource utilization of palliative care was needed. The 44 patients who died at home had greater cancer disease severity, fewer admissions, and the proportion of families desiring a home death for the patient was higher.

Conclusions

Although the differences in palliative outcome indicators were minor between patients who died at home and those who died in the hospital, understanding the determinants and change of indicators after palliative care service at different death places may be helpful for improving the quality of end-of-life care.
"They see me as mentally ill": the stigmatization experiences of Chinese menopausal women in the family
Authors: Li Qiong , Gu Jintu , Huang Jianyuan , Zhao Pei , Luo Chenliang
Published: April 2023

Background

Menopausal women are regarded as “abnormal people” in China and are often discriminated against and ostracized, especially in the privacy of their homes. However, research on the stigmatization of menopausal women in China is limited. The aim of this study is to explore and describe the stigmatization experiences of Chinese menopausal women in the family and their feelings about these experiences.

Methods

A phenomenological qualitative research design involving in-depth semi-structured interviews was selected. Our data analysis adopted Colaizzi's methodology.

Results

Fourteen menopausal women participated in this study. Four themes and 12 subthemes emerged: (1) violent treatment (verbal and physical violence); (2) lack of attention and companionship (lack of understanding of physical and psychological suffering, neglect of the value of labour and difficulty finding someone to talk to and accompany them); (3) coping struggles (keeping quiet, fighting back, changing inappropriate perceptions and developing a menopausal transition management plan); and (4) despair (deep-rooted perceptions, restrictions on travel and consumption, and unknown "healing" times).

Conclusion

Our results suggest that Chinese menopausal women suffer physically and mentally within their families. The stigma of menopause is both a symptom of the broad societal lack of knowledge regarding menopause and a reflection of the patriarchal oppression of women in a specific cultural context. Accordingly, this study can help menopausal women and society in general better understand the former’s stigmatization experiences and amplify their inner voices. Moreover, it can serve as a reference for the formulation of menopause-related health policies in China and for advocating and promoting humanistic care for menopausal women.
Effectiveness and safety analysis of Danggui Shaoyao Powder for the treatment of non-alcoholic fatty liver disease: study protocol for a randomized, double-blind, placebo-controlled clinical trial
Authors: Huang Qian , An Ziming , Xin Xin , Sun Qinmei , Gao Siting , Lv Sheng , Xu Xiao , Yang Shuohui , Lu Fang , Yuan Jie , Zhao Yu , Hu Yiyang , Liu Ping , Feng Qin
Published: April 2023

Background

The incidence of non-alcoholic fatty liver disease (NAFLD) has been on the rise in recent years, and there are no effective drugs to treat NAFLD; therefore, effective prevention and treatment of NAFLD have become a new challenge. Danggui Shaoyao Powder (DGSY) is a classic prescription commonly used in clinical practice and has been shown to reduce hepatic steatosis in patients with NAFLD. In addition, previous studies have shown that DGSY can alleviate hepatic steatosis and inflammation in NAFLD mice. Although clinical practice and basic studies have shown that DGSY is effective in NAFLD, high levels of clinical evidence are lacking. Therefore, a standardized RCT study protocol is required to evaluate its clinical efficacy and safety.

Methods and analysis

This study will be a randomized, double-blind, placebo-controlled, and single-center trial. According to the random number table, NAFLD participants will be randomly divided into the DGSY or placebo group for 24 weeks. The follow-up period will be 6 weeks after drug withdrawal. The primary outcome is the relative change in MRI-proton density fat fraction (MRI-PDFF) from baseline to 24 weeks. Absolute changes in serum alanine aminotransferase (ALT), liver stiffness measurement (LSM), body mass index (BMI), blood lipid, blood glucose, and insulin resistance index will be selected as secondary outcomes to comprehensively evaluate the clinical efficacy of DGSY in the treatment of NAFLD. The safety of DGSY will be evaluated by renal function, routine blood and urine tests, and electrocardiogram.

Discussion

This study will provide evidence-based medical corroboration for the clinical application of DGSY and promote the development and application of this classic prescription.

Trial registration

http://www.chictr.org.cn. Trial number: ChiCTR2000029144. Registered on 15 Jan 2020.
“But at home, with the midwife, you are a person”: experiences and impact of a new early postpartum home-based midwifery care model in the view of women in vulnerable family situations
Authors: Schwind Bettina , Zemp Elisabeth , Jafflin Kristen , Späth Anna , Barth Monika , Maigetter Karen , Merten Sonja , Kurth Elisabeth
Published: April 2023

Background

Postpartum home-based midwifery care is covered by basic health insurance in Switzerland for all families with newborns but must be self-organized. To ensure access for all, Familystart, a network of self-employed midwives, launched a new care model in 2012 by ensuring the transition from hospital to home through cooperation with maternity hospitals in the Basel area. It has particularly improved the access to follow-up care for families in vulnerable situations needing support beyond basic services. In 2018, the SORGSAM (Support at the Start of Life) project was initiated by Familystart to enhance parental resources for better postpartum health outcomes for mothers and children through offering improved assistance to psychosocially and economically disadvantaged families. First, midwives have access to first-line telephone support to discuss challenging situations and required actions. Second, the SORGSAM hardship fund provides financial compensation to midwives for services not covered by basic health insurance. Third, women receive financial emergency support from the hardship fund.

Aim

The aim was to explore how women living in vulnerable family situations experienced the new early postpartum home-based midwifery care model provided in the context of the SORGSAM project, and how they experienced its impact.

Methods

Findings are reported from the qualitative part of the mixed-methods evaluation of the SORGSAM project. They are based on the results of seven semi-structured interviews with women who, due to a vulnerable family postpartum situation at home, received the SORGSAM support. Data were analyzed following thematic analysis.

Results

Interviewed women experienced the early postpartum care at home, as “relieving and strengthening” in that midwives coordinated patient care that opened up access to appropriate community-based support services. The mothers expressed that they felt a reduction in stress, an increase in resilience, enhanced mothering skills, and greater parental resources. These were attributed to familiar and trusting relationships with their midwives where participants acknowledged deep gratitude.

Conclusion

The findings show the high acceptance of the new early postpartum midwifery care model. These indicate how such a care model can improve the well-being of women in vulnerable family situations and may prevent early chronic stress in children.
Three-dimensional transesophageal echocardiographic evaluation of pulmonary vein anatomy prior to cryoablation: validation with cardiac CT scan
Authors: Nagy Laszlo Tibor , Jenei Csaba , Papp Timea Bianka , Urbancsek Reka , Kolozsvari Rudolf , Racz Agnes , Raduly Arnold Peter , Veisz Richard , Csanadi Zoltan
Published: April 2023

Background

Anatomical characteristics of the left atrium and the pulmonary veins (PVs) may be relevant to the success rate of cryoballoon (CB)-ablation for atrial fibrillation (AF). Cardiac computed tomography (CCT) is considered as the gold standard for preablation imaging. Recently, three-dimensional transesophageal echocardiography (3DTOE) has been proposed for preprocedural assessment of cardiac structures relevant to CB-ablation. The accuracy of 3DTOE has not been validated by other imaging modalities.

Objective

We prospectively evaluated the feasibility and the accuracy of 3DTOE imaging for the assessment of left atrial and PV structures prior to pulmonary vein isolation (PVI). In addition, CCT was used to validate the measurements obtained with 3DTOE.

Methods

PV anatomy of 67 patients (59.7% men, mean age 58.5 ± 10.5 years) was assessed using both 3DTOE and CCT scan prior to PVI with the Arctic Front CB. The following parameters were measured bilaterally: PV ostium area (OA), the major and minor axis diameters of the ostium (a > b) and the width of the carina between the superior and the inferior PVs. In addition, the width of the left lateral ridge (LLR) between the left atrial appendage and the left superior PV. Evaluation of inter-technique agreement was based on linear regression with Pearson correlation coefficient (PCC) and Bland–Altman analysis of biases and limits of agreement.

Results

Moderate positive correlation (PCC 0.5–0.7) was demonstrated between the two imaging methods for the right superior PV’s OA and both axis diameters, the width of the LLR and left superior PV (LSPV) minor axis diameter (b) with limits of agreement ˂50% and no significant biases. Low positive or negligible correlation (PCC < 0.5) was found for both inferior PV parameters.

Conclusions

Detailed assessment of the right superior PV parameters, LLR and LSPV b is feasible with 3DTOE prior to AF ablation. This 3DTOE measurements demonstrated a clinically acceptable inter-technique agreement with those obtained with CCT.

Graphical Abstract
Human dendritic cell maturation induced by amorphous silica nanoparticles is Syk-dependent and triggered by lipid raft aggregation
Authors: Guillet Éléonore , Brun Émilie , Ferard Céline , Hardonnière Kévin , Nabhan Myriam , Legrand François-Xavier , Pallardy Marc , Biola-Vidamment Armelle
Published: April 2023

Background

Synthetic amorphous silica nanoparticles (SAS-NPs) are widely employed in pharmaceutics, cosmetics, food and concretes. Workers and the general population are exposed daily via diverse routes of exposure. SAS-NPs are generally recognized as safe (GRAS) by the Food and Drug Administration, but because of their nanoscale size and extensive uses, a better assessment of their immunotoxicity is required. In the presence of immune “danger signals”, dendritic cells (DCs) undergo a maturation process resulting in their migration to regional lymph nodes where they activate naive T-cells. We have previously shown that fumed silica pyrogenic SAS-NPs promote the two first steps of the adaptative immune response by triggering DC maturation and T-lymphocyte response, suggesting that SAS-NPs could behave as immune “danger signals”. The present work aims to identify the mechanism and the signalling pathways involved in DC phenotype modifications provoked by pyrogenic SAS-NPs. As a pivotal intracellular signalling molecule whose phosphorylation is associated with DC maturation, we hypothesized that Spleen tyrosine kinase (Syk) may play a central role in SAS-NPs-induced DC response.

Results

In human monocyte-derived dendritic cells (moDCs) exposed to SAS-NPs, Syk inhibition prevented the induction of CD83 and CD86 marker expression. A significant decrease in T-cell proliferation and IFN-γ, IL-17F and IL-9 production was found in an allogeneic moDC:T-cell co-culture model. These results suggested that the activation of Syk was necessary for optimal co-stimulation of T-cells. Moreover, Syk phosphorylation, observed 30 min after SAS-NP exposure, occurred upstream of the c-Jun N-terminal kinase (JNK) Mitogen-activated protein kinases (MAPK) and was elicited by the Src family of protein tyrosine kinases. Our results also showed for the first time that SAS-NPs provoked aggregation of lipid rafts in moDCs and that MβCD-mediated raft destabilisation altered Syk activation.

Conclusions

We showed that SAS-NPs could act as an immune danger signal in DCs through a Syk-dependent pathway. Our findings revealed an original mechanism whereby the interaction of SAS-NPs with DC membranes promoted aggregation of lipid rafts, leading to a Src kinase-initiated activation loop triggering Syk activation and functional DC maturation.
Harm reduction and recovery services support (HRRSS) to mitigate the opioid overdose epidemic in a rural community
Authors: Heo Moonseong , Beachler Taylor , Sivaraj Laksika B. , Tsai Hui-Lin , Chea Ashlyn , Patel Avish , Litwin Alain H. , Zeller T. Aaron
Published: April 2023

Background

Rural areas in the United States (US) are ravaged by the opioid overdose epidemic. Oconee County, an entirely rural county in northwest South Carolina, is likewise severely affected. Lack of harm reduction and recovery resources (e.g., social capital) that could mitigate the worst outcomes may be exacerbating the problem. We aimed to identify demographic and other factors associated with support for harm reduction and recovery services in the community.

Methods

The Oconee County Opioid Response Taskforce conducted a 46-item survey targeting a general population between May and June in 2022, which was mainly distributed through social media networks. The survey included demographic factors and assessed attitudes and beliefs toward individuals with opioid use disorder (OUD) and medications for OUD, and support for harm reduction and recovery services, such as syringe services programs and safe consumption sites. We developed a Harm Reduction and Recovery Support Score (HRRSS), a composite score of nine items ranging from 0 to 9 to measure level of support for placement of naloxone in public places and harm reduction and recovery service sites. Primary statistical analysis using general linear regression models tested significance of differences in HRRSS between groups defined by item responses adjusting for demographic factors.

Results

There were 338 survey responses: 67.5% were females, 52.1% were 55 years old or older, 87.3% were Whites, 83.1% were non-Hispanic, 53.0% were employed, and 53.8% had household income greater than US$50,000. The overall HRRSS was relatively low at a mean of 4.1 (SD = 2.3). Younger and employed respondents had significantly greater HRRSS. Among nine significant factors associated with HRRSS after adjusting for demographic factors, agreement that OUD is a disease had the greatest adjusted mean difference in HRSSS (adjusted diff = 1.22, 95% CI=(0.64, 1.80), p < 0.001), followed by effectiveness of medications for OUD (adjusted diff = 1.11, 95%CI=(0.50, 1.71), p < 0.001).

Conclusions

Low HRRSS indicates low levels of acceptance of harm reduction potentially impacting both intangible and tangible social capital as it relates to mitigation of the opioid overdose epidemic. Increasing community awareness of the disease model of OUD and the effectiveness of medications for OUD, especially among older and unemployed populations, could be a step toward improving community uptake of the harm reduction and recovery service resources critical to individual recovery efforts.
Elastin is responsible for the rigidity of the ligament under shear and rotational stress: a mathematical simulation study
Authors: Naya Yuki , Takanari Hiroki
Published: April 2023

Background

An accurate understanding of the mechanical response of ligaments is important for preventing their damage and rupture. To date, ligament mechanical responses are being primarily evaluated using simulations. However, many mathematical simulations construct models of uniform fibre bundles or sheets using merely collagen fibres and ignore the mechanical properties of other components such as elastin and crosslinkers. Here, we evaluated the effect of elastin-specific mechanical properties and content on the mechanical response of ligaments to stress using a simple mathematical model.

Methods

Based on multiphoton microscopic images of porcine knee collateral ligaments, we constructed a simple mathematical simulation model that individually includes the mechanical properties of collagen fibres and elastin (fibre model) and compared with another model that considers the ligament as a single sheet (sheet model). We also evaluated the mechanical response of the fibre model as a function of the elastin content, from 0 to 33.5%. Both ends of the ligament were fixed to a bone, and tensile, shear, and rotational stresses were applied to one of the bones to evaluate the magnitude and distribution of the stress applied to the collagen and elastin at each load.

Results

Uniform stress was applied to the entire ligament in the sheet model, whereas in the fibre model, strong stress was applied at the junction between collagen fibres and elastin. Even in the same fibre model, as the elastin content increased from 0 to 14.4%, the maximum stress and displacement applied to the collagen fibres during shear stress decreased by 65% and 89%, respectively. The slope of the stress–strain relationship at 14.4% elastin was 6.5 times greater under shear stress than that of the model with 0% elastin. A positive correlation was found between the stress required to rotate the bones at both ends of the ligament at the same angle and elastin content.

Conclusions

The fibre model, which includes the mechanical properties of elastin, can provide a more precise evaluation of the stress distribution and mechanical response. Elastin is responsible for ligament rigidity during shear and rotational stress.
Mid term freedom from atrial fibrillation following hybrid ablation, a systematic review and meta analysis
Authors: Eranki Aditya , Wilson-Smith Ashley , Flynn Campbell , Williams Michael , Manganas Con
Published: April 2023

Introduction

Atrial Fibrillation (AF) is a common tachyarrhythmia affecting 33 million people worldwide. Hybrid AF ablation utilises a surgical (epicardial) ablation followed by an endocardial catheter-based ablation. The aim of this systematic review and meta-analysis is to summarize the literature reporting mid-term freedom from AF following hybrid ablation.

Methods

An electronic search of databases was performed to identify all relevant studies providing mid-term (2 year) outcomes following hybrid ablation for AF. The primary study outcome was to assess the mid-term freedom from AF following hybrid ablation, utilising the metaprop function on Stata® (Version 17.0, StataCorp, Texas, USA). Subgroup analysis was performed to assess the impact of various operative characteristics on mid-term freedom from AF. The secondary outcomes assessed mortality and procedural complication rate.

Results

The search strategy identified 16 studies qualifying for inclusion in this meta-analysis, with 1242 patients in total. The majority of papers were retrospective cohort studies (15) and one study was a randomized control trial (RCT). The mean follow up was 31.5 ± 8.4 months. Following hybrid ablation, the overall mid-term freedom from AF was 74.6% and 65.4% for patients off antiarrhythmic drugs (AAD). Actuarial freedom from AF was 78.2%, 74.2% and 73.6% at 1, 2 and 3 years respectively. No significant differences in mid-term freedom from AF based epicardial lesion set (box vs pulmonary vein isolation) or Left atrial appendage/Ganglionated Plexus/Ligament of Marshall ablation or staged vs concomitant procedures. There were 12 deaths overall following the hybrid procedure with a pooled complication rate of 5.53%.

Conclusion

Hybrid AF ablation offers promising mid-term freedom from AF reported at a mean follow-up of 31.5 months. The overall complication rate remains low. Further analysis of high-quality studies with randomized data and long-term follow up will help verify these results.
Community mental health care network: an evaluative approach in a Brazilian state
Authors: Coelho Vívian Andrade Araújo , da Gama Carlos Alberto Pegolo , Andrade Leonardo Isolani e , Silva Mariana Arantes e , Guimarães Denise Alves , de Azevedo Guimarães Eliete Albano , Modena Celina Maria
Published: April 2023

In recent decades, public policies of the Unified Health System (SUS) in Brazil have structured a community mental health care network (RAPS) based on various community actions and services. This study carried out evaluative research on the implementation of the structure and process dimensions of this care network in Minas Gerais, the second most populous state of Brazil, generating indicators that can enhance the strategic management of the public health system in the strengthening the psychosocial care in the state. The application of a multidimensional instrument, previously validated (IMAI-RAPS), in 795 of the 853 municipalities in Minas Gerais was carried out between June and August 2020. Regarding the structural dimension, we noticed an adequate implementation of services like ‘Family Health Strategy,’ ‘Expanded Family Health Center,’ and ‘Psychosocial Care Centers’ but a lack of ‘Beds in General Hospitals’ destinated to mental health care, ‘Unified Electronic Medical Records’ and ‘Mental Health Training Activities for Professionals.’ In the process dimension, adequate implementation of actions such as ‘Multidisciplinary and Joint Care,’ ‘Assistance to Common Mental Disorders by Primary Health Care,’ ‘Management of Psychiatric Crises in Psychosocial Care Centers,’ ‘Offer of Health Promotion Actions,’ and ‘Discussion of Cases by Mental Health Teams’ point to a form of work consistent with the guidelines. However, we detected difficulties in the implementation of ‘Psychosocial Rehabilitation Actions,’ ‘Productive Inclusion,’ ‘User Protagonism,’ ‘Network Integration,’ and practical activities for the effectiveness of collaborative care. We found a better implementation of the mental health care network in more populous, demographically dense, and socioeconomically developed cities, which shows the importance of regional sharing of services that are not possible for small cities. The evaluation practices of mental health care networks are scarce throughout the Brazilian territory, a fact also found in Minas Gerais, highlighting the need for its expansion not only in the scientific sphere but also in the daily life of the various levels of management.
Personalized ventilatory strategy based on lung recruitablity in COVID-19-associated acute respiratory distress syndrome: a prospective clinical study
Authors: Taenaka Hiroki , Yoshida Takeshi , Hashimoto Haruka , Firstiogusran Andi Muhammad Fadlillah , Ishigaki Suguru , Iwata Hirofumi , Enokidani Yusuke , Ebishima Hironori , Kubo Naoko , Koide Moe , Koyama Yukiko , Sakaguchi Ryota , Tokuhira Natsuko , Horiguchi Yu , Uchiyama Akinori , Fujino Yuji
Published: April 2023

Background

Heterogeneity is an inherent nature of ARDS. Recruitment-to-inflation ratio has been developed to identify the patients who has lung recruitablity. This technique might be useful to identify the patients that match specific interventions, such as higher positive end-expiratory pressure (PEEP) or prone position or both. We aimed to evaluate the physiological effects of PEEP and body position on lung mechanics and regional lung inflation in COVID-19-associated ARDS and to propose the optimal ventilatory strategy based on recruitment-to-inflation ratio.

Methods

Patients with COVID-19-associated ARDS were consecutively enrolled. Lung recruitablity (recruitment-to-inflation ratio) and regional lung inflation (electrical impedance tomography [EIT]) were measured with a combination of body position (supine or prone) and PEEP (low 5 cmH2O or high 15 cmH2O). The utility of recruitment-to-inflation ratio to predict responses to PEEP were examined with EIT.

Results

Forty-three patients were included. Recruitment-to-inflation ratio was 0.68 (IQR 0.52–0.84), separating high recruiter versus low recruiter. Oxygenation was the same between two groups. In high recruiter, a combination of high PEEP with prone position achieved the highest oxygenation and less dependent silent spaces in EIT (vs. low PEEP in both positions) without increasing non-dependent silent spaces in EIT. In low recruiter, low PEEP in prone position resulted in better oxygenation (vs. both PEEPs in supine position), less dependent silent spaces (vs. low PEEP in supine position) and less non-dependent silent spaces (vs. high PEEP in both positions). Recruitment-to-inflation ratio was positively correlated with the improvement in oxygenation and respiratory system compliance, the decrease in dependent silent spaces, and was inversely correlated with the increase in non-dependent silent spaces, when applying high PEEP.

Conclusions

Recruitment-to-inflation ratio may be useful to personalize PEEP in COVID-19-associated ARDS. Higher PEEP in prone position and lower PEEP in prone position decreased the amount of dependent silent spaces (suggesting lung collapse) without increasing the amount of non-dependent silent spaces (suggesting overinflation) in high recruiter and in low recruiter, respectively.
Effectiveness and safety of Daixie Decoction granules combined with metformin for the treatment of T2DM patients with obesity: study protocol for a randomized, double-blinded, placebo-controlled, multicentre clinical trial
Authors: Liu Zhidong , Zhang Kepei , Zhang Jianpin , Wang Fei , Zhou Yang , Wang Lin , Wang Miao , Zhang Yi , Zhou Shigao
Published: April 2023

Background

Type 2 diabetes mellitus (T2DM) with obesity is a glycolipid metabolism disorder, which makes hypoglycaemic treatment more complex and increases the proportion of multidrug combinations. In addition, patients are more prone to adverse reactions and gradually lose compliance with treatment. Previous clinical trials have demonstrated that Daixie Decoction granules (DDG) can reduce body weight and blood lipids and improve the quality of life of T2DM with obesity. But there are a lack of further evaluations for the efficacy and safety of DDG combined with metformin.

Methods/design

The study is designed as a multicentre, randomized, double-blind, placebo-controlled clinical trial. Participants who meet the Nathrow criteria will be randomly assigned to the intervention group and control group (n1 = n2 = 133). Based on a unified diet control and exercise therapy, the intervention group will be treated with DDG and metformin, and the control group will be treated with DDG placebo and metformin. All subjects will receive a 6-month treatment followed by a 6-month follow-up. Effective rate of a 1% decrease in HbA1c and 3% decrease in body weight will serve as the primary outcome. The secondary outcome include fasting plasma glucose, blood lipids, C-peptides, insulin, inflammatory factors, insulin resistance index (HOMA-IR) and the subcutaneous and visceral fat content in the upper abdomen measured by MRI. Blood routine, urine routine, stool routine, liver and kidney function, EKG and other safety indicators and major adverse reactions were monitored during total treatment and follow-up time.

Discussion

We aimed to determine the efficacy and safety of DDG combined with metformin for the treatment of T2DM patients with obesity.

Trial registration

Trial registration: ChiCTR, ChiCTR2000036290. Registered 22 August 2014,  http://www.chictr.org.cn/showprojen.aspx? proj=59001
Infectious endocarditis caused by Bartonella henselae associated with infected pets: two case reports
Authors: Gonçalves-Oliveira Jonathan , Damasco Paulo Vieira , Assis Matheus Ribeiro da S. , Freitas Dominique E. , Pessoa Junior Adonai Alvino , de Sousa Luiza S. , Rodrigues Nicollas G. , Damasco Paula H. , Ribeiro Pedro F. , Barbosa Giovanna F. , Moreira Namir S. , Guedes Jeferson F. , Coutinho Henrique M. da Rocha , Madi Kalil , de Lemos Elba R. Sampaio
Published: April 2023

Background

Blood culture-negative infective endocarditis is a potentially severe disease that can be associated with infectious agents such as Bartonella spp., Coxiella burnetti, Tropheryma whipplei, and some fungi.

Case presentation

Reported here are two cases of blood culture-negative infective endocarditis in patients with severe aortic and mitral regurgitation in Brazil; the first case is a 47-year-old white man and the second is a 62-year-old white woman. Bartonella henselae deoxyribonucleic acid was detectable in the blood samples and cardiac valve with vegetation paraffin-fixed tissue samples. Additionally, an investigation was carried out on patients’ pets, within the context of One Health, and serum samples collected from cats and dogs were reactive by indirect immunofluorescence assay.

Conclusions

Even though the frequency of bartonellosis in Brazil is unknown, physicians should be aware of the possibility of blood culture-negative infective endocarditis caused by Bartonella, particularly in patients with weight loss, kidney changes, and epidemiological history for domestic animals.
In-phase and quadrature filter shape index modulation
Authors: Saad Majed , Chamas Al Ghouwayel Ali , Hijazi Hussein , Bader Faouzi , Palicot Jacques
Published: April 2023

This paper proposes a novel modulation scheme called “In Phase and Quadrature-Filter Shape Index Modulation” (IQ-FSIM). It aims to enhance the spectral/energy efficiencies (SE/EE) while generalizing several existing modulations and index modulation (IM) domains. In this system, the bitstream is divided into three sub-streams. The first is mapped using amplitude–phase modulation, and the other two are mapped separately to an index of a filter shape at the in-phase and quadrature components. IQ-FSIM in SISO mode enhances the SE by $$2\log _2 N$$

2

log
2

N

(double FSIM gain), thanks to the independent indexation of N different filter shapes on each component changing at the symbol rate. A low-complexity matched filter-based detector that reaches the optimal joint ML performance is proposed. The theoretical lower bounds for the probability of filter index error and the symbol/bit error rate (SER/BER) are derived and validated. The computational complexity of the proposed IQ-FSIM transceiver is estimated and compared to its predecessor FSIM, where it is shown that IQ-FSIM provides up to 93.7% complexity reduction compared to FSIM along with different advantages. In addition, the results reveal that both IQ-FSIM and its special case FSIM, even with non-optimal filter shapes, outperform the equivalent schemes with/without IM of the same SE in AWGN, flat, and frequency-selective fading channels.
Analysis of mathematical model involving nonlinear systems of Caputo–Fabrizio fractional differential equation
Authors: Kebede Shiferaw Geremew , Lakoud Assia Guezane
Published: April 2023

In this paper, we consider a mathematical model of a coronavirus disease involving the Caputo–Fabrizio fractional derivative by dividing the total population into the susceptible population $\mathcal{S}(t)$
S
(
t
)
, the vaccinated population $\mathcal{V}(t)$
V
(
t
)
, the infected population $\mathcal{I}(t)$
I
(
t
)
, the recovered population $\mathcal{R}(t)$
R
(
t
)
, and the death class $\mathcal{D}(t)$
D
(
t
)
. A core goal of this study is the analysis of the solution of a proposed mathematical model involving nonlinear systems of Caputo–Fabrizio fractional differential equations. With the help of Lipschitz hypotheses, we have built sufficient conditions and inequalities to analyze the solutions to the model. Eventually, we analyze the solution for the formed mathematical model by employing Krasnoselskii’s fixed point theorem, Schauder’s fixed point theorem, the Banach contraction principle, and Ulam–Hyers stability theorem.
Identifying ecological risk and cost–benefit value for supporting habitat restoration: a case study from Sansha Bay, southeast China
Authors: Lin Yanhong , Chen Qiuming , Huang Faming , Xue Xiongzhi , Zhang Yang
Published: April 2023

Background

Coastal wetlands with high biodiversity and productivity provide essential ecosystem services that have a significant positive socio-economic impact. However, coastal reclamation, pollution, and climate change are threatening coastal wetlands. Thus, it is critical to identify priority areas for restoration and improve habitat resilience to adapt to environmental changes. Here, we propose a general analysis framework integrating nature-based solutions (NbS) into habitat restoration to increase coastal resilience to multiple stressors in Sansha Bay, southeast China.

Results

The total loss of value in ecosystem services due to reclamation in Sansha Bay was US$162.18 million from 2000 to 2015. The coastal habitats were at medium risk of degradation, with some high-risk areas concentrated in the northwest and along the west coasts, which were prioritized for restoration.

Conclusions

Our proposed framework, which integrates hard and soft engineering such as mudflat renovation, mangrove afforestation, and an ecological seawall, can aid in the improvement of coastal resilience. The project cost was US$12.71 million and was estimated to generate US$36.75 million in environmental services. We recommend evaluating and monitoring shoreline changes, environmental factors, and marine biological resources using long-term sampling surveys and remote sensing methods. Our findings can serve as a guide for government decision-making in coastal restoration planning and management.
Remote sensing supported analysis of the effect of wind erosion on local air pollution in arid regions: a case study from Iğdır province in eastern Türkiye
Authors: Öztürk Yahya , Yulu Adem , Turgay Orkun
Published: April 2023

PM pollution is one of the most important environmental problems worldwide. One of the sources of PM pollution, which has a negative impact on human health, is dust that enters the atmosphere, especially in arid regions. Iğdır Province, located in the east of Anatolia, has an arid climate character and was selected as the most polluted province in Europe in 2021 and 2022 (in terms of PM2.5pollution). In this study, the effect of wind erosion-induced dust on air pollution in Iğdır province was investigated. We think that local wind erosion during the summer season (May–September) in the province is effective on PM pollution. Because there are no industrial activities, vehicular traffic, fuel consumption and volcanic activities that cause PM pollution in the summer season around Iğdır. On the other hand, Türkiye’s second largest wind erosion area and the other two wind erosion areas are located here, and dust storms are quite frequent. The causes of local wind erosion, which is one of the main factors in air pollution in the summer period, were investigated from a geographical perspective and various data sets were utilized. Then, wind erosion sites were examined and their regional distributions were indicated. Research findings on wind erosion sites were supported by remote sensing techniques (quartz index, aerosol density, etc.). All the data obtained support the idea that wind erosion is a dominant factor in the high level of PM pollution during the summer season in this area. Because the number of days with strong winds during this period is quite high and EU, WHO and national PM limit values are exceeded almost every day.
Giant cervico-parotid lipoma
Authors: Benfadil Drissia , Hatab Rahima , Bellaouchi Ahlam , Azzedine Lachakar , El Idrissi El Ayoubi Fahd
Published: April 2023

Background

Giant cervico-parotid lipomas are rare entities. This is why we report in this article a case of a giant cervical lipoma extending to the parotid region.

Case presentation

This case is a 34-year-old patient with no particular history (no history of cervical trauma, no history of medication, no history of cervical irradiation, no history of similar cases in the family), presenting with a giant cervicoparotidal lipoma without signs of compression. The treatment was surgical. The follow-up did not reveal any complication or recurrence.

Conclusion

By reporting this case, we emphasize that cervical lipomas, even if it reaches a large volume, do not manifest themselves by signs of compression, and they can be easily removed without having postsurgical complications.
Pathologic Complete Response and Individual Patient Prognosis After Neoadjuvant Chemotherapy Plus Anti–Human Epidermal Growth Factor Receptor 2 Therapy of Human Epidermal Growth Factor Receptor 2–Positive Early Breast Cancer
Authors: van Mackelenbergh Marion T. , Loibl Sibylle , Untch Michael , Buyse Marc , Geyer Charles E. , Gianni Luca , Schneeweiss Andreas , Conte Pierfranco , Piccart Martine , Bonnefoi Herve , Jackisch Christian , Nekljudova Valentina , Tang Gong , Valagussa Pinuccia , Neate Colin , Gelber Richard , Poncet Coralie , Squifflet Pierre , Saad Everardo D. , Heinzmann Dominik , Denkert Carsten , Rastogi Priya , Cortes Javier , Guarneri Valentina , de Azambuja Evandro , Cameron David , Ismael Gustavo , Wolmark Norman , Cortazar Patricia ,   on behalf of the CTNeoBC project
Published: April 2023

PURPOSE

The achievement of pathologic complete response (pCR) is strongly prognostic for event-free survival (EFS) and overall survival (OS) in patients with early breast cancer (EBC), and adapting postneoadjuvant therapy improves long-term outcomes for patients with HER2-positive disease not achieving pCR. We sought to investigate prognostic factors for EFS and OS among patients with and without pCR after neoadjuvant systemic treatment consisting of chemotherapy plus anti-HER2 therapy.

MATERIALS AND METHODS

We used individual data from 3,710 patients randomly assigned in 11 neoadjuvant trials for HER2-positive EBC with ≥100 patients enrolled, available data for pCR, EFS, and OS, and follow-up ≥3 years. We assessed baseline clinical tumor size (cT) and clinical nodal status (cN) as prognostic factors using stratified (by trial and treatment) Cox models separately for hormone receptor–positive versus hormone receptor–negative disease, and for patients who had pCR (pCR+; ypT0/is, ypN0) versus patients who did not achieve a pCR (pCR−).

RESULTS

The median follow-up overall was 61.2 months. In pCR+ patients, cT and cN were significant independent prognostic factors for EFS, whereas only cT was a significant predictor for OS. In pCR− patients, cT, cN, and hormone receptor status were significant independent predictors for both EFS and OS. Regardless of hormone receptor status, cT, and cN, the 5-year EFS/OS rates were higher in pCR+ patients than in pCR− patients. In most subsets with regards to hormone receptor and pCR status, cT and cN were independent prognostic factors for both EFS and OS, including pCR+ patients.

CONCLUSION

These results confirm that patients achieving pCR have far better survival outcomes than patients who do not. The traditional poor prognostic features, namely tumor size and nodal status, remain important even after a pCR.
Risk for Brain Arteriovenous Malformation Rupture During Pregnancy and Puerperium
Authors: Karlsson Bengt , Johansson Arne V. , Jokura Hidefumi , Petridis Athanasios , Yang Huai-Che , Yamamoto Masaaki , Martinez Roberto , Kawagishi Jun , Guo Wan-Yuo , Chung Wen-Yuh , Söderman Michael , Nga Vincent
Published: April 2023

BACKGROUND:

The hemorrhage risk of unruptured and untreated cerebral arteriovenous malformations (AVMs) has been shown to be higher for female patients than male patients in their child bearing ages. Although it has been neurosurgical practice to advise female patients in their childbearing ages to postpone pregnancy until proven AVM obliteration, there is no literature consensus regarding this potential hemorrhage risk increase.

OBJECTIVE:

To accurately quantify the risk increase for AVM hemorrhage during pregnancy.

METHODS:

This study is based on data from previous publications, consisting of known age at the first AVM hemorrhage in 3425 patients. The risk increase during pregnancy could be calculated from the difference in age distribution for the first AVM hemorrhage between male patients and female patients, taking the average pregnancy time per female into account. A comparison was also made with data for all hospital discharges (13 751) in Germany 2008 to 2018 with the diagnosis brain AVM.

RESULTS:

The average pregnancy and puerperium time was 1.54 years per female in the patient population, which was used to determine the annual AVM hemorrhage risk during pregnancy to be around 9%. The increased risk during pregnancy was further evidenced by analysis of a subgroup of 105 female patients, for which pregnancy status at the time of hemorrhage was known.

CONCLUSION:

The quantified annual risk for AVM hemorrhage during pregnancy is about 3 times higher than that of male patients at corresponding age. This provides an important basis for advising female patients with patent AVMs about the increased risk for hemorrhage that a pregnancy would entail.