bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Long-Term Physical Activity in Relation to Cancer-Related Health Outcomes: A 12-Month Follow-up of the Phys-Can RCT
Authors: Mazzoni Anne-Sophie , Helgesen Bjørke Ann Christin , Stenling Andreas , Börjeson Sussanne , Sjövall Katarina , Berntsen Sveinung , Demmelmaier Ingrid , Nordin Karin
Published: June 2023

Purpose:

While moderate-to-vigorous intensity physical activity (MVPA) is associated with various health improvements shortly after completion of exercise interventions, it remains unclear which health benefits can be expected when MVPA levels are maintained in the long term in cancer survivors. We aimed to assess the associations of (1) MVPA level at 12-month follow-up and (2) long-term MVPA patterns (from immediately post-intervention to 12-month follow-up) with different cancer-related health outcomes.

Methods:

In the Physical training and Cancer (Phys-Can) RCT, 577 participants diagnosed with breast (78%), prostate (19%), or colorectal (3%) cancer were randomized to 6 months of exercise during curative cancer treatment. Accelerometer-assessed physical activity and outcome data (ie, cancer-related fatigue, health-related quality of life [HRQoL], anxiety and depression, functioning in daily life, cardiorespiratory fitness, sedentary time and sleep) were collected immediately post-intervention and at 12-month follow-up. Based on the sample’s median of MVPA immediately post-intervention (65 minutes/day) and the changes between the 2 measurement points, 4 categories with different long-term MVPA patterns were created: High & Increasing, High & Decreasing, Low & Increasing, and Low & Decreasing. Multiple linear regression analyses were performed for the analyses.

Results:

A total of 353 participants were included in the analyses. At 12-month follow-up, a higher MVPA level was significantly associated with lower fatigue in 3 domains (general fatigue [β = −.33], physical fatigue [β = −.53] and reduced activity [β = −.37]), higher cardiorespiratory fitness (β = .34) and less sedentary time (β = −.35). For long-term MVPA patterns, compared to the participants in the “Low & Decreasing” category, those in the “High & Increasing” category reported significantly lower fatigue in 3 domains (general fatigue [β = −1.77], physical fatigue [β = −3.36] and reduced activity [β = −1.58]), higher HRQoL (β = 6.84) and had less sedentary time (β = −1.23).

Conclusion:

Our results suggest that long-term physical activity is essential for improving health outcomes post-intervention in cancer survivors. Cancer survivors, including those who reach recommended MVPA levels, should be encouraged to maintain or increase MVPA post-intervention for additional health benefits.

Trial registration:

NCT02473003 (10/10/2014)
Full robotic endovascular treatment for various head and neck hemorrhagic lesions
Authors: Saber Hamidreza , Beaman Charles , Morales Jose , Kimball David , Kaneko Naoki , Tateshima Satoshi
Published: June 2023

Background

The use of robotics in neuro-interventional surgery is continuously expanding with promises to increase accuracy and safety. We have previously described the first human, full robotic intervention using the CorPath GRX Robotic System. Here we report a series of fully robotic interventions and outcomes using this robotic device for endovascular treatment of extracranial embolization.

Methods

The patient and disease characteristics, procedural details, and imaging outcomes of consecutive patients undergoing robotically assisted extracranial embolization between October 2021 and August 2022.

Results

Six patients underwent robotically assisted extracranial embolization of head and neck hemorrhagic lesions. Four patients presented with uncontrolled epistaxis or hemoptysis associated with nasopharyngeal tumors and one patient had epistaxis due to COVID-19 infection complications. All patients were treated with coil embolization and four patients were also treated with particles. All procedures were performed with robotic intervention, whereas four procedures required partial manual conversion. There was no morbidity or complications associated with the procedures and desired outcome was achieved in 100% of the procedures.

Conclusion

Our series support the feasibility of complete robotic intervention using the CorPath GRX System with accurate control of the guiding catheter, microcatheter, wire, and coil delivery with successful treatment of acute extracranial hemorrhagic lesions.
Middle meningeal artery embolization of septated chronic subdural hematomas
Authors: Martinez-Gutierrez Juan Carlos , D’Amato Salvatore A , Zeineddine Hussein A , Nahhas Michael I , Kole Matthew J , Kim Hyun Woo , Kim Youngran , Dawes Bryden H , Chen Peng Roc , Blackburn Spiros L , Sheth Sunil A , Spiegel Gary , Chen Ching-Jen , Mahapatra Ashutosh , Kitagawa Ryan S , Dannenbaum Mark J
Published: June 2023

Introduction

Middle meningeal artery embolization (MMAE) has emerged as a promising new treatment for patients with chronic subdural hematomas (cSDH). Its efficacy, however, upon the subtype with a high rate of recurrence—septated cSDH—remains undetermined.

Methods

From our prospective registry of patients with cSDH treated with MMAE, we classified patients based on the presence or absence of septations. The primary outcome was the rate of recurrence of cSDH. Secondary outcomes included a reduction in cSDH thickness, midline shift, and rate of reoperation.

Results

Among 80 patients with 99 cSDHs, the median age was 68 years (IQR 59–77) with 20% females. Twenty-eight cSDHs (35%) had septations identified on imaging. Surgical evacuation with burr holes was performed in 45% and craniotomy in 18.8%. Baseline characteristics between no-septations (no-SEP) and septations (SEP) groups were similar except for median age (SEP vs no-SEP, 72.5 vs. 65.5, p  = 0.016). The recurrence rate was lower in the SEP group (SEP vs. no-SEP, 3 vs. 16.7%, p = 0.017) with higher odds of response from MMAE for septated lesions even when controlling for evacuation strategy and antithrombotic use (OR = 0.06, CI [0.006–0.536], p = 0.012). MMAE resulted in higher mean absolute thickness reduction (SEP vs. no-SEP, −8.2 vs. −4.8 mm, p = 0.016) with a similar midline shift change. The rate of reoperation did not differ (6.2 vs. 3.1%, p = 0.65).

Conclusion

MMAE appears to be equal to potentially more effective in preventing the recurrence of cSDH in septated lesions. These findings may aid in patient selection.
Attenuation of immune activation in patients with multiple sclerosis on a wheat-reduced diet: a pilot crossover trial
Authors: Engel Sinah , Klotz Luisa , Wirth Timo , Fleck Ann-Katrin , Pickert Geethanjali , Eschborn Melanie , Kreuzburg Samia , Curella Valentina , Bittner Stefan , Zipp Frauke , Schuppan Detlef , Luessi Felix
Published: June 2023

Background:

Western lifestyle has been associated with an increase in relapsing–remitting multiple sclerosis (RRMS). In mice, dietary wheat amylase–trypsin inhibitors (ATIs) activate intestinal myeloid cells and augment T cell-mediated systemic inflammation.

Objective:

The aim of this study was to assess whether a wheat- and thus ATI-reduced diet might exert beneficial effects in RRMS patients with modest disease activity.

Methods:

In this 6-month, crossover, open-label, bicentric proof-of-concept trial, 16 RRMS patients with stable disease course were randomized to either 3 months of a standard wheat-containing diet with consecutive switch to a > 90% wheat-reduced diet, or vice versa.

Results:

The primary endpoint was negative, as the frequency of circulating pro-inflammatory T cells did not decrease during the ATI-reduced diet. We did, however, observe decreased frequencies of CD14+ CD16++ monocytes and a concomitant increase in CD14++ CD16− monocytes during the wheat-reduced diet interval. This was accompanied by an improvement in pain-related quality of life in health-related quality of life assessed (SF-36).

Conclusion:

Our results suggest that the wheat- and thus ATI-reduced diet was associated with changes in monocyte subsets and improved pain-related quality of life in RRMS patients. Thus, a wheat (ATI)-reduced diet might be a complementary approach accompanying immunotherapy for some patients.

Registration:

German Clinical Trial Register (No. DRKS00027967).
Lexical and syntactic deficits analyzed via automated natural language processing: the new monitoring tool in multiple sclerosis
Authors: Šubert Martin , Novotný Michal , Tykalová Tereza , Srpová Barbora , Friedová Lucie , Uher Tomáš , Horáková Dana , Rusz Jan
Published: June 2023

Background:

Impairment of higher language functions associated with natural spontaneous speech in multiple sclerosis (MS) remains underexplored.

Objectives:

We presented a fully automated method for discriminating MS patients from healthy controls based on lexical and syntactic linguistic features.

Methods:

We enrolled 120 MS individuals with Expanded Disability Status Scale ranging from 1 to 6.5 and 120 age-, sex-, and education-matched healthy controls. Linguistic analysis was performed with fully automated methods based on automatic speech recognition and natural language processing techniques using eight lexical and syntactic features acquired from the spontaneous discourse. Fully automated annotations were compared with human annotations.

Results:

Compared with healthy controls, lexical impairment in MS consisted of an increase in content words ( p = 0.037), a decrease in function words ( p = 0.007), and overuse of verbs at the expense of noun ( p = 0.047), while syntactic impairment manifested as shorter utterance length ( p = 0.002), and low number of coordinate clause ( p < 0.001). A fully automated language analysis approach enabled discrimination between MS and controls with an area under the curve of 0.70. A significant relationship was detected between shorter utterance length and lower symbol digit modalities test score ( r = 0.25, p = 0.008). Strong associations between a majority of automatically and manually computed features were observed ( r > 0.88, p < 0.001).

Conclusion:

Automated discourse analysis has the potential to provide an easy-to-implement and low-cost language-based biomarker of cognitive decline in MS for future clinical trials.
Clinical outcomes of a novel ‘all-suture’ fixation for valgus-impacted proximal humeral fractures
Authors: Brooker-Thompson Chad , Mohan Hariharan , Chotai Neil , Baring Toby
Published: June 2023

Background

Conventional techniques for the fixation of displaced proximal humeral fractures include the use of locking plates, intramedullary nailing, hemiarthroplasty and reverse shoulder replacement. Valgus-impacted fractures are a common subtype of proximal humeral fracture, but there are few publications concerning the outcomes of treatment. This study aims to review outcomes following an ‘all-suture’ technique for this fracture subtype without the use of transosseous sutures.

Methods

All patients over the age of 18 who presented with 3- or 4-part valgus-impacted proximal humeral fractures and who underwent ‘all-suture’ repair at our centre were included. We reviewed their post-operative imaging and collected data on post-operative complications and patient-reported outcome measures.

Results

We identified 15 patients who had undergone all-suture fixation. The cohort's mean age was 56. Eleven patients were female. Eight patients had 3-part fractures and seven patients had 4-part fractures. There were no major post-operative complications. All fractures united. The mean Oxford Shoulder Score was 43.7 and the mean Single Assessment Numerical Evaluation score was 85.9 at the final follow-up.

Discussion

Our results suggest that all-suture fixation of proximal humeral fractures presents an attractive alternative to conventional techniques, whilst avoiding complications relating to metalwork implantation.
Ibuprofen-Induced Renal Tubular Acidosis: Case Report on a Not-So-Basic Clinical Conundrum
Authors: Ghimire Anukul , Li David , Amin Leena
Published: June 2023

Rationale:

Renal tubular acidosis (RTA) is a cause of non-anion gap metabolic acidosis (NAGMA) that is infrequently diagnosed and is due to various underlying etiologies that impair the kidney’s ability to retain bicarbonate or excrete acid. Ibuprofen is an over-the-counter non-steroidal anti-inflammatory medication that is used by patients widely for a variety of reasons. Although it is well known that ibuprofen and other non-steroidal anti-inflammatory drugs may have nephrotoxic effects, the role of ibuprofen as a cause of RTA and hypokalemia is not well recognized.

Presenting Concerns:

A 66-year-old man with chemotherapy-treated lymphoma in remission and ongoing heavy ibuprofen use for chronic pain presented to hospital with a 1-week history of increasing lethargy and otherwise unremarkable review of systems. Investigations showed acute kidney injury, hypokalemia, hyperchloremia, and NAGMA with elevated urinary pH and positive urine anion gap.

Diagnoses:

The final diagnosis of distal RTA secondary to ibuprofen was made after ruling out gastrointestinal bicarbonate loss and additional secondary causes of RTA, including other medications, autoimmune conditions, and obstructive uropathy.

Interventions:

The patient was admitted and treated with intravenous sodium bicarbonate for 24 hours with correction of hypokalemia via oral supplementation. His ibuprofen-containing medication was discontinued.

Outcomes:

His acute kidney injury and electrolyte abnormalities resolved within 48 hours of initiating treatment with concurrent resolution of his lethargy. He was discharged home and advised to stop taking ibuprofen.

Lessons Learned:

We report a case of patient with hypokalemia and NAGMA secondary to ibuprofen and highlight the importance of monitoring for this side effect in patients taking ibuprofen.
ChatGPT's potential role in non-English-speaking outpatient clinic settings
Authors: Zhu Zhoule , Ying Yuqi , Zhu Junming , Wu Hemmings
Published: June 2023

Researchers recently utilized ChatGPT as a tool for composing clinic letters, highlighting its ability to generate accurate and empathetic communications. Here we demonstrated the potential application of ChatGPT as a medical assistant in Mandarin Chinese-speaking outpatient clinics, aiming to improve patient satisfaction in high-patient volume settings. ChatGPT achieved an average score of 72.4% in the Chinese Medical Licensing Examination's Clinical Knowledge section, ranking within the top 20th percentile. It also demonstrated its potential for clinical communication in non-English speaking environments. Our study suggests that ChatGPT could serve as an interface between physicians and patients in Chinese-speaking outpatient settings, possibly extending to other languages. However, further optimization is required, including training on medical-specific datasets, rigorous testing, privacy compliance, integration with existing systems, user-friendly interfaces, and the development of guidelines for medical professionals. Controlled clinical trials and regulatory approval are necessary before widespread implementation. As chatbots’ integration into medical practice becomes more feasible, rigorous early investigations and pilot studies can help mitigate potential risks.
The Effects of the Interactions Between Agro-Production, Economic, and Financial Development on Bank Sustainability
Authors: Zheng Changjun , Jean-Petit Sinamenye
Published: June 2023

The Sub-Saharan African region encounters a deficiency in agricultural financing, which can be attributed to its constraints in accessing international investments in general and the low engagement of bank risk-taking in particular. This situation leads to underproduction, which exacerbates poverty and malnutrition in the region. Thus, this study investigates the impact of the interaction effects between agricultural production, economic development (ED), and financial development (FD via FDI and DC) on bank stability ratios across 40 countries, encompassing 350 operational banks, during the period covering 2010 to 2019. The research employs the Generalized Method of Moments (GMM) technique and verifies its consistency with Two-Stage Least Squares (2SLS) and the Z-Score Approach. The results highlight two findings: first, the interaction effects between economic development, agricultural production, and financial development factors have significantly greater impacts on bank sustainability than their individual effects without interactions. Secondly, these interaction effects sustain significantly bank stability in two ways: on the one hand, they increase bank returns (through both ROE and ROA), while on the other hand, they reduce bank riskiness (via negative effects on NPL and positive effects on LLR). The study concludes that those interaction effects significantly sustain the stability of the African banking system. The SS African states (via their central banks) should promote farming finance services and enforce a minimum ratio of farming loans for each commercial bank’s credit portfolio as a solution to the investment deficiency in the sector. Hence, this can solve food production level issues, ensure food security, and effectively sustain both the banking system and real economic development.
A Case of Abnormal Liver Function Tests in a Patient Receiving Total Parenteral Nutrition
Authors: Tran Tram , Rim Daniel Sungku , Nolen-Doerr Eric , Lopez Maryellen , Nah Youngdoh , Sharma Kavita , Shin Jeong-Hun , Kim Dong Wook
Published: June 2023

Hepatic dysfunction is prevalent in patients receiving total parenteral nutrition (TPN), resulting from steatosis, cholestasis, and cholecystitis. Regular assessments and monitoring of TPN patients are essential, even for clinically stable patients on long-term TPN. Furthermore, it is crucial to establish a differential diagnosis for hepatic dysfunction and investigate for other possible causes of elevated liver enzymes and underlying liver conditions. We present the case of a 56-year-old female patient with severe protein-calorie malnutrition on TPN, who exhibited significantly elevated liver enzymes during the routine periodic assessment. Subsequent investigation revealed that the patient had been taking traditional Chinese herbal medications concurrently with TPN. After discontinuing the herbal medications, the patient’s liver enzymes returned to normal levels within 3 weeks.
Bone Morphological Characteristics as Risk Factors for Anterior Cruciate Ligament Injury: Comparison Between Contact and Noncontact Injury
Authors: Choi Nam-Hong , Lee Dong-Min , Victoroff Brian N.
Published: June 2023

Background:

Altered bone morphologies are considered risk factors for noncontact anterior cruciate ligament (ACL) injuries.

Purpose/Hypothesis:

This study aimed to investigate bone morphological characteristics as risk factors for ACL tears in contact injuries and compare these factors with those for noncontact ACL injuries. We hypothesized that altered bone morphologies would also be risk factors for contact ACL injury.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

Enrolled were patients who underwent primary ACL reconstructions between January 2000 and December 2021 within 6 weeks after injury. Patients in the ACL group were classified according to injury mechanism (contact vs noncontact). During the same period, a control group of patients matched by age, height, and body mass index to the ACL group was selected. The lateral femoral condylar ratio (LFCR), notch width index (NWI), and lateral posterior tibial slope (PTS) were measured. Measured parameters were compared between the control, contact, and noncontact groups using analysis of variance.

Results:

There were 86 patients in the control group, 102 patients in the contact ACL group, and 105 patients in the noncontact ACL group. The demographic characteristics of the 3 groups did not differ significantly. The contact group had significantly higher LFCRs and lower NWIs compared with the control group ( P < .001 and P = .001, respectively). The noncontact group had significantly higher LFCRs and PTSs and lower NWIs compared with the control group ( P = .031; P < .001; and P < .001, respectively). The noncontact group had significantly higher PTSs and lower NWIs compared with the contact group ( P = .003 and P =.014, respectively). In the contact group, the LFCR, PTS, and NWI were significant risk factors for ACL tears (odds ratio [OR], 1.25 [ P < .001]; OR, 1.16 [ P = .008]; and OR, 1.27 [ P = .001], respectively), and in the noncontact group, the PTS and NWI were significant risk factors for ACL tears (OR, 1.20 [ P < .001]; OR, 1.59 [ P < .001], respectively).

Conclusion:

Altered bone morphological characteristics of the knee were found to be risk factors for ACL tears in contact injuries as well as noncontact injuries. Altered morphology has a more significant effect in noncontact ACL injuries.
Taking Individual Choices Seriously: A process perspective of self-selection in strategy work
Authors: Friesl Martin , Brielmaier Christoph , Dobusch Leonhard
Published: June 2023

An increasing body of work investigates the participation of a diverse set of actors in strategy making. We argue that extant research tends to gloss over a fundamental condition underpinning such participation: while participation may reflect a hierarchical mandate, insofar as it relates to the actual involvement of employees, it is the result of a process of self-selection. From this perspective, forms of participative strategizing are neither fully the outcome of deliberate top-down choice, nor do they form a random pattern that is subject to the whims of individual employees. Such forms of strategizing are rather, as we argue in this paper, based on an endogenous logic of whether and how an individual self-selects, and in turn involves her/himself in the process, or not. To conceptualize the broader phenomenon of strategy participation, we draw on practice theory to conceptualize how individuals knowingly choose to involve themselves in strategizing events and we develop in turn a process model of self-selection as an ongoing social accomplishment. This model elaborates different patterns of participation in strategy making (stabilizing and shifting trajectories) with variable emergent outcomes. We end the paper by discussing the implications of our theorizing for ongoing research on open and participatory strategizing, and for the body of work on strategy as practice.
Resistance mechanism to Notch inhibition and combination therapy in human T-cell acute lymphoblastic leukemia
Authors: Cao Linlin , Ruiz Buendía Gustavo A. , Fournier Nadine , Liu Yuanlong , Armand Florence , Hamelin Romain , Pavlou Maria , Radtke Freddy
Published: June 2023

Gain-of-function mutations in NOTCH1 are among the most frequent genetic alterations in T-cell acute lymphoblastic leukemia (T-ALL), highlighting the Notch signaling pathway as a promising therapeutic target for personalized medicine. Yet, a major limitation for long-term success of targeted therapy is relapse due to tumor heterogeneity or acquired resistance. Thus, we performed a genome-wide CRISPR-Cas9 screen to identify prospective resistance mechanisms to pharmacological NOTCH inhibitors and novel targeted combination therapies to efficiently combat T-ALL. Mutational loss of phosphoinositide-3-kinase regulatory subunit 1 (PIK3R1) causes resistance to Notch inhibition. PIK3R1 deficiency leads to increased PI3K/AKT signaling, which regulates cell cycle and the spliceosome machinery, both at the transcriptional and posttranslational level. Moreover, several therapeutic combinations have been identified, in which simultaneous targeting of the cyclin-dependent kinases 4 and 6 (CDK4/6) and NOTCH proved to be the most efficacious in T-ALL xenotransplantation models.
Evaluating the pattern of antibiotic resistance of urinary tract infection (UTI)-causing bacteria in the urine culture samples of patients in the infectious ward of Imam Khomeini Hospital, Kermanshah, in Iran from 2016–2018
Authors: Shirvani Maria , Keramati Ali , Esmaeli Mojtaba
Published: June 2023

Background

Increasing resistance of bacteria to antimicrobial agents is a significant problem worldwide. This study aimed to assess the pattern of antibiotic resistance among bacteria that cause urinary tract infections (UTIs) in patients admitted to the infectious ward of Imam Khomeini Hospital in Kermanshah between 2016 and 2018, based on urine culture samples.

Methods

The present study was a cross-sectional and descriptive study. The study’s statistical population included all patients referred to the infectious disease ward of Imam Khomeini Hospital due to urinary tract infections during the project period. Urine samples were collected in sterile containers, and by using a calibrated loop, the urine sample was cultured on EMB and blood agar media under sterile conditions. Microbial sensitivity was performed by standard disk diffusion method, and the results were analyzed using SPSS-V 16 software.

Results

The antibiotic resistance assays showed that the highest resistance included nalidixic acid (73.5%), ciprofloxacin (72.1%), cotrimoxazole (70.6%), and ceftazidime (61.8%), cefixime (57.4%), ceftriaxone (48.5%), gentamicin (32.4%), cephalothin (16.6%), nitrofurantoin (10.3%), norfloxacin (5.9%), cefotaxime (4.4%), imipenem (2.9%), cefepime (2.9%), ampicillin (2.9%), ceftizoxime (1.5%), vancomycin (1.5%), cefazolin (1.5%), and chloramphenicol (1.5%), respectively. In addition, investigating the antibiotic resistance of UTI-causing bacteria according to the gender and age of the patients in the present study showed no significant statistical difference (P > 0.05).

Conclusion

The bacteria causing urinary infections in the study area mainly belonged to the E. coli and Klebsiella families. Considering the determination of antibiotic sensitivity patterns in common organisms in the studied area, its report to doctors can be considered in experimental treatments.
Polypharmacy with potentially inappropriate medications as a risk factor of new onset sarcopenia among community-dwelling Japanese older adults: a 9-year Kashiwa cohort study
Authors: Tanaka Tomoki , Akishita Masahiro , Kojima Taro , Son Bo-Kyung , Iijima Katsuya
Published: June 2023

Background

Clinical evidence demonstrating a longitudinal association between prescribed medications and sarcopenia onset is lacking. We investigated the association of polypharmacy (the use of five or more medications) and potentially inappropriate medications (PIMs) with sarcopenia risk in community-dwelling older adults.

Methods

In this longitudinal population-based cohort study, 2,044 older residents with no long-term care needs were randomly selected from a community in Kashiwa, Japan. Baseline data collection was conducted in 2012, with follow-ups in 2013, 2014, 2016, 2018, and 2021. Prescribed medications and PIMs (drugs listed in the Screening Tool for Older Person’s Appropriate Prescriptions for the Japanese or potentially muscle-wasting drugs) were identified through interviews. New-onset sarcopenia was identified according to the 2019 criteria of the Asian Working Group for Sarcopenia over a 9-year period and analyzed. We used Cox proportional hazards models to test the longitudinal association of prescribed medications with sarcopenia onset.

Results

Of the 1,549 participants without sarcopenia at baseline (mean age, 72.5 ± 5.5 years; 49.1% women; median and interquartile range, 6.0 [4.0–9.0] years), 230 experienced new-onset sarcopenia during the follow-up. After adjusting for confounders, polypharmacy combined with PIM use was strongly associated with new-onset sarcopenia (adjusted hazard ratio, 2.35; 95% confidence interval, 1.58–3.51; P < 0.001). No significant associations were observed for either PIM use or polypharmacy alone.

Conclusions

Polypharmacy combined with PIM use, but not polypharmacy alone, was associated with an increased risk of new-onset sarcopenia over the 9-year follow-up period among community-dwelling older adults. Limiting polypharmacy and imposing the prescription of appropriate medications may facilitate sarcopenia prevention.
Organism type of infection is associated with prognosis in sepsis: an analysis from the MIMIC-IV database
Authors: Guo Qiuping , Qu Peng , Cui Wanfu , Liu Mingrong , Zhu Huiling , Chen Weixin , Sun Nan , Geng Shiyu , Song Weihua , Li Xu , Lou Anni
Published: June 2023

Background

Sepsis has a high mortality rate, which is expensive to treat, and is a major drain on healthcare resources; it seriously impacts the quality of human life. The clinical features of positive or non-positive blood cultures have been reported, but the clinical features of sepsis with different microbial infections and how they contribute to clinical outcomes have not been adequately described.

Methods

We extracted clinical data of septic patients with a single pathogen from the online Medical Information Mart for Intensive Care(MIMIC)-IV database. Based on microbial cultures, patients were classified into Gram-negative, Gram-positive, and fungal groups. Then, we analyzed the clinical characteristics of sepsis patients with Gram-negative, Gram-positive, and fungal infections. The primary outcome was 28-day mortality. The secondary outcomes were in-hospital mortality, the length of hospital stay, the length of ICU stay, and the ventilation duration. In addition, Kaplan–Meier analysis was used for the 28-day cumulative survival rate of patients with sepsis. Finally, we performed further univariate and multivariate regression analyses for 28-day mortality and created a nomogram for predicting 28-day mortality.

Results

The analysis showed that bloodstream infections showed a statistically significant difference in survival between Gram-positive and fungal organisms; drug resistance only reached statistical significance for Gram-positive bacteria. Through univariate and multivariate analysis, it was found that both the Gram-negative bacteria and fungi were independent risk factors for the short-term prognosis of sepsis patients. The multivariate regression model showed good discrimination, with a C-index of 0.788. We developed and validated a nomogram for the individualized prediction of 28-day mortality in patients with sepsis. Application of the nomogram still gave good calibration.

Conclusions

Organism type of infection is associated with mortality of sepsis, and early identification of the microbiological type of a patient with sepsis will provide an understanding of the patient's condition and guide treatment.
Risk factors associated with vitamin D deficiency in preterm neonates: a single-center step-wise regression analysis
Authors: Jamali Zahra , Ghorbani Fereshteh , Shafie’ei Mohammad , Tolooefar Fatemeh , Maleki Elham
Published: June 2023

Background

Vitamin D deficiency is particularly concerning in pregnant women, leading to various health-related issues in mothers and their babies, especially those born prematurely, including neonatal skeletal and respiratory disorders. In addition, there have been several reports indicating the presence of multiple impactful factors in the development of vitamin D deficiency. Therefore, we aimed to evaluate the vitamin D level in very preterm and moderately preterm newborns and investigate its association with presumed influential factors.

Methods

This cross-sectional descriptive study was performed on 54 mothers and their preterm neonates with gestational ages less than 34 weeks at delivery (i.e., very preterm and moderately preterm). After the serum vitamin D levels were determined from samples obtained in the first 24 h after birth, the babies were divided into two groups based on the presence or absence of deficiency. The relationship between several factors and the neonatal serum vitamin D level was investigated separately and in a linear step-wise regression model.

Results

The differences between the groups regarding maternal age, gestational age, neonate's gender, birth weight, and delivery method with neonatal vitamin D levels were not statistically significant. However, maternal vitamin D levels strongly correlated with neonatal vitamin D levels (P-value < 0.001,r = 0.636). The regression model also yielded a strong predictive capability (P-value < 0.001, AdjustedR2 = 0.606), with the maternal vitamin D level demonstrating a significant impact.

Conclusions

Low vitamin D levels in pregnant mothers correlate with deficient levels in their preterm neonates. Therefore, as vitamin D deficiency significantly affects both the mother's and newborn's health, it is recommended that healthcare providers provide comprehensive plans for vitamin D supplementation during pregnancy.
Perceived inequality in society may not motivate increased food intake in the absence of personal socioeconomic disadvantage
Authors: Cheon Bobby K. , Low Xenia , Wijaya Darren Jeffian , Lee Albert
Published: June 2023

Background

Greater levels of socioeconomic inequality across societies have been associated with higher rates of obesity and cardiometabolic disease. While these relationships could be attributed to poorer quality of health services and lower access to healthier lifestyles among disadvantaged groups in societies with greater economic inequality, this explanation does not account for those who experience relative economic security in such unequal societies (e.g., the middle and upper classes). Here, we tested whether perceptions of greater disparities between social classes in one’s society (i.e., perceived societal inequality) may promote eating behaviors that risk excess energy intake.

Methods

In two studies, participants completed an experimental manipulation that situated them as middle class within a hypothetical society that was presented to have either large disparities in socioeconomic resources between classes (high inequality condition) or low disparities (low inequality condition), while keeping the participants’ objective socioeconomic standing constant across conditions. In Study 1 (pre-registered), participants (n = 167) completed the perceived societal inequality manipulation before a computerized food portion selection task to measure desired portion sizes for a variety of foods. Study 2 (n = 154) involved a similar design as Study 1, but with inclusion of a neutral control condition (no awareness of class disparities) followed by ad libitum consumption of potato chips.

Results

While the high inequality condition successfully elicited perceptions of one’s society as having greater socioeconomic inequalities between classes, it did not generate consistent feelings of personal socioeconomic disadvantage. Across both studies, we observed no differences between conditions in average selected portion sizes or actual energy intake.

Conclusions

Taken together with prior research on the effects of subjective socioeconomic disadvantage on increased energy intake, these findings suggest that perceptions of inequality in one’s society may be insufficient to stimulate heightened energy intake in the absence of personal socioeconomic disadvantage or inadequacy.
Hospital challenges and managerial approaches to combat COVID-19 outbreak: a qualitative study in southeastern Iran
Authors: Ebrahimi Rigi Zahra , Namjoo Zakieh , Jabarpour Maryam , Ahmadinejad Mehdi , Ahmadipour Maryam , Mangolian Shahrbabaki Parvin , Dehghan Mahlagha
Published: June 2023

Background

During the covid-19 pandemic, hospitals have faced several challenges, so they need to identify and address effective management strategies to cope with these challenges that enhance their current knowledge to deal with similar challenges in the future. This study aimed to identify managerial strategies for dealing with Covid-19 pandemic challenges at a hospital in southeastern Iran.

Methods

This qualitative content analysis study used purposive sampling to select eight managers, three nurses, and one worker from Shahid Bahonar Hospital. In this study, semi-structured interviews were used to collect data and Lundman and Graneheim’s approach was used to analyze them.

Results

Three hundred fifty codes remained after constant comparison, compression, and merging. The results demonstrated one theme “Managerial reengineering in the healthcare system during the Covid-19 crisis”, two main categories, seven subcategories and, 19 sub- subcategories. The first main category was “The difficulty of managing challenges,“ including “Insufficient resources and physical space”, “Socio-organizational challenges” and, “Incompetence and unpreparedness of managers.“ The second main category was “Reforming the management duties.“ This category included “Planning and decision-making,“ “Organization,“ “Leadership and motivation,“ and “Monitoring and control.”

Conclusions

Hospitals and managers were less prepared to cope with the Covid-19 crisis challenges due to health system organizations’ less attention to biological crises. Healthcare organizations can carefully evaluate these challenges, and the strategies managers adopt to deal with these problems. They also can identify the strategies’ strengths and weaknesses and propose more effective strategies. As a result, healthcare organizations will be better prepared for similar crises.
Effectiveness of mHealth consultation services for preventing postpartum depressive symptoms: a randomized clinical trial
Authors: Arakawa Yuki , Haseda Maho , Inoue Kosuke , Nishioka Daisuke , Kino Shiho , Nishi Daisuke , Hashimoto Hideki , Kondo Naoki
Published: June 2023

Background

Although many conventional healthcare services to prevent postpartum depression are provided face-to-face, physical and psychosocial barriers remain. These barriers may be overcome by using mobile health services (mHealth). To examine the effectiveness of mHealth professional consultation services in preventing postpartum depressive symptoms in real-world settings, we conducted this randomized controlled trial in Japan, where universal free face-to-face perinatal care is available.

Methods

This study included 734 pregnant women living in Yokohama city who could communicate in Japanese, recruited at public offices and childcare support facilities. The participants were randomized to the mHealth group (intervention, n = 365), where they could use a free app-based mHealth consultation service with gynecologists/obstetricians, pediatricians, and midwives whenever and as many times as they wanted between 6 p.m. and 10 p.m. on weekdays throughout their pregnancy and postpartum periods (funded by the City of Yokohama government) or the usual care group (control, n = 369). The primary outcome was the risk of elevated postpartum depressive symptoms, defined as Edinburgh Postnatal Depression Scale score ≥ 9. Secondary outcomes were self-efficacy, loneliness, perceived barriers to healthcare access, number of clinic visits, and ambulance usage. All outcomes were collected three months post-delivery. We also conducted subgroup analyses assessing the differences in the treatment effect by sociodemographic status.

Results

Most women completed all questionnaires (n = 639 of 734, response rate: 87%). The mean baseline age was 32.9 ± 4.2 years, and 62% were primipara. Three months post-delivery, women in the mHealth group had a lower risk of elevated postpartum depressive symptoms (47/310 [15.2%]) compared to the usual care group (75/329 [22.8%], risk ratio: 0.67 [95% confidence interval: 0.48–0.93]). Compared with the usual care group, women in the mHealth group had higher self-efficacy, less loneliness, and fewer perceived barriers to healthcare access. No differences were observed in the frequency of clinic visits or ambulance usage. Furthermore, in the subgroup analyses, we did not find differences in the treatment effect by sociodemographic status.

Conclusions

Local government-funded mHealth consultation services have a preventive effect on postpartum depressive symptoms, removing physical and psychological barriers to healthcare access in real-world settings.

Trial registration

UMIN-CTR identifier: UMIN000041611. Registered 31 August 2021.
Association of Mediterranean diet with survival after breast cancer diagnosis in women from nine European countries: results from the EPIC cohort study
Authors: Castro-Espin Carlota , Bonet Catalina , Crous-Bou Marta , Nadal-Zaragoza Núria , Tjønneland Anne , Mellemkjær Lene , Hajji-Louati Mariem , Truong Thérèse , Katzke Verena , Le Cornet Charlotte , Schulze Matthias B. , Jannasch Franziska , Masala Giovanna , Sieri Sabina , Panico Salvatore , Di Girolamo Chiara , Skeie Guri , Borch Kristin Benjaminsen , Olsen Karina Standahl , Sánchez Maria-Jose , Amiano Pilar , Chirlaque María-Dolores , Guevara Marcela , Sund Malin , Bodén Stina , Gunter Marc J. , Gonzalez-Gil Esther M. , Weiderpass Elisabete , Aguilera-Buenosvinos Inmaculada , Tsilidis Kostas K. , Heath Alicia K. , Aune Dagfinn , Dossus Laure , Agudo Antonio
Published: June 2023

Background

The Mediterranean diet has been associated with lower risk of breast cancer (BC) but evidence from prospective studies on the role of Mediterranean diet on BC survival remains sparse and conflicting. We aimed to investigate whether adherence to Mediterranean diet prior to diagnosis is associated with overall and BC-specific mortality.

Methods

A total of 13,270 incident breast cancer cases were identified from an initial sample of 318,686 women in 9 countries from the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Adherence to Mediterranean diet was estimated through the adapted relative Mediterranean diet (arMED), a 16-point score that includes 8 key components of the Mediterranean diet and excludes alcohol. The degree of adherence to arMED was classified as low (score 0–5), medium (score 6–8), and high (score 9–16). Multivariable Cox proportional hazards models were used to analyze the association between the arMED score and overall mortality, and Fine-Gray competing risks models were applied for BC-specific mortality.

Results

After a mean follow-up of 8.6 years from diagnosis, 2340 women died, including 1475 from breast cancer. Among all BC survivors, low compared to medium adherence to arMED score was associated with a 13% higher risk of all-cause mortality (HR 1.13, 95%CI 1.01–1.26). High compared to medium adherence to arMED showed a non-statistically significant association (HR 0.94; 95% CI 0.84–1.05). With no statistically significant departures from linearity, on a continuous scale, a 3-unit increase in the arMED score was associated with an 8% reduced risk of overall mortality (HR3-unit 0.92, 95% CI: 0.87–0.97). This result sustained when restricted to postmenopausal women and was stronger among metastatic BC cases (HR3-unit 0.81, 95% CI: 0.72–0.91).

Conclusions

Consuming a Mediterranean diet before BC diagnosis may improve long-term prognosis, particularly after menopause and in cases of metastatic breast cancer. Well-designed dietary interventions are needed to confirm these findings and define specific dietary recommendations.
Widely targeted quantitative lipidomics and prognostic model reveal plasma lipid predictors for nasopharyngeal carcinoma
Authors: Chen Xi , Li Ying-xue , Cao Xun , Qiang Meng-yun , Liang Chi-xiong , Ke Liang-ru , Cai Zhuo-chen , Huang Ying-ying , Zhan Ze-jiang , Zhou Jia-yu , Deng Ying , Zhang Lu-lu , Huang Hao-yang , Li Xiang , Mei Jing , Xie Guo-tong , Guo Xiang , Lv Xing
Published: June 2023

Background

Dysregulation of lipid metabolism is closely associated with cancer progression. The study aimed to establish a prognostic model to predict distant metastasis-free survival (DMFS) in patients with nasopharyngeal carcinoma (NPC), based on lipidomics.

Methods

The plasma lipid profiles of 179 patients with locoregionally advanced NPC (LANPC) were measured and quantified using widely targeted quantitative lipidomics. Then, patients were randomly split into the training (125 patients, 69.8%) and validation (54 patients, 30.2%) sets. To identify distant metastasis-associated lipids, univariate Cox regression was applied to the training set (P < 0.05). A deep survival method called DeepSurv was employed to develop a proposed model based on significant lipid species (P < 0.01) and clinical biomarkers to predict DMFS. Concordance index and receiver operating curve analyses were performed to assess model effectiveness. The study also explored the potential role of lipid alterations in the prognosis of NPC.

Results

Forty lipids were recognized as distant metastasis-associated (P < 0.05) by univariate Cox regression. The concordance indices of the proposed model were 0.764 (95% confidence interval (CI), 0.682–0.846) and 0.760 (95% CI, 0.649–0.871) in the training and validation sets, respectively. High-risk patients had poorer 5-year DMFS compared with low-risk patients (Hazard ratio, 26.18; 95% CI, 3.52–194.80; P < 0.0001). Moreover, the six lipids were significantly correlated with immunity- and inflammation-associated biomarkers and were mainly enriched in metabolic pathways.

Conclusions

Widely targeted quantitative lipidomics reveals plasma lipid predictors for LANPC, the prognostic model based on that demonstrated superior performance in predicting metastasis in LANPC patients.
Engineering a triple-functional magnetic gel driving mutually-synergistic mild hyperthermia-starvation therapy for osteosarcoma treatment and augmented bone regeneration
Authors: Yu Kexiao , Zhou Hang , Xu Yamei , Cao Youde , Zheng Yuanyi , Liang Bing
Published: June 2023

Malignant bone tumors result in high rates of disability and death and are difficult to treat in terms of killing tumors and repairing bone defects. Compared with other hyperthermia strategies, magnetic hyperthermia has become an effective therapy for treating malignant bone tumors due to its lack of depth limitations. However, tumor cells express heat shock protein (HSP) to resist hyperthermia, which reduces its curative effect. Competitive ATP consumption can reduce HSP production; fortunately, the basic principle of starvation therapy by glucose oxidase (GOx) is consuming glucose to control ATP production, thereby restricting HSP generation. We developed a triple-functional magnetic gel (Fe3O4/GOx/MgCO3@PLGA) as a magnetic bone repair hydrogels (MBRs) with liquid‒solid phase transition capability to drive magneto-thermal effects to simultaneously trigger GOx release and inhibit ATP production, reducing HSP expression and thereby achieving synergistic therapy for osteosarcoma treatment. Moreover, magnetic hyperthermia improves the effect of starvation therapy on the hypoxic microenvironment and achieves a reciprocal strengthening therapeutic effect. We further demonstrated that in situ MBRs injection effectively suppressed tumor growth in 143B osteosarcoma tumor-bearing mice and an in-situ bone tumor model in the rabbit tibial plateau. More importantly, our study also showed that liquid MBRs could effectively match bone defects and accelerate their reconstruction via magnesium ion release and enhanced osteogenic differentiation to augment the regeneration of bone defects caused by bone tumors, which generates fresh insight into malignant bone tumor treatment and the acceleration of bone defect repair.