bluuebunny/crossref_metadata_2025 huggingface dataset:
Dosimetric comparison of five different radiotherapy treatment planning approaches for locally advanced non‐small cell lung cancer with sequential plan changes
Authors: Saito Masahide , Komiyama Takafumi , Marino Kan , Aoki Shinichi , Akita Tomoko , Matsuda Masaki , Sano Naoki , Suzuki Hidekazu , Koji Ueda , Nemoto Hikaru , Onishi Hiroshi
Published: October 2023

Background

The purpose of this study was to compare the dosimetric characteristics of five different treatment planning techniques for locally advanced non‐small cell lung cancer (LA‐NSCLC) with sequential plan changes.

Methods

A total of 13 stage III NSCLC patients were enrolled in this study. These patients had both computed tomography (CT) images for initial and boost treatment plans. The latter CT images were taken if tumor shrinkage was observed after 2 weeks of treatment. The prescription dose was 60 Gy/30 Fr (initial: 40 Gy/20 Fr, and boost: 20 Gy/10 Fr). Five techniques (forward‐planed 3‐dimensional conformal radiotherapy [F‐3DCRT] on both CT images, inverse‐planned 3DCRT [I‐3DCRT] on both CT images, volumetric modulated arc therapy [VMAT] on both CT images, F‐3DCRT on initial CT plus VMAT on boost CT [bVMAT], and hybrid of fixed intensity‐modulated radiotherapy [IMRT] beams and VMAT beams on both CT images [hybrid]) were recalculated for all patients. The accumulated doses between initial and boost plans were compared among all treatment techniques.

Results

The conformity indexes (CI) of the planning target volume (PTV) of the five planning techniques were 0.34 ± 0.10, 0.57 ± 0.10, 0.86 ± 0.08, 0.61 ± 0.12, and 0.83 ± 0.11 for F‐3DCRT, I‐3DCRT, VMAT, bVMAT, and hybrid, respectively. In the same manner, lung volumes receiving >20 Gy (V20Gy) were 21.05 ± 10.56%, 20.86 ± 6.45, 19.50 ± 7.38%, 19.98 ± 10.04%, and 17.74 ± 7.86%. There was significant improvement about CI and V20Gy for hybrid compared with F‐3DCRT (p < 0.05).

Conclusion

The IMRT/VMAT hybrid technique for LA‐NSCLC patients improved target CI and reduced lung doses. Furthermore, if IMRT was not available initially, starting with 3DCRT might be beneficial as demonstrated in the bVMAT procedure of this study.
Form follows function: Nuclear morphology as a quantifiable predictor of cellular senescence
Authors: Belhadj Jakub , Surina Surina , Hengstschläger Markus , Lomakin Alexis J.
Published: October 2023

Enlarged or irregularly shaped nuclei are frequently observed in tissue cells undergoing senescence. However, it remained unclear whether this peculiar morphology is a cause or a consequence of senescence and how informative it is in distinguishing between proliferative and senescent cells. Recent research reveals that nuclear morphology can act as a predictive biomarker of senescence, suggesting an active role for the nucleus in driving senescence phenotypes. By employing deep learning algorithms to analyze nuclear morphology, accurate classification of cells as proliferative or senescent is achievable across various cell types and species both in vitro and in vivo. This quantitative imaging‐based approach can be employed to establish links between senescence burden and clinical data, aiding in the understanding of age‐related diseases, as well as assisting in disease prognosis and treatment response.
Measuring the impact of the COVID‐19 pandemic on colorectal cancer presentation: a retrospective comparative study
Authors: Fullard Kirsten , Steffens Daniel , Solomon Michael , Shin Joo‐Shik , Koh Cherry
Published: October 2023

Backgrounds

The Coronavirus disease 2019 (COVID‐19) pandemic provided challenges to surgical care in Australia. This study aimed to measure the potential impact of COVID‐19 on colorectal cancer presentation through surgical volume and cancer staging at a major tertiary referral hospital in the city of Sydney Australia.

Methods

A retrospective cohort study was performed using routinely collected data from consecutive colorectal cancer patients undergoing surgery during the COVID‐19 period (1 March 2020 to 1 October 2021) and compared with the pre‐COVID‐19 period (1 March 2018 to 1 October 2019). The main outcomes included patient demographics, surgical volume (including overall, elective and emergency) and cancer staging. Differences in outcomes between the two studied periods were compared using Pearson's chi‐squared test, Fisher test or t‐test.

Results

A total of 381 patients composed the COVID‐19 group (Mean age = 62.4 years) and 364 patients composed the pre‐COVID‐19 group (Mean age = 65.6 years; P<0.001). No significant differences were observed for overall, elective or emergency surgical volumes. Patients in the COVID‐19 group had a reduction in Stage I and an increase in Stage II and III disease, with Stage IV and recurrent disease being similar with a variation of <1% when compared to the pre‐COVID‐19 group (P<0.001).

Conclusions

Disruptions in patient screening, diagnosis and management from elective surgery restrictions and patient hesitancy may not have resulted in observed changes to surgical volume, however, it may have contributed to an increase in Stages II and III colorectal cancer during COVID‐19.
Latent State Infrastructure and Financialisation: Insight from a Post‐Apartheid Public Pension Fund and Real Estate
Authors: Pillay Gonzalez Sarita
Published: October 2023

South Africa's Government Employees Pension Fund (GEPF) is among the world's largest pension funds, public or private. The pension fund's sizeable coffers reflect reforms to its structure undertaken as a safeguard for apartheid bureaucrats. Today, the fund is entangled in South Africa's financial markets. Through an analysis of the GEPF's investment in real estate, it is shown how investments by a government employees’ pension fund intertwine with real estate financialisation in South Africa. Representative of the latent state infrastructure that is not often the site of interrogation in scholarship nor activism, the case of the GEPF can help expand our understanding of the relationship between the state and financialisation.
The ESSENCE‐Q: Can specialist supervision improve scoring agreement across specialist and public health nurses/nursery teachers?
Authors: Kitazoe Noriko , Mimoto Sae , Fukunaga Ichiro , Hamaguchi Masako , Hatakenaka Yuhei , Gillberg Christopher
Published: October 2023

Aim

This study aimed to explore whether the supervision of community public health nurses (PHNs) and nursery school teachers (NSTs) by a specialist, familiar with Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations (ESSENCE), improved the agreement of ESSENCE‐Questionnaire (ESSENCE‐Q) scoring, across raters.

Methods

A PHN, two NSTs, and a speech‐language pathologist (SLP), familiar with ESSENCE, independently assessed 32 children. The ESSENCE‐Q results were divided into the first (child 1–18) and second groups (the 19th child and the following children). Changes in score discrepancies were analysed for ESSENCE‐Q cutoff scores and total ESSENCE‐Q scores across raters. The SLP scores were used as a reference to evaluate sensitivity and specificity.

Results

The total ESSENCE‐Q scores of the PHN and NSTs showed higher concordance in the second group (p < 0.05). Comparisons of the differences between the PHN/NSTs and SLP in total ESSENCE‐Q scores showed a significantly smaller difference in the NSTs' scores in the second group (p < 0.05).

Conclusion

The findings suggest that specialist supervision may lead to a better agreement between PHN and NSTs regarding ESSENCE‐Q scores.
Development of a model to identify patients who do not need oesophageal biopsies when eosinophilic oesophagitis is suspected
Authors: Kamboj Amrit K. , Cotton Cary C. , Liu Liang Yen , Tome June , Snyder Diana L. , Alexander Jeffrey A. , Ravi Karthik , Harmsen William S. , Dellon Evan S. , Katzka David A.
Published: October 2023

Background

Predictive models for eosinophilic oesophagitis (EoE) may not fully rule in the diagnosis.

Aim

To develop a reverse model that predicts against EoE to eliminate the need for oesophageal biopsies.

Methods

In this two‐centre study, a predictive model was developed (Mayo Clinic) and validated (University of North Carolina [UNC]). Cross‐sectional data from consecutive adult patients without prior EoE who underwent upper enoscopy with oesophageal biopsies were used. EoE cases had ≥15 eosinophils/high‐power field while controls had no eosinophils. Data were collected on patient clinical and endoscopic features. Multiple variable logistic regression was used to identify predictors of non‐EoE status while maintaining specificity ≥95%. A secondary model was developed to predict against the need for endoscopy in patients suspected of having EoE without alarm symptoms.

Results

The Mayo and UNC cohorts consisted of 345 (EoE = 94, non‐EoE = 251) and 297 patients (EoE = 84, non‐EoE = 213), respectively. A primary model based on clinical and endoscopic features predicted against EoE with c‐statistic 0.92 (95% CI: 0.88–0.96), specificity 95%, and sensitivity 65%. This model was validated (UNC) with c‐statistic 0.87 (95% CI: 0.82–0.92). A simplified scoring system was created and a threshold of ≥12 points excluded EoE with 95% specificity and 50% sensitivity. A secondary model based on clinical characteristics alone predicted against EoE with c‐statistic 0.86 (95% CI: 0.82–0.90), specificity 95% and sensitivity 39% and validated (UNC) with c‐statistic 0.78 (95% CI: 0.71–0.85).

Conclusion

A simplified scoring system accurately identified a group of patients with a low likelihood of EoE where unnecessary oesophageal biopsies can be avoided, potentially resulting in resource and cost savings.
Infection control, subjective estimates, and the ethics of testing during the COVID‐19 pandemic
Authors: Cato Susumu , Ishida Shu
Published: October 2023

On March 16, 2020, the Director‐General of the World Health Organization said: “We have a simple message to all countries—test, test, test.” This seems like sound advice, but what if limiting the number of tests has a positive effect on infection control? Although this may rarely be the case, the possibility raises an important ethical question that is closely related to a central tension between deontological and consequentialist approaches to ethics. In this paper, we first argue that early during the COVID‐19 pandemic, Japan offers an interesting case because it experienced few deaths due to COVID while the number of tests was limited, suggesting that there may be cases in which low testing contributes to infection control indeed. After that, we examine deontological constraints on such a “low‐testing” policy, focusing on issues related to a supposed “right to know,” which is a central issue in medical ethics in general.
Corporate fraud, political connections, and media bias: Evidence from China
Authors: Wang Jiamin , Li Qian , Lai Chenmeng , Song Victor
Published: October 2023

This article empirically examines how political connections (PCs) affect a firm's media reaction after corporate fraud. Using data for Chinese listed companies from 2008 to 2021, we find that the media reports more positively for firms with PCs than for others that do not possess such advantages after the enforcement against fraud. The results are robust to a series of robustness checks and endogeneity corrections. When decomposing media reports, we find that PCs only facilitate positive media coverage but do not impede negative media coverage, which is more pronounced in state‐controlled media. This suggests that PCs protect firms’ branding by facilitating positive media reports rather than withholding bad news. Moreover, we find this protective effect is more pronounced in firms with stronger PCs, weaker anti‐corruption regulation, lighter punishment for fraud, private ownership, and more donations. Further, the consequences analysis shows that this kind of protective effect significantly increases the probability of future fraud and stock price crashes. Our findings present a new perspective on the role of PCs and provide evidence for political bias in media coverage.
Navigating danger through nuisance: Racialized urban fears, gentrification, and sensory enskilment in Amsterdam
Authors: Fiore Elisa
Published: October 2023

In this article, I employ the notion of sensory enskilment to investigate the embodied relations through which White Dutch middle‐class residents of the Indische Buurt, a rapidly gentrifying multicultural neighborhood in the east of Amsterdam, learn to tune in to sensory nuisance to discern safe and unsafe bodies and places in their surroundings. The analysis involves examining those institutional and interactional avenues of (unwitting) sensory learning through which habituated perceptual patterns of stigmatization that conflate the everyday sensory order of Moroccan‐Dutch youths with feelings of urban insecurity are cultivated, produced, and consolidated. Studying the ways in which sensory knowledge is implicated in the reproduction of socioeconomic exclusions in contested urban territories can shed new light on discussions around urban sensory politics and draw attention to the enrolment of the senses in revanchist urban renewal.
Literaturrecherche zur Therapie der Necrobiosis lipoidica in der Kindheit
Authors: Schiefer‐Niederkorn Anna , Sadoghi Birgit , Binder Barbara
Published: October 2023

Die Necrobiosis lipoidica (NL) ist eine seltene granulomatöse Erkrankung mit scharf begrenzten, teleangiektatischen, braun‐roten Plaques mit atroph‐gelblichen Zentren, die zu Ulzerationen neigen und hauptsächlich an den Schienbeinen auftreten. Bei Kindern ist NL sehr selten, jedoch sind die Therapieresistenz, das problematische kosmetische Erscheinungsbild, die schmerzhaften Ulzerationen und die mögliche Entwicklung von Plattenepithelkarzinomen besonders herausfordernd für diese Altersgruppe. Unsere Literaturrecherche inkludiert 29 Berichte über NL bei Patienten unter 18 Jahren, die seit 1990 auf PubMed, EMBASE und Medline publiziert wurden. Das mittlere Alter war 14,3 Jahre mit weiblicher Prädominanz von 2 : 1 und hoher Prävalenz von Diabetes mellitus (80%). Aus den Daten geht hervor, dass hochpotente topische Steroide bis zu zweimal täglich Behandlung erster Wahl sind. Therapierefraktäre Fälle können auf Tacrolimus umgestellt werden. Ulzerationen profitieren von phasenadaptierter Wundversorgung und antientzündlichen medizinischen Verbänden wie mit medizinischem Honig. Das Hinzufügen einer hyperbaren Sauerstoffbehandlung zur lokalen oder systemischen Therapie kann bei schwer behandelbaren ulzerierten Läsionen in Betracht gezogen werden. Therapieresistente Fälle können umgestellt werden auf topische Photochemotherapie oder systemische Behandlung mit TNF‐alpha‐Inhibitoren, systemischen Steroiden (bevorzugt bei Patienten ohne Diabetes), Pentoxifyllin oder Hydroxychloroquin. Necrobiosis lipoidica in der Kindheit ist mit über 40% fehlgeschlagenen Therapieversuchen schwer zu behandeln, weshalb weitere Forschung über Patientenregister empfohlen wird.
Perioperative Antibiotikaprophylaxe in der Dermatochirurgie – Positionspapier der Arbeitsgruppe Antibiotic Stewardship der Deutschen Gesellschaft für Dermatochirurgie (DGDC), Teil 2: Spezielle Indikationen und Situationen
Authors: Balakirski Galina , Becker Sören L. , Hartmann Daniela , Kofler Lukas , Kunte Christian , Müller Cornelia S. L. , Volz Thomas , Kendziora Benjamin , Schlager Justin Gabriel , Löser Christoph R.
Published: October 2023

Neben der Vermeidung postoperativer Wundinfektionen nach dermatochirurgischen Eingriffen hat die perioperative Antibiotikaprophylaxe (PAP) das Ziel, das Auftreten weiterer postoperativer Infektionskomplikationen, insbesondere der bakteriellen Endokarditis oder hämatogener Gelenkprotheseninfektionen, zu verhindern. In der vorliegenden Arbeit werden spezielle Situationen dargestellt, in denen eine PAP notwendig werden kann. So benötigen Patienten nach Herzklappenersatz jeglicher Art, einschließlich Transkatheter‐Klappenersatz oder bei Verwendung von Prothesenmaterial zur Herzklappenkorrektur, oder Patienten nach einer durchgemachten bakteriellen Endokarditis bei zweizeitigen dermatochirurgischen Eingriffen, Eingriffen an der Schleimhaut oder ulzerierten Tumoren eine PAP.

Auch die Anwendung einer PAP in speziellen Situationen wie bei sekundärer Wundheilung, septischen dermatochirurgischen Eingriffen oder Ulcus cruris‐Chirurgie werden in dieser Arbeit anhand der aktuellen wissenschaftlichen Literatur ausführlich dargestellt und diskutiert. Die vorliegende Arbeit ist der 2. Teil des Positionspapiers der Arbeitsgruppe Antibiotic Stewardship der Deutschen Gesellschaft für Dermatochirurgie und formuliert evidenzbasierte Empfehlungen für die Verabreichung einer PAP bei dermatochirurgischen Eingriffen bei speziellen Indikationen und Situationen. Dies ist von besonderer Wichtigkeit, da bei dermatochirurgischen Eingriffen, wie im ersten Teil dargelegt, im Regelfall auf eine PAP verzichtet werden kann und sollte.
Wünsche und Vorsorgeplanung für das Lebensende von Patienten mit fortgeschrittenem Hautkrebs
Authors: Volberg Christian , Schrade Severin , Heers Hendrik , Carrasco Anna J. Pedrosa , Morin Astrid , Gschnell Martin
Published: October 2023

Hintergrund

Patienten mit fortgeschrittenem oder metastasiertem Hautkrebs haben eine eingeschränkte Lebenserwartung und versterben zum größten Teil, trotz moderner Behandlungsmöglichkeiten, an dem Tumorleiden. Bislang ist unbekannt, welche Präferenzen für die Versorgung in der letzten Lebensphase bei diesen Patienten bestehen.

Patienten und Methodik

150 Patienten mit fortgeschrittenem Hautkrebs (AJCC/UICC Stadium III oder IV) wurden mit Hilfe eines strukturierten Fragebogens interviewt.

Ergebnisse

75% der Befragten wünschen sich im häuslichen Umfeld zu versterben, wobei ein höheres Tumorstadium und ein vermehrtes Nachdenken über die Versorgung am Lebensende davon wegführen. Nur 42% haben diesen Wunsch jedoch jemandem mitgeteilt. Vorsorgedokumente haben 55% der Teilnehmer ausgefüllt, während jüngere Patienten dies signifikant seltener tun (95%‐KI: 0,11–0,56; p = 0,001). Die Mehrzahl der Patienten (62%) wünscht sich Gespräche mit dem behandelnden Dermatoonkologen über Versorgungsmöglichkeiten am Lebensende.

Schlussfolgerungen

Auch wenn der Zeitpunkt des Todes nicht absehbar ist, so erscheint eine frühzeitig in die Wege geleitete vorausschauende Versorgungsplanung für das Lebensende sinnvoll. Die behandelnden Dermatoonkologen sollten hierbei die Initiative ergreifen und Patienten bei routinemäßigen Kontrollen auf dieses Thema ansprechen. Hier könnte es von Nutzen sein, den Patienten und Angehörigen die Versorgungsmöglichkeiten vorzustellen und Strategien für den Fall einer gesundheitlichen Verschlechterung zu erstellen.
Body‐Mass‐Index vs. Taille‐zu‐Größe‐Verhältnis bei Patientinnen mit Lipohyperplasia dolorosa (vulgo Lipödem)
Authors: Brenner Erich , Forner‐Cordero Isabel , Faerber Gabriele , Rapprich Stefan , Cornely Manuel
Published: October 2023

Hintergrund

Das Lipödem, auch Lipohyperplasia dolorosa (LiDo) genannt, ist eine schmerzhafte Erkrankung von Frauen, die zu einer unverhältnismäßigen Ansammlung von subkutanem Fettgewebe in den Extremitäten führt. Das Risiko für Diabetes und kardiometabolische Störungen ist im Vergleich zur Adipositas geringer, doch kann eine gleichzeitige Adipositas die Diagnose und Behandlung erschweren.

Patientinnen und Methodik

Diese retrospektive Studie umfasste 607 LiDo‐Patientinnen, ≥ 18 Jahre, Stadium 1–3, aus Deutschland, dem Vereinigten Königreich und Spanien. Die Daten wurden im Rahmen der Standard‐Erstuntersuchung erhoben.

Ergebnisse

Basierend auf dem Verhältnis von Taillenumfang zu Körpergröße (Waist‐to‐Height‐Ratio; WHtR) waren 15,2% der Patientinnen untergewichtig, 45,5% normalgewichtig, 22,1% übergewichtig und 17,3% adipös. Es bestand ein signifikanter Zusammenhang zwischen der WHtR‐Kategorie und der Altersgruppe. Der Body‐Mass‐Index (BMI) wird häufig überschätzt, was zu Fehldiagnosen von Fettleibigkeit führt.

Schlussfolgerungen

Die Verwendung des BMI hat auch Auswirkungen auf die jüngste Entscheidung des Gemeinsamen Bundesausschusses über die Kostenerstattung von Fettabsaugungen durch die Krankenkassen. Patientinnen mit einem BMI von über 40 kg/m2 sind von der Kostenübernahme ausgeschlossen, und Patientinnen mit einem BMI zwischen 35 kg/m2 und 40 kg/m2 müssen zunächst eine konservative Adipositastherapie erhalten. Die alleinige Verwendung des BMI bei Lipödemen ist unzuverlässig und führt im Gegensatz zum WHtR zu ungenauen Diagnosen, die Übergewicht und Adipositas überbewerten.
S3‐Leitlinie “Aktinische Keratose und Plattenepithelkarzinom der Haut“ – Update 2023, Teil 1: Therapie der aktinischen Keratose, Morbus Bowen, Cheilitis actinica, berufsbedingte Erkrankung und Versorgungsstrukturen
Authors: Heppt Markus V. , Leiter Ulrike , Steeb Theresa , Alter Mareike , Amaral Teresa , Bauer Andrea , Bechara Falk G. , Becker Jürgen C. , Breitbart Eckhard W. , Breuninger Helmut , Diepgen Thomas , Dirschka Thomas , Eigentler Thomas , El Gammal A. K. Stephan , Felcht Moritz , Flaig Michael J. , Follmann Markus , Fritz Klaus , Grabbe Stephan , Greinert Rüdiger , Gutzmer Ralf , Hauschild Axel , Hillen Uwe , Ihrler Stephan , John Swen Malte , Kofler Lukas , Koelbl Oliver , Krause‐Bergmann Albrecht , Kraywinkel Klaus , Krohn Steffen , Langer Thomas , Loquai Carmen , Löser Christoph R. , Mohr Peter , Nashan Dorothée , Nothacker Monika , Pfannenberg Christina , Salavastru Carmen , Schmitz Lutz , Stockfleth Eggert , Szeimies Rolf‐Markus , Ulrich Claas , Voelter‐Mahlknecht Susanne , Vordermark Dirk , Weichenthal Michael , Welzel Julia , Wermker Kai , Wiegand Susanne , Garbe Claus , Berking Carola
Published: October 2023

Aktinische Keratosen (AK) sind häufige Hautveränderungen bei hellhäutigen Menschen mit dem Potenzial, in ein kutanes Plattenepithelkarzinom (PEK) überzugehen. Beide Erkrankungen können mit erheblicher Morbidität verbunden sein und stellen eine große Krankheitslast insbesondere in der älteren Bevölkerung dar. Um eine evidenzbasierte Grundlage für die klinische Entscheidungsfindung zu schaffen, wurde die S3‐Leitlinie „Aktinische Keratose und kutanes Plattenepithelkarzinom“ aktualisiert und um die Themen Plattenepithelkarzinom in situ (Morbus Bowen) und Cheilitis actinica, die Manifestation der AK am Lippenrot, erweitert. Die Leitlinie richtet sich dabei an Dermatologen, Allgemeinmediziner, HNO‐Ärzte, Chirurgen, Onkologen, Radiologen und Strahlentherapeuten in Klinik und Praxis sowie an andere medizinische Fachgebiete, politische Entscheidungsträger und Versicherungsgesellschaften, die sich mit der Diagnose und Behandlung von Patienten mit nichtmelanozytärem Hautkrebs befassen. Für Patienten und deren Angehörige existiert eine gesonderte Patientenleitlinie. In diesem Teil behandeln wir die Themen Therapie der aktinischen Keratose, Morbus Bowen, Cheilitis actinica, berufsbedingte Erkrankung an AK und PEK sowie Versorgungsstrukturen.
Proportionality and Mexico's pandemic management during the COVID‐19 crisis
Authors: Holzer Felicitas , Alcántara Ivette M. Ortiz , Eichinger Tobias , März Julian W.
Published: October 2023

Mexico's pandemic management and the absence of measures have been harshly criticized as being disproportionate. This paper examines whether the proportionality principle was properly applied to Mexico's COVID‐19 response and outlines three reasons against such an endeavor, namely (i) the content of “proportionate measures” remained insufficiently well defined, (ii) there were yet fundamental rights conflicts to resolve, and (iii) the situation was moreover characterized by epistemic uncertainty.
Metabolic syndrome, genetic susceptibility, and risk of chronic obstructive pulmonary disease: The UK Biobank Study
Authors: Li Shiwen , Zhang Tingjing , Yang Honghao , Chang Qing , Zhao Yuhong , Chen Liangkai , Zhao Li , Xia Yang
Published: October 2023

Aim

To investigate the effect of metabolic syndrome (MetS), genetic predisposition, and their interactions, on the risk of developing chronic obstructive pulmonary disease (COPD).

Methods

Cohort analyses included 287 868 participants from the UK Biobank Study. A genetic risk score for COPD was created using 277 single nucleotide polymorphisms. Cox proportional hazard models were used to evaluate the hazard ratios (HRs) with 95% confidence intervals (CIs) for COPD in relation to exposure factors.

Results

During 2 658 936 person‐years of follow‐up, 5877 incident cases of COPD were documented. Compared with participants without MetS, those with MetS had a higher risk of COPD (HR 1.24, 95% CI 1.17‐1.32). Compared to participants with low genetic predisposition, those with high genetic predisposition had a 17% increased risk of COPD. In the joint analysis, compared with participants without MetS and low genetic predisposition, the HR for COPD for those with MetS and high genetic predisposition was 1.50 (95% CI 1.36‐1.65; P < 0.001). However, no significant interaction between MetS and genetic risk was found.

Conclusions

Metabolic syndrome was found to be associated with an increased risk of COPD, regardless of genetic risk. It is crucial to conduct further randomized control trials to determine whether managing MetS and its individual components can potentially reduce the likelihood of developing COPD.
Left atrial strain brings new insights for evaluating early diastolic dysfunction in patients with well‐functioning bicuspid aortic valve
Authors: Tan Yuting , Deng Wenhui , Liu Tianshu , Huang Lei , Zhang Ruize , Zhang Yichan , Fu Yanan , Fang Lingyun , Li Yuman , Zhang Li , Xie Mingxing , Wang Jing
Published: October 2023

Background

Left atrial reservoir strain (LARS) is an early sensor of left ventricular (LV) diastolic dysfunction. Still, the clinical implications of LARS in patients with well‐functioning bicuspid aortic valve (BAV) remain unknown.

Materials

The study recruited 103 patients with well‐functioning BAV and 50 controls with tricuspid aortic valves. LARS, LV global longitudinal strain (LVGLS) and aortic elasticity indices (aortic strain, aortic distensibility and stiffness index) were acquired. This study aimed to analyze the changes of LARS and further explore the influential factors of LARS in patients with well‐functioning BAV.

Results

Patients with BAV had lower LARS (34.17 ± 4.85 vs. 44.72 ± 6.06 %, P < .001) and LVGLS (20.53 ± 1.28 vs. 22.30 ± .62 %, P < .001), and abnormal aortic elasticity indices (aortic strain:7.14 ± 1.57 vs. 10.99 ± 1.03 %, aortic distensibility: 5.82 ± 1.50 vs. 8.98 ± 2.42 (10−6 cm2 dyne−1), and stiffness index: 6.30 ± 2.30 vs. 3.92 ± .98, all P < .05) compared with controls. LARS was associated with LVGLS (r = .799), interventricular septum index (r = −.232), lateral e' (r = .290), septal e' (r = .308), E/e' ratio (r = −.392), aortic strain (r = .829), aortic distensibility (r = .361), and stiffness index (r = −.724) (all P < .05). LVGLS, aortic strain and E/e' ratio were independent influencers of LARS in the multifactorial analysis model (all P < .05).

Conclusion

In patients with well‐functioning BAV, decreased LARS may provide evidence of subclinical LV diastolic function impairment. LARS may be helpful for clinical risk stratification in such a population.
A cross‐sectional cohort study on the skin microbiota in patients with different acne durations
Authors: Sun Lang , Wang Qingqun , Wang Huan , Huang Jing , Yu Zheng
Published: October 2023

Acne is a chronic disease that often persists for years. Skin microbial communities play an essential role in the development of acne. However, limited information is available about the dynamic patterns of skin microbiota in acne. This study aimed to characterize microbial community changes in skin pores and surfaces of acne patients with varying disease time. In this study, a total of 70 skin samples from 22 subjects were collected and sequenced using 16S rRNA amplicon sequencing. Although microbial compositions in skin pores were similar over time, significant differences in microbial structure were observed on the skin surface, with the dominance of Cutibacterium in the first 3 years and replacement by Staphylococcus in 4–6 years. Lactobacillus and Acinetobacter were more abundant in the normal group and continuingly decreased with disease time on the skin surface. Microbial networks further revealed substantial increases in microbial interactions in the 4–6 years group in both skin surfaces and pores. These results demonstrate that the skin microbiota alters with the disease duration and may provide a potential guide in redirecting skin microbiota towards healthy states.
Cognition mediates response to anthropogenic noise in wild Western Australian magpies (Gmynorhina tibicen dorsalis)
Authors: Blackburn Grace , Ashton Benjamin J. , Thornton Alex , Woodiss‐Field Sarah , Ridley Amanda R.
Published: October 2023

Anthropogenic noise is a pollutant of growing concern, with wide‐ranging effects on taxa across ecosystems. Until recently, studies investigating the effects of anthropogenic noise on animals focused primarily on population‐level consequences, rather than individual‐level impacts. Individual variation in response to anthropogenic noise may result from extrinsic or intrinsic factors. One such intrinsic factor, cognitive performance, varies between individuals and is hypothesised to aid behavioural response to novel stressors. Here, we combine cognitive testing, behavioural focals and playback experiments to investigate how anthropogenic noise affects the behaviour and anti‐predator response of Western Australian magpies (Gymnorhina tibicen dorsalis), and to determine whether this response is linked to cognitive performance. We found a significant population‐level effect of anthropogenic noise on the foraging effort, foraging efficiency, vigilance, vocalisation rate and anti‐predator response of magpies, with birds decreasing their foraging, vocalisation behaviours and anti‐predator response, and increasing vigilance when loud anthropogenic noise was present. We also found that individuals varied in their response to playbacks depending on their cognitive performance, with individuals that performed better in an associative learning task maintaining their anti‐predator response when an alarm call was played in anthropogenic noise. Our results add to the growing body of literature documenting the adverse effects of anthropogenic noise on wildlife and provide the first evidence for an association between individual cognitive performance and behavioural responses to anthropogenic noise.
Effect of oral health interventions for dependent older people—A systematic review
Authors: Salazar Josefina , Andersen Christina , Øzhayat Esben Boeskov
Published: October 2023

Background

There is an increasing proportion of older people in the population worldwide, with a large group being dependent on the care of others. Dependent older people are more vulnerable to oral diseases, which can heavily impact their quality of life (OHRQoL) and general health.

Objective

The purpose of this systematic review was to comprehensively assess interventions to improve oral health or guarantee access and adherence to dental treatment of dependent older people.

Methods

We searched MEDLINE, EMBASE, CENTRAL and clinical trial registries. Two reviewers performed the selection, data extraction, risk of bias evaluation using the Cochrane Risk of Bias tool and assessment of certainty of the evidence. When possible, we conducted a meta‐analysis to calculate effect estimates and their 95%CIs. Primary outcomes were OHRQoL, oral/dental health, and use of the oral care system.

Results

We included a total of 30 randomised clinical trials assessing educational and non‐educational interventions for community‐dwelling older people (n = 2) and those residing in long‐term care facilities (n = 28). Most studies assessed oral hygiene and showed that interventions may result in a reduction in dental plaque in the short term (with low certainty of evidence), but there is limited evidence for long‐term effectiveness. Only one study assessed OHRQoL, and none evaluated changes in the use of the oral health care system.

Conclusion

Our findings do not provide strong conclusions in favour of any specific intervention, mainly due to study quality and imprecision. There is limited information about the long‐term effect of interventions, and further research is needed, especially targeting community‐dwelling older people.

PROSPERO ID: CRD42021231721.
Orthodontists’ instructions for oral hygiene in patients with removable and fixed orthodontic appliances
Authors: Baumer Christina , Schmidtmann Irene , Ohlendorf Daniela , Ferrari Peron Priscila , Wehrbein Heinrich , Erbe Christina
Published: October 2023

Introduction

The aim of this questionnaire‐based survey was to evaluate information on frequencies, instructions and products relating to oral hygiene (OH) in orthodontic practices.

Methods

Using a computer‐generated randomization list, 1000 orthodontists were selected and sent a questionnaire. The size and number of inhabitants of the federal states of Germany were considered. The federal states with the highest return rate (Baden‐Wuerttemberg [BW], Bavaria [B], Hesse [H], Lower Saxony [LS], Nordrhein‐Westphalia [NRW]) were considered and differences between the 16 federal states were divided into North, South, East and Central Germany.

Results

The response rate of the questionnaires was 52.4%. The majority (53.8%) worked in one practice alone. Most (59.1%) have been orthodontists for 5–25 years. For vestibular multibracket appliances (MBA) in BW, B, H and LS over 90% recommended interdental brushes (IDB). In NRW 91.4% recommend fluoride gel. In B and H more than 80% chose electric toothbrush (ETB), in BW, LS and NRW more than 80% manual toothbrush (MTB). For lingual MBA (LMBA) in BW, H, LS and NRW with approximately 50% each fluoride gel, IDB and MTB were chosen. In B fluoride gel, IDB and ETB. For removable apparatus (RA), five federal states recommended MTB (>80%) and ETB (BW, B, H > 80%; NRW > 70%; LS > 60%).

Conclusion

Electric toothbrushes are recommended for the use with all appliances, only with removable appliances manual toothbrushes are favoured. For vestibular MBA it is strongly advised to use IDB additionally.
Synthesis of cationic polysaccharide derivatives and their hypocholesterolaemic capacity
Authors: Lee Jung Kul , Kim Sang Yong , Kim Soo Un , Kim Jung Hoe
Published: October 2023

High‐capacity bile acid‐sequestering biopolymers with cationic polysaccharide derivatives have been developed. Cholestyramine, the bile acid sequestrant most widely used for treating hypercholesterolaemia, has unpleasant side effects because of the hydrophobic nature of its backbone. Methylan, a high‐viscosity polysaccharide produced by Methylobacterium organophilum, was selected as a model polysaccharide for derivatization. Methylan was aminated to add dialkylaminoalkyl and free amino groups at hydroxyl sites in the methylan backbone, and these derivatives were quaternized to produce pH‐independent cationic polyelectrolytes. The in vitro bile acid‐binding capacity of quaternized DEAE‐methylan was ≅50% higher than that of cholestyramine. The bile acid‐binding capacity of methylan derivatives increased with the number of carbons in the alkyl groups, indicating that hydrophobic interaction is a secondary factor for the sequestration of bile acids.
Associations of age‐adjusted coefficient of variation of R‐R intervals with autonomic and peripheral nerve function in non‐elderly persons with diabetes
Authors: Sugimoto Kazuhiro , Miyaoka Hirozumi , Sozu Takashi , Sekikawa Naohiro , Wada Ryota , Watanabe Yuko , Tamura Akira , Yamazaki Toshiro , Ohta Setsu , Suzuki Susumu
Published: October 2023

Aims/Introduction

Early diagnosis of diabetes‐associated cardiac autonomic neuropathy using the coefficient of variation of R‐R intervals (CVRR) may improve outcomes for individuals with diabetes. The present study examined the associations of decreased CVRR at rest and during deep breathing (DB) with other autonomic nerve function parameters.

Materials and Methods

The electronic records of 141 inpatients with diabetes (22–65 years) admitted to our hospital between March 2015 and March 2019 were analyzed retrospectively. After assessment by exclusion criteria, 51 inpatients were included. All inpatients were assessed for peripheral and autonomic nerve function, clinical characteristics, and physical abilities.

Results

Inpatients with decreased CVRR at rest (n = 9 (17.6%)) and during DB (n = 12 (23.5%)) had a longer duration of known diabetes, a higher prevalence of diabetic retinopathy, lower body mass index (BMI), skeletal mass index (SMI), and knee extension strength, and a higher proportion of impaired standing balance. Decreased CVRR at rest was associated with a greater fall in diastolic BP from supine to standing, higher resting HR, longer QTc, longer time of voiding, and sensory symptoms.

Conclusions

Decreased CVRR at rest and during deep breathing was associated with lower BMI, SMI, and knee strength and a higher proportion of impaired standing balance among non‐elderly inpatients with diabetes. Decreased CVRR at rest appeared more strongly associated with a greater orthostatic BP decline, higher resting heart rate, longer QTc, lower urinary tract dysfunction, and sensory symptoms than a decreased CVRR during deep breathing.
Forged at Workforce Entry? CEO Imprinting, Information Uncertainty and Merger Wave Timing
Authors: Fralich Russell , Ahmadsimab Alireza
Published: October 2023

We examine the imprinting effect of labour market conditions on a CEO's merger wave timing decisions. Based on a sample of 720 CEOs of US‐based firms in merger waves between 1995 and 2018, we found that CEOs who started their careers during periods of poor labour market conditions tend to delay merger wave entry, while those who began under better conditions act earlier. We also found that the market uncertainty at the beginning of the merger wave decays this effect on CEOs whose workforce entry coincided with poor labour market conditions. This study contributes to the M&A literature by highlighting the long‐term impact of early career experiences on CEO merger wave timing decisions and how those preferences may decay when faced with different conditions later in their careers.
Self‐administered non‐invasive vagus nerve stimulation therapy for severe pharmacoresistant restless legs syndrome: outcomes at 6 months
Authors: Hartley Sarah , Bao Guillaume , Russo Ashley , Zagdoun Marine , Chevallier Sylvain , Lofaso Frédéric , Leotard Antoine , Azabou Eric
Published: October 2023

Severe pharmacoresistant restless legs syndrome (RLS) is difficult to manage and a source of suffering to patients. We studied the effectiveness at 6 months of an innovative treatment: transauricular vagus nerve stimulation (taVNS) in the left cymba concha in a case series of 15 patients, 53% male, mean (SD) age 62.7 (12.3) years with severe pharmacoresistant RLS (mean [SD] International Restless Legs Rating Scale [IRLS] score of 31.9 [2.9]) at baseline. Following an 8‐week non‐randomised hospital‐based study with eight 1‐h sessions of taVNS, patients were trained to administer taVNS at home and were followed up for 6 months. The primary outcome measure was the IRLS score, secondary outcome measures were quality of life, mood disorders using the Hospital Anxiety and Depression scale (HAD) subscales for depression (HADD) and anxiety (HADA). At the 6‐month follow‐up 13/15 patients continued to use weekly taVNS. Symptom severity decreased (mean [SD] IRLS score 22.2 [9.32] at 6 months, p = 0.0005). Four of the 15 patients had an IRLS score of <20 at 6 months and two an IRLS score of 5. Quality of life significantly improved compared to baseline (mean [SD] score at baseline 49.3 [18.1] versus 65.66 [22.58] at 6 months, p = 0.0005) as did anxiety and depression symptoms (mean [SD] HADA score at baseline 8.9 [5.4] versus 7.53 [4.42] at 6 months, p = 0.029; and HADD score at baseline 5.2 [4.5] versus 4.73 [4.44] at 6 months, p = 0.03). Treatment was well tolerated, and no adverse events were reported. Our case series shows a potential role for self‐administered taVNS in patients with severe pharmacoresistant RLS. Randomised controlled trials are needed to confirm the utility of taVNS.
Assessing the diagnostic yield of achalasia using provocative testing in high‐resolution esophageal manometry: Serial diagnostic study
Authors: Dervin Humayra , Endersby James , Sanagapalli Santosh , Mills Holly , Sweis Rami
Published: October 2023

Background

Chicago Classification v4.0 recommends that if achalasia is demonstrated with single water swallows (SWS); provocative testing is not required. We determine whether provocative testing in patients with suspected achalasia can change manometric findings and reproduce symptoms.

Methods

Between 2016 and 2022, 127 consecutive manometry studies of patients with achalasia were retrospectively analyzed. All patients underwent SWS, a solid meal (SM) and/or a rapid drink challenge (RDC). Demographic data, fluoroscopy, gastroscopy, and pre‐and post‐treatment Eckardt scores were collated.

Key Results

Of 127 achalasia patients (50.6 ± 16.6 years and 54.6% male), all completed a SM and 116 (91.3%) completed RDC; overall 83 were naïve (65.4%) to previous therapy. 15.4% patients with normal integrated relaxation pressure (IRP) on SWS demonstrated obstruction with RDC. SM gave a different achalasia phenotype in 44.9% of patients (p ⟨ 0.001). Twelve patients with normal IRP during SWS had persistent/recurrent obstruction during provocative testing; 83.3% had previous achalasia therapy. None of 13 patients with Type III (TIII) achalasia with SWS exhibited a change in manometric findings with provocative testing. Impedance bolus heights were lower in patients with TIII achalasia and those with normal IRP with SWS. During the SM, symptoms were reproduced in 56.7% of patients. Forty‐six of 103 patients (44.7%) underwent therapy based upon the final achalasia subtype which was defined by the provocative test result of the high‐resolution manometry (HRM) study. All treatments were effective, regardless of the achalasia subtype.

Conclusions and Inferences

Manometric findings remain unchanged when TIII achalasia is diagnosed with SWS. In patients with normal IRP, Type I, or Type II achalasia during SWS, provocative testing can alter achalasia phenotype or uncover achalasia where diagnosis is unclear. Further, it can reproduce symptoms. Such findings can personalize and guide effective therapeutic decisions.
Do roots need a good haircut for water uptake?
Authors: Boursiac Yann , Bauget Fabrice
Published: October 2023

This article is a Commentary on Duddek et al. (2023), 240: 2484–2497.
High density mapping of complex atrial tachycardia in patients after cardiac surgery
Authors: Fu Lu , Xue Yumei
Published: October 2023

To provide an overview of the current application of high‐density mapping (HDM) in the mechanism of complex atrial tachycardias (ATs). Complex ATs are frequently scar‐related, after history of previous cardiac surgery and large scars. These scar‐related ATs are difficult to manage medically and frequently recur after electrical cardioversion. HDM technologies have enabled rigorous elucidation of AT mechanisms in patients post cardiac surgery. This article showed the application of HDM technology in complex ATs from the mechanisms of complex ATs, the development of HDM technology, and the identification of scars or critical isthmus from HDM. HDM‐guided approach is highly effective for identifying the ATs mechanism and critical isthmus.
Mexiletine: Antiarrhythmic mechanisms, emerging clinical applications and mortality
Authors: Olleik Farah , Kamareddine Mohammed Hussein , Spears Jenna , Tse Gary , Liu Tong , Yan Gan‐Xin
Published: October 2023

Mexiletine, a class Ib antiarrhythmic drug, exhibits its major antiarrhythmic effect via inhibition of the fast and late Na+ currents in myocardial tissues that are dependent on the opening of Na+ channels for their excitation. Through a comprehensive examination of mexiletine's therapeutic benefits and potential risks, we aim to provide valuable insights that reinforce its role as a vital therapeutic option for patients with ventricular arrhythmias, long QT syndrome, and other heart rhythm disorders. This review will highlight the current understandings of the antiarrhythmic effects and rationales for recent off‐label use and address the mortality and proarrhythmic effects of mexiletine utilizing published basic and clinical studies over the past five decades.
Sociopolitical consequences of COVID‐19 in the Americas, Europe, and Asia: A multilevel, multicountry investigation of risk perceptions and support for antidemocratic practices
Authors: Pizarro José J. , Cakal Huseyin , Méndez Lander , Zumeta Larraitz N. , Gracia‐Leiva Marcela , Basabe Nekane , Navarro‐Carrillo Ginés , Cazan Ana‐Maria , Keshavarzi Saeed , López‐López Wilson , Yahiiaiev Illia , Alzugaray‐Ponce Carolina , Villagrán Loreto , Moyano‐Díaz Emilio , Petrović Nebojša , Mathias Anderson , Techio Elza M. , Wlodarczyk Anna , Alfaro‐Beracoechea Laura , Ibarra Manuel L. , Michael Andreas , Mhaskar Sumeet , Martínez‐Zelaya Gonzalo , Bilbao Marian , Delfino Gisela , Carvalho Catarina L. , Pinto Isabel R. , Mohsin Falak Zehra , Espinosa Agustín , Cueto Rosa María , Cavalli Stefano , da Costa Silvia , Amutio Alberto , Alonso‐Arbiol Itziar , Páez Darío
Published: October 2023

Although different social crises may eventually favor undemocratic and authoritarian forms of governance, at some point, such antidemocratic practices require the support of a significant part of the population to be implemented. The present research investigates how and whether the COVID‐19 pandemic might have favoured greater support for antidemocratic governmental practices, on the premise of regaining control and security. Using data from 17 countries (N = 4364) and national‐level indicators (i.e., real number of contagions and deaths, and sociopolitical indicators), we test how the risk of contagion and death from COVID‐19, along with personal orientations (i.e., social dominance orientation [SDO], right‐wing authoritarianism [RWA], and perceived anomie) motivate authoritarian and antidemocratic practices. Results from multilevel models indicate that risk perception and perceptions of political instability predict a wish for stronger leadership, agreement with martial law, and support for a controlling government especially when SDO and RWA are high, while more egalitarian and less conservative people agree less with these authoritarian measures in spite of the levels of risk perception. We discuss the implications for these findings for future research on similar but also dissimilar external events (natural disasters, war, or terror incidents) and the consequences for societies with higher authoritarian tendencies.