bluuebunny/crossref_metadata_2025 huggingface dataset:
PD-1 Deficiency in Regulatory T Cells May be Involved in the Pathogenesis of Takayasu's Arteritis
Authors: Gao Na , Li Taoao , Cui Wei , Zhao Limin , Zhang Jianghui , Pan Lili
Published: July 2023

Objectives

This study aims to investigate whether PD-1 expressions are abnormal in patients with TAK.

Methods

PD-1 expression was analyzed by flow cytometry. Serum cytokines IL-10, IL-7, IL-2, IL-15, CCL2, CCL3, and CXCL10 were detected using a cytokine cytometric bead array. Immunohistochemistry staining analysis was used to test PD-1 and programmed death-ligand 1 (PD-L1) expression in the aorta of three patients with TAK and three patients with atherosclerosis as controls.

Results

The mean fluorescence intensity of PD-1 in CD4+PD-1+ cells was decreased in patients with TAK and the frequency of CD4+Foxp3−PD-1+ cells among CD4+T cells was also decreased in peripheral blood relative to healthy controls ( P < .05). The percentage of CD4+CD25+Foxp3+PD-1+ cells in the CD4+CD25+T cell population was lower in patients with TAK than in healthy control and was lower in active TAK group ( P < .05). Comparing PD-1 and PDL-1 expression in aorta tissue showed that patients with TAK tended to have lower levels than patients with atherosclerosis, but the difference was not significant ( P > .05). Patients with TAK had higher serum levels of IL-10, IL-7, CCL2, and CCL3 ( P < .05).

Conclusions

Abnormal expression of PD-1 in serum and aorta tissue of patients with TAK may contribute to TAK pathogenesis.

Key points

PD-1 expression in both peripheral blood and aorta tissue of TAK patients decreased relative to healthy controls, indicating that PD-1 might be involved in TAK pathogenesis.
Domestic Violence and the Law: A Study of Complaints Under the Protection of Women From Domestic Violence Act, 2005 in Maharashtra, India
Authors: Panchal Trupti Jhaveri , Thusoo Sumati , Inamdar Vedika , Balaji Akshaya
Published: July 2023

Violence against women is a complex phenomenon that is deeply embedded in Indian society. In this mixed methods article, court records data (2005–2010) from two sites in Maharashtra, India along with in-depth interviews with stakeholders were analyzed to examine the implementation of the Protection of Women from Domestic Violence Act, 2005 (PWDVA). Out of 77.28% married women who filed a case under the PWDVA, 60.28% of them reported dowry-related harassment. Maharashtra has the social infrastructure in place to implement the law, although optimal use needs to be ensured for speedy delivery of justice.
Not My Business: How Individuals’ Role Identities Shape Sensegiving During Corporate Sustainability Initiatives
Authors: Hoppmann Joern , Richert Marcel , Busch Timo
Published: July 2023

Managing organizational change toward corporate sustainability requires leaders to engage in sensegiving activities to alter organizational members’ interpretation of issues within and outside the organization. However, we still lack detailed insights into how efforts aimed at changing members’ cognitive frames through sensegiving are shaped by differences in members’ roles and role identities. To address this shortcoming, we draw on an 18-month longitudinal case study of a sustainability initiative within a medium-sized firm. We show that role identities shape the effectiveness of sensegiving, since they can lead individuals to dodge, delete, or disregard frame-challenging information. At the same time, persistent differences in frames across individuals within the organization may lead organizational members to constrain, criticize, or counteract others’ role adjustment. By developing a framework that shows how interactions between sensegiving, role identities, and cognitive frames shape organizational change, our work contributes to the literature on corporate sustainability, sensemaking/sensegiving, and role identities.
Preoperative stoma site marking reduces postoperative stoma-related complications in emergency surgery: A single center retrospective cohort study
Authors: Nozawa Hiroaki , Sasaki Sanae , Hayashi Chieko , Kawasaki Akiko , Sasaki Kazuhito , Murono Koji , Emoto Shigenobu , Ishihara Soichiro
Published: July 2023

Background and objective:

Stoma site marking is an important factor in reducing stoma-related complications, thereby influencing the long-term quality of life in the elective setting. The impact of preoperative stoma site marking in emergency stoma creation is largely unknown. We aimed to determine whether preoperative stoma site marking in emergency stoma creation reduces stoma-related complications.

Methods:

Patients who underwent emergency stoma creation at our hospital between 2009 and 2022 were examined by reviewing our prospective database and retrospective chart review. Subjects were classified into the “marking (+)” or “marking (−)” group according to stoma site marking (194 and 151 patients, respectively). The changes in the frequency of stoma marking over time and the effects of stoma marking on stoma-related complications were analyzed.

Results:

The overall frequency of grade 2 or higher stoma-related complications was lower in the marking (+) group than in the marking (−) group (24% versus 36%, p = 0.010). Stoma site marking was associated with fewer soma site bleeding (2% versus 10%, p < 0.001), and the frequency of peristomal dermatitis was also lower (10%) in the marking (+) group (versus 18%, p = 0.042). Moreover, the lack of stoma site marking was an independent risk factor for overall stoma-related complications (adjusted odds ratio: 1.69, p = 0.034).

Conclusions:

Preoperative stoma site marking was associated with stoma-related complications in emergency surgery. The clinical significance of our attempt is worth validating with prospective studies.
Whistleblowing and complicity in normative theorizing on political corruption
Authors: Santoro Daniele
Published: July 2023

In their work “Political Corruption: The Internal Enemy of Public Institutions,” Ceva and Ferretti defend a conception of corruption as a breach of the duty of accountability for officeholders. I address two key aspects of their proposal. First, I contend that whistleblowing disclosures should be limited to acts of last resort, rather than as a common practice of ensuring answerability. Second, I argue that their account does not adequately distinguish between degrees of involvement in corrupt activities. Within hierarchical organizations, not all officeholders possess the same capacity and power to counteract unjust practices. Different contributory roles entail varying degrees of responsibility within the normative structure of answerability defended by the authors.
Postcolonial Autoethnography: Healing Wounded Humanities
Authors: Lamichhane Basanta Raj , Luitel Bal Chandra
Published: July 2023

We have encountered the views of research as apolitical, ahistorical, aculture, and value free: the most powerful weapon for the imposition of Western-Eurocentric thought. It does not embrace the voice and epistemology of Othered people. Against this backdrop, we offer significant features of postcolonial autoethnography. It has three major attributes: exploring the colonial legacy for revitalizing others, dialectical reasoning to create a synergy of meaning perspectives, and metaphor of transformative praxis to bring a paradigm shift. Likewise, we describe three ethical considerations: empathy, inclusiveness, and healing, which possibly help empower the researcher and research participants to become conscious citizens.
Hypoperfusion intensity ratio as a predictor of outcomes after thrombectomy triage: A call for data homogeneity
Authors: Adusumilli Gautam , Kobeissi Hassan , Ghozy Sherief , Kallmes Kevin M. , Brinjikji Waleed , Kallmes David , Heit Jeremy J.
Published: July 2023

Background

Collateral blood flow markers have been associated with outcomes after thrombectomy in patients presenting with acute ischemic stroke due to large vessel occlusion (AIS-LVO). Hypoperfusion intensity ratio (HIR), a metric reflecting tissue level collaterals, is one such marker with the potential to delineate patients who do and do not do well after thrombectomy. We determined if HIR correlated with successful reperfusion after thrombectomy.

Methods

Using Nested Knowledge, we screened literature for studies comparing patients with favorable versus unfavorable HIR, distinguished by a cutoff of 0.4, who underwent thrombectomy triage. The primary outcome was reperfusion success, as measured by thrombolysis in cerebral infarction ≥2b and secondary outcomes included rate of symptomatic intracranial hemorrhage, mortality at 90 days, and modified Rankin scale scores 0–2 at 90 days. A random effects model was used to compute pooled prevalence rates and their corresponding 95% confidence intervals (CI).

Results

Three studies with 973 patients, 496 with favorable HIR, and 477 with unfavorable HIR were included in this meta-analysis. The odds of reperfusion success were not significantly different between patients who had favorable versus unfavorable HIR (OR 0.96, 95% CI: 0.31–3.04) across two of the studies. Analysis of the remaining outcome variables was precluded by significant heterogeneity in data element reporting.

Conclusions

This meta-analysis was considerably limited by heterogeneity. Future meta-analyses on this topic, and other topics in the field of neurointervention would benefit from improved harmonization of study design and data element reporting.
Middle meningeal artery embolization with polyvinyl alcohol particles in a patient with ophthalmic artery origin from middle meningeal artery: Case report and technical note
Authors: Lee Young M. , Mattay Raghav R. , Haddad Alexander F. , Rinaldo Lorenzo , Savastano Luis
Published: July 2023

This is a case report of an adult with chronic subdural hematoma (cSDH) who underwent endovascular treatment for middle meningeal artery (MMA) embolization. There was a prominent meningo-ophthalmic branch with an absence of an ophthalmic artery from the internal carotid artery. MMA embolization was performed utilizing particles with no complications and the resolution of the cSDH was within 4 months. This case report demonstrates that despite extreme variant anatomy, MMA embolization with particles is feasible, effective, and safe when appropriate techniques are used.
Far from the generalised norm: Recognising the interplay between contextual particularities and principals’ leadership in schools in low-socio-economic status communities
Authors: Hirsh Åsa , Liljenberg Mette , Jahnke Anette , Karlsson Pérez Åsa
Published: July 2023

Focusing on the interplay between community context and principals’ leadership, this study contributes knowledge of the situated dimensions of school leadership. Based on qualitative content analysis of the statements of 20 principals leading schools in low-socio-economic status communities in a highly segregated Swedish city, we address the research questions: (1) Which context-related characteristics of low-socio-economic status schools emerge, and what challenges do they entail? and (2) How do such characteristics and challenges affect and contribute to shaping the principals’ leadership? The findings indicate four community-context characteristics, which also characterise or affect the schools’ student and parent base and, in some respects, also the staff of the schools: high mobility, comprehensive linguistic and cultural diversity, comprehensive knowledge diversity, and extensive problem complexity. The analysis reveals that these characteristics entail work-related challenges with implications of both quantitative and qualitative nature, contributing to shaping a leadership that is present, gatekeeping, sheltering, collaborative, and compensatory and aimed at maintaining a resilient organisation. Considering the findings, the importance of recognising the particularities of context and the context-specific knowledge required is highlighted, as well as the potential value of tailored context-sensitive training and support for principals from local education administrations and universities.
Solving women’s voices? A theoretical framework for talking through the algorithm
Authors: Dawson Kate
Published: July 2023

This article offers a four-dimensional framework for analyzing technologies of gendered voice, especially those which have sought to correct or “solve” the supposedly unruly, unpleasant, or otherwise problematic voices of women. While modern technologies such as artificially intelligent assistants Siri and Alexa implement digital algorithms for cultivating feminine voices, this framework insists upon a broad conceptualization of algorithms to consider how predigital technologies and institutions of vocal cultivation also anticipate and echo such contemporary means of vocal norm-production and control. By imagining gendered voice through this broad lens of the algorithm, we can begin to deconstruct the ways in which technologies and institutions of voice have historically operated as algorithms that attempt to “solve” women’s voices by making them amenable to hegemonic, patriarchal values, uses, and ideals. The research builds upon existing communication literature surrounding the nature and functionality of algorithms as well as feminist posthumanist theory, which provides a richer conceptualization of how algorithms of voice enact both a political and material discipline upon women’s voices.
“I’m Going to Be a Working Person”: Self-Determination in Employment Settings for Adults With Intellectual and Developmental Disabilities
Authors: Sinclair James , Gilson Carly B. , Dulas Heather
Published: July 2023

Adults with intellectual and developmental disabilities (IDD) often face societal barriers to accessing employment due to stigma and discrimination. For people with IDD who have an employment history, little is known about their experiences in accessing employment opportunities. Self-determination behaviors are considered an integral component to a successful adulthood, yet there is limited research that gives voice to people with IDD describing their self-determination and experiences with employment. This study used qualitative content analysis to examine self-determination behaviors in employment experiences of 18 adults with disabilities. Participants provided clear examples of self-determined behaviors which benefited their navigation in work and life. Participants shared advice for other adults with IDD on how to attain employment. Implications for future research and practices are provided.
Is it in the Game? Reflections of Race-Based Stereotypes in EA SPORTS FIFA 22
Authors: Anderson Johnathan
Published: July 2023

Scholars have long worked to explore the existence of race-based stereotypes and narratives within sports media. Video game scholars share in this curiosity of understanding the extent to which racial stereotypes are being embedded into games and the role that they may play in cultivating or perpetuating racial stereotypes among their players. Utilizing framing and schema theories as a guide for understanding the media’s role in developing stereotypes, the present study conducted a content analysis of player data present in EA SPORTS’ FIFA 22 to investigate whether racial stereotypes were being embedded in the most popular sports video game (SVG) title through its player attributes. Each athlete represented in the game is given a 0–99 rating across a total of 35 attributes with the intention of reflecting the player’s real-life ability in these areas. Through an analysis of the avatar’s skin tones alongside their respective values for each of the attributes selected for analysis, the study found significant differences between athletes of different skin tones across nearly all of the attributes present that reinforce the Brain vs Brawn narratives scholars have located in many sporting contexts. Conclusions and suggestions of next steps are discussed.
Relaxation and Performance During Microsurgical Learning
Authors: Cortellini Lara , Nogueira Antoine , Christen Thierry , Lattion Justine , Durand Sébastien
Published: July 2023

Introduction: Microsurgical learning is a difficult and stressful process, requiring self-control to achieve relaxation. The purpose of this study is to evaluate peripheral and central nervous system relaxation during microsurgical training. Methods: This cohort study included ten medical students with no previous experience in microsurgery. The somatic peripheral nervous system was evaluated by the force applied to a custom-designed microsurgical needle holder. The autonomic peripheral nervous system was assessed by a heart rate monitor. Central nervous system relaxation was evaluated by the State and Trait Anxiety Inventory scores. The quality of the anastomosis was graded by the Microsurgical Anastomosis Rating Scale (MARS10). These data were compared to a group of 5 senior microsurgeons who underwent a single assessment. Results: The time to complete the anastomosis and the force decreased significantly with training after only 2 weeks ( P < .05). After 4 weeks of training, no statistical difference was observed between students and experts regarding force while the time of suture was still significantly different at 30 days ( P = .001). The maximum heart rate decreased significantly at 2 weeks ( P = .01). Anxiety scores decreased significantly between days 1 and 15 ( P = .002 and P = .036). The MARS10 score demonstrates that the quality of the suture increases significantly during the first 15 days ( P = .006). Conclusion: Peripheral and central nervous system relaxation as well as the quality of the microsurgical anastomosis increase significantly after only 15 days of learning. The force-sensing microsurgical needle holder offers a new tool for the evaluation of relaxation and can function as a learning aid.
Broadening the Spectrum of SLC22A5 Phenotype: Primary Carnitine Deficiency Presenting with Focal Myoclonus
Authors: Khries Maymunah , Lim Albert , Mitra Dipayan , Anderson Mark , Bengtsson Jan , Bowron Ann , Harris Elizabeth , Blickwedel Jessica , Wood Karen , Basu Anna P.
Published: July 2023

Primary carnitine deficiency (PCD) is caused by pathogenic variants of the SLC22A5 gene, which encodes a transmembrane protein that functions as a high affinity carnitine transporter. Carnitine is essential for the transport of acyl-CoA, produced from fatty acids, into the mitochondria where they are oxidised to produce energy. We present the case history of an 8-year-old boy who presented with fever, lethargy, focal rhythmic (3 Hz) left wrist twitching, and severe encephalopathy. MRI brain showed basal ganglia involvement. Metabolic investigations revealed low serum carnitine; whole genome sequencing confirmed compound heterozygous SLC22A5 mutations. With carnitine replacement, intensive care support, and neurorehabilitation, he made a remarkable recovery, regaining independent breathing, speech, mobility, and hand use. Seizure presentation in PCD is rare and presentation with sustained focal myoclonus has not been previously reported. This case expands the known phenotype of PCD. Prompt carnitine replacement is imperative.
Reimagining Family Engagement in Online Literacy Clinics During the Pandemic
Authors: Rogers Rebecca , Dozier Cheryl , Deeney Theresa , Elias Martille , Huggins Shelly , Jorge Liliane , Msengi Shadrack , Ferris Abigail , Chileshe Chibamba Agnes
Published: July 2023

During the dual pandemics of COVID-19 and continuing racial injustices, many literacy clinics pivoted to online instruction. Educators were now in students’ homes for virtual literacy lessons. To understand how literacy clinics responded, teacher educators analyzed a national survey of clinic directors’ perspectives. Analysis regarding family communication and participation led to six categories: parent involvement, communication, family presence, learning with families v. teaching families, diminished/enhanced experiences, and access/digital divide. Contrasting examples from these categories were chosen to create a research-based verbatim audio play. Teacher educators then used fieldnotes, artifacts, and transcripts from their clinical experiences to create vignettes of clinic instruction, which they then put into dialogue with survey findings to reconceptualize, animate, and (re)present these as navigating digital divides/access, challenging school-centric definitions of family literacy, and building community with families in online settings. Findings from this study highlight that as the technological landscape of literacy clinics changes, so must our understanding of engaging with families’ literacy practices.
“It Makes Me More Aware of What I Should be Looking for”: Using Holistic Assessment to Foster Strength-Based Understanding of Students’ Biliteracy Development
Authors: Zoeller Emily , Garcia-Torres Yesenia V.
Published: July 2023

Deficit mindsets of multilingual writers must be upended. Yet, little research has been done to explore how to prepare bilingual teachers with strength-based orientations, especially in approaches to assessment. Using a holistic biliteracy lens, this qualitative case study explored how Transliteracy observation shaped teachers’ understanding of biliterate writing development in K-5 dual language settings. Findings showed that teachers learned that writing is multifaceted and observable, influenced by oral language, and reflective of one linguistic repertoire. Participants gained a deeper understanding of biliteracy development and their students’ capabilities, supporting an asset-based orientation that challenged monolingual norms. Implications for teacher preparation are shared.
P-TransUNet: an improved parallel network for medical image segmentation
Authors: Chong Yanwen , Xie Ningdi , Liu Xin , Pan Shaoming
Published: July 2023

Deep learning-based medical image segmentation has made great progress over the past decades. Scholars have proposed many novel transformer-based segmentation networks to solve the problems of building long-range dependencies and global context connections in convolutional neural networks (CNNs). However, these methods usually replace the CNN-based blocks with improved transformer-based structures, which leads to the lack of local feature extraction ability, and these structures require a huge number of data for training. Moreover, those methods did not pay attention to edge information, which is essential in medical image segmentation. To address these problems, we proposed a new network structure, called P-TransUNet. This network structure combines the designed efficient P-Transformer and the fusion module, which extract distance-related long-range dependencies and local information respectively and produce the fused features. Besides, we introduced edge loss into training to focus the attention of the network on the edge of the lesion area to improve segmentation performance. Extensive experiments across four tasks of medical image segmentation demonstrated the effectiveness of P-TransUNet, and showed that our network outperforms other state-of-the-art methods.
Characterization and in-depth genome analysis of a halotolerant probiotic bacterium Paenibacillus sp. S-12, a multifarious bacterium isolated from Rauvolfia serpentina
Authors: Singh Rajnish Prakash , Kumari Kiran , Sharma Parva Kumar , Ma Ying
Published: July 2023

Background

Members of Paenibacillus genus from diverse habitats have attracted great attention due to their multifarious properties. Considering that members of this genus are mostly free-living in soil, we characterized the genome of a halotolerant environmental isolate belonging to the genus Paenibacillus. The genome mining unravelled the presence of CAZymes, probiotic, and stress-protected genes that suggested strain S-12 for industrial and agricultural purposes.

Results

Molecular identification by 16 S rRNA gene sequencing showed its closest match to other Paenibacillus species. The complete genome size of S-12 was 5.69 Mb, with a GC-content 46.5%. The genome analysis of S-12 unravelled the presence of an open reading frame (ORF) encoding the functions related to environmental stress tolerance, adhesion processes, multidrug efflux systems, and heavy metal resistance. Genome annotation identified the various genes for chemotaxis, flagellar motility, and biofilm production, illustrating its strong colonization ability.

Conclusion

The current findings provides the in-depth investigation of a probiotic Paenibacillus bacterium that possessed various genome features that enable the bacterium to survive under diverse conditions. The strain shows the strong ability for probiotic application purposes.
Clinical factors associated with acute abdominal symptoms induced by gastric anisakiasis: a multicenter retrospective cohort study
Authors: Okagawa Yutaka , Sumiyoshi Tetsuya , Imagawa Takayuki , Sakano Hiroya , Tamura Fumito , Arihara Yohei , Kanari Yusuke , Sakurada Akira , Oiwa Shutaro , Jin Takashi , Tomita Yusuke , Minami Shinya , Hisai Hiroyuki , Muramatsu Hirohito , Katsuki Shinichi , Maeda Masahiro , Kondo Hitoshi
Published: July 2023

Background

Gastric anisakiasis typically causes severe abdominal symptoms; however, we incidentally detected asymptomatic gastric anisakiasis cases during esophagogastroduodenoscopy. The factors associated with developing acute abdominal symptoms induced by gastric anisakiasis remain unclear. Therefore, this study aimed to investigate the clinical factors associated with abdominal symptoms of gastric anisakiasis by comparing symptomatic and asymptomatic cases.

Methods

This was a retrospective cohort study involving 264 patients diagnosed with gastric anisakiasis at nine hospitals in Japan between October 2015 and October 2021. We analyzed patients’ medical records and endoscopic images and compared the clinical factors between the symptomatic and asymptomatic groups.

Results

One hundred sixty-five patients (77.8%) were diagnosed with abdominal symptoms, whereas 47 (22.2%) were asymptomatic. Older age, male sex, diabetes mellitus, gastric mucosal atrophy, and gastric mucosal atrophy of the Anisakis penetrating area were significantly more common in the asymptomatic group than in the symptomatic group. Multivariate analysis revealed that age (p = 0.007), sex (p = 0.017), and presence or absence of mucosal atrophy (p = 0.033) were independent factors for the occurrence of acute abdominal symptoms. In addition, cases that were Helicobacter pylori naïve, with an elevation of white blood cells, or without an elevation of eosinophils were more common in the symptomatic group than in the asymptomatic group.

Conclusions

Age, sex, and presence or absence of gastric mucosal atrophy were the clinical factors associated with the occurrence of acute abdominal symptoms. Older and male patients and those with gastric mucosal atrophy were less likely to show abdominal symptoms. The mechanisms of the occurrence of symptoms induced by gastric anisakiasis remain unclear; however, our results will help clarify this issue in the future.
Epidemiological and clinical characteristics of scrub typhus in northern Fujian, China, from 2015 to 2019
Authors: Huang Jin , Deng Kaixiang , Chen Jiawei , Zhang Meiquan
Published: July 2023

Background

This study aimed to analyze the epidemiological and clinical characteristics of scrub typhus in northern Fujian Province on the southeast coast of China.

Methods

A retrospective analysis was performed on 303 patients with scrub typhus admitted to the First Hospital of Nanping City, Fujian Province, from January 2015 to December 2019. The epidemic characteristics were analyzed, such as the annual number of cases, age distribution, sex distribution, and seasonal distribution in each region. The patient's clinical manifestations, signs, complications, auxiliary examinations, and prognosis were analyzed.

Results

From 2015 to 2019, the age distribution of scrub typhus cases was mainly concentrated in 40–49 y (17.16%), 50–59 y (24.09%), and 60–69 y (26.73%). There were no sex differences among the patients. 68.98% of the cases were concentrated in rural areas, with farmers having the highest proportion. However, this study compared prognostic factors in the cured and uncured groups, and found significant differences in non-farmer occupation and diagnosis time ≥ 8 days. Scrub typhus showed two peaks north of Fujian; the prominent peak was from June to July, and the other slight rise was from October to November. The SDE plot showed that the cases were mainly concentrated in Yanping, Shunchang, Zhenghe, and Songxi counties. The number of cases in hilly and mountainous areas was higher than in plain areas. The main diagnostic methods in this area are based on specific eschar and epidemiology, while the positive rate of the Weil-Felix test is low.

Conclusions

The results of this study can guide primary care institutions to improve the level of diagnosis and treatment of scrub typhus and take effective public health intervention measures in endemic areas.
Feasibility of using software-aided selection of virtual monoenergetic level for optimal image quality of acute necrotising pancreatitis based on dual-energy computed tomography: a preliminary study
Authors: Yuan Yuan , Liao Kai , Huang Zixing , Deng Liping , Tang Hehan , Wang Yi , Ye Zheng , Chen Xinyue , Song Bin , Li Zhenlin
Published: July 2023

Objective

This study aimed to assess the feasibility of software-aided selection of monoenergetic level for acute necrotising pancreatitis (ANP) depiction compared to other automatic image series generated using dual-energy computed tomography (CT).

Methods

The contrast-enhanced dual-source dual-energy CT images in the portal venous phase of 48 patients with ANP were retrospectively analysed. Contrast-to-noise ratio (CNR) of pancreatic parenchyma-to-necrosis, signal-to-noise ratio (SNR) of the pancreas, image noise, and score of subjective diagnosis were measured, calculated, and compared among the CT images of 100 kV, Sn140 kV, weighted-average 120 kV, and optimal single-energy level for CNR.

Results

CNR of pancreatic parenchyma-to-necrosis in the images of 100 kV, Sn140 kV, weighted-average 120 kV, and the optimal single-energy level for CNR was 5.18 ± 2.39, 3.13 ± 1.35, 5.69 ± 2.35, and 9.99 ± 5.86, respectively; SNR of the pancreas in each group was 6.31 ± 2.77, 4.27 ± 1.56, 7.21 ± 2.69, and 11.83 ± 6.30, respectively; image noise in each group was 18.78 ± 5.20, 17.79 ± 4.63, 13.28 ± 3.13, and 9.31 ± 2.96, respectively; and score of subjective diagnosis in each group was 3.56 ± 0.50, 3.00 ± 0.55, 3.48 ± 0.55, and 3.88 ± 0.33, respectively. The four measurements of the optimal single-energy level for CNR images were significantly different from those of images in the other three groups (P < 0.05). CNR of pancreatic parenchyma-to-necrosis, SNR of the pancreas, and score of subjective diagnosis in the images of the optimal single-energy level for CNR were significantly higher, while the image noise was lower than those in the other three groups (all P = 0.000).

Conclusion

Optimal single-energy level imaging for CNR of dual-source CT could improve quality of CT images in patients with ANP, enhancing the display of necrosis in the pancreas.
Immediate visual reproduction negatively correlates with brain entropy of parahippocampal gyrus and inferior occipital gyrus in bipolar II disorder adolescents
Authors: Liu Haiqin , Gao Weijia , Cao Weifang , Meng Qingmin , Xu Longchun , Kuang Liangfeng , Guo Yongxin , Cui Dong , Qiu Jianfeng , Jiao Qing , Su Linyan , Lu Guangming
Published: July 2023

Background

Brain entropy reveals complexity and irregularity of brain, and it has been proven to reflect brain complexity alteration in disease states. Previous studies found that bipolar disorder adolescents showed cognitive impairment. The relationship between complexity of brain neural activity and cognition of bipolar II disorder (BD-II) adolescents remains unclear.

Methods

Nineteen BD-II patients (14.63 ±1.57 years old) and seventeen age-gender matched healthy controls (HCs) (14.18 ± 1.51 years old) were enlisted. Entropy values of all voxels of the brain in resting-state functional MRI data were calculated and differences of them between BD-II and HC groups were evaluated. After that, correlation analyses were performed between entropy values of brain regions showing significant entropy differences and clinical indices in BD-II adolescents.

Results

Significant differences were found in scores of immediate visual reproduction subtest (VR-I, p = 0.003) and Stroop color-word test (SCWT-1, p = 0.015; SCWT-2, p = 0.004; SCWT-3, p = 0.003) between the two groups. Compared with HCs, BD-II adolescents showed significant increased brain entropy in right parahippocampal gyrus and right inferior occipital gyrus. Besides, significant negative correlations between brain entropy values of right parahippocampal gyrus, right inferior occipital gyrus and immediate visual reproduction subtest scores were observed in BD-II adolescents.

Conclusions

The findings of the present study suggested that the disrupted function of corticolimbic system is related with cognitive abnormality of BD-II adolescents. And from the perspective temporal dynamics of brain system, the current study, brain entropy may provide available evidences for understanding the underlying neural mechanism in BD-II adolescents.
The emergence of socioeconomic inequalities in smoking during adolescence and early adulthood
Authors: Alves Joana , Perelman Julian , Ramos Elisabete , Kunst Anton E
Published: July 2023

Background

While it is known that educational inequalities in smoking start during early and middle adolescence, it is unknown how they further develop until adulthood. The aim of this article is to map, in the Portuguese context, how educational inequalities in smoking emerge from pre-adolescence until young adulthood.

Methods

This study used longitudinal data from the EPITeen Cohort, which recruited adolescents enrolled in schools in Porto, Portugal. We included the 1,038 participants followed at ages 13 (2003/2004), 17, 21, and 24 years. We computed the odds ratio (OR) for the prevalence of smoking states (never smoking, experimenter, less-than-daily, daily and former smoker) and the incidence of transitions between these states, as function of age and education, stratified by sex. We also added interaction terms between age and education.

Results

Educational inequalities in daily smoking prevalence, with higher prevalence among those with lower educational level, emerged at 17 years old and persisted until higher ages. They were formed in a cumulative way by the increased risk of experimenting between 13 and 17 years, and increased risk of becoming daily smoker between 17 and 21 years. The incidence of smoking cessation was higher among the higher educated. Inequalities were formed similarly for women and men, but with lower level and showed no significance among women.

Conclusions

These results highlight that actions to prevent smoking should also take in account the potential impact in smoking inequalities, and should focus not only on middle adolescence but also on late adolescence and early adulthood.
Predicting COVID-19 exposure risk perception using machine learning
Authors: Bakkeli Nan Zou
Published: July 2023

Background

Self-perceived exposure risk determines the likelihood of COVID-19 preventive measure compliance to a large extent and is among the most important predictors of mental health problems. Therefore, there is a need to systematically identify important predictors of such risks. This study aims to provide insight into forecasting and understanding risk perceptions and help to adjust interventions that target various social groups in different pandemic phases.

Methods

This study was based on survey data collected from 5001 Norwegians in 2020 and 2021. Interpretable machine learning algorithms were used to predict perceived exposure risks. To detect the most important predictors, the models with best performance were chosen based on predictive errors and explained variances. Shapley additive values were used to examine individual heterogeneities, interpret feature impact and check interactions between the key predictors.

Results

Gradient boosting machine exhibited the best model performance in this study (2020: RMSE=.93, MAE=.74, RSQ=.22; 2021: RMSE=.99, MAE=.77, RSQ=.12). The most influential predictors of perceived exposure risk were compliance with interventions, work-life conflict, age and gender. In 2020, work and occupation played a dominant role in predicting perceived risks whereas, in 2021, living and behavioural factors were among the most important predictors. Findings show large individual heterogeneities in feature importance based on people’s sociodemographic backgrounds, work and living situations.

Conclusion

The findings provide insight into forecasting risk groups and contribute to the early detection of vulnerable people during the pandemic. This is useful for policymakers and stakeholders in developing timely interventions targeting different social groups. Future policies and interventions should be adapted to the needs of people with various life situations.
The COVID-19 pandemic and its impact on health experiences of asylum seekers to the United States
Authors: Singer Elizabeth , Molyneux Kevin , Gogerly-Moragoda Mahalya , Kee Dustin , Baranowski Kim A.
Published: July 2023

Background

The COVID-19 pandemic exacerbated preexisting barriers to accessing healthcare and social services faced by asylum seekers to the United States. This study aimed to uncover the impact of the first year of the COVID-19 pandemic on asylum seekers, including socio-economic stressors and access to medical information, healthcare, and testing.

Method

We conducted 15 semi-structured, in-depth interviews with adult asylum seekers to the U.S. and systematically analyzed the resulting transcripts using a consensual qualitative research approach.

Results

The transcripts yielded six domains: (1) knowledge and understanding of COVID-19; (2) attitudes and practices relating to COVID-19 precautions; (3) experience of COVID-19 symptoms; (4) current physical and mental health; (5) access to and interaction with health care; (6) discrimination based on asylum status.

Conclusions

Although participants had knowledge about COVID-19’s communicability and regularly used masks, their living conditions frequently hindered their ability to quarantine and isolate, and their lack of insurance was often a deterrent to them seeking medical care. Notably, immigration status was not a significant factor discouraging participants from seeking care during the pandemic. The findings build on existing knowledge about this community and may help define areas where support and services can be expanded in current and future pandemics.
Expression of proinflammatory cytokines and proinsulin by bone marrow-derived cells for fracture healing in long-term diabetic mice
Authors: Fujikawa Hitomi , Kojima Hideto , Terashima Tomoya , Katagi Miwako , Yayama Takafumi , Kumagai Kosuke , Mori Kanji , Saito Hideki , Imai Shinji
Published: July 2023

Background

Diabetes mellitus (DM) causes bone dysfunction due to poor bone quality, leading to severe deterioration in patient of quality of life. The mechanisms of bone metabolism in DM remain unclear, although chemical and/or mechanical factors are known to disrupt the homeostasis of osteoblasts and osteoclasts. The purpose of this study was to identify the changes of osteoblasts and osteoclasts under long-term hyperglycaemic conditions, using a mouse fracture model of long-term hyperglycemia (LT-HG).

Methods

C57BL/6J mice and green fluorescent protein (GFP) -positive bone marrow transplanted C57BL/6J mice with LT-HG, maintained under a state of hyperglycaemia for 2 months, were used in this study. After the experimental fracture, we examined the immunohistochemical expression of proinsulin and tumor necrosis factor (TNF) -α at the fracture site. C57BL/6J fracture model mice without hyperglycaemia were used as controls.

Results

In the LT-HG mice, chondrocyte resorption was delayed, and osteoblasts showed an irregular arrangement at the callus site. The osteoclasts were scattered with a decrement in the number of nuclei. The expression of proinsulin was confirmed in bone marrow derived cells (BMDCs) with neovascularization 2 and 3 weeks after fracture. Immunopositivity for TNF-α was also confirmed in immature chondrocytes and BMDCs with neovascularization at 2 weeks, and the number of positive cells was not decreased at 3 weeks. Examination of GFP-grafted hyperglycaemic mice showed that the majority of cells at the fracture site were GFP-positive. Immunohistochemistry showed that the rate of double positives was 15% for GFP and proinsulin and 47% for GFP and TNF-α.

Conclusion

LT-HG induces an increase in the number of proinsulin and TNF-α positive cells derived from BMDCs. We suggest that proinsulin and TNF-α positive cells are involved in both bone formation and bone resorption after fracture under hyperglycaemic conditions, resulting in the delay of bone healing.
Support for relatives in the intensive care unit: lessons from a cross-sectional multicentre cohort study during the COVID-19 pandemic
Authors: Renckens Sophie C. , Pasman H. Roeline , Klop Hanna T. , du Perron Chantal , van Zuylen Lia , Steegers Monique A. H. , ten Tusscher Birkitt L. , Abbink Floor C. H. , de Ruijter Wouter , Vloet Lilian C. M. , Koster Stephanie C. E. , Onwuteaka-Philipsen Bregje D.
Published: July 2023

Background

Support for relatives is highly important in the intensive care unit (ICU). During the first COVID-19 wave  support for relatives had to be changed considerably. The alternative support could have decreased the quality and sense of support. We aimed to evaluate how support for relatives in Dutch ICUs was organised during the first COVID-19 wave and how this was experienced by these relatives in comparison to relatives from pre-COVID-19 and the second wave. Additionally, we aimed to investigate which elements of support are associated with positive experiences.

Methods

We performed a cross-sectional multicentre cohort study in six Dutch ICUs in the Netherlands. Written questionnaires were distributed among relatives of ICU patients from pre-COVID-19, the first wave and the second wave. The questionnaire included questions on demographics, the organisation of support, and the experiences and satisfaction of relatives with the support.

Results

A total of 329 relatives completed the questionnaire (52% partner, 72% woman and 63% ICU stay of 11 days or longer). Support for relatives of ICU patients during the first COVID-19 wave differed significantly from pre-COVID-19 and the second wave. Differences were found in all categories of elements of support: who, when, how and what. Overall, relatives from the three time periods were very positive about the support. The only difference in satisfaction between the three time periods, was the higher proportion of relatives indicating that healthcare professionals had enough time for them during the first wave. Elements of support which were associated with many positive experiences and satisfaction were: fixed timeslot, receiving information (e.g. leaflets) on ≥ 2 topics, discussing > 5 topics with healthcare professionals, and being offered emotional support.

Conclusions

Although, support for relatives in the ICU changed considerably during the COVID-19 pandemic, relatives were still positive about this support. The altered support gave insight into avenues for improvement for future comparable situations as well as for normal daily ICU practice: e.g. daily contact at a fixed timeslot, offering video calling between patients and relatives, and offering emotional support. ICUs should consider which elements need improvement in their practice.
Management of severe acute respiratory distress syndrome: a primer
Authors: Grotberg John C. , Reynolds Daniel , Kraft Bryan D.
Published: July 2023

This narrative review explores the physiology and evidence-based management of patients with severe acute respiratory distress syndrome (ARDS) and refractory hypoxemia, with a focus on mechanical ventilation, adjunctive therapies, and veno-venous extracorporeal membrane oxygenation (V-V ECMO). Severe ARDS cases increased dramatically worldwide during the Covid-19 pandemic and carry a high mortality. The mainstay of treatment to improve survival and ventilator-free days is proning, conservative fluid management, and lung protective ventilation. Ventilator settings should be individualized when possible to improve patient-ventilator synchrony and reduce ventilator-induced lung injury (VILI). Positive end-expiratory pressure can be individualized by titrating to best respiratory system compliance, or by using advanced methods, such as electrical impedance tomography or esophageal manometry. Adjustments to mitigate high driving pressure and mechanical power, two possible drivers of VILI, may be further beneficial. In patients with refractory hypoxemia, salvage modes of ventilation such as high frequency oscillatory ventilation and airway pressure release ventilation are additional options that may be appropriate in select patients. Adjunctive therapies also may be applied judiciously, such as recruitment maneuvers, inhaled pulmonary vasodilators, neuromuscular blockers, or glucocorticoids, and may improve oxygenation, but do not clearly reduce mortality. In select, refractory cases, the addition of V-V ECMO improves gas exchange and modestly improves survival by allowing for lung rest. In addition to VILI, patients with severe ARDS are at risk for complications including acute cor pulmonale, physical debility, and neurocognitive deficits. Even among the most severe cases, ARDS is a heterogeneous disease, and future studies are needed to identify ARDS subgroups to individualize therapies and advance care.
Elevated MMP-8 levels, inversely associated with BMI, predict mortality in mechanically ventilated patients: an observational multicenter study
Authors: Ruan Hang , Li Shu-sheng , Zhang Qin , Ran Xiao
Published: July 2023

Background

The present study aimed to investigate the correlation between weight status and mortality in mechanically ventilated patients and explore the potential mediators.

Methods

Three medical centers encompassing 3301 critically ill patients receiving mechanical ventilation were assembled for retrospective analysis to compare mortality across various weight categories of patients using machine learning algorithms. Bioinformatics analysis identified genes exhibiting differential expression among distinct weight categories. A prospective study was then conducted on a distinct cohort of 50 healthy individuals and 193 other mechanically ventilated patients. The expression levels of the genes identified through bioinformatics analysis were quantified through enzyme-linked immunosorbent assay (ELISA).

Results

The retrospective analysis revealed that overweight individuals had a lower mortality rate than underweight individuals, and body mass index (BMI) was an independent protective factor. Bioinformatics analysis identified matrix metalloproteinase 8 (MMP-8) as a differentially expressed gene between overweight and underweight populations. The results of further prospective studies showed that overweight patients had significantly lower MMP-8 levels than underweight patients ((3.717 (2.628, 4.191) vs. 2.763 (1.923, 3.753), ng/ml,P = 0.002). High MMP-8 levels were associated with increased mortality risk (OR = 4.249,P = 0.005), indicating that elevated level of MMP-8 predicts the mortality risk of underweight patients receiving mechanical ventilation.

Conclusions

This study provides evidence for a protective effect of obesity in mechanically ventilated patients and highlights the potential role of MMP-8 level as a biomarker for predicting mortality risk in this population.