bluuebunny/crossref_metadata_2025 huggingface dataset:
Day-to-Day Glycemic Variability Using Continuous Glucose Monitors in Endurance Athletes
Authors: Bowler Amy-Lee M. , Burke Louise M. , Coffey Vernon G. , Cox Gregory R.
Published: May 2024

Objectives:

The application of continuous glucose monitors (CGMs) to measure interstitial glucose in athletic populations is limited by the lack of accepted athlete-specific reference values. The aim of this study was to develop athlete-specific reference ranges for glycemic variability under standardized diet and exercise conditions.

Methods:

A total of 12 elite racewalkers (n = 7 men, 22.4 ± 3.5 years, VO2max 61.6 ± 7.3 mL kg−1 min−1) completed two 4-d trials separated by 4-d. Athletes were provided a high-energy, high-carbohydrate diet (225 ± 1.6 kJ kg−1 day−1, 8.4 ± 0.3 g kg−1 day−1 carbohydrate) and completed standardized daily exercise. The timing of food consumed and exercise undertaken were matched each day across the 4-d trials. Interstitial glucose data were collected via Freestyle Libre 2 CGMs. Glycemic variability was calculated as the mean amplitude of glycemic excursions (MAGEs), mean of daily differences (MODD), and standard deviation (SD).

Results:

Twenty-four hour MODD, MAGE, and SD for interstitial glucose were 12.6 ± 1.8 mg/dL (0.7 ± 0.1 mmol/L), 36.0 ± 5.4 mg/dL (2.0 ± 0.3 mmol/L), and 16.2 ± 1.8 mg/dL (0.9 ± 0.1 mmol/L), respectively. Twenty-four hour mean glucose (MG; 102.6 ± 5.4 mg/dL [5.7 ± 0.3 mmol/L]) was higher than overnight (91.8 ± 5.4 mg/dL [5.1 ± 0.3 mmol/L]; P < .0001) and was lower in women than men (99.0 ± 3.6 mg/dL [5.5 ± 0.2 mmol/L] vs 104.4 ± 3.6 mg/dL [5.8 ± 0.2 mmol/L]; P = .059, d = 1.4).

Conclusions:

This study provides reference indices under standardized diet and exercise conditions for glycemic variability derived from CGMs in endurance athletes which are similar than previously reported for healthy individuals, despite strenuous daily training and a high daily energy and carbohydrate diet.
Efficacy and Safety of Ultrasound Guided Inter-semispinal Plane Block for Postoperative Analgesia in Posterior Cervical Laminectomy - A Prospective Randomised Controlled Study
Authors: Ramachandran Karthik , Chandramohan Madhanmohan , Shetty Ajoy Prasad , Subramanian Balavenkat , Kanna Rishi Mugesh , Rajasekaran Shanmuganathan
Published: May 2024

Study design

Prospective, randomized controlled study.

Objective

To assess the safety and efficacy of an ultrasound-guided ISP block for postoperative analgesia in posterior cervical laminectomy.

Methods

88 patients requiring posterior cervical laminectomy were randomized into two groups, those who underwent ISP block with multimodal analgesia (ISPB group) and those with only multimodal analgesia (control group). Demographic details, intraoperative parameters (blood loss, duration of surgery, perioperative total opioid consumption, muscle relaxants used), and postoperative parameters (numeric rating scale, satisfaction score, mobilization time, and complications) were recorded.

Results

The total opioid consumption (128.41 + 39.65vs 284.09 + 140.92mcg; P < .001), muscle relaxant usage (46.14 + 6.18 mg vs 59.32 + 3.97 mg; P < .001), surgical duration (128.61 + 26.08/160.23 + 30.99mins; P < .01), and intra-operative blood loss (233.18 + 66.08 mL vs 409.77 + 115.41 mL; P < .01) were significantly less in the ISPB group compared to the control. In the postoperative period, the control group’s pain score was significantly higher ( P < .001) in the initial 48 hours. The Modified Observer Alertness/Sedation Score (MOASS) score and satisfaction scores were significantly better in the ISPB compared to the control ( P < .001). The mean time required to ambulate was statistically less in ISPB (4.30 + 1.64hours) when compared to controls (9.48 + 3.07hours) ( P < .001).

Conclusion

In patients undergoing posterior cervical laminectomy, ISP block is a safe and effective technique with better outcomes than standard multi-modal analgesia alone, in terms of reduced intra-operative opioid requirements and blood loss, better postoperative analgesia, and early mobilization.
Factors influencing Chinese international students’ preference for Australia as a study destination: A qualitative analysis
Authors: Leonov Denis
Published: May 2024

Australia competes with other popular study destinations for its share in the international student market. As the largest cohort of international students in the country, this article explores factors influencing Chinese students to select Australia as their final study destination instead of the United States, the United Kingdom, or Canada. Within the theoretical lens of the push-and-pull model and drawing on semi-structured interviews with 22 Chinese graduates who studied at Australian universities, this research provides evidence about the factors driving Chinese international students to choose Australia as their study destination. Notably, the research participants had also considered other study destination countries for their popularity among young Chinese, sought-after education systems, and career opportunities. However, higher costs and colder climates were among the major push factors of those countries. A prior connection to the country was Australia’s foremost pull factor. China’s competitive education system and labour market, and social and cultural norms pushed participants to seek international education options.
Pilot evaluation of the Fiscal Mapping Process for sustainable financing of evidence-based youth mental health treatments: A comparative case study analysis
Authors: Dopp Alex R. , North Maddison N. , Gilbert Marylou , Ringel Jeanne S. , Silovsky Jane F. , Blythe Mellicent , Edwards Dan , Schmidt Susan , Funderburk Beverly
Published: May 2024

Background

Sustained delivery of evidence-based treatments (EBTs) is essential to addressing the public health impacts of youth mental health problems, but is complicated by the limited and fragmented funding available to youth mental health service agencies. Supports are needed that can guide service agencies in accessing sustainable funding for EBTs. We conducted a pilot evaluation of the Fiscal Mapping Process, an Excel-based strategic planning tool that helps service agency leaders identify and coordinate financing strategies for their EBT programs.

Method

Pilot testing of the Fiscal Mapping Process was completed with 10 youth mental health service agencies over a 12-month period, using trauma-focused cognitive-behavioral therapy or parent–child interaction therapy programs. Service agency representatives received initial training and monthly coaching in using the tool. We used case study methods to synthesize all available data (surveys, focus groups, coaching notes, document review) and contrast agency experiences to identify key findings through explanation building.

Results

Key evaluation findings related to the process and outcomes of using the Fiscal Mapping Process, as well as contextual influences. Process evaluation findings helped clarify the primary use case for the tool and identified the importance—and challenges—of engaging external collaborators. Outcome evaluation findings documented the impacts of the Fiscal Mapping Process on agency-reported sustainment capacities (strategic planning, funding stability), which fully explained reported improvements in outcomes (extent and likelihood)—although these impacts were incremental. Findings on contextual factors documented the influence of environmental and organizational capacities on engagement with the tool and concerns about equitable impacts, but also the view that the process could usefully generalize to other EBTs.

Conclusions

Our pilot evaluation of the Fiscal Mapping Process was promising. In future work, we plan to integrate the tool into EBT implementation initiatives and test its impact on long-term sustainment outcomes across various EBTs, while increasing attention to equity considerations.
Students’ perceptions of the quality and utility of assessment feedback: Implications for educational leadership and quality assurance
Authors: Hill-Berry Nola P , Hutton-Rose Nellian E
Published: May 2024

In this article, the researchers present the results of an investigation into students’ perceptions of the quality and utility of assessment feedback, and implications for educational leadership and quality assurance. A quantitative approach was taken to conduct a survey among a wide representation of students in one academic unit at a University in Jamaica. Data were collected over a 1-month period. This survey was administered online using the students’ group email addresses and allowing voluntary participation. Using a 20-point questionnaire with close-ended items, the researchers investigated student’s perceptions about the methods used to provide assessment feedback, the quality of feedback, timeliness of the feedback, students’ attitude toward feedback, as well as the utility and value of the assessment feedback. The findings of this study were similar to what was found in the literature. For students to value and use assessment feedback, it must be clear, specific, provide directions for improvement, and must be communicated in a timely manner, using the most appropriate method. Both the students’ perceptions of the quality of assessment feedback and their utility of assessment feedback were good. The findings of this study have implications for educational leadership and quality assurance.
Public preferences of environmental peacebuilding: The case of forest conservation projects in Colombia
Authors: Schmid Dominique , Vlaskamp Martijn C
Published: May 2024

To date, no studies have examined the nationwide support for environmental peacebuilding projects in post-conflict countries, that is, projects that seek to use the management of natural resources as a way of fostering peace and cooperation. However, public support can be crucial for the legitimacy and effectiveness of these projects. This article aims to address this gap by exploring which project characteristics influence public support for environmental peacebuilding projects. It does so through a conjoint experiment in Colombia with 1,504 survey respondents, focusing on forest conservation projects. The findings indicate that provisions related to the reintegration of ex-combatants and the dialogue between victims and ex-combatants resonate positively with respondents. Participants from the political right or those opposed to the 2016 peace agreement were somewhat less responsive to this information. The most significant impact was observed with provisions for job creation and public investments that targeted the entire population. Based on these findings, we conclude that the inclusion of environmental peacebuilding provisions in forest conservation projects can increase public support for them in post-conflict countries.
Wind-urban structure interplay in PM2.5 variation: Insights from multi-seasonal mobile air quality campaign
Authors: Ray Noah , Dong Pinliang , South John , Liang Lu
Published: May 2024

The health risks associated with particulate matter pollution (PM2.5) highlight the importance of comprehending key drivers of its spatial and temporal variability. While explanatory modeling is widely used for statistical inference in such applications, the role of wind variables (speed, direction) and their interplay with built environment are often overlooked. This study addresses this gap through a mobile air quality campaign in a suburban area over 10 days for each of three distinct seasons. We developed four innovative wind-based buffers to account for the wind factors and assess the impact of LiDAR-derived 3D built environment structure on PM2.5 variability at local and regional scales. Our second objective is to assess the predictive capabilities of wind-based variables. Results indicate that in our low-elevation, low-rise building study area, the built environment does not emerge as a significant factor, contrary to findings in larger, denser urban areas. Wind direction proves more effective in capturing concentration fluctuations than wind speed, and its interaction with pollution source orientation can change pollution dynamics. This study introduces new insights and methodologies for incorporating wind-related factors into the analysis of air pollution dynamics, offering opportunities for further investigation in various urban settings.
Directionality characteristics of horizontal response spectra from the 2022 Mw 6.9 Chihshang, Taiwan earthquake
Authors: Poulos Alan , Miranda Eduardo
Published: May 2024

Horizontal earthquake ground motion intensity, and specifically response spectral ordinates, vary with orientation. This phenomenon is usually referred to as ground motion directionality and can be separated into two aspects: the orientation where the maximum spectral response occurs and the variation of response spectral ordinates as the orientation moves away from the orientation of maximum spectral response. This work studies both aspects using the recent 2022 Mw 6.9 Chihshang, Taiwan earthquake, which was recorded by a dense network of strong motion stations with various geological and topographical settings. The mean variation of response spectral ordinates with orientation is found to be slightly more significant than that of previous shallow crustal earthquakes in active tectonic regimes. Moreover, the orientation of maximum spectral response is found to be close to the transverse orientation, which is perpendicular to the orientation at a given site that points to the earthquake epicenter, confirming prior observations made for strike-slip earthquakes. These results suggest that the location of a site relative to the seismic source could be used to modify the outputs of ground motion models to estimate spectral responses at specific horizontal orientations.
Anaesthesia management of a patient with Bethlem Myopathy for elective tonsillectomy: a case report
Authors: McGarrigle Conor , McGrath Launcelot , Khan Ehtesham
Published: May 2024

Background

Bethlem Myopathy is a collagen VI-related myopathy presenting as a rare hereditary muscular disorder with progressive muscular weakness and joint contractures. Despite its milder clinical course relative to other myopathies, anaesthetic management can be challenging. High arched palates and fixed flexion deformities may contribute to a difficult airway. A progressive decline in pulmonary function can present later into adulthood. This respiratory decline can carry secondary cardiovascular consequences due to the progressive nature of restrictive lung disease, including right sided heart disease and pulmonary hypertension. We describe a case of a male patient with Bethlem Myopathy undergoing anaesthesia, to contribute to the limited body of literature on this condition and enhance awareness and guidance amongst anaesthesiologists on approaching patients with this condition. This is the first case report within the literature of its kind.

Case presentation

This case details a 33-year-old male with Bethlem Myopathy undergoing tonsillectomy. Diagnosed in childhood following developmental delays, the patient had no prior anaesthetic exposure and no family history of anaesthetic complications. Anaesthetic induction was achieved without complications, avoiding depolarizing muscle relaxants and careful airway management. Extreme care was taken in patient positioning to prevent complications. The surgery proceeded without incident and muscle paralysis was reversed with Suggammadex, resulting in no adverse post-operative respiratory complications. The patient was discharged on the first post-operative day without any respiratory or cardiovascular compromise.

Conclusions

Bethlem Myopathy, while often exhibiting a mild clinical course, can present anaesthetic challenges. Awareness of potential complications including a difficult airway, cardiovascular and respiratory implications as well as the need for specialised monitoring and positioning is crucial to ensure a safe peri-operative course.
An evaluation of computational methods for aggregate data meta-analyses of diagnostic test accuracy studies
Authors: Zhao Yixin , Khan Bilal , Negeri Zelalem F.
Published: May 2024

Background

A Generalized Linear Mixed Model (GLMM) is recommended to meta-analyze diagnostic test accuracy studies (DTAs) based on aggregate or individual participant data. Since a GLMM does not have a closed-form likelihood function or parameter solutions, computational methods are conventionally used to approximate the likelihoods and obtain parameter estimates. The most commonly used computational methods are the Iteratively Reweighted Least Squares (IRLS), the Laplace approximation (LA), and the Adaptive Gauss-Hermite quadrature (AGHQ). Despite being widely used, it has not been clear how these computational methods compare and perform in the context of an aggregate data meta-analysis (ADMA) of DTAs.

Methods

We compared and evaluated the performance of three commonly used computational methods for GLMM - the IRLS, the LA, and the AGHQ, via a comprehensive simulation study and real-life data examples, in the context of an ADMA of DTAs. By varying several parameters in our simulations, we assessed the performance of the three methods in terms of bias, root mean squared error, confidence interval (CI) width, coverage of the 95% CI, convergence rate, and computational speed.

Results

For most of the scenarios, especially when the meta-analytic data were not sparse (i.e., there were no or negligible studies with perfect diagnosis), the three computational methods were comparable for the estimation of sensitivity and specificity. However, the LA had the largest bias and root mean squared error for pooled sensitivity and specificity when the meta-analytic data were sparse. Moreover, the AGHQ took a longer computational time to converge relative to the other two methods, although it had the best convergence rate.

Conclusions

We recommend practitioners and researchers carefully choose an appropriate computational algorithm when fitting a GLMM to an ADMA of DTAs. We do not recommend the LA for sparse meta-analytic data sets. However, either the AGHQ or the IRLS can be used regardless of the characteristics of the meta-analytic data.
Expression analysis and mapping of Viral—Host Protein interactions of Poxviridae suggests a lead candidate molecule targeting Mpox
Authors: Loganathan Tamizhini , Fletcher John , Abraham Priya , kannangai Rajesh , Chakraborty Chiranjib , El Allali Achraf , Alsamman Alsamman M. , Zayed Hatem , C George Priya Doss
Published: May 2024

Background

Monkeypox (Mpox) is an important human pathogen without etiological treatment. A viral-host interactome study may advance our understanding of molecular pathogenesis and lead to the discovery of suitable therapeutic targets.

Methods

GEO Expression datasets characterizing mRNA profile changes in different host responses to poxviruses were analyzed for shared pathway identification, and then, the Protein–protein interaction (PPI) maps were built. The viral gene expression datasets of Monkeypox virus (MPXV) and Vaccinia virus (VACV) were used to identify the significant viral genes and further investigated for their binding to the library of targeting molecules.

Results

Infection with MPXV interferes with various cellular pathways, including interleukin and MAPK signaling. While most host differentially expressed genes (DEGs) are predominantly downregulated upon infection, marked enrichments in histone modifiers and immune-related genes were observed. PPI analysis revealed a set of novel virus-specific protein interactions for the genes in the above functional clusters. The viral DEGs exhibited variable expression patterns in three studied cell types: primary human monocytes, primary human fibroblast, and HeLa, resulting in 118 commonly deregulated proteins. Poxvirus proteins C6R derived protein K7 and K7R of MPXV and VACV were prioritized as targets for potential therapeutic interventions based on their histone-regulating and immunosuppressive properties. In the computational docking and Molecular Dynamics (MD) experiments, these proteins were shown to bind the candidate small molecule S3I-201, which was further prioritized for lead development.

Results

MPXV circumvents cellular antiviral defenses by engaging histone modification and immune evasion strategies. C6R-derived protein K7 binding candidate molecule S3I-201 is a priority promising candidate for treating Mpox.
Prescription drug monitoring programs and prescription pain medication misuse among U.S. high school students—2019
Authors: Liu Kevin , Benedetti Marco , Evans Alexander , Zhu Motao
Published: May 2024

Background

Prescription drug monitoring programs (PDMPs) are state-level databases that track and inform prescribing practices to reduce prescription drug diversion and misuse. To our knowledge, only three studies have examined the impact of PDMPs on opioid-related outcomes among adolescents, and none have focused on prescription pain medication misuse among adolescents.

Methods

This study leveraged data from the 2019 National Youth Risk Behavior Survey (YRBS) to explore the associations between five categories of PDMP dimensions and the prevalence of self-reported prescription pain medication misuse. Demographic factors’ associations with self-reported prescription pain medication misuse were also examined.

Results

In 2019, none of the PDMP dimensions were associated with self-reported prescription pain medication misuse among U.S. high school students, adjusting for gender, grade, race/ethnicity, and sexual orientation.

Conclusions

None of the five PDMP dimensions were associated with lower prescription pain medication misuse, however further research is needed, especially as new YRBS data become available.
Cement-augmented locked plate fixation proximal humerus fractures in elderly patient: a systematic review and meta-analysis
Authors: Li Dong-Yang , Zhang Kun
Published: May 2024

Background

This systemic review and meta-analysis aimed to evaluate the clinical outcomes of proximal humeral fracture in elderly patient fixation using locked plate with or without cement augmentation.

Methods

The databases of PubMed, Embase, and Cochrane Library were searched in August 2023 for literature comparing the clinical outcomes of patients with PHFs treated with locked plate alone and locked plate augmented with cement. Data describing study design; level of evidence; inclusion criteria; demographic information; final follow-up; revision rate; implant failure rate; avascular necrosis rate; total complication rate; constant score; and disability of arm, shoulder, and hand (DASH) score were collected.

Results

Eight studies (one randomized-controlled trial and seven observational studies), involving 664 patients, were identified. Compared with locked plates alone, using cement-augmented locked plates reduced the implant failure rate (odds ratio (OR) = 0.19; 95% confidence interval (CI) 0.10–0.39; P < 0.0001) and total complication rate (OR = 0.45; 95% CI 0.29–0.69; P = 0.0002) and improved DASH scores (mean difference (MD) = 2.99; 95% CI 1.00–4.98; P = 0.003). However, there was no significant difference in clinical outcomes, including revision rate, avascular necrosis rate, and constant score.

Conclusion

In this review and meta-analysis, fixation of the PHFs in elderly patients using locked plates with or without cement augmentation has no significant difference in revision rate, but the implant failure and total complication rates may be lesser on using the cement-augmented locked plate for fixation than on using a locked plate alone. Good results are expected for most patients treated with this technique.

Trial registration

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)21 guidelines were followed to conduct this systematic review and meta-analysis and was registered as a protocol in PROSPERO (CRD42022318798).
Association of neutrophil-lymphocyte ratio with all-cause and cardiovascular mortality in US adults with diabetes and prediabetes: a prospective cohort study
Authors: Chen Guangshu , Che Li , Lai Meizheng , Wei Ting , Chen Chuping , Zhu Ping , Ran Jianmin
Published: May 2024

Background

The neutrophil-lymphocyte ratio (NLR) is a novel hematological parameter to assess systemic inflammation. Prior investigations have indicated that an increased NLR may serve as a potential marker for pathological states such as cancer and atherosclerosis. However, there exists a dearth of research investigating the correlation between NLR levels and mortality in individuals with diabetes and prediabetes. Consequently, this study aims to examine the connection between NLR and all-cause as well as cardiovascular mortality in the population of the United States (US) with hyperglycemia status.

Methods

Data were collected from a total of 20,270 eligible individuals enrolled for analysis, spanning ten cycles of the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. The subjects were categorized into three groups based on tertiles of NLR levels. The association of NLR with both all-cause and cardiovascular mortality was evaluated using Kaplan-Meier curves and Cox proportional hazards regression models. Restricted cubic splines were used to visualize the nonlinear relationship between NLR levels and all-cause and cardiovascular mortality in subjects with diabetes after accounting for all relevant factors.

Results

Over a median follow-up period of 8.6 years, a total of 1909 subjects with diabetes died, with 671 deaths attributed to cardiovascular disease (CVD). And over a period of 8.46 years, 1974 subjects with prediabetes died, with 616 cases due to CVD. The multivariable-adjusted hazard ratios (HRs) comparing high to low tertile of NLR in diabetes subjects were found to be 1.37 (95% CI, 1.19–1.58) for all-cause mortality and 1.63 (95% CI, 1.29–2.05) for CVD mortality. And the correlation between high to low NLR tertile and heightened susceptibility to mortality from any cause (HR, 1.21; 95% CI, 1.03–1.43) and CVD mortality (HR, 1.49; 95% CI, 1.08–2.04) remained statistically significant (both p-values for trend < 0.05) in prediabetes subjects. The 10-year cumulative survival probability was determined to be 70.34%, 84.65% for all-cause events, and 86.21%, 94.54% for cardiovascular events in top NLR tertile of diabetes and prediabetes individuals, respectively. Furthermore, each incremental unit in the absolute value of NLR was associated with a 16%, 12% increase in all-cause mortality and a 25%, 24% increase in cardiovascular mortality among diabetes and prediabetes individuals, respectively.

Conclusions

The findings of this prospective cohort study conducted in the US indicate a positive association of elevated NLR levels with heightened risks of overall and cardiovascular mortality among adults with diabetes and prediabetes. However, potential confounding factors for NLR and the challenge of monitoring NLR’s fluctuations over time should be further focused.
Novice providers’ success in performing lumbar puncture: a randomized controlled phantom study between a conventional spinal needle and a novel bioimpedance needle
Authors: Lilja Helmiina , Talvisara Maria , Eskola Vesa , Heikkilä Paula , Sievänen Harri , Palmu Sauli
Published: May 2024

Background

Lumbar puncture (LP) is an important yet difficult skill in medical practice. In recent years, the number of LPs in clinical practice has steadily decreased, which reduces residents’ clinical exposure and may compromise their skills and attitude towards LP. Our study aims to assess whether the novel bioimpedance needle is of assistance to a novice provider and thus compensates for this emerging knowledge gap.

Methods

This randomized controlled study, employing a partly blinded design, involved 60 s- and third-year medical students with no prior LP experience. The students were randomly assigned to two groups consisting of 30 students each. They performed LP on an anatomical lumbar model either with the conventional spinal needle or the bioimpedance needle. Success in LP was analysed using the independent samples proportion procedure. Additionally, the usability of the needles was evaluated with pertinent questions.

Results

With the conventional spinal needle, 40% succeeded in performing the LP procedure, whereas with the bioimpedance needle, 90% were successful (p < 0.001). The procedures were successful at the first attempt in 5 (16.7%) and 15 (50%) cases (p = 0.006), respectively. Providers found the bioimpedance needle more useful and felt more confident using it.

Conclusions

The bioimpedance needle was beneficial in training medical students since it significantly facilitated the novice provider in performing LP on a lumbar phantom. Further research is needed to show whether the observed findings translate into clinical skills and benefits in hospital settings.
Barriers to equitable healthcare services for under-five children in Ethiopia: a qualitative exploratory study
Authors: Fekadu Hailu , Mekonnen Wubegzier , Adugna Aynalem , Kloos Helmut , Hailemariam Damen
Published: May 2024

Background

Disparities in child healthcare service utilization are unacceptably high in Ethiopia. Nevertheless, little is known about underlying barriers to accessing child health services, especially among low socioeconomic subgroups and in remote areas. This study aims to identify barriers to equity in the use of child healthcare services in Ethiopia.

Methods

Data were obtained from 20 key- informant interviews (KII) and 6 focus group discussions (FGD) with mothers and care givers. This study was conducted in Oromia Region, Arsi Zone, Zuway Dugda District from June 1–30, 2023. The study participants for this research were selected purposively. The information was collected based on the principle of saturation after sixteen consecutives interview were conducted. Both KII and FGD were audio-recorded and complementary notes were taken to record observations about the participants’ comments and their interactions. Each interview and FGD data were transcribed word-for-word in the local Afaan Oromo and Amaharic languages and then translated to English language. Finally, the data were analyzed thematically using NVivo 14 software and narrated in the linked pattern of child health service utilization.

Results

This study identified six major themes which emerged as barriers to healthcare utilization equity for caregivers and their -under-five children. Barriers related to equity in low level of awareness regarding need, low socioeconomic status, geographical inaccessibility, barriers related to deficient healthcare system, community perception and cultural restrictions, and barriers of equity related to political instability and conflict. The most commonly recognized barriers of equity at the community level were political instability, conflict, and a tremendous distance to a health facility. Transportation challenges, poor functional services, closure of the health facility in working hours, and lack of proper planning to address the marginalized populations were identified barriers of equity at organizational or policy level.

Conclusion

This study showed that inequity in child healthcare utilization is an important challenge confronting Ethiopia. To achieve equity, policy makers and planners need to change health policy and structure to be pro-poor. It is also necessary to improve the healthcare system to increase service utilization and access for impoverished women, individuals with lower levels of education, and residents of isolated rural areas. Furthermore, context specific information pertaining to cultural barriers and political ecology are required.
SP2509, a specific antagonist of LSD1, exhibits antiviral properties against Porcine epidemic diarrhea virus
Authors: Zhao Xinyu , Zhang Yuhang , Qu Shiyin , Tang Wuyang , He Tianqiong , Li Pishun , Zheng Xiaofeng
Published: May 2024

Background

Porcine epidemic diarrhea virus (PEDV), a type of coronavirus, is one of the main pathogens that can infect pigs of all ages. It causes diarrhea and acute death of newborn piglets, resulting in massive economic losses to the worldwide swine industry. While vaccination remains the primary approach in combating PEDV, it often fails to address all the challenges posed by the infection, particularly in light of the emergence of evolving mutant strains. Therefore, there is a critical need to identify potent antiviral drugs that can effectively safeguard pigs against PEDV infection.

Results

In this study, the antiviral efficacy of SP2509, a specific antagonist of Lysine-specific demethylase 1(LSD1), was evaluated in vitro. The RT-qPCR, Western blot, TCID50, and IFA showed that at a concentration of 1µmol/L, SP2509 significantly inhibited PEDV infection. Additionally, viral life cycle assays showed that SP2509 operates by impeding PEDV internalization and replication rather than attachment and release. Regarding mechanism, in Huh-7 cells, knockdowns LSD1 can suppress PEDV replication. This indicated that the inhibition effect of SP2509 on PEDV largely depends on the activity of its target protein, LSD1.

Conclusion

Our results in vitro show that SP2509 can inhibit PEDV infection during the internalization and replication stage and revealed a role of LSD1 as a restriction factor for PEDV. These imply that LSD1 might be a target for interfering with the viral infection, and SP2509 could be developed as an effective anti-PEDV agent.
Identification of DNA methylation characteristics associated with metastasis and prognosis in colorectal cancer
Authors: Qian Fang , Li Qiang , Chang Huidan , Wei Kai , Chen Xiaoyi , Huang Tao , Li Yixue
Published: May 2024

Colorectal cancer (CRC) is prone to metastasis and recurrence after surgery, which is one of the main causes for its poor treatment and prognosis. Therefore, it is essential to identify biomarkers associated with metastasis and recurrence in CRC. DNA methylation has a regulatory role in cancer metastasis, tumor immune microenvironment (TME), and prognosis and may be one of the most valuable biomarkers for predicting CRC metastasis and prognosis. We constructed a diagnostic model and nomogram that can effectively predict CRC metastasis based on the differential methylation CpG sites (DMCs) between metastatic and non-metastatic CRC patients. Then, we identified 17 DMCs associated with progression free survival (PFS) of CRC and constructed a prognostic model. The prognosis model based on 17 DMCs can predict the PFS of CRC with medium to high accuracy. The results of immunohistochemical analysis indicated that the protein expression levels of the genes involved in prognostic DMCs were different between normal and colorectal cancer tissues. According to the results of immune-related analysis, we found that the low-risk patients had better immunotherapy response. In addition, high risk scores were negatively correlated with high tumor mutation burden (TMB) levels, and patients with low TMB levels in the high-risk group had the worst PFS. Our work shows the clinical value of DNA methylation in predicting CRC metastasis and PFS, as well as their correlation with TME, immunotherapy, and TMB, which helps understand the changes of DNA methylation in CRC metastasis and improving the treatment and prognosis of CRC.
Prognostic value of metabolic dysfunction-associated steatotic liver disease over coronary computed tomography angiography findings: comparison with no-alcoholic fatty liver disease
Authors: Nishihara Takahiro , Miyoshi Toru , Nakashima Mitsutaka , Miki Takashi , Toda Hironobu , Yoshida Masatoki , Ichikawa Keishi , Osawa Kazuhiro , Yuasa Shinsuke
Published: May 2024

Background

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the proposed name change for non-alcoholic fatty liver disease (NAFLD). This study aimed to investigate the association of cardiovascular disease risk with MASLD and NAFLD in patients who underwent clinically indicated coronary computed tomography angiography (CCTA).

Methods

This retrospective study included 2289 patients (60% men; mean age: 68 years) with no history of coronary artery disease who underwent CCTA. The steatotic liver was defined as a hepatic-to-spleen attenuation ratio of < 1.0 on CT just before CCTA. MASLD is defined as the presence of hepatic steatosis along with at least one of the five cardiometabolic risk factors. Adverse CCTA findings were defined as obstructive and/or high-risk plaques. Major adverse cardiac events (MACE) encompassed composite coronary events, including cardiovascular death, acute coronary syndrome, and late coronary revascularization.

Results

MASLD and NAFLD were identified in 415 (18%) and 368 (16%) patients, respectively. Adverse CCTA findings were observed in 40% and 38% of the patients with MASLD and with NAFLD, respectively. Adverse CCTA findings were significantly associated with MASLD (p = 0.007) but not NAFLD (p = 0.253). During a median follow-up of 4.4 years, 102 (4.4%) MACE were observed. MASLD was significantly associated with MACE (hazard ratio 1.82, 95% CI 1.18–2.83, p = 0.007), while its association with NAFLD was not significant (p = 0.070). By incorporating MASLD into a prediction model of MACE, including the risk score and adverse CCTA findings, global chi-squared values significantly increased from 87.0 to 94.1 (p = 0.008).

Conclusions

Patients with MASLD are likely to have a higher risk of cardiovascular disease than those with NAFLD. Concurrent assessment of MASLD during CCTA improves the identification of patients at a higher risk of cardiovascular disease among those with clinically indicated CCTA.
Minimal residual disease profiling predicts pathological complete response in esophageal squamous cell carcinoma
Authors: Yue Pinli , Bie Fenglong , Zhu Jiarun , Gao Lin-Rui , Zhou Zhendiao , Bai Guangyu , Wang Xiaobing , Zhao Ziyi , Xiao Ze-Fen , Li Yong , Zhou Aiping , Liu Wen-Yang , Jiao Yuchen , Gao Shugeng
Published: May 2024

Accurate presurgical prediction of pathological complete response (pCR) can guide treatment decisions, potentially avoiding unnecessary surgeries and improving the quality of life for cancer patients. We developed a minimal residual disease (MRD) profiling approach with enhanced sensitivity and specificity for detecting minimal tumor DNA from cell-free DNA (cfDNA). The approach was validated in two independent esophageal squamous cell carcinoma (ESCC) cohorts. In a cohort undergoing neoadjuvant, surgical, and adjuvant therapy (NAT cohort), presurgical MRD status precisely predicted pCR. All MRD-negative cases (10/10) were confirmed as pCR by pathological evaluation on the resected tissues. In contrast, MRD-positive cases included all the 27 non-pCR cases and only one pCR case (10/10 vs 1/28, P < 0.0001, Fisher’s exact test). In a definitive radiotherapy cohort (dRT cohort), post-dRT MRD status was closely correlated with patient prognosis. All MRD-negative patients (25/25) remained progression-free during the follow-up period, while 23 of the 26 MRD-positive patients experienced disease progression (25/25 vs 3/26, P < 0.0001, Fisher’s exact test; progression-free survival, P < 0.0001, log-rank test). The MRD profiling approach effectively predicted the ESCC patients who would achieve pCR with surgery and those likely to remain progression-free without surgery. This suggests that the cancer cells in these MRD-negative patients have been effectively eliminated and they could be suitable candidates for a watch-and-wait strategy, potentially avoiding unnecessary surgery.
Epithelial cells derived exosomal miR-203a-3p facilitates stromal inflammation of type IIIA chronic prostatitis/chronic pelvic pain syndrome by targeting DUSP5 and increasing MCP-1 generation
Authors: Song Guojing , Zhao Fuhan , Ni Rongrong , Deng Bingqian , Chen Saipeng , Hu Ruimin , Zheng Jun , Peng Yiji , Liu Heting , Luo Yang , Zhou Zhansong , Huang Gang , Shen Wenhao
Published: May 2024

Increased proinflammatory cytokines and infiltration of inflammatory cells in the stroma are important pathological features of type IIIA chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS-A), and the interaction between stromal cells and other cells in the inflammatory microenvironment is closely related to the inflammatory process of CP/CPPS-A. However, the interaction between stromal and epithelial cells remains unclear. In this study, inflammatory prostate epithelial cells (PECs) released miR-203a-3p-rich exosomes and facilitated prostate stromal cells (PSCs) inflammation by upregulating MCP-1 expression. Mechanistically, DUSP5 was identified as a novel target gene of miR-203a-3p and regulated PSCs inflammation through the ERK1/2/MCP-1 signaling pathway. Meanwhile, the effect of exosomes derived from prostatic fluids of CP/CPPS-A patients was consistent with that of exosomes derived from inflammatory PECs. Importantly, we demonstrated that miR-203a-3p antagomirs-loaded exosomes derived from PECs targeted the prostate and alleviated prostatitis by inhibiting the DUSP5-ERK1/2 pathway. Collectively, our findings provide new insights into underlying the interaction between PECs and PSCs in CP/CPPS-A, providing a promising therapeutic strategy for CP/CPPS-A.
Item analysis on the quality of life scale for anxiety disorders QLICD-AD(V2.0) based on classical test theory and item response theory
Authors: Shi Hongqiang , Ren Yu , Xian Junding , Ding Haifeng , Liu Yuxi , Wan Chonghua
Published: May 2024

Background

Anxiety disorders can cause serious physical and psychological damage, so many anxiety scales have been developed internationally to measure anxiety disorders, but due to the cultural differences and cultural dependence of quality of life between Chinese and Western cultures, it is difficult to reflect the main characteristics of Chinese patients. Therefore, we developed a scale suitable for Chinese patients with anxiety disorders: the Anxiety Disorders Scale of the Quality of Life Instruments for Chronic Diseases (QLICD-AD), hoping to achieve satisfactory QOL assessments for anxiety disorders.

Objectives

Items from the Anxiety Disorders Scale of the Quality of Life in Chronic Disease Instrument QLICD-AD system were analyzed using CTT and IRT to lay the groundwork for further refinement of the scale to accurately measure anxiety disorders.

Methods

120 patients with anxiety disorder were assessed using the QLICD-AD (V2.0). Descriptive statistics, variability method, correlation coefficient method, factor analysis and Cronbach’s coefficient of CTT, and graded response model (GRM) of item response theory were used to analyze the items of the scale.

Result

CTT analysis showed that the standard deviation of each item was between 0.928 and 1.466; Pearson correlation coefficients of item-to-domain were generally greater than 0.5 and also greater than that of item-to-other domain; the Cronbach ‘s of the total scale was 0.931, α of each domain was between 0.706 and 0.865. IRT analysis showed that the discrimination was between 1.14 and 1.44. The difficulty parameter of all items increased with the increase of grade. But some items (GPH6,GPH8,GPS3,GSO2-GSO4,AD2,AD5) difficulty parameters were less than 4 or greater than 4. The average of information amount was between 0.022 and 0.910.

Conclusion

Based on CTT and IRT analysis, most items of the QLICD-AD (V2.0) scale have good performance and good differentiation, but a few items still need further revision. Suggests that the QLICD-AD (V2.0) appears to be a valid measure of anxiety disorders. It may effectively improve the diagnosticity of anxiety disorders, but due to the limitations of the current sample, further validation is needed in a broader population extrapolation trial.
A rare case of TFEB/6p21/VEGFA-amplified renal cell carcinoma diagnosed by whole-exome sequencing: clinicopathological and genetic feature report and literature review
Authors: Zhang Ruiqi , Ding Meili , Zhu Xingyao , Li Xiang , Hu Qi , Tao Lin , Hu Wenhao , Zou Hong
Published: May 2024

Background

TFEB/6p21/VEGFA-amplified renal cell carcinoma (RCC) is rare and difficult to diagnose, with diverse histological patterns and immunohistochemical and poorly defined molecular genetic characteristics.

Case presentation

We report a case of a 63-year-old male admitted in 2017 with complex histomorphology, three morphological features of clear cell, eosinophilic and papillary RCC and resembling areas of glomerular and tubular formation. The immunophenotype also showed a mixture of CD10 and P504s. RCC with a high suspicion of collision tumors was indicated according to the 2014 WHO classification system; no precise diagnosis was possible. The patient was diagnosed at a different hospital with poorly differentiated lung squamous cell carcinoma one year after RCC surgery. We exploited molecular technology advances to retrospectively investigate the patient’s molecular genetic alterations by whole-exome sequencing. The results revealed a 6p21 amplification in VEGFA and TFEB gene acquisition absent in other RCC subtypes. Clear cell, papillary, chromophobe, TFE3-translocation, eosinophilic solid and cystic RCC were excluded. Strong TFEB and Melan-A protein positivity prompted rediagnosis as TFEB/6p21/VEGFA-amplified RCC as per 2022 WHO classification. TMB-L (low tumor mutational load), CCND3 gene acquisition and MRE11A and ATM gene deletion mutations indicated sensitivity to PD-1/PD-L1 inhibitor combinations and the FDA-approved targeted agents Niraparib (Grade C), Olaparib (Grade C), Rucaparib (Grade C) and Talazoparib (Class C). GO (Gene Ontology) and KEGG enrichment analyses revealed major mutations and abnormal CNVs in genes involved in biological processes such as the TGF-β, Hippo, E-cadherin, lysosomal biogenesis and autophagy signaling pathways, biofilm synthesis cell adhesion substance metabolism regulation and others. We compared TFEB/6p21/VEGFA-amplified with TFEB-translocated RCC; significant differences in disease onset age, histological patterns, pathological stages, clinical prognoses, and genetic characteristics were revealed.

Conclusion

We clarified the patient’s challenging diagnosis and discussed the clinicopathology, immunophenotype, differential diagnosis, and molecular genetic information regarding TFEB/6p21/VEGFA-amplified RCC via exome analysis and a literature review.
A cross-sectional study of ERG expression and the relationship with clinicopathological features of Prostate cancer in Southwestern Uganda
Authors: Mitala Yekosani , Ssenkumba Brian , Birungi Abraham , Kiconco Ritah , Mutakooha Marvin Mwesigwa , Atwine Raymond
Published: May 2024

Background

Prostate cancer is the leading cause of cancer-related death and the second most commonly diagnosed cancer among men in Uganda and most countries in Sub-Saharan Africa (SSA). The TMPRSS2-ERG fusion gene is the most common genetic alteration seen among prostate cancer patients. There are several contradicting reports about the association of ERG protein with poor prognosis, high PSA, and Gleason score. This study determined the prevalence of ERG expression and the relationship with PSA, Gleason score, and Age of prostate cancer patients in Southwestern Uganda.

Methods

We reviewed 130 archived prostate biopsy (needle and TURP) specimens from patients of age ≥ 50 years who had a histological diagnosis of prostate cancer. We obtained their biodata, and preoperative PSA, from the archived records. We did Immunohistochemistry (IHC) to determine the prevalence of ERG expression.

Results

The mean patient age in our study was 74.64 ± 10.19 years. Pre-operative PSA levels had been done for 79.2% of the participants. Most cancers (58.46%) were of high grade (grade group 3–5). ERG expression prevalence was 75.4% and its expression was independent of age, re-operative PSA, and Gleason score.

Conclusion

There is a significantly higher prevalence of ERG expression in our study compared to what is reported in other African-based studies. The expression of the ERG is independent of age, Gleason score, and serum PSA levels. A high proportion of our prostate cancer has high-grade disease at the time of diagnosis.