bluuebunny/crossref_metadata_2025 huggingface dataset:
Biomimetic retractable DNA nanocarrier with sensitive responsivity for efficient drug delivery and enhanced photothermal therapy
Authors: Yang Yuanhuan , Cai Xueting , Shi Menglin , Zhang Xiaobo , Pan Yang , Zhang Yue , Ju Huangxian , Cao Peng
Published: February 2023

Background

The coalition of DNA nanotechnology with diversiform inorganic nanoparticles offers powerful tools for the design and construction of stimuli-responsive drug delivery systems with spatiotemporal controllability, but it remains challenging to achieve high-density oligonucleotides modification close to inorganic nanocores for their sensitive responsivity to optical or thermal signals.

Results

Inspired by Actinia with retractable tentacles, here we design an artificial nano-Actinia consisted of collapsible DNA architectures attached on gold nanoparticle (AuNP) for efficient drug delivery and enhanced photothermal therapy. The collapsible spheroidal architectures are formed by the hybridization of long DNA strand produced in situ through rolling circle amplification with bundling DNA strands, and contain numerous double-helical segments for the intercalative binding of quercetin as the anti-cancer drug. Under 800-nm light irradiation, the photothermal conversion of AuNPs induces intensive localized heating, which unwinds the double helixes and leads to the disassembly of DNA nanospheres on the surface of AuNPs. The consequently released quercetin can inhibit the expression of heat shock protein 27 and decrease the thermal resistance of tumor cells, thus enhancing photothermal therapy efficacy.

Conclusions

By combining the deformable DNA nanostructures with gold nanocores, this Actinia-mimetic nanocarrier presents a promising tool for the development of DNA-AuNPs complex and opens a new horizon for the stimuli-responsive drug delivery.

Graphical Abstract
Melatonin and 5-fluorouracil combination chemotherapy: opportunities and efficacy in cancer therapy
Authors: Mafi Alireza , Rezaee Malihe , Hedayati Neda , Hogan Sara Diana , Reiter Russel J. , Aarabi Mohammad-Hossein , Asemi Zatollah
Published: February 2023

Combined chemotherapy is a treatment method based on the simultaneous use of two or more therapeutic agents; it is frequently necessary to produce a more effective treatment for cancer patients. Such combined treatments often improve the outcomes over that of the monotherapy approach, as the drugs synergistically target critical cell signaling pathways or work independently at different oncostatic sites. A better prognosis has been reported in patients treated with combination therapy than in patients treated with single drug chemotherapy. In recent decades, 5-fluorouracil (5-FU) has become one of the most widely used chemotherapy agents in cancer treatment. This medication, which is soluble in water, is used as the first line of anti-neoplastic agent in the treatment of several cancer types including breast, head and neck, stomach and colon cancer. Within the last three decades, many studies have investigated melatonin as an anti-cancer agent; this molecule exhibits various functions in controlling the behavior of cancer cells, such as inhibiting cell growth, inducing apoptosis, and inhibiting invasion. The aim of this review is to comprehensively evaluate the role of melatonin as a complementary agent with 5-FU-based chemotherapy for cancers. Additionally, we identify the potential common signaling pathways by which melatonin and 5-FU interact to enhance the efficacy of the combined therapy.

Graphic abstract
Targeting and regulation of autophagy in hepatocellular carcinoma: revisiting the molecular interactions and mechanisms for new therapy approaches
Authors: Hashemi Mehrdad , Nadafzadeh Niloufar , Imani Mohammad Hassan , Rajabi Romina , Ziaolhagh Setayesh , Bayanzadeh Seyedeh Delaram , Norouzi Raheleh , Rafiei Reihaneh , Koohpar Zeinab Khazaei , Raei Behnaz , Zandieh Mohammad Arad , Salimimoghadam Shokooh , Entezari Maliheh , Taheriazam Afshin , Alexiou Athanasios , Papadakis Marios , Tan Shing Cheng
Published: February 2023

Autophagy is an evolutionarily conserved process that plays a role in regulating homeostasis under physiological conditions. However, dysregulation of autophagy is observed in the development of human diseases, especially cancer. Autophagy has reciprocal functions in cancer and may be responsible for either survival or death. Hepatocellular carcinoma (HCC) is one of the most lethal and common malignancies of the liver, and smoking, infection, and alcohol consumption can lead to its development. Genetic mutations and alterations in molecular processes can exacerbate the progression of HCC. The function of autophagy in HCC is controversial and may be both tumor suppressive and tumor promoting. Activation of autophagy may affect apoptosis in HCC and is a regulator of proliferation and glucose metabolism. Induction of autophagy may promote tumor metastasis via induction of EMT. In addition, autophagy is a regulator of stem cell formation in HCC, and pro-survival autophagy leads to cancer cell resistance to chemotherapy and radiotherapy. Targeting autophagy impairs growth and metastasis in HCC and improves tumor cell response to therapy. Of note, a large number of signaling pathways such as STAT3, Wnt, miRNAs, lncRNAs, and circRNAs regulate autophagy in HCC. Moreover, regulation of autophagy (induction or inhibition) by antitumor agents could be suggested for effective treatment of HCC. In this paper, we comprehensively review the role and mechanisms of autophagy in HCC and discuss the potential benefit of targeting this process in the treatment of the cancer.

Graphical abstract
Renal nerve stimulation identifies renal innervation and optimizes the strategy for renal denervation in canine
Authors: Liu Hang , Li Yidan , Zhou Hao , Chen Weijie , Xu Yanping , Du Huaan , Zhang Bo , Xia Tianli , Li Dan , Ou Zhenhong , Tang Ruotian , Chen Qingsong , Zhao Binyi , Yin Yuehui
Published: February 2023

Background

Renal denervation (RDN) was still performed without any intra-procedural method for nerve mapping. Whether renal nerve stimulation (RNS) is an efficient way to identify renal autonomic innervation and optimize the strategy for RDN remain to be worthy for further exploration.

Methods

The characteristics of renal autonomic innervation at the sites with different blood pressure (BP) responses to RNS were explored. Then, dogs anatomically eligible for RDN were randomly assigned into elevated BP response ablation group, reduced BP response ablation group, and RNS-control group. The postoperative outcomes were measured at baseline and after 4 weeks follow-up.

Results

The proportion of afferent sensory nerve was higher at elevated BP response sites (ERS) than reduced BP response sites (RRS) and non-response sites (NRS) (P = 0.012 and P = 0.004). Conversely, the proportion of parasympathetic nerve at RRS was the highest (RRS vs. ERS, P = 0.017; RRS vs. NRS, P = 0.023). More importantly, there was a significant correlation between systolic blood pressure changes and the area ratios of afferent sensory and parasympathetic nerve (R = 0.859; P < 0.001). In addition, ablation at BP-elevation sites can result in a significant decrease in BP and plasma norepinephrine (NE) after 4 weeks (P = 0.002; P = 0.008), while ablation at BP-reduction sites can lead to significant increases in BP and plasma NE (P = 0.016; P = 0.033).

Conclusions

RNS is an effective method to identify renal autonomic innervation. It could not only help to identify optimal target sites, but also avoid ablation of sympathetic-inhibitory areas during RDN.
Exploring the effects of COVID-19 on family planning: results from a qualitative study in rural Uganda following COVID-19 lockdown
Authors: Sileo Katelyn M. , Muhumuza Christine , Helal Teddy , Olfers Allison , Lule Haruna , Sekamatte Samuel , Kershaw Trace S. , Wanyenze Rhoda K. , Kiene Susan M.
Published: February 2023

Background

The COVID-19 pandemic has likely affected the already high unmet need for family planning in low- and middle-income countries. This qualitative study used Andersen’s Behavioral Model of Health Service Use as a theoretical framework to explore the possible ways in which the COVID-19 pandemic, including the impact of a 3-month government mandated lockdown, might affect family planning outcomes in rural Uganda. A secondary aim was to elicit recommendations to improve family planning service delivery in the context of COVID-19.

Methods

Between June and October 2020, we conducted four focus group discussions with men and women separately (N = 26) who had an unmet need for family planning, and 15 key-informant interviews with community leaders and family planning stakeholders. Data were analyzed using thematic analysis.

Results

We identified a significant disruption to the delivery of family planning services due to COVID-19, with potential negative effects on contraceptive use and risk for unintended pregnancy. COVID-19 had a negative effect on individual enabling factors such as family income, affecting service access, and on community enabling factors, such as transportation barriers and the disruption of community-based family planning delivery through village health teams and mobile clinics. Participants felt COVID-19 lockdown restrictions exacerbated existing contextual predisposing factors related to poverty and gender inequity, such as intimate partner violence and power inequities that diminish women’s ability to refuse sex with their husband and their autonomy to use contraceptives. Recommendations to improve family planning service delivery in the context of COVID-19 centered on emergency preparedness, strengthening community health systems, and creating new ways to safely deliver contractive methods directly to communities during future COVID-19 lockdowns.

Conclusions

This study highlights the consequences of COVID-19 lockdown on family planning distribution, as well as the exacerbation of gender inequities that limit women’s autonomy in pregnancy prevention measures. To improve family planning service uptake in the context of COVID-19, there is a need to strengthen emergency preparedness and response, utilize community structures for contraceptive delivery, and address the underlying gender inequities that affect care seeking and service utilization.
Porcine circovirus 3 (PCV-3) variability: Is it in the virus or in the classification criteria?
Authors: Franzo Giovanni , Segalés Joaquim
Published: February 2023

The continuous discovery of new viruses during the last decades has increased the need for new classification approaches and rules. Currently, the International Committee on Taxonomy of Viruses classifies viruses up to the species level. However, because of the higher variability of most of these infectious agents, a below-species categorization is often required for proper epidemiological investigations. Unfortunately, variable criteria are typically proposed by different research groups, leading to misleading and poorly reproducible results. This scenario occurred for the recently identified Porcine circovirus 3. Although genotype definition standards had been defined by a group of experts in the field, recent articles have been published introducing new genotypes, whose classification rules are not reported. We therefore would like to stress the usefulness of defining and maintaining a common language to allow proper results comparison among groups. We consider the consensus opinion of a heterogeneous expert team as the most valuable approach. Nevertheless, if other approaches are proposed, the disclosure of the criteria and the comparison with previous literature should be deemed mandatory to allow effective results reproducibility, interpretation and sharing.
Surgical correction of a ventricular septal defect in a child with spinal muscular atrophy type 2 treated with nusinersen sodium: a case report
Authors: Biçer Mehmet , Kozan Şima , Öztürk Figen , Akçay Ayfer Arduç
Published: February 2023

Introduction

Spinal muscular atrophy (SMA) is a severe, inherited neuromuscular disorder characterized by progressive muscle weakness and atrophy. Cardiac pathology co-existence is reported more frequently in the severely affected patient groups. Structural heart anomalies, mainly septal, and outflow tract defects are commonly observed pathologies.

Case presentation

We herein report the case of a 23 days-old female patient with the diagnosis of spinal muscular atrophy type 2 complicated with structural heart defects. Successful pulmonary banding, and at the age of 17 months, subsequent surgical atrial and ventricular septal defect closure were performed on our patient who was under treatment of Nusinersen Sodium. Post-operative recovery was uncomplicated. Cardiac assessments were normal, and the patient was neurologically improving in her recent follow-up.

Conclusion

In the literature, there are no reported cases of successful surgical repair of heart defects in spinal muscular atrophy patients. These patients can be perceived as risky surgical candidates with suboptimal postoperative recovery given the unfavorable disease prognosis of SMA in untreated patients. We report our promising experience with a SMA type 2 patient undergoing a disease-modifying medical treatment. The SMA patients under treatment may be potential candidates for successful surgical cardiac correction given their overall improved prognosis.
Slight religiosity associated with a lower incidence of any fracture among healthy people in a multireligious country
Authors: Kobayashi Daiki , Kuga Hironori , Shimbo Takuro
Published: February 2023

Background

The aim of this study was to evaluate the association between the degree of religiosity and subsequent fractures and a decrease in bone mineral density in a Japanese population.

Methods

We conducted a retrospective longitudinal study at St. Luke’s International Hospital in Tokyo, Japan, from 2005 to 2018. All participants who underwent voluntary health check-ups were included. Our outcomes were any fractures and the change in T-score from baseline to each visit. We compared these outcomes by the self-reported degree of religiosity (not at all; slightly; somewhat; very) and adjusted for potential confounders.

Results

A total of 65,898 participants were included in our study. Their mean age was 46.2(SD:12.2) years, and 33,014(50.1%) were male. During a median follow-up of 2,500 days (interquartile range (IQR):987–3,970), 2,753(4.2%) experienced fractures, and their mean delta T-score was -0.03%(SD:18.3). In multivariable longitudinal analyses, the slightly religious group had a statistically lower adjusted odds ratio (AOR) for a fracture than the nonreligious group(AOR:0.81,95% confidence interval(CI):0.71 to 0.92).

Conclusions

We demonstrated that slightly religious people, but not somewhat or very religious people, had a lower incidence of fracture than nonreligious individuals, although the T-scores were similar regardless of the degree of religiosity.
Independent predictive value of blood inflammatory composite markers in ovarian cancer: recent clinical evidence and perspective focusing on NLR and PLR
Authors: Zhang Chuan-long , Jiang Xiao-chen , Li Yi , Pan Xue , Gao Meng-qi , Chen Yan , Pang Bo
Published: February 2023

Ovarian cancer (OC) is one of the deadliest malignant tumors affecting women worldwide. The predictive value of some blood inflammatory composite markers in OC has been extensively reported. They can be used for early detection and differential diagnosis of OC and can be used for predicting survival, treatment response, and recurrence in the affected patients. Here, we reviewed the predictive values of composite inflammatory markers based on complete blood count, namely neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio, and systemic inflammation index and markers based on blood protein, namely C-reactive protein-to-albumin ratio and prognostic nutritional index in OC, with a focus on NLR and PLR. We referred to the clinical studies on these six markers, reviewed the patient population, and summarized the marker cut-off values, significance, and limitations of these studies. All these studies were retrospective and most of them were single-center clinical studies with small sample sizes. We found that the cut-off values of these markers have not been unified, and methods used to determine these values varied among studies. The predictive value of these markers on survival was mainly reflected in the postoperative patients of multiple subtypes of ovarian cancer including epithelial OC, high-grade serous ovarian carcinoma, and ovarian clear cell carcinoma. We focused on NLR and PLR and calculated their pooled hazard ratios. NLR and PLR were reliable in predicting overall and progression-free survivals in patients with OC. Therefore, it is necessary to adjust important confounding factors and conduct a long-term follow-up prospective cohort study to further clarify the cut-off values of NLR and PLR and their clinical applications.
REPAC: analysis of alternative polyadenylation from RNA-sequencing data
Authors: Imada Eddie L. , Wilks Christopher , Langmead Ben , Marchionni Luigi
Published: February 2023

Alternative polyadenylation (APA) is an important post-transcriptional mechanism that has major implications in biological processes and diseases. Although specialized sequencing methods for polyadenylation exist, availability of these data are limited compared to RNA-sequencing data. We developed REPAC, a framework for the analysis of APA from RNA-sequencing data. Using REPAC, we investigate the landscape of APA caused by activation of B cells. We also show that REPAC is faster than alternative methods by at least 7-fold and that it scales well to hundreds of samples. Overall, the REPAC method offers an accurate, easy, and convenient solution for the exploration of APA.
DNA virome of ticks in the Northeast and Hubei provinces of China reveals diverse single-stranded circular DNA viruses
Authors: Liu Yuhang , Guo Lei , Wang Guoshuai , Gao Fei , Tu Zhongzhong , Xu Deming , Sun Lanshun , Yi Le , Zhu Guoqiang , Tu Changchun , He Biao
Published: February 2023

Background

Ticks are medically important vectors capable of transmitting a variety of pathogens to and between host species. Although the spectrum of tick-borne RNA viruses has been frequently investigated, the diversity of tick-borne DNA viruses remains largely unknown.

Methods

A total of 1571 ticks were collected from forests and infested animals, and the diversity of the viruses they harbored was profiled using a DNA-specific virome method. The viromic data were phylogenetically analyzed and validated by PCR assays.

Results

Although diverse and abundant prokaryotic viruses were identified in the collected ticks, only eukaryotic DNA viruses with single-stranded circular genomes covering the anelloviruses and circular replication-associated (Rep) protein-encoding single-stranded (CRESS) DNA viruses were recovered from ticks. Anelloviruses were detected only in two tick pools, but CRESS DNA viruses were prevalent across these ticks except in one pool of Dermacentor spp. ticks. Phylogenetic analyses revealed that these tick-borne CRESS DNA viruses were related to viruses recovered from animal feces, tissues and even environmental samples, suggesting that their presence may be largely explained by environmental factors rather than by tick species and host blood meals.

Conclusions

Based on the results, tick-borne eukaryotic DNA viruses appear to be much less common than eukaryotic RNA viruses. Investigations involving a wider collection area and more diverse tick species are required to further support this speculation.

Graphical Abstract
Feasibility of tele-guided patient-administered lung ultrasound in heart failure
Authors: Pratzer Ariella , Yuriditsky Eugene , Saraon Tajinderpal , Janjigian Michael , Hafiz Ali , Tsay Jun-Chieh J. , Boodram Pamela , Jejurikar Nikita , Sauthoff Harald
Published: February 2023

Background

Readmission rates for heart failure remain high, and affordable technology for early detection of heart failure decompensation in the home environment is needed. Lung ultrasound has been shown to be a sensitive tool to detect pulmonary congestion due to heart failure, and monitoring patients in their home environment with lung ultrasound could help to prevent hospital admissions. The aim of this project was to investigate whether patient-performed tele-guided ultrasound in the home environment using an ultraportable device is feasible.Affiliations: Journal instruction requires a country for affiliations; however, these are missing in affiliations [1, 2]. Please verify if the provided country are correct and amend if necessary.Correct

Methods

Stable ambulatory patients with heart failure received a handheld ultrasound probe connected to a smart phone or tablet. Instructions for setup were given in person during a clinic visit or over the phone. During each ultrasound session, patients obtained six ultrasound clips from the anterior and lateral chest with verbal and visual tele-guidance from an ultrasound trained clinician. Patients also reported their weight and degree of dyspnea, graded on a 5-point scale. Two independent reviewers graded the ultrasound clips based on the visibility of the pleural line and A or B lines.

Results

Eight stable heart failure patients each performed 10–12 lung ultrasound examinations at home under remote guidance within a 1-month period. There were no major technical difficulties. A total of 89 ultrasound sessions resulted in 534 clips of which 88% (reviewer 1) and 84% (reviewer 2) were interpretable. 91% of ultrasound sessions produced interpretable clips bilaterally from the lateral chest area, which is most sensitive for the detection of pulmonary congestion. The average time to complete an ultrasound session was 5 min with even shorter recording times for the last session. All patients were clinically stable during the study period and no false positive B-lines were observed.

Conclusions

In this feasibility study, patients were able to produce interpretable lung ultrasound exams in more than 90% of remotely supervised sessions in their home environment. Larger studies are needed to determine whether remotely guided lung ultrasound could be useful to detect heart failure decompensation early in the home environment.
“Work WITH us”: a Delphi study about improving eating disorder treatment for autistic women with anorexia nervosa
Authors: Field Sarah L. , Fox John R. E. , Jones Catherine R. G. , Williams Marc O.
Published: February 2023

Background

There is an increased prevalence of anorexia nervosa (AN) in autistic women and this group has poorer treatment outcomes compared to non-autistic women with AN. However, there is little research into improving eating disorder treatment for autistic women. This study investigated how best to support autistic women with AN within eating disorder services.

Method

A three-stage Delphi study was conducted with 49 participants with relevant expertise as a researcher, clinician, or expert by experience.

Results

A total of 70 statements were generated, with 56 reaching consensus after the final round. Statements reaching consensus made recommendations for adaptations to treatment, staff training, and service organisation.

Conclusions

The results highlight the need to distinguish between autism- and AN-related difficulties, accommodate autistic traits such as sensory sensitivities and communication differences, and ensure the autistic voice is present in both the development and delivery of care. Future research should investigate the impact of these adaptations on outcomes. The applicability of these recommendations to autistic people with other eating disorders and of other genders needs to be investigated further.
Promoting engineering students’ social responsibility and willingness to act on socioscientific issues
Authors: Hwang Yohan , Ko Yeonjoo , Shim Sungok Serena , Ok Seung-Yong , Lee Hyunju
Published: February 2023

Background

Despite increasing awareness of the importance of promoting the social responsibility of science, technology, engineering, and mathematics (STEM) professionals, few intervention programs have been developed to enhance the social responsibility of college students or adults in the STEM fields. In this paper, we introduced a new instructional program, called ENACT (engage, navigate, anticipate, conduct, and take action) and examined whether the program increased the social responsibility among safety engineering students (N = 46) recruited from a university located in a southern metropolitan area of South Korea.

Results

In the ENACT program, the college students selected and explored socioscientific issues (SSIs) of their own interest then autonomously engaged in scientific and engineering group projects spanning a semester where they developed solutions to the SSIs and shared them with their communities. At the conclusion of the intervention in this study, they displayed an increased social responsibility regarding the consideration of societal needs and demands, civic engagement and services, and participation in policy decision-making. Social responsibility scores measured after the intervention (post-test) correlated with students' willingness to voluntarily participate in projects involving SSIs. In addition, the intervention effects were more pronounced for the students who initially had medium and low social responsibility scores.

Conclusions

We have shown that social responsibility can be nurtured by systemic instructional approaches, and increased social responsibility can lead to greater commitment to resolving SSIs. Mastering engineering content knowledge and skills is the key element of engineering curricula. However, we are compelled to incorporate social responsibility into the STEM curriculum. We believe that the ENACT model contributes toward this end.
Postoperative regular use of a self‐rehabilitation mobile application for more than two weeks reduces extension deficit and cyclop syndrome after anterior cruciate ligament reconstruction
Authors: Foissey Constant , Abid Hichem , Freychet Benjamin , Sonnery‐Cottet Bertrand , Thaunat Mathieu , Fayard Jean‐Marie
Published: February 2023

Purpose

To investigate the minimum use that correlates with the best outcomes in term of complications associated with self‐directed rehabilitation mobile application and to explore the user profile and usage habits.

Methods

This was a single‐center retrospective study of 356 patients who underwent ACL reconstruction surgery between November 2019 and August 2020. Complications were defined as the presence of an extension deficit ≥ 5° after 6 weeks and/or the presence of cyclops syndrome. The demographics, sports competition level and number of connections were collected by the application.

Results

The complication rate was reduced 4.2‐fold with at least 2 weeks of use (2.4% (3/123) (with 0.8% (1/123) of cyclops syndrome) versus 10.8% (23/212) (with 3.3% (7/212) cyclops syndrome), p = .04). The mean duration of use was 20 ± 23 days with a frequency of 2.1 ± 2.3 connections per day. The usage rate was 50% in week 1, 35% in week 2, and 24% in week 3. There was one peak in the abandon rate during the first few days of use and a second peak at Day 10 when physiotherapy sessions started. There were two dips in the abandon rate associated with the follow‐up visits at Days 21 and 45. Greater use was found in older patients (p = .0001) and female patients (p = .04).

Conclusions

When using the application for a minimum of 2 weeks, the risk of complications was reduced 4.2‐fold. The typical users of a self‐directed rehabilitation application after ACL surgery in this study were women and patients over 30 years of age.

Level of evidence

IV, retrospective.
Immunogenicity of decellularized extracellular matrix scaffolds: a bottleneck in tissue engineering and regenerative medicine
Authors: Kasravi Mohammadreza , Ahmadi Armin , Babajani Amirhesam , Mazloomnejad Radman , Hatamnejad Mohammad Reza , Shariatzadeh Siavash , Bahrami Soheyl , Niknejad Hassan
Published: February 2023

Tissue-engineered decellularized extracellular matrix (ECM) scaffolds hold great potential to address the donor shortage as well as immunologic rejection attributed to cells in conventional tissue/organ transplantation. Decellularization, as the key process in manufacturing ECM scaffolds, removes immunogen cell materials and significantly alleviates the immunogenicity and biocompatibility of derived scaffolds. However, the application of these bioscaffolds still confronts major immunologic challenges. This review discusses the interplay between damage-associated molecular patterns (DAMPs) and antigens as the main inducers of innate and adaptive immunity to aid in manufacturing biocompatible grafts with desirable immunogenicity. It also appraises the impact of various decellularization methodologies (i.e., apoptosis-assisted techniques) on provoking immune responses that participate in rejecting allogenic and xenogeneic decellularized scaffolds. In addition, the key research findings regarding the contribution of ECM alterations, cytotoxicity issues, graft sourcing, and implantation site to the immunogenicity of decellularized tissues/organs are comprehensively considered. Finally, it discusses practical solutions to overcome immunogenicity, including antigen masking by crosslinking, sterilization optimization, and antigen removal techniques such as selective antigen removal and sequential antigen solubilization.
Prevalence of discontinuation of contraceptives due to failure among women aged 14 to 49 years in Uganda: a nation wide cross-sectional survey
Authors: Kisuza Ruth Ketty , Kicaber Saviour , Abila Derrick Bary , Bongomin Felix , Garimoi Christopher Orach
Published: February 2023

Background

Sustained motivation is essential for effective use of contraceptive methods by women in low- and middle-income countries as many women are likely to abandon contraceptives, especially when they continually experience episodes of failure. We aimed to determine the prevalence of discontinuation of contraceptives due to failure and its associated factors among Ugandan women aged 14–49 years.

Methods

A cross sectional study was conducted using the UDHS 2016 data. Multi stage stratified sampling was used to select participants. All eligible women aged 15 to 49 years at the time of the survey were enrolled. Bivariable and Multivariable logistic regression analysis were used to determine the factors associated with contraceptive failure. All analysis were done using Stata version 13. Contraceptive failure (getting pregnant while on contraceptives) within five years preceding the survey was the dependent variable.

Results

A total of 9061 women were included in the study. The overall prevalence of contraceptive failure was 5.6% [n = 506, 95% CI: 5.1–6.1] and was higher (6.2%) among women aged 20–29 years or had completed secondary education (6.1%). Having informed choice on contraceptives [aOR = 0.59, 95% CI: 0.49 – 0.72] and older age [aOR = 0.46, 95% CI: 0.24–0.89] were associated with lower odds of contraceptive failure.

Conclusion

The burden of contraceptive failure among women of reproductive age in Uganda is substantial and significantly varied by women's age, level of education, exposure to the internet, mass media, and informed choice. These findings highlight the need for improved counseling services and contraceptive quality to help women and couples use methods correctly and consistently.
Cytotoxicity associated with acute and chronic administration of synthetic cannabinoids “Strox” in the brain, liver, heart, and testes of male albino rats: histological and immunohistochemical study
Authors: Abdelmoneim Wafaa M. , Bakr Marwa H. , Ghandour Nagwa M. , Mohammed Marwa Kh. , Fawzy Mohamed , Ramadan Abdelrahman G. , Abdellah Nora Z.
Published: February 2023

Background

Synthetic cannabinoids are one of the largest groups of new psychoactive substances that invaded Egypt’s drug abuse market over the past few years.

Aim

Randomized controlled trial study to demonstrate the effects of acute and chronic toxicity by synthetic cannabinoid (Strox) on the brain, liver, heart, and testes in adult male albino rats through histopathological examination by light microscope and immunohistochemistry.

Methods

Total number of fifty male albino rats were divided into five different groups, two control and three treated groups. Negative and positive control groups received distilled water and dimethyl sulfoxide, respectively, acute group received LD50 (lethal dose 50) once and observed for 14 days, chronic group received 1/10 LD50 for 3 months, and finally chronic withdrawal groups received 1/10 LD50 for 3 months and then left 2 weeks without the substance to observe the withdrawal manifestations.

Results

The current study revealed various histopathological changes in all organs with increased expression of cannabinoid receptor 1. The most important findings observed by light microscope examination were shrinkage and degenerative changes in Purkinje cells in brain sections, abnormalities in blood sinusoids and architecture in liver section, disruption in cardiac muscle fiber in heart sections, and finally testes showed irregularities in seminiferous tubules and germinal cells. Immunohistochemical staining for caspase-3 in the brain, liver, and heart showed weak-positive reaction in acute group and a strong reaction with chronic groups. Additionally, increase in collagen fiber was observed in sections of the liver and heart of chronic group.

Conclusions

Synthetic cannabinoid sample (Strox) toxicity caused adverse effects on the brain, liver, heart, and testes as shown by increasing cannabinoid receptor 1 and caspase-3 expression.
The impact of regional deprivation on stroke incidence, treatment, and mortality in Germany
Authors: Belau Matthias Hans , Becher Heiko , Riefflin Maya , Bartig Dirk , Schwettmann Lars , Schwarzbach Christopher Jan , Grau Armin
Published: February 2023

Background

Regional deprivation has been shown to be an influential factor in stroke incidence risk. However, there is a paucity of knowledge on regional differences in stroke incidence and mortality in Germany.

Methods

We assessed data from the Diagnosis Related Groups statistics (2016–2019) and the German Federal Registry of Physicians (2019). Negative binomial regression analysis was used to examine the association between the German Index of Multiple Deprivation 2015 covering 401 districts and district-free cities in Germany and stroke incidence, treatment, and mortality.

Results

The adjusted rate ratios of stroke incidence and mortality with the highest deprivation level compared with the least deprived area were 1.161 (95% CI [1.143, 1.179]) and 1.193 (95% CI [1.148, 1.239]), respectively. Moreover, this study revealed that physician density was higher in district-free cities compared to districts.

Conclusions

Our results indicate that regional deprivation is associated with incident and mortality cases of stroke, necessitating a more targeted approach to stroke prevention in deprived regions.
Subsidizing the Costs of Loyalty: Lima, Montevideo, and the Making of the Loyalist Río de la Plata, 1810–1814
Authors: Caso Bello Álvaro
Published: February 2023

This article rereads the history of loyalist Montevideo through the prism of intraimperial fiscal cooperation and redistribution. On the eve of Buenos Aires’ 1810 revolution, Montevideo received close to one million pesos in external fiscal subsidies; such supplements to its meager tax base help account for its loyalism. As Spain proved unable to directly assist loyal Montevideanos, regency appointees and local corporations turned to loyalist authorities and locals in Lima, Peru. Through original archival research in Peru, Spain, and Uruguay, this article gives the first detailed account of the multiple seaborne missions sent from Montevideo to Lima, which by 1814 secured more than a half-million pesos in monetary assistance. These funds not only sustained military and naval campaigns but also assured big and small imperial stakeholders that the system of fiscal transfers that benefited them had not been brought to a complete halt.
Envisioning African Intersex
Authors: Swarr Amanda Lock
Published: February 2023

Since the 1600s, travelers, scientists, and doctors have claimed that “hermaphroditism” and intersex are disproportionately common among black South Africans. In Envisioning African Intersex Amanda Lock Swarr debunks this claim by interrogating contemporary intersex medicine and demonstrating its indivisibility from colonial ideologies and scientific racism. Tracing the history of racialized research that underpins medical and scientific premises of gendered bodies, Swarr analyzes decolonial actions by intersex South Africans from the 1990s to the present, centering the work of organizers such as Sally Gross, the first openly intersex activist in Africa and a global pioneer of intersex legislation. Swarr also explores African social media activism that advocates for intersex justice and challenges the mistreatment of South African Olympian Caster Semenya. Throughout, Swarr shows how activists displace doctors’ impositions to fashion self-representation. By unseating colonial visions of gender, intersex South Africans are actively disrupting medical violence, decolonizing gender binaries, and inciting policy changes.

All author royalties from Envisioning African Intersex will be donated to Intersex South Africa.
Long-Term Seizure Freedom, Resolution of Epilepsy and Perceived Life Changes in Drug Resistant Temporal Lobe Epilepsy With Hippocampal Sclerosis: Comparison of Surgical Versus Medical Management
Authors: Jayalakshmi Sita , Vasireddy Sindhu , Sireesha Jala , Vooturi Sudhindra , Patil Anuja , Sirisha Sai , Vadapalli Rammohan , Chandrasekhar Y. B. V. K. , Panigrahi Manas
Published: February 2023

BACKGROUND:

Outcome of temporal lobe epilepsy associated with hippocampal sclerosis (TLE-HS) has rarely been evaluated exclusively.

OBJECTIVE:

To compare long-term seizure freedom, resolution of epilepsy, and perceived life changes in patients with drug-resistant TLE-HS who underwent surgery vs those who opted for best medical management.

METHODS:

In this retrospective longitudinal study, 346 patients with TLE-HS who underwent surgery were compared with 325 who received best medical management. Predictors for long-term remission, resolution of epilepsy, and seizure recurrence were analyzed.

RESULTS:

The duration of follow-up ranged from 3-18 (mean 12.61) years. The average age of study population was 28.54 ± 12.27 years with 321 (47.8%) women. Age at onset of epilepsy (11.84 ± 8.48 vs 16.29 ± 11.88;P≤ .001) was lower, and duration of epilepsy (15.65 ± 9.33 vs 12.97 ± 11.44;P< .001) was higher in the surgery group. Seizure freedom at 3 (81.8 vs 19.0%;P< .001), 5 (73% vs 16.1%;P< .001), and 10 years (78.3% vs 18.5;P< .001) and resolution of epilepsy (30.5% vs 0.6%;P< .001) was higher in the surgery group. The overall perceived life changes score was higher in the surgery group (80.96 ± 25.47 vs 66.24 ± 28.13;P< .001). At long-term follow-up (≥10 years), the presence of an aura was the strongest predictor for resolution of epilepsy (β: 2.29 [95% CI; 1.06-4.93];P= .035), whereas acute postoperative seizures (APOS) (β: 6.06 [95% CI 1.57-23.42];P< .001) and an abnormal postoperative EEG (β: 0.222 [95% CI 0.100-0.491];P< .001) were predictors of persistent seizures. Seizure freedom both at 3 and 5 years predicted seizure freedom at 10 years.

CONCLUSION:

Surgery for drug-resistant TLE-HS was associated with higher rate of long-term seizure-freedom, resolution of epilepsy, and reduction of anti-seizure medications with improvement in perceived life changes compared with best medical management. The presence of an aura was predictor for resolution of epilepsy while APOS and an abnormal postoperative EEG were predictors of persistent seizures.
Long-Term Durability of Stand-Alone Lateral Lumbar Interbody Fusion
Authors: Agarwal Nitin , White Michael D. , Roy Souvik , Ozpinar Alp , Alan Nima , Lavadi Raj Swaroop , Okonkwo David O. , Hamilton D. Kojo , Kanter Adam S.
Published: February 2023

BACKGROUND:

The long-term durability of stand-alone lateral lumbar interbody fusion (LLIF) remains unknown.

OBJECTIVE:

To evaluate whether early patient-reported outcome measures after stand-alone LLIF are sustained on long-term follow-up.

METHODS:

One hundred and twenty-six patients who underwent stand-alone LLIF between 2009 and 2017 were included in this study. Patient-reported outcome measures included the Oswestry Disability Index (ODI), EuroQOL-5D (EQ-5D), and visual analog score (VAS) scores. Durable outcomes were defined as scores showing a significant improvement between preoperative and 6-week scores without demonstrating any significant decline at future time points. A repeated measures analysis was conducted using generalized estimating equations (model) to assess the outcome across different postoperative time points, including 6 weeks, 1 year, 2 years, and 5 years.

RESULTS:

ODI scores showed durable improvement at 5-year follow-up, with scores improving from 46.9 to 38.5 (P = .001). Improvements in EQ-5D showed similar durability up to 5 years, improving from 0.48 to 0.65 (P = .03). VAS scores also demonstrated significant improvements postoperatively that were durable at 2-year follow-up, improving from 7.0 to 4.6 (P < .0001).

CONCLUSION:

Patients undergoing stand-alone LLIF were found to have significant improvements in ODI and EQ-5D at 6-week follow-up that remained durable up to 5 years postoperatively. VAS scores were found to be significantly improved at 6 weeks and up to 2 years postoperatively but failed to reach significance at 5 years. These findings demonstrate that patients undergoing stand-alone LLIF show significant improvement in overall disability after surgery that remains durable at long-term follow-up.
Orientation of Osteotomized Vertebrae in 2-Level Pedicle Subtraction Osteotomy Plays a Crucial Role in the Remodeling of Harmonious Sagittal Curve for Severe Thoracolumbar Kyphotic Deformity Caused by Ankylosing Spondylitis
Authors: Li Yao , Qian Bang-ping , Qiu Yong , Yu Yang , Wang Bin
Published: February 2023

BACKGROUND:

Few studies reported the remodeling of harmonious sagittal curve after 2-level pedicle subtraction osteotomy (PSO) for severe thoracolumbar kyphosis in ankylosing spondylitis (AS).

OBJECTIVE:

To investigate how the orientation of osteotomized vertebrae (OV) affects the remodeling of harmonious sagittal curve in patients with AS undergoing 2-level PSO.

METHODS:

Twenty-six patients treated with 2-level PSO were reviewed. Plumb lines of thoracic apex and lumbar apex, the superior/inferior endplate angle of OV, and OV tilt were measured. Patients with AS were grouped based on the postoperative lumbar lordotic apex (LLA, L3 or L4 vs L5 or others).

RESULTS:

The level of thoracic kyphotic apex was positively correlated with that of superior OV postoperatively. Larger sacral slope, L1-L3 lordotic angle, and plumb lines of lumbar apex could be obtained in patients with LLA at L3 or L4, accompanied with larger superior endplate angle of OV and OV tilt of inferior OV (P < .05). Besides, larger lumbar lordotic angle (LL) was observed in these patients (marginally significant, P = .057). For patients with relocated LLA at L5 or others, lower pelvic incidence was observed, accompanied with significant loss of correction (P < .05) and worse Visual Analog Scale scores (marginally significant, P = .054) during follow-up.

CONCLUSION:

Ventrally leaning inferior OV combined with dorsally leaning superior OV contributed to the most harmonious sagittal curve defined as thoracic kyphotic apex at T8 or above and LLA at L3 or L4. Sagittal curve with LLA at L5 could be acceptable in patients with more severe kyphosis, especially those with low pelvic incidence.
The Impact of Weather and Mode of Transport on Outcomes of Patients With Acute Ischemic Stroke Undergoing Mechanical Thrombectomy
Authors: Sioutas Georgios S. , Amllay Abdelaziz , Chen Ching-Jen , El Naamani Kareem , Abbas Rawad , Jain Paarth , Garg Ananya , Stine Emily A. , Tjoumakaris Stavropoula I. , Herial Nabeel A. , Gooch M. Reid , Zarzour Hekmat , Schmidt Richard F. , Rosenwasser Robert H. , Jabbour Pascal
Published: February 2023

BACKGROUND:

Efficient transfer to mechanical thrombectomy (MT)–capable centers is essential for patients with stroke. Weather may influence stroke risk, transportation, and outcomes.

OBJECTIVE:

To investigate how weather affects stroke patient transfer and outcomes after MT.

METHODS:

We retrospectively collected data for patients with stroke transferred from spoke to our hub hospital to undergo MT between 2017 and 2021. We examined associations between weather, transportation, and patient outcomes.

RESULTS:

We included 543 patients with a mean age of 71.7 years. The median National Institutes of Health Stroke Score increased from 14 to 15 after transportation. The median modified Rankin Scale was 4 at discharge and 90 days, and 3 at the final follow-up (mean 91.7 days). Higher daily temperatures were associated with good outcome, whereas daily drizzle was associated with poor outcome. More patients were transferred by air when visibility was better, and by ground during heavier precipitation, higher humidity, rain, mist, and daily drizzle, fog, and thunder. Patient outcomes were not associated with transportation mode. Among the independent predictors of good outcome, none was a weather variable. Lower hourly relative humidity (P = .003) and longer road distance (P < .001) were independent predictors of using air transportation, among others.

CONCLUSION:

During transportation, higher temperature was associated with good outcome, whereas daily drizzle was associated with poor outcome after MT. Although weather was associated with transportation mode, no differences in outcomes were found between transportation modes. Further studies are needed to modify transfer protocols, especially during cold and rainy days, and potentially improve outcomes.
A Guide to Indoor Rock Climbing Injuries
Authors: Leung Jonathan
Published: February 2023

Rock climbing is an increasingly popular indoor sport with a sizable risk of overuse injuries. Yet, many medical practitioners have little familiarity with evaluating and treating climbing injuries because of the terminology, biomechanical demands, mechanisms of injury, and return to sport counseling needed, unique to the sport. This review seeks to educate practitioners on these aspects. Upper extremity injuries occur more frequently than lower extremity injuries, with finger injuries being most prevalent. Pulley injuries, consisting of rupture of the A2 or A4 annular pulleys are the most common type of injury. Other finger injuries include tenosynovitis of the flexor tendons, as well as lumbrical muscle tears. Elbow injuries occur frequently, with medial epicondylopathy being most common. Brachialis injuries are seldom seen outside of climbing. Lower-extremity injuries are typically more acute in nature, including ankle injuries from falls and knee injuries from strenuous climbing moves.
A Public Sphere for AI
Authors: Tzimas Themis
Published: February 2023

The present article addresses key elements of the unique ontology of AI and argues that these require the expansion of the public sphere, in order to successfully manage the entry of new intelligent actors in legally regulated relationships which are based on the identification of causal connections. In this sense it attempts to link law and political science, given that the governance of any phenomenon or field includes law and in particular the detection, of legally interesting, causal relationships. Regulating such relationships effectively offers legal certainty, which in turn is a fundamental element of effective governance. In our self- evidently, human- centered world, whether we are talking about natural persons, or for legal persons, it is self- evident that there is, in the end, a human hand behind the causal relations with which law is involved. Once other, non- human, intelligent actors gradually enter the forefront, these causal relations become further complicated. It is on these complications and their impact that we focus.