bluuebunny/crossref_metadata_2025 huggingface dataset:
Periprocedural outcome in patients undergoing left atrial appendage occlusion with the Watchman FLX device: The ITALIAN-FLX registry
Authors: Berti Sergio , De Caterina Alberto Ranieri , Grasso Carmelo , Casu Gavino , Giacchi Giuseppe , Pagnotta Paolo , Maremmani Michele , Mazzone Patrizio , Limite Luca , Tomassini Francesco , Greco Francesco , Romeo Maria Rita , Caramanno Giuseppe , Fassini Gaetano , Geraci Salvatore , Chiarito Mauro , Tondo Claudio , Tamburino Corrado , Contarini Marco
Published: April 2023

Introduction

The Watchman FLX is a novel device for transcatheter left atrial appendage occlusion (LAAO) specifically designed to improve procedural performance in more complex anatomies with a better safety profile. Recently, small prospective non-randomized studies have shown good procedural success and safety compared with previous experiences. Results from large multicenter registries are needed to confirm the safety and efficacy of the Watchman FLX device in a real-world setting.

Methods

Italian FLX registry is a retrospective, non-randomized, multicentric study across 25 investigational centers in Italy including consecutive patients undergoing LAAO with the Watchman FLX between March 2019 and September 2021 (N = 772). The primary efficacy outcome was the technical success of the LAAO procedure (peri-device flow ≤ 5 mm) as assessed by intra-procedural imaging. The peri-procedural safety outcome was defined as the occurrence of one of the following events within 7 days after the procedure or by hospital discharge: death, stroke, transient ischemic attack, major extracranial bleeding (BARC type 3 or 5), pericardial effusion with tamponade or device embolization.

Results

A total of 772 patients were enrolled. The mean age was 76 ± 8 with a mean CHA2DS2-VASc score of 4.1 ± 1.4 and a mean HAS-BLED score of 3.7 ± 1.1. Technical success was achieved in 772 (100%) patients with the first device implanted in 760 (98.4%) patients. A peri-procedural safety outcome event occurred in 21 patients (2.7%) with major extracranial bleeding being the most common (1.7%). No device embolization occurred. At discharge 459 patients (59.4%) were treated with dual antiplatelet therapy (DAPT).

Conclusions

The Italian FLX registry represents the largest multicenter retrospective real-world study reporting periprocedural outcome of LAAO with the Watchman FLX device, resulting in a procedural success rate of 100% and a low incidence of peri-procedural major adverse events (2.7%).
Six-months clinical and intracoronary imaging follow-up after reverse T and protrusion or double-kissing and crush stenting for the treatment of complex left main bifurcation lesions
Authors: Abouelnour Amr EI , Olschewski Maximilian , Makmur Giulio , Ullrich Helen , Knorr Maike , Ahoopai Majid , Münzel Thomas , Gori Tommaso
Published: April 2023

Background

There is a debate regarding the best stent strategy for unprotected distal left main (LM) bifurcation disease. Among two-stent techniques, double-kissing and crush (DKC) is favored in current guidelines but is complex and requires expertise. Reverse T and Protrusion (rTAP) was shown to be a comparable strategy regarding short-term efficacy and safety, but with reduced procedural complexity.

Aim

To compare rTAP vs. DKC by optical coherence tomography (OCT) on the intermediate term.

Methods

52 consecutive patients with complex unprotected LM stenoses (Medina 0,1,1 or 1,1,1) were randomized to either DKC or rTAP and followed-up for a median of 189[180–263] days for clinical and OCT outcomes.

Results

At follow-up OCT showed similar change in the side branch (SB) ostial area (primary endpoint). The confluence polygon showed a higher percentage of malapposed stent struts in the rTAP group that did not reach statistical significance (rTAP: 9.7[4.4–18.3] % vs. DKC: 3[0.07–10.9] %; p = 0.064). It also showed a trend towards larger neointimal area relative to the stent area (DKC: 8.8 [6.9 to 13.4] % vs. rTAP: 6.5 [3.9 to 8.9] %; p = 0.07), and smaller luminal area (DKC: 9.54[8.09–11.07] mm2 vs. rTAP: 11.21[9.53–12.42] mm²; p = 0.09) in the DKC group. The minimum luminal area in the parent vessel distal to the bifurcation was significantly smaller in the DKC group (DKC: 4.64 [3.64 to 5.34] mm² vs. rTAP: 6.76 [5.20 to 7.29] mm²; p = 0.03). This segment also showed a trend for smaller stent areas (p = 0.05 to 0.09), and a bigger neointimal area relative to the stent area (DKC: 8.94 [5.43 to 10.5]% vs. rTAP: 4.75 [0.08 to 8.5]%; p = 0.06) in the DKC patients. The incidence of clinical events was comparably low in both groups.

Conclusion

At 6-months, OCT showed a similar change in the SB ostial area (primary endpoint) in rTAP compared to DKC. There was also a trend for smaller luminal areas in the confluence polygon and the distal parent vessel, and a larger neointimal area relative to the stent area, in DKC, along with a tendency for more malapposed stent struts in rTAP.

Clinical Trial Registration

https://clinicaltrials.gov/ct2/show/NCT03714750, identifier: NCT03714750.
Teaching efficacy of undergraduate physical education students toward concepts in physical education
Authors: Spittle Sharna , Spittle Michael , Itoh Sho , Watt Anthony P.
Published: April 2023

Introduction

This study explored teaching efficacy for activities in physical education and how this efficacy relates to confidence and motivation in teaching physical education.

Methods

Students (n = 291, M age = 20.65 years, SD = 2.72) enrolled in a physical education degree course (Bachelor of Sport Science [Physical Education] or Bachelor of Education [P-12] [Primary Physical Education]) completed two questionnaires: the Physical Education Teaching Efficacy Scale (PETES) and Confidence and Motivation to Teach Primary Physical Education Questionnaire (CMTPPE) to measure teaching efficacy, and confidence and motivation teach physical education.

Results

Participants reported lower teaching efficacy for applying scientific knowledge and teaching students with special needs, whereas they reported higher teaching efficacy for accommodating skill level differences and for instruction. Students were generally confident in management and planning in physical education, with 2nd and 3rd year students more confident than 1st year students. Intrinsic motivation for practice (to experience stimulating sensations of fun and excitement as motives for teaching physical education) and extrinsic motivation for performance (governed by rewards and restrictions by the teacher themselves) were the stronger forms of motivation for teaching physical education, whereas intrinsic motivation for knowledge (motivation teaching physical education for pleasure and satisfaction of learning new things) and disengagement (lack of motivation toward teaching physical education) were generally lower. Confidence and motivation were significantly related to teaching efficacy for most activities and confidence was more strongly related to teaching efficacy than motivation was. A path model of the relationships indicated that both year level and course influenced confidence, with confidence then influencing motivation and teaching efficacy for teaching activities in physical education.

Discussion

This study has highlighted the importance of confidence to motivation and self-efficacy for teaching activities in physical education. Practical implications include the identification of areas of lower teaching efficacy in teaching physical education and the relationships between confidence, motivation and self-efficacy in teaching activities in physical education.
Darwin’s finches in human-altered environments sing common song types and are more aggressive
Authors: Colombelli-Négrel Diane , Akçay Çağlar , Kleindorfer Sonia
Published: April 2023

Human-altered landscapes may act as an environmental filter benefiting species or individuals with specific sets of capacities or behaviors. Yet the effects of human activity on culturally transmitted traits in animals are still poorly understood. Combining song recordings and simulated territory intrusions, we investigated whether songs (a cultural trait) and aggressiveness (a personality trait) in small ground finches (Geospiza fuliginosa) differed along a gradient of human activity levels (high-low-high) spanning two habitats with contrasting levels of rainfall (arid lowlands, humid highlands). We found that more common syllable types were more prevalent in arid lowland sites and at sites with high human activity. The number of syllables per song, song duration, song tempo and song rhythmicity did not differ across habitats or levels of human activity. During simulated territorial intrusions, small ground finches living in areas with higher levels of human activity and in the arid lowlands (regardless of human activity) showed the strongest aggressive response compared to those living in areas with lower levels of human activity or in the humid highlands. Thus, prevalence of aggression and syllable commonness correlated with each other across sites. Our results support the idea that resource distribution and human-impacted environments may select jointly for specific behavioral phenotypes such as aggression as well as common cultural traits.
Short-term effects of forest gap size on soil enzyme activity in a Platycladus orientalis plantation
Authors: Fei Fei , Chen Xinli , Guan Qingwei
Published: April 2023

Introduction

Soil enzymes play a critical role in organic matter decomposition and nutrient cycling in forest ecosystems. However, the effects of forest gaps on soil enzyme activities remain uncertain.

Methods

This study aims to investigate the short-term effects of forest gap size on soil enzyme activities in Platycladus orientalis plantations. We conducted a study in a 50-year Platycladus orientalis plantation in Xuzhou, sampling soils from three levels of forest gap size (4 m radius, S; 8 m radius, M and 12 m radius, L) at different positions (within gap, edge, and outside the gap) and control plots (CK, no gaps) 2a after the creation of gaps. Soil peroxidase, dehydrogenase, urease, and invertase activities were measured.

Results

Specifically, we found that M and S gaps had significantly (p < 0.05) higher soil peroxidase activity at the outside position in April and October, respectively, than CK. Additionally, L gaps had significantly (p < 0.05) higher soil dehydrogenase activity at the outside position in April than CK. Furthermore, L and S gaps had significantly (p < 0.05) higher soil urease activity at the outside position in October and July, respectively, than CK. Lastly, L and S gaps had significantly (p < 0.05) higher soil urease activity at the outside position in July than CK.

Conclusion

Our findings highlight the significant impact of canopy gaps on soil enzyme activities, which has important implications for forest management and conservation.
Stronger microbial nutrient limitations in subsoil along the precipitation gradient of agroecosystem: insights from soil enzyme activity and stoichiometry
Authors: Yang Jingjing , Guan Pingting , Zhang Peng , Wu Yunga , Wang Deli , Wu Donghui
Published: April 2023

Introduction

Soil extracellular enzymes are central in terrestrial ecosystem responses to climate change, and their research can be crucial for assessing microbial nutrient demand. However, the effects of climate-induced precipitation patterns on soil microbial nutrient demand in different soil profiles of agroecosystems are rarely studied.

Methods

Here, we present how the precipitation gradient affects soil enzymes related to carbon (C), nitrogen (N) and phosphorus (P) cycling and identified microbial nutrient limitation determinants at five depth intervals (0–10, 10–20, 20–30, 30–40, and 40–50 cm) in seven agroecosystems.

Results and Discussion

We found that N- and P-acquiring enzymes have a tendency to decrease or increase, respectively, but C-acquiring enzymes did not change along the precipitation gradient throughout soil profiles. Soil pH and moisture were the most important factors affecting the enzyme activity in 0–50 cm. Our results also revealed a crucial soil boundary (at 20 cm) that differentiated responses of microbial nutrient limitation to precipitation changes. In the topsoil (0–20 cm), the stoichiometry of soil nutrients did not vary with precipitation. Microbial P limitation was exacerbated with increased precipitation, which was controlled by soil pH and moisture in the topsoil. In contrast, in the subsoil (20–50 cm), soil nutrient stoichiometry decreased with increasing precipitation, and microbial C and P limitation displayed a positive correlation with precipitation. Furthermore, microbial P limitation tended to be stronger in the subsoil than in the topsoil along the precipitation gradient. Microbial C and P limitation was regulated by the soil nutrients and their stoichiometry in the subsoil. Our study is an essential step in soil enzyme activity and stoichiometry response to precipitation in agroecosystems and provides novel insights into understanding microbial nutrient limitation mechanisms in soil profiles along the precipitation gradient.
Cellular and humoral responses after second and third SARS-CoV-2 vaccinations in patients with autoimmune diseases treated with rituximab: specific T cell immunity remains longer and plays a protective role against SARS-CoV-2 reinfections
Authors: Egri Natalia , Calderón Hugo , Martinez Robert , Vazquez Mario , Gómez-Caverzaschi Verónica , Pascal Mariona , Araújo Olga , Juan Manel , González-Navarro Europa Azucena , Hernández-Rodríguez José
Published: April 2023

Background

Humoral and cellular immune responses are known to be crucial for patients to recover from COVID-19 and to protect them against SARS-CoV-2 reinfection once infected or vaccinated.

Objectives

This study aimed to investigate humoral and T cell responses to SARS-CoV-2 vaccination in patients with autoimmune diseases after the second and third vaccine doses while on rituximab and their potential protective role against reinfection.

Methods

Ten COVID-19-naïve patients were included. Three time points were used for monitoring cellular and humoral responses: pre-vaccine to exclude virus exposure (time point 1) and post-second and post-third vaccine (time points 2 and 3). Specific IgG antibodies were monitored by Luminex and T cells against SARS-CoV-2 spike-protein by ELISpot and CoVITEST. All episodes of symptomatic COVID-19 were recorded.

Results

Nine patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis and one with an undifferentiated autoimmune disease were included. Nine patients received mRNA vaccines. The last rituximab infusion was administered for a mean (SD) of 15 (10) weeks before the first vaccine and six patients were CD19-B cell-depleted. After a mean (SD) of 19 (10) and 16 (2) days from the second and third vaccine dose, IgG anti-SARS-CoV-2 antibodies were detected in six (60%) and eight (80%) patients, respectively. All patients developed specific T cell responses by ELISpot and CoVITEST in time points 2 and 3. Previous B cell depletion correlated with anti-SARS-CoV-2 IgG levels. Nine (90%) patients developed mild COVID-19 after a median of 7 months of the third dose.

Conclusion

Rituximab in patients with autoimmune diseases reduces humoral responses but does not avoid the development of T cell responses to SARS-CoV-2 vaccination, which remain present after a booster dose. A steady cellular immunity appears to be protective against subsequent reinfections.
Impaired alveolar macrophage 11β-hydroxysteroid dehydrogenase type 1 reductase activity contributes to increased pulmonary inflammation and mortality in sepsis-related ARDS
Authors: Mahida Rahul Y. , Lax Siân , Bassford Christopher R. , Scott Aaron , Parekh Dhruv , Hardy Rowan S. , Naidu Babu , Matthay Michael A. , Stewart Paul M. , Cooper Mark C. , Perkins Gavin D. , Thickett David R.
Published: April 2023

Background

Acute Respiratory Distress Syndrome (ARDS) is a devastating pulmonary inflammatory disorder, commonly precipitated by sepsis. Glucocorticoids are immunomodulatory steroids that can suppress inflammation. Their anti-inflammatory properties within tissues are influenced by their pre-receptor metabolism and amplification from inactive precursors by 11β-hydroxysteroid dehydrogenase type-1 (HSD-1). We hypothesised that in sepsis-related ARDS, alveolar macrophage (AM) HSD-1 activity and glucocorticoid activation are impaired, and associated with greater inflammatory injury and worse outcomes.

Methods

We analysed broncho-alveolar lavage (BAL) and circulating glucocorticoid levels, AM HSD-1 reductase activity and Receptor for Advanced Glycation End-products (RAGE) levels in two cohorts of critically ill sepsis patients, with and without ARDS. AM HSD-1 reductase activity was also measured in lobectomy patients. We assessed inflammatory injury parameters in models of lung injury and sepsis in HSD-1 knockout (KO) and wild type (WT) mice.

Results

No difference in serum and BAL cortisol: cortisone ratios are shown between sepsis patients with and without ARDS. Across all sepsis patients, there is no association between BAL cortisol: cortisone ratio and 30-day mortality. However, AM HSD-1 reductase activity is impaired in patients with sepsis-related ARDS, compared to sepsis patients without ARDS and lobectomy patients (0.075 v 0.882 v 0.967 pM/hr/106 AMs, p=0.004). Across all sepsis patients (with and without ARDS), impaired AM HSD-1 reductase activity is associated with defective efferocytosis (r=0.804, p=0.008) and increased 30-day mortality. AM HSD-1 reductase activity negatively correlates with BAL RAGE in sepsis patients with ARDS (r=-0.427, p=0.017). Following intra-tracheal lipopolysaccharide (IT-LPS) injury, HSD-1 KO mice demonstrate increased alveolar neutrophil infiltration, apoptotic neutrophil accumulation, alveolar protein permeability and BAL RAGE concentrations compared to WT mice. Caecal Ligation and Puncture (CLP) injury in HSD-1 KO mice results in greater peritoneal apoptotic neutrophil accumulation compared to WT mice.

Conclusions

AM HSD-1 reductase activity does not shape total BAL and serum cortisol: cortisone ratios, however impaired HSD-1 autocrine signalling renders AMs insensitive to the anti-inflammatory effects of local glucocorticoids. This contributes to the decreased efferocytosis, increased BAL RAGE concentrations and mortality seen in sepsis-related ARDS. Upregulation of alveolar HSD-1 activity could restore AM function and improve clinical outcomes in these patients.
Clinical relevance of cell-free DNA quantification and qualification during the first month after lung transplantation
Authors: Pedini Pascal , Coiffard Benjamin , Cherouat Nicem , Casas Sylvia , Fina Frédéric , Boutonnet Audrey , Baudey Jean Baptiste , Aho Printil , Basire Agnes , Simon Sophie , Frassati Coralie , Chiaroni Jacques , Reynaud-Gaubert Martine , Picard Christophe
Published: April 2023

Background

Many studies have reported the relevance of donor-derived cfDNA (dd-cfDNA) after lung transplantation (LTx) to diagnose and monitor acute rejection (AR) or chronic rejection or infection (INF). However, the analysis of cfDNA fragment size has not been studied. The aim of this study was to determine the clinical relevance of dd-cfDNA and cfDNA size profiles in events (AR and INF) during the first month after LTx.

Methods

This prospective, single-center study includes 62 LTx recipients at the Marseille Nord Hospital, France. Total cfDNA quantification was performed by fluorimetry and digital PCR, dd-cfDNA by NGS (AlloSeq cfDNA-CareDX®), and the size profile by BIABooster (Adelis®). A bronchoalveolar lavage and transbronchial biopsies at D30 established the following groups: not-injured and injured graft (AR, INF, or AR+INF).

Results

Quantification of total cfDNA was not correlated with the patient’s status at D30. The percentage of dd-cfDNA was significantly higher for injured graft patients at D30 (p=0.0004). A threshold of 1.72% of dd-cfDNA correctly classified the not-injured graft patients (negative predictive value of 91.4%). Among recipients with dd-cfDNA >1.72%, the quantification of small sizes (80-120bp) >3.70% identified the INF with high performance (specificity and positive predictive value of 100%).

Conclusion

With the aim of considering cfDNA as a polyvalent non-invasive biomarker in transplantation, an algorithm combining the quantification of dd-cfDNA and small sizes of DNA may significantly classify the different types of allograft injuries.
Deep-sea freezer
Authors: Kawagucci Shinsuke , Matsui Yohei , Nomaki Hidetaka , Chen Chong
Published: April 2023

Recovery of samples from the deep ocean in pristine condition is difficult due to large environmental differences between the deep and surface waters through which the samples necessarily must be transported. Here, we propose a concept for deep-sea sample recovery: a deep-sea freezer using thermoelectric cooling capable of generating ice in the deep and recover them frozen on-board ships. As a proof of concept, we present the DSF-α, a prototype Deep-Sea Freezer based on Peltier device rated at 2000 m. In situ assessments of the DSF-α on remotely operated vehicles showed its capacity to reach freezing (-13.0°C) temperatures in the deep, as well as recovering seawater frozen on deck. Although the DSF-α is limited in that achieving sufficient freezing for useful sample recovery is time consuming, the deep-sea freezer opens a whole frontier of new possibilities for preserving various types of deep-sea samples and has the potential to be adapted according to various needs of the deep-sea research community. With the first literal ‘marine snow’ in the deep, we offer a glimpse to a future where the recovery of reliable bathyal samples is no longer laborious.
SPatiotemporal-ENcoded acoustic radiation force imaging of focused ultrasound
Authors: Qi Xu , Sun Jiayu , Zhu Jiayu , Kong Dechen , Roberts Neil , Dong Yijing , Huang Xiaoqi , He Qiang , Xing Haoyang , Gong Qiyong
Published: April 2023

Neuromodulation technology has provided novel therapeutic approaches for diseases caused by neural circuit dysfunction. Transcranial focused ultrasound (FU) is an emerging neuromodulation approach that combines noninvasiveness with relatively sharp focus, even in deep brain regions. It has numerous advantages such as high precision and good safety in neuromodulation, allowing for modulation of both peripheral and central nervous systems. To ensure accurate treatment targeting in FU neuromodulation, a magnetic resonance acoustic radiation force imaging (MR-ARFI) sequence is crucial for the visualization of the focal point. Currently, the commonly used 2D Spin Echo ARFI (2D SE-ARFI) sequence suffers from the long acquisition time, while the echo planar imaging ARFI (EPI-ARFI) sequence with a shorter acquisition time is vulnerable to the magnetic field inhomogeneities. To address these problems, we proposed a spatiotemporal-encoded acoustic radiation force imaging sequence (i.e., SE-SPEN-ARFI, shortened to SPEN-ARFI) in this study. The displacement at the focal spot obtained was highly consistent with that of the SE-ARFI sequence. Our research shows that SPEN-ARFI allows for rapid image acquisition and has less image distortions even under great field inhomogeneities. Therefore, a SPEN-ARFI sequence is a practical alternative for the treatment planning in ultrasound neuromodulation.
Surgical anatomy of sigmoid sinus with evaluation of its venous dominance for advances in preoperative planning
Authors: Zhu Chunran , Chong Yulong , Jiang Chenjun , Xu Wu , Wang Jing , Jiang Chengrong , Liang Weibang , Wang Bei
Published: April 2023

Microvascular decompression (MVD) is a widely adopted neurosurgery in treating cranial nerve diseases providing long-term pain relief. Improving surgical techniques has been a focus of recent studies. Venous structures such as the sigmoid sinus are essential to protect, and whose risk of destruction during surgery increases with size. The medical records of patients who went through MRI ahead of MVD surgery between Dec 2020 and Dec 2021 were reviewed. Section area of sigmoid sinus calculated from the MRI plane of auditory nerve showed a right dominance of the sinus. The improved method concerning the relationship between affected side and the dominant sigmoid sinus offered a better bone window and surgical field by planning the operation incision in advance. Intraoperative adjustment of the bone flap was avoided, and the risk of destructing the sigmoid sinus was reduced.
Evaluating the Talbot-Plateau law
Authors: Greene Ernest , Morrison Jack
Published: April 2023

The Talbot-Plateau law asserts that when the flux (light energy) of a flicker-fused stimulus equals the flux of a steady stimulus, they will appear equal in brightness. To be perceived as flicker-fused, the frequency of the flash sequence must be high enough that no flicker is perceived, i.e., it appears to be a steady stimulus. Generally, this law has been accepted as being true across all brightness levels, and across all combinations of flash duration and frequency that generate the matching flux level. Two experiments that were conducted to test the law found significant departures from its predictions, but these were small relative to the large range of flash intensities that were tested.
ARA-net: an attention-aware retinal atrophy segmentation network coping with fundus images
Authors: Chen Lei , Zhou Yuying , Gao Songyang , Li Manyu , Tan Hai , Wan Zhijiang
Published: April 2023

Background

Accurately detecting and segmenting areas of retinal atrophy are paramount for early medical intervention in pathological myopia (PM). However, segmenting retinal atrophic areas based on a two-dimensional (2D) fundus image poses several challenges, such as blurred boundaries, irregular shapes, and size variation. To overcome these challenges, we have proposed an attention-aware retinal atrophy segmentation network (ARA-Net) to segment retinal atrophy areas from the 2D fundus image.

Methods

In particular, the ARA-Net adopts a similar strategy as UNet to perform the area segmentation. Skip self-attention connection (SSA) block, comprising a shortcut and a parallel polarized self-attention (PPSA) block, has been proposed to deal with the challenges of blurred boundaries and irregular shapes of the retinal atrophic region. Further, we have proposed a multi-scale feature flow (MSFF) to challenge the size variation. We have added the flow between the SSA connection blocks, allowing for capturing considerable semantic information to detect retinal atrophy in various area sizes.

Results

The proposed method has been validated on the Pathological Myopia (PALM) dataset. Experimental results demonstrate that our method yields a high dice coefficient (DICE) of 84.26%, Jaccard index (JAC) of 72.80%, and F1-score of 84.57%, which outperforms other methods significantly.

Conclusion

Our results have demonstrated that ARA-Net is an effective and efficient approach for retinal atrophic area segmentation in PM.
Communication and information sharing with pediatric patients including refugees with advanced cancer, their caregivers, and health care professionals in Jordan: a qualitative study
Authors: Alarjeh Ghadeer , Boufkhed Sabah , Alrjoub Waleed , Guo Ping , Yurduşen Sema , Ahmed Fahad , Abdal-Rahman Mousa , Alajarmeh Sawsan , Alnassan Anwar , Al-Awady Shireen , Kutluk Tezer , Harding Richard , Shamieh Omar
Published: April 2023

Introduction

Effective communication in pediatric palliative cancer care is an important aspect of practice to enhance patient- and family-centered care, and to optimize decision-making. However, little is known about communication preferences practices from the perspectives of children, caregivers and their health care professionals (HCPs) in the Middle Eastern region. Furthermore, involving children in research is crucial but limited. This study aimed to describe the communication and information-sharing preferences and practices of children with advanced cancer, their caregivers, and health care professionals in Jordan.

Methods

A qualitative cross-sectional study was conducted using semi-structured face to face interviews with three groups of stakeholders (children, caregivers and HCPs). Purposive sampling recruited a diverse sample from inpatient and outpatient settings at a tertiary cancer center in Jordan. Procedures were in line with the Consolidated criteria for reporting qualitative research (COREQ) reporting guidelines. Verbatim transcripts were thematically analyzed.

Findings

Fifty-two stakeholders participated: 43 Jordanian and 9 refugees (25 children, 15 caregivers and 12 HCPs). Four major themes emerged: 1) Hiding information between the three stakeholders which includes parents who hide the information from their sick children and ask the HCPs to do so to protect the child from distressful emotions and children who hide their suffering from their parents to protect them from being sad; 2) Communication and sharing of clinical versus non-clinical information; 3) Preferred communication styles such as use of a companionate approach by acknowledging patients and caregivers’ suffering, building a trustful relationship, proactive information sharing, considering child age and medical status, parents as facilitators in communication, and patients’ and caregivers’ health literacy; 4) Communication and information sharing with refugees where they had dialect issues, which hindered effective communication. Some refugees had unrealistically high expectations regarding their child’s care and prognosis, which posed challenges to communication with staff.

Discussion

The novel findings of this study should inform better child-centered practices and better engage them in their care decisions. This study has demonstrated children’s ability to engage in primary research and to express preferences, and parents’ ability to share views on this sensitive topic.
Differences in genome, transcriptome, miRNAome, and methylome in synchronous and metachronous liver metastasis of colorectal cancer
Authors: Horak Josef , Kubecek Ondrej , Siskova Anna , Honkova Katerina , Chvojkova Irena , Krupova Marketa , Manethova Monika , Vodenkova Sona , García-Mulero Sandra , John Stanislav , Cecka Filip , Vodickova Ludmila , Petera Jiri , Filip Stanislav , Vymetalkova Veronika
Published: April 2023

Despite distant metastases being the critical factor affecting patients’ survival, they remain poorly understood. Our study thus aimed to molecularly characterize colorectal cancer liver metastases (CRCLMs) and explore whether molecular profiles differ between Synchronous (SmCRC) and Metachronous (MmCRC) colorectal cancer. This characterization was performed by whole exome sequencing, whole transcriptome, whole methylome, and miRNAome. The most frequent somatic mutations were in APC, SYNE1, TP53, and TTN genes. Among the differently methylated and expressed genes were those involved in cell adhesion, extracellular matrix organization and degradation, neuroactive ligand-receptor interaction. The top up-regulated microRNAs were hsa-miR-135b-3p and -5p, and the hsa-miR-200-family while the hsa-miR-548-family belonged to the top down-regulated. MmCRC patients evinced higher tumor mutational burden, a wider median of duplications and deletions, and a heterogeneous mutational signature than SmCRC. Regarding chronicity, a significant down-regulation of SMOC2 and PPP1R9A genes in SmCRC compared to MmCRC was observed. Two miRNAs were deregulated between SmCRC and MmCRC, hsa-miR-625-3p and has-miR-1269-3p. The combined data identified the IPO5 gene. Regardless of miRNA expression levels, the combined analysis resulted in 107 deregulated genes related to relaxin, estrogen, PI3K-Akt, WNT signaling pathways, and intracellular second messenger signaling. The intersection between our and validation sets confirmed the validity of our results. We have identified genes and pathways that may be considered as actionable targets in CRCLMs. Our data also provide a valuable resource for understanding molecular distinctions between SmCRC and MmCRC. They have the potential to enhance the diagnosis, prognostication, and management of CRCLMs by a molecularly targeted approach.
Abscopal effect observed in visceral and osseous metastases after liver SBRT in combination with nivolumab and relatlimab for sinonasal mucosal melanoma—a case report
Authors: Cerbon Danielle , Moya-Brown Karen , Mihaylov Ivaylo B. , Spieler Benjamin
Published: April 2023

Background

Primary sinonasal mucosal melanoma (SNMM) is a rare, aggressive histology usually diagnosed at advanced stages and associated with poor prognosis. Evidence regarding etiology, diagnosis, and treatment mainly derives from case reports, retrospective series, and national databases. In the treatment of metastatic melanoma, anti-CTLA-4 and anti-PD-1 checkpoint blockade increased 5-year overall survival from ~10% (prior to 2011) to ~50% (between 2011 and 2016). In March of 2022, the FDA approved the use of relatlimab, a novel anti-LAG3 immune checkpoint inhibitor, for the treatment of melanoma.

Case presentation

A 67-year-old woman with locally advanced SNMM underwent debulking surgery, adjuvant RT, and first-line immunotherapy (ImT) with nivolumab but developed local progression. The patient started a second course of ImT with nivolumab and ipilimumab, but this was discontinued after two cycles due to an immune-related adverse event (irAE, hepatitis with elevated liver enzymes). Interval imaging identified visceral and osseous metastases including multiple lesions in the liver and in the lumbar spine. She went on to receive a third course of ImT with nivolumab and the novel agent relatlimab with concurrent stereotactic body radiation therapy (SBRT) to the largest liver tumor only, delivered in five 10-Gy fractions using MRI guidance. A PET/CT performed 3 months after SBRT demonstrated complete metabolic response (CMR) of all disease sites including non-irradiated liver lesions and spinal metastatic sites. After two cycles of the third course of ImT, the patient developed severe immune-related keratoconjunctivitis and ImT was discontinued.

Conclusion

This case report describes the first complete abscopal response (AR) in an SNMM histology and the first report of AR following liver SBRT with the use of relatlimab/nivolumab combination ImT for metastatic melanoma in the setting of both visceral and osseous lesions. This report suggests that the combination of SBRT with ImT potentiates the adaptive immune response and is a viable path for immune-mediated tumor rejection. The mechanisms behind this response are hypothesis-generating and remain an area of active research with exceedingly promising potential.
Laparoscopic distal gastrectomy demonstrates acceptable outcomes regarding complications compared to open surgery for gastric cancer patients with pylorus outlet obstruction
Authors: Wang Sen , Zhang Yigang , Chen Zetian , Li Qingya , Li Fengyuan , Li Zheng , Liu Hongda , Xuan Zhe , Xia Yiwen , Xu Penghui , Fang Lang , Wang Linjun , Zhang Diancai , Xu Hao , Yang Li , Xu Zekuan
Published: April 2023

Background

For gastric cancer (GC) patients with pylorus outlet obstruction (POO), whether laparoscopic surgery has advantages over open surgery remains unclear. This study aims to investigate the differences between patients with and without POO in open and laparoscopic groups and to determine the differences between laparoscopic distal gastrectomy (LDG) and open distal gastrectomy (ODG) in GC patients with POO.

Methods

A total of 241 GC patients with POO who underwent distal gastrectomy at the Department of Gastric Surgery of the First Affiliated Hospital of Nanjing Medical University between 2016 and 2021 were included in this study. A total of 1,121 non-POO patients who underwent laparoscopic surgery and 948 non-POO patients who underwent open surgery from 2016 to 2021 were also enrolled in the study. We compared complication rates and hospital stays between open and laparoscopic groups.

Results

There was no significant difference for LDG between GC patients with and without POO regarding the overall complication rates (P = 0.063), the Grade III–V complication rate (P = 0.673), and the anastomotic complication rate (P = 0.497) from 2016 to 2021. The patients with POO had longer preoperative hospital stay (P = 0.001) and postoperative hospital stay (P=0.007) compared to patients without POO. No significant difference was observed for open patients between POO and non-POO patients regarding the overall complication rate (P = 0.357), grade III–V complication rate (P = 1.000), and anastomosis-related complication rate (P = 0.766). Compared with open surgery in GC patients with POO (n = 111), the total complication rate of the LDG group was 16.2%, which was significantly lower than that of the open group (26.1%, P = 0.041). No significant differences in the Grade III–V complication rate (P = 0.574) and anastomotic complication rate (P = 0.587) were observed between laparoscopic and open groups. Patients receiving laparoscopic surgery had shorter postoperative hospital stay than open surgery (P = 0.001). More resected lymph nodes (LNs) were also observed in the laparoscopic group (P = 0.0145).

Conclusion

The comorbidity of GC with POO does not increase the complication rate after laparoscopic or open distal gastrectomy. In GC patients with POO, laparoscopic surgery shows advantages over open surgery with a lower overall complication rate, shorter postoperative hospital stay, and more harvested lymph nodes. Laparoscopic surgery is a safe, feasible, and effective treatment for GC with POO.
Measuring empathy online and moral disengagement in cyberbullying
Authors: Francisco Sofia Mateus , da Costa Ferreira Paula , Veiga Simão Ana Margarida , Pereira Nádia Salgado
Published: April 2023

This investigation intends to explore how adolescents report empathy in online contexts and moral disengagement in cyberbullying incidents, and how these two constructs are related. To accomplish this goal, three studies were conducted considering the need to develop new instruments to uncover this new approach of measuring empathy and moral disengagement. In the first study, we adapted the Portuguese version of the Empathy Quotient-short form to online contexts, which resulted in the Empathy Quotient in Virtual Contexts (EQVC). We also developed the Process Moral Disengagement in Cyberbullying Inventory (PMDCI), in order to assess moral disengagement in these specific situations. In the second study we conducted exploratory factor analyses (N = 234) of these instruments. Finally, in the third study, we conducted confirmatory factor analyses (N = 345) of both instruments. These results showed how adolescents reported empathy in online contexts and moral disengagement in cyberbullying incidents. Specifically, empathy revealed a bi-dimensional structure including difficulty and self-efficacy in empathizing (Cronbach’s α = 0.44, 0.83, respectively), whereas process moral disengagement revealed four unidimensional questionnaires including locus of behavior, agency, outcome, and recipient (Cronbach’s α = 0.76, 0.65, 0.77, 0.69, respectively). Furthermore, a correlational analysis was also performed of both constructs, and we also considered the variable sex. Results showed that difficulty in empathizing was negatively associated with sex (with girls revealing more difficulty than boys) and all moral disengagement mechanisms except for behavior. Moral disengagement was positively correlated with sex, suggesting boys morally disengaged more from cyberbullying. The instruments provided new insights on how empathy and moral disengagement can be specific to online contexts and cyberbullying situations, and how they can be used in educational programs to promote empathy and gain insight on moral disengagement within this phenomenon.
Implicit theories shape responses to social-evaluative threat
Authors: Ford Máire B.
Published: April 2023

It is important to understand factors that make one more or less vulnerable to the harmful effects of social threat. This study focuses on the role of implicit theories (also referred to as mindsets) in shaping responses to a potent form of social threat, namely social-evaluative threat (SET). 124 individuals participated in an experimental study in which they were induced to have an incremental theory or an entity theory about their social skills. Next, they were exposed to SET in the laboratory. Psychological and physiological responses were assessed including social self-esteem, rumination, spontaneous mentions of concerns about one’s social skills, and heart-rate variability. Compared to those induced to have entity theories, those induced to have incremental theories were buffered from the typical harmful effects of SET on social self-esteem, rumination, and concerns about their social skills. The association between implicit theories and heart-rate variability fell just short of significance.
Relationship between depression, anxiety, stress, and SARS-CoV-2 infection: a longitudinal study
Authors: Ausserhofer Dietmar , Mahlknecht Angelika , Engl Adolf , Piccoliori Giuliano , Pfitscher Gernot , Silbernagl Philipp , Giacomoni Francesca , Pycha Roger , Lombardo Stefano , Gärtner Timon , Mian Michael , Meier Horand , Wiedermann Christian J. , Keim Roland
Published: April 2023

Objectives

We aimed to (1) describe the course of the emotional burden (i.e., depression, anxiety, and stress) in a general population sample during the coronavirus pandemic in 2020 and 2021 and (2) explore the association between emotional burden and a serologically proven infection with SARS-CoV-2.

Study design

This longitudinal study involved a sample of community-dwelling persons aged ≥14 years from the general population of South Tyrol (Province of Bolzano-Bozen, Northern Italy). Data were collected at two stages over a 1-year period in 2020 and 2021.

Methods

Persons were invited to participate in a survey on socio-demographic, health-related and psychosocial variables (e.g., age, chronic diseases, Depression Anxiety Stress Scale, DASS-21), as well as in the serological testing for of SARS-CoV-2-specific immunoglobulins.

Results

In 2020, 855 (23.8%) out of 3,600 persons participated; in 2021, 305 (35.7%) out of 855 were tested again. We observed a statistically significant decrease in mean DASS-21 scores for depression, stress, and total scores between 2020 and 2021, yet not for anxiety. Persons with a confirmed SARS-CoV-2-infection between the first and second data collection exhibited increased emotional burden compared to those without SARS-CoV-2-infection. The odds of participants with a self-reported diagnosis of mental disorder for future infection with SARS-CoV-2 was almost four times higher than that of participants without mental disorders (OR:3.75; 95%CI:1.79-7.83).

Conclusion

Our findings support to the hypothesis of a psycho-neuroendocrine-immune interplay in COVID-19. Further research is necessary to explore the mechanisms underlying the interplay between mental health and SARS-CoV-2 infections.
Combining virtual reality and tactile stimulation to investigate embodied finger-based numerical representations
Authors: de Carvalho Souza Alyson Matheus , Barrocas Roberta , Fischer Martin H. , Arnaud Emanuel , Moeller Korbinian , Rennó-Costa César
Published: April 2023

Finger-based representation of numbers is a high-level cognitive strategy to assist numerical and arithmetic processing in children and adults. It is unclear whether this paradigm builds on simple perceptual features or comprises several attributes through embodiment. Here we describe the development and initial testing of an experimental setup to study embodiment during a finger-based numerical task using Virtual Reality (VR) and a low-cost tactile stimulator that is easy to build. Using VR allows us to create new ways to study finger-based numerical representation using a virtual hand that can be manipulated in ways our hand cannot, such as decoupling tactile and visual stimuli. The goal is to present a new methodology that can allow researchers to study embodiment through this new approach, maybe shedding new light on the cognitive strategy behind the finger-based representation of numbers. In this case, a critical methodological requirement is delivering precisely targeted sensory stimuli to specific effectors while simultaneously recording their behavior and engaging the participant in a simulated experience. We tested the device’s capability by stimulating users in different experimental configurations. Results indicate that our device delivers reliable tactile stimulation to all fingers of a participant’s hand without losing motion tracking quality during an ongoing task. This is reflected by an accuracy of over 95% in participants detecting stimulation of a single finger or multiple fingers in sequential stimulation as indicated by experiments with sixteen participants. We discuss possible application scenarios, explain how to apply our methodology to study the embodiment of finger-based numerical representations and other high-level cognitive functions, and discuss potential further developments of the device based on the data obtained in our testing.
Incidence and factors associated of early non-response in first-treatment and drug-naïve patients with schizophrenia: a real-world study
Authors: Zhang Lin , Bai Aohan , Tang Zhongyu , Liu Xuebing , Li Yi , Ma Jun
Published: April 2023

Background

Schizophrenia is a severe and persistent mental condition that causes disability. For subsequent clinical care, it is extremely practical to effectively differentiate between patients who respond to therapy quickly and those who do not. This study set out to document the prevalence and risk factors for patient early non-response.

Methods

The current study included 143 individuals with first-treatment and drug-naïve (FTDN) schizophrenia. Patients were classified as early non-responders based on a Positive and Negative Symptom Scale (PANSS) score reduction of less than 20% after 2 weeks of treatment, otherwise as early responders. Clinical subgroups’ differences in demographic data and general clinical data were compared, and variables related to early non-response to therapy were examined.

Results

Two weeks later, a total of 73 patients were described as early non-responders, with an incidence of 51.05%. The early non-response subgroup had significantly higher PANSS scores, Positive symptom subscale (PSS) scores, General psychopathology subscale (GPS) scores, Clinical global impression scale - severity of illness (CGI-SI) and Fasting blood glucose (FBG) levels compared to the early-response subgroup. CGI-SI and FBG were risk factors for early non-response.

Conclusion

High rates of early non-response have been seen in FTDN schizophrenia patients, and risk variables for predicting early non-response include CGI-SI scores and FBG levels. However, we need more in-depth studies to confirm the generalizable range of these two parameters.