bluuebunny/crossref_metadata_2025 huggingface dataset:
CT differentiation of the oncocytoma and renal cell carcinoma based on peripheral tumor parenchyma and central hypodense area characterisation
Authors: Qu Jianyi , Zhang Qianqian , Song Xinhong , Jiang Hong , Ma Heng , Li Wenhua , Wang Xiaofei
Published: January 2023

Background

Although the central scar is an essential imaging characteristic of renal oncocytoma (RO), its utility in distinguishing RO from renal cell carcinoma (RCC) has not been well explored. The study aimed to evaluate whether the combination of CT characteristics of the peripheral tumor parenchyma (PTP) and central hypodense area (CHA) can differentiate typical RO with CHA from RCC.

Methods

A total of 132 tumors on the initial dataset were retrospectively evaluated using four-phase CT. The excretory phases were performed more than 20 min after the contrast injection. In corticomedullary phase (CMP) images, all tumors had CHAs. These tumors were categorized into RO (n = 23), clear cell RCC (ccRCC) (n = 85), and non-ccRCC (n = 24) groups. The differences in these qualitative and quantitative CT features of CHA and PTP between ROs and ccRCCs/non-ccRCCs were statistically examined. Logistic regression filters the main factors for separating ROs from ccRCCs/non-ccRCCs. The prediction models omitting and incorporating CHA features were constructed and evaluated, respectively. The effectiveness of the prediction models including CHA characteristics was then confirmed through a validation dataset (8 ROs, 35 ccRCCs, and 10 non-ccRCCs).

Results

The findings indicate that for differentiating ROs from ccRCCs and non-ccRCCs, prediction models with CHA characteristics surpassed models without CHA, with the corresponding areas under the curve (AUC) being 0.962 and 0.914 versus 0.952 and 0.839 respectively. In the prediction models that included CHA parameters, the relative enhancement ratio (RER) in CMP and enhancement inversion, as well as RER in nephrographic phase and enhancement inversion were the primary drivers for differentiating ROs from ccRCCs and non-ccRCCs, respectively. The prediction models with CHA characteristics had the comparable diagnostic ability on the validation dataset, with respective AUC values of 0.936 and 0.938 for differentiating ROs from ccRCCs and non-ccRCCs.

Conclusion

The prediction models with CHA characteristics can help better differentiate typical ROs from RCCs. When a mass with CHA is discovered, particularly if RO is suspected, EP images with longer delay scanning periods should be acquired to evaluate the enhancement inversion characteristics of CHA.
Normobaric oxygen may attenuate the headache in patients with patent foramen povale and migraine
Authors: Wang Mengqi , Lan Duo , Dandu Chaitu , Ding Yuchuan , Ji Xunming , Meng Ran
Published: January 2023

Background and purposes

There has been both great interest in and skepticism about the strategies for headache inhibition in patients with patent foramen ovale and migraines (PFO-migraine). Furthermore, many questions remain about the fundamental pathophysiology of PFO-migraines. Herein, the inhibiting effect of normobaric oxygenation (NBO) on PFO-migraine was analyzed.

Methods

This real-world self-control study consecutively enrolled patients during the ictal phase of migraines who had patent foramen ovale (PFO) confirmed by Trans esophageal Ultrasound(TEE). After comparing the baseline arterial oxygen partial pressure (PaO2) in their blood gas with that of healthy volunteers, all the patients with PFO-migraine underwent treatment with NBO (8 L/min. for 1 h/q8h) inhalation through a mask. Their clinical symptoms, blood gas, and electroencephalograph (EEG) prior to and post-NBO were compared.

Results

A total of 39 cases with PFO-migraine (in which 36% of participants only had a small-aperture of PFO) and 20 non-PFO volunteers entered the final analysis. Baseline blood gas analysis results showed that the PaO2 in patients with PFO-migraine were noticeably lower than PaO2 levels in non-PFO volunteers. After all patients with PFO-migraines underwent NBO treatment, 29(74.4%) of them demonstrated dramatic headache attenuation and a remarkable increase in their arterial PaO2 levels after one time treatment of NBO inhalation (p < 0.01). The arterial PaO2 levels in these patients gradually went down during the following 4 h after treatment. 5 patients finished their EEG scans prior to and post-NBO, and 4(80%) were found to have more abnormal slow waves in their baseline EEG maps. In the follow up EEG maps post-NBO treatment for these same 4 patients, the abnormal slow waves disappeared remarkably.

Conclusions

Patients with PFO–migraine may derive benefit from NBO treatment. PFOs result in arterial hypoxemia due to mixing of venous blood, which ultimately results in brain hypoxia and migraines. This series of events may be the key pathologic link explaining how PFOs lead to migraines. NBO use may attenuate the headaches from migraines by correcting the hypoxemia.
A mixed-methods evaluation of a state-wide outreach perinatal mental health service
Authors: Cibralic Sara , Fay-Stammbach Tracey , Tucker Debbie , Song Deborah , Eapen Valsamma
Published: January 2023

Background

Access to perinatal mental health services in rural and remote areas is scarce, particularly perinatal psychiatry services. Telehealth, together with psychiatry consultation-liaison services are one way to improve access to areas of need. The New South Wales State-wide Outreach Perinatal Services – Mental Health (SwOPS) program is a Sydney-based program, offering specialist perinatal consultation-liaison services to rural and remote community mental health clinicians caring for perinatal women with significant mental health problems. This study aimed to evaluate healthcare practitioners’ perceptions of the SwOPS program.

Method

Healthcare practitioners (N = 31) were purposely recruited to participate in the study. Data were analysed using a mixed-methods cross-sectional design.

Results

Most participants reported being familiar with and satisfied with the service. As a result of accessing the service, participants reported an increase in knowledge and confidence regarding caring for women with moderate-to-severe or complex mental health conditions. Qualitative comments highlight the participant’s perceptions of the program.

Conclusion

This study provides useful insights about a state-wide telehealth psychiatry consultation-liaison service from the perspective of practitioners. It highlights the benefits, facilitators, and barriers associated with implementing such services.
Diagnosis and management of keratoconus by eye care practitioners in Kenya
Authors: Rashid Zahra Aly , Moodley Vanessa R , Mashige Khathutshelo Percy
Published: January 2023

Background

To explore current eye care practice in keratoconus diagnosis and management in Kenya.

Methods

An online questionnaire was distributed to ophthalmic clinical officers (OCO) and optometrists.

Results

A total of 203 responses were received from 52 OCOs and 151 optometrists with a response rate of 24.4% and 53.5% respectively. The majority reported having access to retinoscopes (88.5%; p = 0.48) and slit lamps (76.7; p = 0.14). Few practitioners had access to a corneal topographer (13.5%; p = 0.08) and rigid contact lens (CL) fitting sets (OCOs 5.8%, optometrists 33.8%; p < 0.01). One-third did not feel that retinoscopy (38.7%; p = 0.21), slit lamp findings (30.3%; p = 0.10) and corneal topography (36.6%; p = 0.39) are important investigations in keratoconus diagnosis. Corneal topography was not recommended in two-thirds of patients (59.0%; p = 0.33) with vernal keratoconjunctivitis (VKC). The majority counselled against eye rubbing in mild (73.6%; p = 0.90) VKC, 52.9% in moderate (p = 0.40) and 43.6% in severe (p = 0.24) cases. The majority prescribed spectacles in mild (90.2%; p = 0.95), 29% (p = 0.97) in moderate and 1.9% (p = 0.05) in severe cases. When the binocular best corrected visual acuity (BCVA) with spectacles was ≤ 6/18, 76.9% of OCOs and 58.9% of optometrists referred for CLs (p = 0.02). When binocular BCVA with CLs dropped to ≤ 6/18, 83.7% (p = 0.18) referred to the ophthalmologist for surgical intervention. Few OCOs fitted rigid CLs (15.4% OCOs, 51.0% optometrists; p = 0.01), majority referred to optometrists (82.7% OCOs, 43.7% optometrists; p < 0.01). Progression was monitored in 70.1% (p = 0.11) of mild, 50.9% (p = 0.54) moderate and 25.3% (p = 0.31) advanced cases. Few OCOs (15.4%) performed corneal cross-linking (CXL). A few respondents (5.4%; p = 0.13) did not know when to refer keratoconus patients for CXL. Co-management with ophthalmologists was reported by 58.0% (p = 0.06) of respondents.

Conclusion

The results of this study highlight the need to map services for keratoconus patients, review current curricula and continuous education priorities for mid-level ophthalmic workers, develop guidelines for the diagnosis and management of keratoconus and improve interdisciplinary collaboration.
Cognitive rehabilitation for improving cognitive functions and reducing the severity of depressive symptoms in adult patients with Major Depressive Disorder: a systematic review and meta-analysis of randomized controlled clinical trials
Authors: Mokhtari Saba , Mokhtari Asieh , Bakizadeh Farah , Moradi Alireza , Shalbafan Mohammadreza
Published: January 2023

Introduction

Nearly 40% of patients with Major Depressive Disorder (MDD) have been found to experience cognitive impairment in at least one domain. Cognitive impairment associated with MDD is disproportionately represented in patients that have not fully returned to psychosocial functioning. As awareness regarding cognitive dysfunction in MDD patients grows, so does the interest in developing newer treatments that specifically address these deficits.

Method

In the present study, we conduct a systematic review of controlled randomized clinical trials that used cognitive training and remediation interventions for improving cognitive functions and reducing symptom severity in adult patients with MDD. We selected studies published before March 2022 using search databases including PubMed, ScienceDirect, Scopus, and Google scholar. For conducting the meta-analysis, standard differences in means with the random effect model and with a 95% confidence interval of change in outcome measures from baseline to post-intervention between the cognitive rehabilitation and the control groups were calculated.

Results

The database search resulted in identifying 756 studies of interest, which ultimately 15 studies with 410 participants in the cognitive rehabilitation group and 339 participants in the control group were included. The meta-analysis of the data extracted from these studies, shows a moderate and significant effect on the executive function (d = 0.59 (95% CI, 0.25 to 0.93) p-value = 0.001, I2 = 15.2%), verbal learning (d = 0.45 (95% CI, 0.12 to 0.78) p-value = 0.007, I2 = 0.00%), and working memory (d = 0.41 (95% CI, 0.18 to 0.64) p-value < 0.001, I2 = 33%) of MDD patients. Although, there were no significant difference between intervention and control group in attention (d = 0.32 (95% CI, -0.01 to 0.66) p-value = 0.058, I2 = 0.00%) or depressive symptoms.

Conclusion

This systematic review and meta-analysis indicate that cognitive rehabilitation is an effective intervention for the executive function, verbal learning, and working memory of MDD patients. Due to the importance of these neuropsychological deficits in day-to-day life and the core symptoms of MDD, cognitive rehabilitation should be considered an important part of treating MDD. Further research in this area and concentrated on these particular deficits is warranted.
Obstacles and facilitators to communicating with children about their parents’ mental illness: a qualitative study in a sub-district of Mpumalanga, South Africa
Authors: Dean Lucy , Buechner Hadassah , Moffett Bianca , Maritze Meriam , Dalton Louise J. , Hanna Jeffrey R. , Rapa Elizabeth , Stein Alan , Tollman Stephen , Kahn Kathleen
Published: January 2023

Background

Given that common mental disorders are one of the leading causes of disease burden worldwide, it is likely that many children are growing up with a parent or other adult within their family who has anxiety or depression. Parents with a mental illness may not consider it appropriate to discuss their illness with their child, and consequently an absence of communication may lead to stigmatization, shame, misunderstanding their parents’ symptoms, and even blaming themselves. There is a scarcity of research exploring the experiences and perceptions of healthcare professionals about communication with children of parents with mental illness in low-resource and African contexts.

Methods

A qualitative study using semi-structured interviews with healthcare professionals (n = 15) was conducted within the Bushbuckridge sub-district of Mpumalanga Province, South Africa. Data were analysed using Thematic Analysis.

Results

Four themes were identified relating to the obstacles around communication with children. These included: (1) finding an appropriate language to describe mental illness, as well as the prevailing cultural explanations of mental illness (2) the stigma associated with mental illness (3) the perceived role of children in society and (4) mental health services and staff skills. Two themes that addressed facilitators of communication about parental mental illness were identified: (1) the potential to increase mental health awareness amongst the broader community through social media, the internet, and general psychoeducation (2) healthcare professionals’ concerns for the wellbeing and future mental health of patients’ children, as well as their hopes for increased mental health awareness amongst future generations.

Conclusions

This study provides insight into healthcare professionals’ attitudes and perceptions about talking to patients and families within their community about mental illness. The results provide recommendations about possible ways to promote sharing information about a parent’s mental illness with children at an individual and community level. Future research should focus on the collaborative creation of culturally sensitive psychoeducational resources and evidence-based guidelines. This must be supported by systemic and organisational change in order for professionals to successfully facilitate conversations with patients who are parents, and their children.
Pattern of weight gain in pregnant women in slum areas of Hamadan using multilevel ordinal regression
Authors: Manoochehri Zohreh , Moghimbeigi Abbas , Ezzati-Rastegar Khadije , Faradmal Javad
Published: January 2023

Background

Adequate gestational weight gain (GWG) is an important factor for maternal and fetal health. This is especially important in low-income and slum areas due to limited access to health services and malnutrition. Thus, the purpose of this study is to evaluate the pattern of GWG changes in the slum areas of Hamadan in Iran.

Methods

In this longitudinal study, the study sample consisted of 509 pregnant women who referred to nine health care clinics in the slum areas of Hamadan. Women's weight gain based on the recommended GWG by U.S. Institute of Medicine (IOM) was divided into three categories: Inadequate weight gain, Adequate weight gain, and Excessive weight gain. In order to evaluate the trend of GWG, a multi-level ordinal model was used.

Results

According to pre-pregnancy BMI, a little more than half people (56.6%) were overweight or obese. 85.4% women in the first trimester and 49.1% in the second trimester did not have adequate GWG, but in the third trimester (38.9%) had adequate GWG. Based on multivariate analysis, pre- pregnancy BMI has a significant effect on the odds of inadequate GWG (P-value = 0.021); with one unit increase in pre-pregnancy BMI, the odds of inadequate GWG grows by 1.07 times compared to adequate and excessive GWG.

Conclusions

In general, women did not have adequate weight gain in the first and second trimesters.Thus, designing appropriate interventions to achieve optimal GWG seems to be necessary in slums.
Surgical mortality in patients in extremis: futility in emergency abdominal surgery
Authors: Ramírez-Giraldo Camilo , Isaza-Restrepo Andrés , García-Peralta Juan Camilo , González-Tamayo Juliana , Ibáñez-Pinilla Milcíades
Published: January 2023

Background

The number of older patients with multiple comorbidities in the emergency service is increasingly frequent, which implies the risk of incurring in futile surgical interventions. Some interventions generate false expectations of survival or quality of life in patients and families and represent a negligible therapeutic benefit in patients whose chances of survival are minimal. In order to address this dilemma, we describe mortality in a cohort of patients undergoing emergency laparotomy with a risk ≥ 75% per the ACS NSQIP Surgical Risk Calculator.

Methods

A retrospective observational study was designed to analyze postoperative mortality and factors associated with postoperative mortality in a cohort of patients undergoing emergency laparotomy between January 2018 and December 2021 in a high-complexity hospital who had a mortality risk ≥ 75% per the ACS NSQIP Surgical Risk Calculator.

Results

A total of 890 emergency laparotomies were performed during the study period, and 50 patients were included for the analysis. Patient median age was 82.5 (IQR: 18.25) years old and 33 (66.00%) were male. The most frequent diagnoses were mesenteric ischemia 21 (42%) and secondary peritonitis 18 (36%). Mortality in the series was 92%. Twenty-four (54.34%) died within the first 24 h of the postoperative period; 11 (23.91%) within 72 h and 10 (21.73%) within 30 days. APACHE II and SOFA scores were statistically significantly higher in patients who died.

Conclusions

All available tools should be used to make decisions, with the most reliable and objective information possible, and be particularly vigilant in patients at extreme risk (mortality risk greater than 75% according to ACS NSQIP Surgical Risk Calculator) to avoid futility and its consequences. The available information should be shared with the patient, the family, or their guardians through an assertive and empathetic communication strategy. It is necessary to insist on a culture of surgical ethics based on reflection and continuous improvement in patient care and to know how to accompany them in order to have a proper death.
The morphology of permanent maxillary first molars evaluated by cone-beam computed tomography among a Yemeni population
Authors: Mufadhal Abdulbaset A. , Madfa Ahmed A.
Published: January 2023

Background

The study's objective was to use CBCT to ascertain the root and root canal anatomy of the permanent maxillary first molars in a Yemeni population. It was considered how gender affected the prevalence of root canal morphology.

Methods

A sample of 373 CBCT records of maxillary permanent first molars belonging to 373 Yemeni individuals (162 males and 211 females) aged between 12 and 65 years were included in this study. Using CBCT on the teeth, the root form and canal morphology for each root based on Vertucci's classification were evaluated. The distribution of MB2 occurrence was documented. The prevalence and resemblance of the men and females were investigated. The Chi-square test was performed to evaluate the findings.

Results

Of the 373 maxillary first molars studied, the three separated root form was found in 94.9% of the studied MFMs while the two fused and one separate root form was found in 4.5%. The majority of the three-rooted MFMs (82.6%) had more than three root canals (four canals in 77.2% and five canals in 5.4%). The prevalence of MB2 was as high as 82.3% of the three-rooted MFMs. Vertucci type II configuration was the most frequent canal type (25%) followed by Vertucci type III (23.1%) and Vertucci type I (17.7%) in the mesiobuccal root. Vertucci type I was the most prevalent canal configuration in the distobuccal root and palatal root of the three-rooted MFMs (96% and 99.5%, respectively).

Conclusions

The maxillary first molars' root canal morphology indicated notable variations among a Yemeni population. The maxillary first molars of most of the Yemeni participants in this study had three roots and four canals. In light of the high occurrence of MB2 (82.3%) in permanent maxillary first molars, our findings emphasize the need of searching for and using cutting-edge techniques to locate the MB2 canals. Males outnumbered females in proportion.
Using cognitive interviews to improve a measure of organizational readiness for implementation
Authors: McClam Maria , Workman Lauren , Dias Emanuelle M. , Walker Timothy J. , Brandt Heather M. , Craig Derek W. , Gibson Robert , Lamont Andrea , Weiner Bryan J. , Wandersman Abraham , Fernandez Maria E.
Published: January 2023

Background

Organizational readiness is a key factor for successful implementation of evidence-based interventions (EBIs), but a valid and reliable measure to assess readiness across contexts and settings is needed. The R = MC2 heuristic posits that organizational readiness stems from an organization’s motivation, capacity to implement a specific innovation, and its general capacity. This paper describes a process used to examine the face and content validity of items in a readiness survey developed to assess organizational readiness (based on R = MC2) among federally qualified health centers (FQHC) implementing colorectal cancer screening (CRCS) EBIs.

Methods

We conducted 20 cognitive interviews with FQHC staff (clinical and non-clinical) in South Carolina and Texas. Participants were provided a subset of items from the readiness survey to review. A semi-structured interview guide was developed to elicit feedback from participants using “think aloud” and probing techniques. Participants were recruited using a purposive sampling approach and interviews were conducted virtually using Zoom and WebEx. Participants were asked 1) about the relevancy of items, 2) how they interpreted the meaning of items or specific terms, 3) to identify items that were difficult to understand, and 4) how items could be improved. Interviews were transcribed verbatim and coded in ATLAS.ti. Findings were used to revise the readiness survey.

Results

Key recommendations included reducing the survey length and removing redundant or difficult to understand items. Additionally, participants recommended using consistent terms throughout (e.g., other units/teams vs. departments) the survey and changing pronouns (e.g., people, we) to be more specific (e.g., leadership, staff). Moreover, participants recommended specifying ambiguous terms (e.g., define what “better” means).

Conclusion

Use of cognitive interviews allowed for an engaged process to refine an existing measure of readiness. The improved and finalized readiness survey can be used to support and improve implementation of CRCS EBIs in the clinic setting and thus reduce the cancer burden and cancer-related health disparities.
Tetrahydrocurcumin regulates the tumor immune microenvironment to inhibit breast cancer proliferation and metastasis via the CYP1A1/NF-κB signaling pathway
Authors: Zeng Anqi , Yu Xinyue , Chen Bao , Hao Lu , Chen Ping , Chen Xue , Tian Yuan , Zeng Jing , Hua Hua , Dai Ying , Zhao Junning
Published: January 2023

The NF-κB signaling pathway is overactivated in tumor cells, and the activation of the NF-κB signaling pathway releases a large number of inflammatory factors, which enhance tumor immunosuppression and promote tumor metastasis. The cytochrome P450 (CYP450) system consists of important metabolic enzymes present in different tissues and progressive tumors, which may lead to changes in the pharmacological action of drugs in inflammatory diseases such as tumors. In this study, the anticancer effect of tetrahydrocurcumin (THC), an active metabolite of curcumin, on breast cancer cells and the underlying mechanism were investigated. Result showed that THC selectively inhibited proliferation and triggered apoptosis in breast cancer cells in a concentration- and time-dependent manner. Moreover, THC-induced cell apoptosis via a mitochondria-mediated pathway, as indicated by the upregulated ratio of Bax/Bcl-2 and reactive oxygen species (ROS) induction. In addition, THC could affect the CYP450 enzyme metabolic pathway and inhibit the expression of CYP1A1 and activation of the NF-κB pathway, thereby inhibiting the migration and invasion of breast cancer cells. Furthermore, after overexpression of CYP1A1, the inhibitory effects of THC on the proliferation, metastasis, and induction of apoptosis in breast cancer cells were weakened. The knockdown of CYP1A1 significantly enhanced the inhibitory effect of THC on the proliferation, metastasis, and apoptosis induction of breast cancer cells. Notably, THC exhibited a significant tumor growth inhibition and anti-pulmonary metastasis effect in a tumor mouse model of MCF-7 and 4T1 cells by regulating the tumor immunosuppressive microenvironment. Collectively, these results showed that TH could effectively trigger apoptosis and inhibit the migration of breast cancer cells via the CYP1A1/NF-κB signaling pathway, indicating that THC serves as a potential candidate drug for the treatment of breast cancer.
Clinical usefulness of the lymphocyte-to-monocyte ratio and aggregate index of systemic inflammation in patients with esophageal cancer: a retrospective cohort study
Authors: Wang Hui-Ke , Wei Qian , Yang Ya-Lan , Lu Tai-Ying , Yan Yan , Wang Feng
Published: January 2023

Background

Multiple perioperative inflammatory markers are considered important factors affecting the long-term survival of esophageal cancer (EC) patients. Hematological parameters, whether single or combined, have high predictive value.

Aim

To investigate the inflammatory status of patients with preoperative EC using blood inflammatory markers, and to establish and validate competing risk nomogram prediction models for overall survival (OS) and progression-free survival (PFS) in EC patients.

Methods

A total of 508 EC patients who received radical surgery (RS) treatment in The First Affiliated Hospital of Zhengzhou University from August 5, 2013, to May 1, 2019, were enrolled and randomly divided into a training cohort (356 cases) and a validation cohort (152 cases). We performed least absolute shrinkage and selection operator (LASSO)-univariate Cox- multivariate Cox regression analyses to establish nomogram models. The index of concordance (C-index), time-dependent receiver operating characteristic (ROC) curves, time-dependent area under curve (AUC) and calibration curves were used to evaluate the discrimination and calibration of the nomograms, and decision curve analysis (DCA) was used to evaluate the net benefit of the nomograms. The relative integrated discrimination improvement (IDI) and net reclassification improvement (NRI) were calculated to evaluate the improvement in predictive accuracy of our new model compared with the AJCC staging system and another traditional model. Finally, the relationship between systemic inflammatory response markers and prognostic survival was explored according to risk plot, time-dependent AUC, Kaplan–Meier and restricted cubic spline (RCS).

Results

Based on the multivariate analysis for overall survival (OS) in the training cohort, nomograms with 10 variables, including the aggregate index of systemic inflammation (AISI) and lymphocyte-to-monocyte ratio (LMR), were established. Time-dependent ROC, time-dependent AUC, calibration curves, and DCA showed that the 1-, 3-, and 5 year OS and PFS probabilities predicted by the nomograms were consistent with the actual observations. The C-index, NRI, and IDI of the nomograms showed better performance than the AJCC staging system and another prediction model. Moreover, risk plot, time-dependent AUC, and Kaplan–Meier showed that higher AISI scores and lower LMR were associated with poorer prognosis, and there was a nonlinear relationship between them and survival risk.

Conclusion

AISI and LMR are easy to obtain, reproducible and minimally invasive prognostic tools that can be used as markers to guide the clinical treatment and prognosis of patients with EC.
Patient-level performance evaluation of a smartphone-based malaria diagnostic application
Authors: Yu Hang , Mohammed Fayad O. , Abdel Hamid Muzamil , Yang Feng , Kassim Yasmin M. , Mohamed Abdelrahim O. , Maude Richard J. , Ding Xavier C. , Owusu Ewurama D.A. , Yerlikaya Seda , Dittrich Sabine , Jaeger Stefan
Published: January 2023

Background

Microscopic examination is commonly used for malaria diagnosis in the field. However, the lack of well-trained microscopists in malaria-endemic areas impacted the most by the disease is a severe problem. Besides, the examination process is time-consuming and prone to human error. Automated diagnostic systems based on machine learning offer great potential to overcome these problems. This study aims to evaluate Malaria Screener, a smartphone-based application for malaria diagnosis.

Methods

A total of 190 patients were recruited at two sites in rural areas near Khartoum, Sudan. The Malaria Screener mobile application was deployed to screen Giemsa-stained blood smears. Both expert microscopy and nested PCR were performed to use as reference standards. First, Malaria Screener was evaluated using the two reference standards. Then, during post-study experiments, the evaluation was repeated for a newly developed algorithm, PlasmodiumVF-Net.

Results

Malaria Screener reached 74.1% (95% CI 63.5–83.0) accuracy in detecting Plasmodium falciparum malaria using expert microscopy as the reference after a threshold calibration. It reached 71.8% (95% CI 61.0–81.0) accuracy when compared with PCR. The achieved accuracies meet the WHO Level 3 requirement for parasite detection. The processing time for each smear varies from 5 to 15 min, depending on the concentration of white blood cells (WBCs). In the post-study experiment, Malaria Screener reached 91.8% (95% CI 83.8–96.6) accuracy when patient-level results were calculated with a different method. This accuracy meets the WHO Level 1 requirement for parasite detection. In addition, PlasmodiumVF-Net, a newly developed algorithm, reached 83.1% (95% CI 77.0–88.1) accuracy when compared with expert microscopy and 81.0% (95% CI 74.6–86.3) accuracy when compared with PCR, reaching the WHO Level 2 requirement for detecting both Plasmodium falciparum and Plasmodium vivax malaria, without using the testing sites data for training or calibration. Results reported for both Malaria Screener and PlasmodiumVF-Net used thick smears for diagnosis. In this paper, both systems were not assessed in species identification and parasite counting, which are still under development.

Conclusion

Malaria Screener showed the potential to be deployed in resource-limited areas to facilitate routine malaria screening. It is the first smartphone-based system for malaria diagnosis evaluated on the patient-level in a natural field environment. Thus, the results in the field reported here can serve as a reference for future studies.
Geospatial techniques for monitoring and mitigating climate change and its effects on human health
Authors: Kamel Boulos Maged N. , Wilson John P.
Published: January 2023

This article begins by briefly examining the multitude of ways in which climate and climate change affect human health and wellbeing. It then proceeds to present a quick overview of how geospatial data, methods and tools are playing key roles in the measurement, analysis and modelling of climate change and its effects on human health. Geospatial techniques are proving indispensable for making more accurate assessments and estimates, predicting future trends more reliably, and devising more optimised climate change adaptation and mitigation plans.
Criminalization and coercion: sexual encounters with police among a longitudinal cohort of women who exchange sex in Baltimore, Maryland
Authors: Nestadt Danielle Friedman , Schneider Kristin E. , Tomko Catherine , Sherman Susan G.
Published: January 2023

Background

The criminalization of sex work and drug use creates unequal power dynamics easily exploited by police. Women who exchange sex (WES) in settings around the globe have reported coerced sex and sexual assault by police, and some have reported police as paying clients. Little research has examined nuances underlying WES’s sexual interactions with police.

Methods

A cohort of cisgender WES (N = 308) was recruited through targeted sampling in Baltimore, Maryland and completed a structured survey every 6 months for 18 months. Follow-up surveys included detailed questions about recent sexual encounters with police. In bivariate and multivariate models using generalized estimating equations to account for intra-person correlation, we examined correlates of reporting recent sex with police over time.

Results

One-third reported recent sex with police at any study visit. At each time point, about 90% of women who reported sex with police reported any uniformed or non-uniformed police had paid for sex. Between 72 and 85% had been solicited for paid sex by uniformed police. Between 41 and 50% of women who reported recent sex with police indicated they had done so because they feared arrest otherwise; one-third were directly pressured for sex by police to avoid arrest or trouble. In the final adjusted model, severe food insecurity [adjusted odds ratio (aOR) = 2.05; 95% confidence interval (CI) 1.13–3.71], Black race (vs. white, non-Hispanic; aOR = 1.90; 95% CI 1.13–3.17), recent arrest (aOR = 1.51; 95% CI 1.01–2.27), nonfatal overdose (aOR = 1.94; 95% CI 1.24–3.01), and client- or non-paying intimate partner-perpetrated violence (aOR = 2.46; 95% CI 1.63–3.71) were significantly independently associated with recent sex with police.

Conclusions

Sexual encounters between WES and police in Baltimore are common and often coerced to avoid arrest in a setting where both drug use and sex work are criminalized. Recent sex with police was more prevalent among WES who were racially marginalized, highly structurally vulnerable, and/or at high risk for drug overdose—and therefore subject to the dual-criminalization of sex work and drug use. This indicates deep power imbalances and their exploitation by police as the root of such sexual encounters and adds to the evidence regarding the need for decriminalization to support the health and wellbeing of WES.
Predisposition to cortical neurodegenerative changes in brains of hypertension prone rats
Authors: Ben-Shabat Moti , Awad-Igbaria Yaseen , Sela Shifra , Gross Bella , Yagil Yoram , Yagil Chana , Palzur Eilam
Published: January 2023

Background

Substantial evidence suggests that hypertension is a significant risk factor for cognitive decline. However, it is unclear whether the genetic predisposition to hypertension is also associated with cellular dysfunction that promotes neurodegeneration.

Methods

Changes in blood pressure were evaluated following dietary salt-loading or administration of a regular diet in Sabra Normotensive (SBN/y) and Sabra Hypertension-prone rats (SBH/y). We performed quantitative RT-PCR and immunofluorescence staining in brain cortical tissues before salt loading and 6 and 9 months after salt loading. To examine the expression of brain cortical proteins involved in the gene regulation (Histone Deacetylase-HDAC2; Histone Acetyltransferase 1-HAT1), stress response (Activating Transcription Factor 4-ATF4; Eukaryotic Initiation Factor 2- eIF2α), autophagy (Autophagy related 4A cysteine peptidase- Atg4a; light-chain 3-LC3A/B; mammalian target of rapamycin complex 1- mTORC1) and apoptosis (caspase-3).

Results

Prior to salt loading, SBH/y compared to SBN/y expressed a significantly higher level of cortical HAT1 (protein), Caspase-3 (mRNA/protein), LC3A, and ATF4 (mRNA), lower levels of ATG4A (mRNA/protein), LC3A/B, HDAC2 (protein), as well as a lower density of cortical neurons. Following dietary salt loading, SBH/y but not SBN/y developed high blood pressure. In hypertensive SBH/y, there was significant upregulation of cortical HAT1 (protein), Caspase-3 (protein), and eIF2α ~ P (protein) and downregulation of HDAC2 (protein) and mTORC1 (mRNA), and cortical neuronal loss.

Conclusions

The present findings suggest that genetic predisposition to hypertension is associated in the brain cortex with disruption in autophagy, gene regulation, an abnormal response to cellular stress, and a high level of cortical apoptosis, and could therefore exacerbate cellular dysfunction and thereby promote neurodegeneration.
Prevalence and correlates of reproductive coercion across ten sites: commonalities and divergence
Authors: Wood Shannon N. , Thomas Haley L. , Guiella Georges , Bazié Fiacre , Mosso Rosine , Fassassi Raimi , Akilimali Pierre Z. , Thiongo Mary , Gichangi Peter , Oumarou Sani , OlaOlorun Funmilola M. , Omoluabi Elizabeth , Khanna Anoop , Kibira Simon Peter Sebina , Makumbi Fredrick , Decker Michele R.
Published: January 2023

Background

Reproductive coercion (RC) is a type of abuse where a partner asserts control over a woman’s reproductive health trajectories. Recent research emphasizes that RC experiences may differ within and across low- and middle-income countries (LMICs), as compared to higher income contexts, given social pressures surrounding childbearing. To date, nationally representative surveys have lacked comprehensive measures for RC, leading to gaps in understanding its prevalence and risk factors. Across eight LMICs (10 sites), we aimed to (1) validate the RC Scale; (2) calculate prevalence of RC and specific behaviors; and (3) assess correlates of RC.

Methods

This analysis leverages cross-sectional Performance Monitoring for Action (PMA) data collected from November 2020 to May 2022. Analyses were limited to women in need of contraception (Burkina Faso n = 2767; Côte d'Ivoire n = 1561; Kongo Central, Democratic Republic of Congo (DRC) n = 830; Kinshasa, DRC n = 846; Kenya n = 4588; Kano, Nigeria n = 535; Lagos, Nigeria n = 612; Niger n = 1525; Rajasthan, India n = 3017; Uganda n = 2020). Past-year RC was assessed via five items adapted from the original RC Scale and previously tested in LMICs. Confirmatory factor analysis examined fit statistics by site. Per-item and overall prevalence were calculated. Site-specific bivariate and multivariable logistic regression examined RC correlates across the socioecological framework.

Results

Confirmatory factor analysis confirmed goodness of fit across all sites, with moderate internal consistency (alpha range: 0.66 Cote d’Ivoire–0.89 Kinshasa, DRC/Lagos, Nigeria). Past-year reported prevalence of RC was highest in Kongo Central, DRC (20.3%) and lowest in Niger (3.1%). Prevalence of individual items varied substantially by geography. Polygyny was the most common RC risk factor across six sites (adjusted odds ratio (aOR) range: 1.59–10.76). Increased partner education levels were protective in Kenya and Kano, Nigeria (aOR range: 0.23–0.67). Other assessed correlates differed by site.

Conclusions

Understanding RC prevalence and behaviors is central to providing woman-centered reproductive care. RC was most strongly correlated with factors at the partner dyad level; future research is needed to unpack the relative contributions of relationship power dynamics versus cultural norms surrounding childbearing. Family planning services must recognize and respond to women’s immediate needs to ensure RC does not alter reproductive trajectories, including vulnerability to unintended pregnancy.
Limb loading enhances skill transfer between augmented and physical reality tasks during limb loss rehabilitation
Authors: Hunt Christopher L. , Sun Yinghe , Wang Shipeng , Shehata Ahmed W. , Hebert Jacqueline S. , Gonzalez-Fernandez Marlis , Kaliki Rahul R. , Thakor Nitish V.
Published: January 2023

Background

Virtual and augmented reality (AR) have become popular modalities for training myoelectric prosthesis control with upper-limb amputees. While some systems have shown moderate success, it is unclear how well the complex motor skills learned in an AR simulation transfer to completing the same tasks in physical reality. Limb loading is a possible dimension of motor skill execution that is absent in current AR solutions that may help to increase skill transfer between the virtual and physical domains.

Methods

We implemented an immersive AR environment where individuals could operate a myoelectric virtual prosthesis to accomplish a variety of object relocation manipulations. Intact limb participants were separated into three groups, the load control (CGLD; $$N=4$$

N
=
4

), the AR control (CGAR; $$N=4$$

N
=
4

), and the experimental group (EG; $$N=4$$

N
=
4

). Both the CGAR and EG completed a 5-session prosthesis training protocol in AR while the CGLD performed simple muscle training. The EG attempted manipulations in AR while undergoing limb loading. The CGAR attempted the same manipulations without loading. All participants performed the same manipulations in physical reality while operating a real prosthesis pre- and post-training. The main outcome measure was the change in the number of manipulations completed during the physical reality assessments (i.e. completion rate). Secondary outcomes included movement kinematics and visuomotor behavior.

Results

The EG experienced a greater increase in completion rate post-training than both the CGAR and CGLD. This performance increase was accompanied by a shorter motor learning phase, the EG’s performance saturating in less sessions of AR training than the CGAR.

Conclusion

The results demonstrated that limb loading plays an important role in transferring complex motor skills learned in virtual spaces to their physical reality analogs. While participants who did not receive limb loading were able to receive some functional benefit from AR training, participants who received the loading experienced a greater positive change in motor performance with their performance saturating in fewer training sessions.
Training curriculum in minimally invasive emergency digestive surgery: 2022 WSES position paper
Authors: de’Angelis Nicola , Marchegiani Francesco , Schena Carlo Alberto , Khan Jim , Agnoletti Vanni , Ansaloni Luca , Barría Rodríguez Ana Gabriela , Bianchi Paolo Pietro , Biffl Walter , Bravi Francesca , Ceccarelli Graziano , Ceresoli Marco , Chiara Osvaldo , Chirica Mircea , Cobianchi Lorenzo , Coccolini Federico , Coimbra Raul , Cotsoglou Christian , D’Hondt Mathieu , Damaskos Dimitris , De Simone Belinda , Di Saverio Salomone , Diana Michele , Espin‐Basany Eloy , Fichtner‐Feigl Stefan , Fugazzola Paola , Gavriilidis Paschalis , Gronnier Caroline , Kashuk Jeffry , Kirkpatrick Andrew W. , Ammendola Michele , Kouwenhoven Ewout A. , Laurent Alexis , Leppaniemi Ari , Lesurtel Mickaël , Memeo Riccardo , Milone Marco , Moore Ernest , Pararas Nikolaos , Peitzmann Andrew , Pessaux Patrick , Picetti Edoardo , Pikoulis Manos , Pisano Michele , Ris Frederic , Robison Tyler , Sartelli Massimo , Shelat Vishal G. , Spinoglio Giuseppe , Sugrue Michael , Tan Edward , Van Eetvelde Ellen , Kluger Yoram , Weber Dieter , Catena Fausto
Published: January 2023

Background

Minimally invasive surgery (MIS), including laparoscopic and robotic approaches, is widely adopted in elective digestive surgery, but selectively used for surgical emergencies. The present position paper summarizes the available evidence concerning the learning curve to achieve proficiency in emergency MIS and provides five expert opinion statements, which may form the basis for developing standardized curricula and training programs in emergency MIS.

Methods

This position paper was conducted according to the World Society of Emergency Surgery methodology. A steering committee and an international expert panel were involved in the critical appraisal of the literature and the development of the consensus statements.

Results

Thirteen studies regarding the learning curve in emergency MIS were selected. All but one study considered laparoscopic appendectomy. Only one study reported on emergency robotic surgery. In most of the studies, proficiency was achieved after an average of 30 procedures (range: 20–107) depending on the initial surgeon’s experience. High heterogeneity was noted in the way the learning curve was assessed. The experts claim that further studies investigating learning curve processes in emergency MIS are needed. The emergency surgeon curriculum should include a progressive and adequate training based on simulation, supervised clinical practice (proctoring), and surgical fellowships. The results should be evaluated by adopting a credentialing system to ensure quality standards. Surgical proficiency should be maintained with a minimum caseload and constantly evaluated. Moreover, the training process should involve the entire surgical team to facilitate the surgeon’s proficiency.

Conclusions

Limited evidence exists concerning the learning process in laparoscopic and robotic emergency surgery. The proposed statements should be seen as a preliminary guide for the surgical community while stressing the need for further research.
Combination of external fixation using digital six-axis fixator and internal fixation to treat severe complex knee deformity
Authors: Liu Shu-guang , Yu Deng-jie , Li Hui , Opoku Michael , Li Jun , Zhang Bao-gang , Li Yu-sheng , Qiao Feng
Published: January 2023

Background

Severe knee valgus/varus or complex multiplanar deformities are common in clinic. If not corrected in time, cartilage wear will be aggravated and initiate the osteoarthritis due to lower limb malalignment. Internal fixation is unable to correct severe complex deformities, especially when combined with lower limb discrepancy (LLD). Based on the self-designed digital six-axis external fixator Q spatial fixator (QSF), which can correct complex multiplanar deformities without changing structures, accuracy of correction can be improved significantly.

Methods

This retrospective study included 24 patients who suffered from complex knee deformity with LLD treated by QSF and internal fixation at our institution from January 2018 to February 2021. All patients had a closing wedge distal femoral osteotomy with internal fixation for immediate correction and high tibia osteotomy with QSF fixation for postoperative progressive correction. Data of correction prescriptions were computed by software from postoperative CT scans.

Results

Mean discrepancy length of operative side was 2.39 ± 1.04 cm (range 0.9–4.4 cm) preoperatively. The mean difference of lower limb was 0.32 ± 0.13 cm (range 0.11–0.58 cm) postoperatively. The length of limb correction had significant difference (p < 0.05). The mean MAD and HKA decreased significantly (p < 0.05), and the mean MPTA and LDFA increased significantly (p < 0.05). There were significant increase (p < 0.05) in the AKSS-O, AKSS-F and Tegner Activity Score. The lower limb alignment was corrected (p < 0.05). The mean time of removing external fixator was 112.8 ± 17.9 days (range 83–147 days).

Conclusions

Complex knee deformity with LLD can be treated by six-axis external fixator with internal fixation without total knee arthroplasty. Lower limb malalignment and discrepancy can be corrected precisely and effectively by this approach.