bluuebunny/crossref_metadata_2025 huggingface dataset:
Endovascular approaches for the treatment of dural carotid-cavernous fistulas: A systematic review
Authors: Harake Edward S , Nieblas-Bedolla Edwin , Wilseck Zachary , Chaudhary Neeraj , Armonda Rocco A , Pandey Aditya S , Dowlati Ehsan
Published: August 2024

Introduction

Dural carotid-cavernous fistulas (dCCFs), also known as indirect carotid-cavernous fistulas, represent abnormal connections between the arterial and venous systems within the cavernous sinus that are typically treated via endovascular approach. We aim to investigate the clinical characteristics of patients with dCCFs based on the endovascular treatment approach and assess angiographic and clinical outcomes.

Methods

A systematic review of the literature was performed. Data including number of patients, demographics, presenting clinical symptoms, etiology of fistula, Barrow classification, and embolization material were collected and evaluated. Outcome measures collected included degree of fistula occlusion, postoperative symptoms, complications, and mean follow-up time.

Results

A total of 52 studies were included examining four primary endovascular approaches for treating dCCFs: transarterial, transfemoral–transvenous (transpetrosal or other), transorbital (percutaneous or via cutdown), and direct transfacial access. Overall data was collected from 736 patients with 817 dCCFs. Transarterial approaches exhibit lower dCCF occlusion rates (75.6%) compared to transvenous techniques via the inferior petrosal sinus (88.1%). The transorbital approach via direct puncture or surgical cutdown offers a more direct path to the cavernous sinus, although with greater complications including risk of orbital hematoma. The direct transfacial vein approach, though limited, shows up to 100% occlusion rates and minimal complications.

Conclusion

We provide a comprehensive review of four main endovascular approaches for dCCFs. In summary, available endovascular treatment options for dCCFs have expanded and provide effective solutions with generally favorable outcomes. While the choice of approach depends on individual patient factors and technique availability, traditional transvenous procedures have emerged as the first-line endovascular treatment. There is growing, favorable literature on direct transorbital and transfacial approaches; however, more studies directly comparing these general transvenous options are necessary to refine treatment strategies.
Optimizing thrombectomy in medium vessel occlusion: Focus on vessel diameter
Authors: Tanaka Yujiro , Watanabe Daisuke , Kanoko Yusuke , Inoue Aya , Kato Daichi , Igasaki Shota , Kikuta Akira , Ogasawara Motoyori , Kanemaru Kodai , Maruoka Hibiku
Published: August 2024

Objectives

Mechanical thrombectomy for medium vessel occlusion (MeVO) is a challenging field with limited results. In this study, we aimed at evaluating the efficacy and safety of a procedural strategy beginning with occluded vessel diameter measurement and matched aspiration catheter selection.

Materials and Methods

We retrospectively analyzed all sequentially treated patients by mechanical thrombectomy at two comprehensive stroke centers between May 2020 and April 2023, focusing on the occluded vessel diameter. We included patients who underwent thrombectomy for MeVO based on the matching strategy (a procedural approach involving vessel diameter assessment, matching aspiration catheter selection, and firm clot engagement with or without a stent retriever). We evaluated efficacy and safety using the modified Thrombolysis in the Cerebral Infarction Scale (mTICI) and intracranial hemorrhage (ICH) and procedure-related complications.

Results

Seventy patients fulfilled the final inclusion criteria. The median occluded vessel diameter was 1.71 mm. We achieved mTICI 2b/2c/3 in 82.9% and mTICI 2c/3 in 51.4% of the cases and did not observe any symptomatic ICH. We detected asymptomatic subarachnoid hemorrhage (SAH) in 24.3% of the cases, that is, 5.6%, 20.0%, and 45.5% in the vessel diameter groups ≥2.0, 1.5–2.0, and ≤1.5 mm, respectively. The SAH incidence was significantly higher in narrower vessel groups. The occluded vessel diameter and the contact method with clots predicted clinical outcomes.

Conclusions

Matching strategy-based thrombectomy yields acceptable efficiency and safety results. In narrower vessels, it is optimal to engage matched aspiration catheters and clots without the assistance of conventional stent retrievers.
From the Museum to the Studio: Rethinking Visual Representations of White-Washed Stories of North American History
Authors: Richer Natilie
Published: August 2024

Treating visual representations as a socio-legal text that offers entry points to critical debates about colonial legacies, experiences, and resistance, this article explores how visual and representational culture both shape and have the potential to destabilize the legal regime of colonialism. Drawing on display practices undertaken by Ontario’s largest community museum, The Ken Seiling Waterloo Region Museum, as well as the individual practices of Cree visual artist, Kent Monkman, this article is driven by the following question: How can visual representations be used to reveal, speak back to, and unsettle colonialism as a legal cultural order?
Additional EBUS-guided intralesional amphotericin B injection combined systemic intravenous therapy in pulmonary mucormycosis: a case report
Authors: Wang Yang , Ning Weiwei , Liu Chao , Su Nan , Zhu Qingqing , Chen Yanbin , Chen Cheng
Published: August 2024

Mucormycosis is an invasive fungal infection that can result in severe lung infections, with pulmonary mucormycosis (PM) being one of the most prevalent manifestations. Prompt diagnosis is crucial for patient survival, as PM often exhibits rapid clinical progression and carries a high fatality rate. Broncho-alveolar lavage fluid or endobronchial biopsy (EBB) has been commonly employed for diagnosing PM, although there is limited mention of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the literature. In this report, we present a case of PM in a patient with diabetes. While EBB did not yield evidence of Rhizopus infection, a definitive diagnosis was obtained through EBUS-TBNA. The patient underwent combination therapy, including oral medication, nebulization, and EBUS-guided intrafocal amphotericin B injection, which resulted in significant improvement following the failure of initial therapy with amphotericin B injection cholesterol sulfate complex. Our case highlights the potential of EBUS-TBNA not only for mediastinal lymphadenopathy but also for obtaining extraluminal lesion specimens. Furthermore, for patients with an inadequate response to mono-therapy and no access to surgical therapy, the addition of EBUS-guided intralesional amphotericin B injection to systemic intravenous therapy may yield unexpected effects.
Acute drug-use-related native tricuspid valve infective endocarditis: a non-surgical disease
Authors: El-Dalati Sami , Alnabelsi Talal , Gurley John , Cremeans Kelli , Reda Hassan , London-Bounds Tessa , Ogburn Erinn , Sekela Michael
Published: August 2024

As a result of the ongoing opioid epidemic, physicians have encountered increasing rates of drug-use-related native tricuspid valve infective endocarditis (DU-TVIE), a complex multi-faceted disease that is best managed by interdisciplinary teams. Despite the large number of patients with DU-TVIE, there is little data to support the optimal treatment strategy with respect to medical and surgical therapy. The recent introduction of percutaneous mechanical aspiration of tricuspid valve vegetations has added another treatment modality that is also of uncertain benefit. Here we review the literature on the management of DU-TVIE and highlight the multi-step treatment approach developed by the multidisciplinary endocarditis team at the University of Kentucky.
Putting Musical Feelings Into Words: Children's Verbal Descriptions of Music-Evoked Experiences
Authors: Owen Caroline , Egermann Hauke , Schiavio Andrea
Published: August 2024

There is limited empirical research devoted to exploring children's subjective responses to music, despite extensive examination in the literature of their ability to recognize emotions said to be expressed by music. To address this gap, we recruited 26 participants aged between 5 and 11 years with the aim of learning more about their capacity to report on their music-evoked experiences, and to test the suitability of a categorical measurement scale as an age-appropriate self-report format. Participants were invited to give free descriptions of how six musical stimuli made them feel and to rate their music-evoked experiences using the categorical scale. Their responses revealed an awareness of music-induced feelings, visual imagery, and imagined narrative, and the capacity to describe these in detail. All participants were able to use the categorical measurement scale; however, the richness of their free responses suggests that an open format might capture more comprehensive and meaningful data than a forced-choice format. We recommend further testing with a much larger sample of participants from a wider population.
A Hierarchical Model of the Symptom-Level Structure of Psychopathology in Youth
Authors: Forbes Miriam K. , Watts Ashley L. , Twose Maddison , Barrett Angelique , Hudson Jennifer L. , Lyneham Heidi J. , McLellan Lauren , Newton Nicola C. , Sicouri Gemma , Chapman Cath , McKinnon Anna , Rapee Ronald M. , Slade Tim , Teesson Maree , Markon Kristian , Sunderland Matthew
Published: August 2024

More comprehensive modeling of psychopathology in youth is needed to facilitate a developmentally informed expansion of the Hierarchical Taxonomy of Psychopathology (HiTOP) model. In this study, we examined a symptom-level model of the structure of psychopathology in children and adolescents—most aged 11 to 17 years—bringing together data from large clinical, community, and representative samples ( N = 18,290) covering nearly all major forms of mental disorders and related content domains (e.g., aggression). The resulting hierarchical and dimensional model was based on the points of convergence among three statistical approaches and included 15 narrow dimensions nested under four broad dimensions of (a) internalizing, (b) externalizing, (c) eating pathology, and (d) uncontrollable worry, obsessions, and compulsions. We position these findings within the context of the existing literature and articulate implications for future research. Ultimately, these findings add to the rapidly growing literature on the structure of psychopathology in youth and move a step closer toward quantifying (dis)continuities in psychopathology’s structure across the life span.
Prevalence and Characteristics of Veterans with Severe Hearing Loss: A Descriptive Study
Authors: Friedmann David R , Nicholson Andrew , O'Brien-Russo Colleen , Sherman Scott , Chodosh Joshua
Published: August 2024

Hearing loss is common among Veterans, and extensive hearing care resources are prioritized within the Veterans Administration (VA). Severe hearing loss poses unique communication challenges with speech understanding that may not be overcome with amplification. We analyzed data from the VA Audiometric Repository between 2005 and 2017 and the relationship between hearing loss severity with speech recognition scores. We hypothesized that a significant subset of Veterans with severe or worse hearing loss would have poor unaided speech perception outcomes even with adequate audibility. Sociodemographic characteristics and comorbidities were compiled using electronic medical records as was self-report measures of hearing disability. We identified a cohort of 137,500 unique Veterans with 232,789 audiograms demonstrating bilateral severe or worse hearing loss (four-frequency PTA > 70 dB HL). The median (IQR; range) age of Veterans at their first audiogram with severe or worse hearing loss was 81 years (74 to 87; 21–90+), and a majority were male (136,087 [99%]) and non-Hispanic white (107,798 [78.4%]). Among those with bilateral severe or worse hearing loss, 41,901 (30.5%) also had poor speech recognition scores (<50% words), with greater hearing loss severity correlating with worse speech perception. We observed variability in speech perception abilities in those with moderate-severe and greater levels of hearing loss who may derive limited benefit from amplification. Veterans with communication challenges may warrant alternative approaches and treatment strategies such as cochlear implants to support communication needs.
Optimizing Access in Hip Arthroscopy
Authors: Richardson Meghan W. , Goodloe J. Brett , Su Charles A. , Gwathmey F. Winston
Published: August 2024

Background:

Arthroscopic access to the hip can be challenging. We present a reproducible, safe, and efficient method for arthroscopic access to the hip. This can be especially beneficial for hips that may be predisposed to more difficult access.

Indications:

Hip arthroscopy is indicated in patients with symptomatic femoral acetabular impingement (FAI) who have failed conservative treatment options. FAI surgery aims to address both bony impingement and labral pathology in the hip.

Technique:

In this technique, we describe methodical steps to hip access. These steps include special attention to patient positioning and preoperative radiographs, air arthrogram, bevel control for needle joint entry, careful interpretation of intraoperative fluoroscopy, and adequate capsulotomy for viewing.

Results:

The majority of patients undergoing hip arthroscopy for FAI have improvements in both hip function and pain. Preoperative findings of increased center edge angle and male sex may predispose patients to more difficult hip arthroscopy access. The use of this technique may aid in reproducible access.

Discussion/Conclusion:

Hip arthroscopy is a good option for patients who have failed conservative treatment options and have signs and symptoms of FAI. Reproducible, safe, and efficient access to the hip is critical to starting hip arthroscopy cases.

Patient Consent Disclosure Statement:

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
The 2023 Alaska National Seismic Hazard Model
Authors: Powers Peter M , Altekruse Jason M , Llenos Andrea L , Michael Andy J , Haynie Kirstie L , Haeussler Peter J , Bender Adrian M , Rezaeian Sanaz , Moschetti Morgan P , Smith James A , Briggs Richard W , Witter Robert C , Mueller Charles S , Zeng Yuehua , Girot Demi L , Herrick Julie A , Shumway Allison M , Petersen Mark D
Published: August 2024

US Geological Survey (USGS) National Seismic Hazard Models (NSHMs) are used extensively for seismic design regulations in the United States and earthquake scenario development, as well as risk assessment and mitigation for both buildings and infrastructure. This 2023 update of the long-term, time-independent Alaska NSHM includes substantial changes to both the earthquake rupture forecast (ERF) and ground motion models (GMMs). The ERF includes numerous additions to the finite-fault model, considers two deformation models, and introduces updated declustering and smoothing algorithms in the gridded background seismicity model. For the Alaska–Aleutian subduction zone, megathrust earthquakes occur on an updated structural and segmentation model, and the moment magnitude (M) 8+ rupture and rate model include a logic tree branch that considers slip rates derived from geodetic models of interface coupling. The megathrust model considers multiple models of down-dip width, and magnitudes are computed using newly developed scaling relations. For subduction intraslab events and subduction interface events with M < 7, the 2023 update uses a smoothed seismicity model with rupture depths derived from Slab2. The 2023 model updates GMMs in all tectonic settings using the recently published Next Generation Attenuation Subduction (NGA-Sub) GMMs for subduction interface and intraslab events, and the NGA-West2 GMMs for active crustal settings. Collectively, additions and updates to the Alaska NSHM result in hazard increases across most of south-central Alaska relative to the previous model, published in 2007. These changes are primarily due to the adoption of updated rate models for the large-magnitude interface events and the NGA-Sub GMMs that have much higher aleatory variability (sigma), consistent with global observations, and that include models of epistemic uncertainty.
Impact of ground motion uncertainty evolution from post-earthquake data on building damage assessment
Authors: Lozano Jorge-Mario , Tien Iris , Nichols Elliot , Frost J. David
Published: August 2024

Accurate damage assessment after an earthquake is crucial for effective emergency response. Using ground motion information enables rapid building damage assessment when detailed damage data are unavailable. While uncertainty in earthquake parameters plays a significant role in the accuracy of rapid estimations, it is usually treated as a constant parameter rather than as a dynamic parameter that considers the amount of ground motion data collected that evolve over time. This work investigates the impact of incorporating evolving ground motion uncertainty in ground motion estimations from US Geological Survey’s (USGS) ShakeMap on post-disaster damage assessments from two methodologies: the revised Thiel–Zsutty (TZR) model and Federal Emergency Management Agency’s (FEMA) Hazus. Using data from the 2020 Indios earthquake in Puerto Rico and the 2014 Napa earthquake, we find that changes in uncertainty in estimates of peak ground acceleration reach 65% between early and late versions of the ShakeMap. We propose a process to integrate this evolution with the two damage assessment methodologies through a Monte Carlo simulation-based approach, demonstrating that it is critical to introduce dynamic ground motion uncertainty in the damage assessment process to avoid propagating unreliable measures. Both methodologies show that resulting damage estimates can be characterized by narrower distributions, indicative of reduced uncertainty and increased precision in damage estimates. For the TZR model, an improved estimate of post-disaster loss is achieved with narrower bounds in distributions of expected high scenario loss. For Hazus, the results show potential changes in the most probable damage state with an average change of 13% in the most probable damage state. The described methodology also demonstrates how uncertainty in the resulting damage state distributions can be reduced compared with the use of the current Hazus methodology.
Exploring the Impact of Buying Dimensions on Purchase Intention
Authors: Soin Gaurav , K. Khatik Rajendra , K. Upamannyu Nischay
Published: August 2024

The present research is a portrayal to examine the impact of financially independent mothers’ prior product knowledge and information search on their purchase intention of nourishment products for their children. The research is empirical in nature, and the sampling element is financially independent mothers. Mothers who are part of a couple or a family may need to consult with their partner or other family members before making a purchase, making it more difficult to understand their intentions. On the other hand, financially independent mothers have more autonomy and can make decisions more quickly and easily. Non-probability purposive sampling techniques were used to approach the target population. The findings of the present study demonstrate that prior product knowledge and information search influence the purchase intention for nutrition products in the context of financially independent mothers. The study’s implications are multifaceted and offer valuable insights for marketers, policymakers, healthcare professionals and brands targeting mothers and children in the nourishment product market.
Development of a diagnostic predictive model for determining child stunting in Malawi: a comparative analysis of variable selection approaches
Authors: Mkungudza Jonathan , Twabi Halima S. , Manda Samuel O. M.
Published: August 2024

Background

Childhood stunting is a major indicator of child malnutrition and a focus area of Global Nutrition Targets for 2025 and Sustainable Development Goals. Risk factors for childhood stunting are well studied and well known and could be used in a risk prediction model for assessing whether a child is stunted or not. However, the selection of child stunting predictor variables is a critical step in the development and performance of any such prediction model. This paper compares the performance of child stunting diagnostic predictive models based on predictor variables selected using a set of variable selection methods.

Methods

Firstly, we conducted a subjective review of the literature to identify determinants of child stunting in Sub-Saharan Africa. Secondly, a multivariate logistic regression model of child stunting was fitted using the identified predictors on stunting data among children aged 0–59 months in the Malawi Demographic Health Survey (MDHS 2015–16) data. Thirdly, several reduced multivariable logistic regression models were fitted depending on the predictor variables selected using seven variable selection algorithms, namely backward, forward, stepwise, random forest, Least Absolute Shrinkage and Selection Operator (LASSO), and judgmental. Lastly, for each reduced model, a diagnostic predictive model for the childhood stunting risk score, defined as the child propensity score based on derived coefficients, was calculated for each child. The prediction risk models were assessed using discrimination measures, including area under-receiver operator curve (AUROC), sensitivity and specificity.

Results

The review identified 68 predictor variables of child stunting, of which 27 were available in the MDHS 2016–16 data. The common risk factors selected by all the variable selection models include household wealth index, age of the child, household size, type of birth (singleton/multiple births), and birth weight. The best cut-off point on the child stunting risk prediction model was 0.37 based on risk factors determined by the judgmental variable selection method. The model’s accuracy was estimated with an AUROC value of 64% (95% CI: 60%-67%) in the test data. For children residing in urban areas, the corresponding AUROC was AUC = 67% (95% CI: 58–76%), as opposed to those in rural areas, AUC = 63% (95% CI: 59–67%).

Conclusion

The derived child stunting diagnostic prediction model could be useful as a first screening tool to identify children more likely to be stunted. The identified children could then receive necessary nutritional interventions.
Specific antigen-based stratification of membranous nephropathy in patients after haematopoietic stem cell allotransplantation - a case series and literature review
Authors: Bosnić Kovačić Ines , Matošević Matija , Laganović Mario , Dika Živka , Fištrek Prlić Margareta , Ivandić Ema , Ćorić Marijana , Bulimbašić Stela , Duraković Nadira , Perić Zinaida , Desnica Lana , Vrhovac Radovan , Jelaković Bojan , Sethi Sanjeev , Vuković Brinar Ivana
Published: August 2024

Background

Nephrotic syndrome (NS) is a rare complication that can occur after haematopoietic stem cell transplantation (HSCT). In patients with membranous nephropathy (MN) who have undergone allogeneic HSCT, a new antigen called protocadherin FAT1 has been identified. Our objective is to present a case series of MN patients after HSCT with a novel antigen-based stratification.

Case presentations

Patients who developed full-blown NS due to MN after an HSCT were enrolled in the University Hospital Centre Zagreb study. The first two patients were treated with an HSCT for acute myeloid leukaemia, and both developed NS after cessation of graft versus host disease (GVHD) prophylaxis. The first patient had reduced kidney function, while the second had completely preserved function. Kidney biopsy showed MN with only subepithelial deposits. A thorough examination revealed that there was no secondary cause of the disease. The patients achieved complete remission after undergoing immunosuppression treatment. The third patient underwent HSCT for acute lymphoblastic leukaemia. He developed both acute and chronic GVHD and also experienced avascular hip necrosis. After sixteen years, the patient developed NS with preserved kidney function. The kidney specimen showed membranous nephropathy (MN) with mesangial and subepithelial deposits. Extensive research was conducted, but no secondary cause for the MN was detected. All three cases tested negative for anti-PLA2R antibodies. Biopsy tissue samples were analysed using laser microdissection and tandem mass spectrometry of glomeruli for the detection of different specific antigens. Patients one and two tested positive for FAT1, whereas patient three tested positive for PCSK6.

Conclusions

MN can develop at various time intervals after HSCT. Specific antigen testing can help establish the relationship between MN and HSCT. In the future, serum testing for anti-FAT1 antibodies in HSCT patients could be significant in diagnosing FAT1-associated MN, similar to how anti-PLA2R antibodies are significant in diagnosing PLA2R-associated MN.
Autonomic neuropathy in dialysis patients – investigations with a new symptom score (COMPASS 31)
Authors: Schramm Catharina Verena , Schramm Michael Christoph , Trautner Markus , Hinz Michael , Mitzner Steffen
Published: August 2024

Background

Symptoms of autonomic neuropathy (AN) are common in patients with diabetes and advanced renal disease. As yet different domains of autonomic neuropathy cannot be detected by a singular laboratory or invasive test. COMPASS 31, a new self-assessment test, has shown reliable results not only in cardiac autonomic neuropathy but also in different sub-domains when judging manifestation of AN by scores.

Methods

One hundred eighty-three patients with or without diabetes were enrolled, one hundred nineteen of them were treated with permanent dialysis therapy (HD), sixty-four patients served as controls (eGFR > 60 ml/min.) Using COMPASS 31 different symptoms of AN were assessed (orthostatic intolerance, vasomotor, secretomotor, gastrointestinal, bladder, pupillomotor changes) and transferred into AN-scores.

Results

AN was more pronounced in dialysis patients compared with controls (AN-score 27,5 vs. 10,0; p < 0,01). These differences were present also in every sub-domain of AN (orthostatic intolerance, vasomotor, secretomotor, gastrointestinal, bladder, pupillomotor changes; p < 0,05 for all sub-domains). In diabetic patients there was a strong correlation between symptoms of AN and diabetes duration (correlation coefficient r = 0,45, p < 0,001). Current glycemic control (HbA1c), body mass index (BMI), sex, and height had no influence on AN when comparing dialysis patients and controls. C-reactive protein (CRP) showed a positive linear correlation with AN-scores (correlation coefficient r = 0,21; p < 0,05).

Conclusion

Symptoms of AN are more pronounced in dialysis patients not only in total but also in all different domains of neuropathic changes. Longlasting diabetic disease promotes development of AN, as duration of diabetes was positively correlated with AN. Future longitudinal studies might help to identify the high cardiovascular and mortality risk in dialysis patients by the easy-to-use COMPASS 31 without need of invasive and time-spending methods for diagnosing AN.
Psychological capital educational program and its effect on nurse interns’ innovative behavior
Authors: Kotb Ahmed Hussien Ahmed , Shazly Mona Mostafa , Mostafa Hemat Abdel-Azeem
Published: August 2024

Background

Nurse interns’ capacity for innovative behavior is a key component of healthcare settings because of increasing demands and complexities. Thus, it is important to find strategies that promote their innovative behavior. The development of psychological capital (PsyCap) improves positive behaviors and attitudes, such as engagement, motivation, and satisfaction, in the work environment. Therefore, this study aimed to assess the effect of a PsyCap educational program on nurse interns’ innovative behavior.

Methods

A quasi-experimental design was used in this study. This study was executed at Fayoum University hospitals. The study participants comprised all the available nurse interns (n = 223) registered in the internship year (2022–2023) in the aforementioned settings. The data were gathered using three instruments, namely, the PsyCap Knowledge Questionnaire, the PsyCap Questionnaire, and the Innovative Behavior Inventory.

Results

The nurse interns’ mean scores regarding total knowledge about PsyCap, total perception of PsyCap, and total perception of innovative behavior significantly improved through the posttest phase (41.27 ± 9.31, 92.22 ± 6.26, 91.31 ± 9.06, respectively) and the follow-up phase (37.83 ± 8.83, 89.96 ± 6.31, 88.89 ± 8.33) in comparison with the pretest phase (14.39 ± 5.83, 69.04 ± 8.13, 60.55 ± 7.15).

Conclusion

The PsyCap educational program was effective and beneficial for improving the nurse interns’ perceptions of innovative behavior. Therefore, PsyCap interventions should be implemented in hospitals through professional development programs and orientation programs.
Construct validity and reliability of Amharic version of DASS-21 scale among Ethiopian Defense University College of Health Science students
Authors: Tsegaye Bitew Sintayehu , Asemu Meseret Molla , Hailu Habtamu Belay
Published: August 2024

Background

DASS-21 is the common and widely used tool for assessing depression, anxiety and stress. However, its validity and Reliability in Ethiopian Amharic language is not assessed.

Objective

To translate the DASS-21 and assess its validity and reliability among Ethiopian Defense University college of health science students in Bishoftu, Ethiopia.

Method

An institutional based cross-sectional study was conducted using a self-administered questionnaire. A total of 435 students from different departments in accordance with their proportional size were participated in this study. As to the sampling technique, the study units were selected from each department and year of study using simple random sampling proportional to size. Confirmatory factor analyses were employed to assess the factor structure and construct validity of Amharic version of the DASS-21. Cronbach alpha coefficient and corrected item total correlation was calculated to assess the internal consistency of Amharic version of DASS-21.

Result

Among 435 undergraduate students who participated in the study, 246(56.6%) were the age of 18–25 year and majority 347(79.8%) were males. Regarding their year of study; 200 (46.0%) were first year students. Confirmatory factor analysis indicates a good model fit of the three correlated factors (Comparative fit index (CFI) = 0.92 with root mean square error of approximation (RMSEA) = 0.059[0.052–0.066] and standardize root mean residual SRMR = 0.045). The internal consistency of overall DASS-21 and each sub scale were in acceptable range (0.91, 0.82, 0.77 and 0.77) respectively.

Conclusion

Amharic version of DASS-21 was found to be a valid and reliable instrument to measure the mental problem especially, Depression, Anxiety and Stress among university students.
Spermatozoon-propelled microcellular submarines combining innate magnetic hyperthermia with derived nanotherapies for thrombolysis and ischemia mitigation
Authors: Weng Pei-Wei , Liu Chia-Hung , Jheng Pei-Ru , Chiang Chia-Che , Chen Yan-Ting , Rethi Lekshmi , Hsieh Yves S. Y. , Chuang Andrew E.-Y.
Published: August 2024

Thrombotic cardiovascular diseases are a prevalent factor contributing to both physical impairment and mortality. Thrombolysis and ischemic mitigation have emerged as leading contemporary therapeutic approaches for addressing the consequences of ischemic injury and reperfusion damage. Herein, an innovative cellular-cloaked spermatozoon-driven microcellular submarine (SPCS), comprised of multimodal motifs, was designed to integrate nano-assembly thrombolytics with an immunomodulatory ability derived from innate magnetic hyperthermia. Rheotaxis-based navigation was utilized to home to and cross the clot barrier, and finally accumulate in ischemic vascular organs, where the thrombolytic motif was “switched-on” by the action of thrombus magnetic red blood cell-driven magnetic hyperthermia. In a murine model, the SPCS system combining innate magnetic hyperthermia demonstrated the capacity to augment delivery efficacy, produce nanotherapeutic outcomes, exhibit potent thrombolytic activity, and ameliorate ischemic tissue damage. These findings underscore the multifaceted potential of our designed approach, offering both thrombolytic and ischemia-mitigating effects. Given its extended therapeutic effects and thrombus-targeting capability, this biocompatible SPCS system holds promise as an innovative therapeutic agent for enhancing efficacy and preventing risks after managing thrombosis.

Graphical abstract
CAR T cell therapy for refractory pediatric systemic lupus erythematosus: a new era of hope?
Authors: Stojkic Ivana , Harper Lauren , Coss Samantha , Kallash Mahmoud , Driest Kyla , Lamb Margaret , Ardoin Stacy P. , Akoghlanian Shoghik
Published: August 2024

Systemic lupus erythematosus (SLE) is a chronic autoimmune condition that can affect multiple organ systems and is heterogenous in its presentation and response to therapy. When diagnosed in childhood, SLE is associated with increased morbidity and mortality compared to adult SLE, often requiring substantial immunosuppression with the risk of significant side effects. There remains a significant unmet need for new therapies that can improve disease control and reduce glucocorticoid and other toxic medication exposure for patients with severe or refractory disease. The pathogenesis of SLE involves B cell dysregulation and autoantibody production, which are a hallmark of the disease. Currently approved B cell directed therapies often result in incomplete B cell depletion and may not target long-lived plasma cells responsible for SLE autoantibodies. It is hypothesized that by persistently eliminating both B cells and plasmablasts, CAR T therapy can halt autoimmunity and prevent organ damage in patient’s refractory to current B cell-depleting treatments. Herein we summarize the current preclinical and clinical data utilizing CAR T cells for SLE and discuss the future of this treatment modality for lupus.
Transcriptional and epigenetic characterization of a new in vitro platform to model the formation of human pharyngeal endoderm
Authors: Cipriano Andrea , Colantoni Alessio , Calicchio Alessandro , Fiorentino Jonathan , Gomes Danielle , Moqri Mahdi , Parker Alexander , Rasouli Sajede , Caldwell Matthew , Briganti Francesca , Roncarolo Maria Grazia , Baldini Antonio , Weinacht Katja G. , Tartaglia Gian Gaetano , Sebastiano Vittorio
Published: August 2024

Background

The Pharyngeal Endoderm (PE) is an extremely relevant developmental tissue, serving as the progenitor for the esophagus, parathyroids, thyroids, lungs, and thymus. While several studies have highlighted the importance of PE cells, a detailed transcriptional and epigenetic characterization of this important developmental stage is still missing, especially in humans, due to technical and ethical constraints pertaining to its early formation.

Results

Here we fill this knowledge gap by developing an in vitro protocol for the derivation of PE-like cells from human Embryonic Stem Cells (hESCs) and by providing an integrated multi-omics characterization. Our PE-like cells robustly express PE markers and are transcriptionally homogenous and similar to in vivo mouse PE cells. In addition, we define their epigenetic landscape and dynamic changes in response to Retinoic Acid by combining ATAC-Seq and ChIP-Seq of histone modifications. The integration of multiple high-throughput datasets leads to the identification of new putative regulatory regions and to the inference of a Retinoic Acid-centered transcription factor network orchestrating the development of PE-like cells.

Conclusions

By combining hESCs differentiation with computational genomics, our work reveals the epigenetic dynamics that occur during human PE differentiation, providing a solid resource and foundation for research focused on the development of PE derivatives and the modeling of their developmental defects in genetic syndromes.
Short-term outcomes and inflammatory stress response following laparoscopy or robotic-assisted transabdominal preperitoneal inguinal hernia repair (TAPP): study protocol for a prospective, randomized trial (ROLAIS)
Authors: Valorenzos Alexandros Valsamidis , Nielsen Kristian Als , Kaiser Karsten , Helligsø Per , Ellebæk Mark Bremholm , Dorfelt Allan , Petersen Sofie Ronja , Pedersen Andreas Kristian , Nielsen Michael Festersen
Published: August 2024

Background

Inguinal hernia repair is a frequently performed surgical procedure, with laparoscopic repair emerging as the preferred approach due to its lower complication rate and faster recovery compared to open repair. Mesh-based tension-free repair is the gold standard for both methods. In recent years, robotic hernia repair has been introduced as an alternative to laparoscopic repair, offering advantages such as decreased postoperative pain and improved ergonomics.

This study aims to compare the short- and long-term outcomes, including the surgical stress response, postoperative complications, quality of life, and sexual function, between robotic-assisted transabdominal preperitoneal (rTAPP) and laparoscopic TAPP inguinal hernia repairs.

Methods

This randomized controlled trial will involve 150 patients from the Surgical Department of the University Hospital of Southern Denmark, randomized to undergo either rTAPP or laparoscopic TAPP. Surgical stress will be quantified by measuring C-reactive protein (CRP) and cytokine levels. Secondary outcomes include complication rates, quality of life, sexual function, and operative times. Data analysis will adhere to the intention-to-treat principle and will be conducted once all patient data are collected, with outcomes assessed at various postoperative intervals.

Discussion

This study holds significance in evaluating the potential advantages of robotic-assisted surgery in the context of inguinal hernia repairs.

It is hypothesized that rTAPP will result in a lower surgical stress response and potentially lower the risk of postoperative complications compared to conventional laparoscopic TAPP. The implications of this research could influence future surgical practices and guidelines, with a focus on patient recovery and healthcare costs. The findings of this study will contribute to the ongoing discourse surrounding the utilization of robotic systems in surgery, potentially advocating for their broader implementation if the benefits are substantiated.

Trial registration

ClinicalTrials.gov NCT05839587. Retrospectively registered on 28 February 2023.
Cardiac sarcoidosis presenting as multiple right intra-atrial masses mimicking cardiac tumor
Authors: Gohri Jay , Luthra Harshvardhan , Qureshi Khushboo , Reddy Karnati Prudhveer
Published: August 2024

Background

Cardiac sarcoidosis though in itself, a rare entity, very rarely presents primarily with conduction abnormalities as the primary manifestation in the spectrum of presentations accounted by this chronic granulomatous systemic disease. Sarcoidosis presenting as intra-atrial masses is virtually unheard of.

Case

A middle aged female presented with progressive conduction system disease was found to have right atrial masses of unclear etiologic on relevant imaging. Over the course of 3 months she underwent a dual-chamber ICD implant for her eventual complete heart block and a surgical resection following an inconclusive biopsy of the right atrial free wall mass. She was then diagnosed with cardiac sarcoidosis and started on immunosupressants almost instantaneously as a part of her treatment.

Conclusion

This is an entirely new and unreported presentation of cardiac sarcoidosis as an intra-atrial mass. Through this case we bring light to cardiac sarcoidosis as a potential differential for intra-cardiac masses and how with available data do we go about treating it.
Causative agent for perioperative anaphylaxis in a child with autism successfully identified using the intradermal test under general anesthesia
Authors: Amano Yasuhiro , Mizutani Kumi , Kato Yuki , Fujii Tasuku , Yagami Akiko , Tamura Takahiro
Published: August 2024

Background

The skin-prick and intradermal tests are the main diagnostic methods used to identify the causative agent in patients with suspected perioperative anaphylaxis. Although the intradermal test is more sensitive than the skin-prick test, multiple intradermal injections can be painful for children. Here, we present the case of a child with autism and suspected perioperative anaphylaxis. The causative agent was successfully identified using the intradermal test under general anesthesia.

Case presentation

An 8-year-old boy with autism developed anaphylaxis during general anesthesia for the fourth cleft lip and palate surgery. An allergic workout was performed, but both the skin-prick and basophil activation tests for suspected causative agents yielded negative results. The patient was afraid of multiple injections, and an intradermal test was performed under general anesthesia by anesthesiologists and allergists. Piperacillin was confirmed as the causative agent, and subsequent surgery using the same anesthetic agents without piperacillin was uneventful.

Conclusions

Concerted efforts should be made to identify the causative agent for diagnosing perioperative anaphylaxis.
Beyond content delivery: harnessing emotional intelligence for community building in fully online digital spaces
Authors: Stolba Aneta , Hope Ashley , Branch Jessie , Manoj Prerana , Trinier Jessica , Behboudi Atefeh , vanOostveen Roland , Childs Elizabeth
Published: August 2024

The onset of the pandemic catalyzed a paradigm shift in educational methodologies, bringing various forms, such as hybrid, distance, and fully online models, into focus. The following study explores the affective domain in online learning, focusing on how emotions, facial expressions, and body language influence engagement and support community building in fully online learning environments. This research explores the role of emotional intelligence in Fully Online Learning Communities (FOLC) and examines the impact of positive and negative emotions on interpersonal engagement and participation. Findings indicate positive emotions to be closely linked to increased engagement and active participation. The study also highlights the importance of exploring body language in digital learning environments and addresses challenges posed by technological barriers in fully online learning spaces. Emotional intelligence is pivotal in online learning and community building, emphasizing the need to understand how to create emotionally supportive digital learning environments. Outcomes indicate a need for future research to focus on understanding the role of cultural dimensions in supporting learner agency and community building in the fully online learning context.
The symptoms evolution of long COVID‑19 (SE-LC19): a new patient-reported content valid instrument
Authors: Rofail Diana , Somersan-Karakaya Selin , Mylonakis Eleftherios , Choi Julia Y. , Przydzial Krystian , Marquis Sarah , Zhao Yuming , Hussein Mohamed , Norton Thomas D. , Podolanczuk Anna J. , Geba Gregory P.
Published: August 2024

Background

The field of long COVID research is rapidly evolving, however, tools to assess and monitor symptoms and recovery of the disease are limited. The objective of the present study was to develop a new patient-reported outcomes instrument, the Symptoms Evolution of Long COVID‑19 (SE-LC19), and establish its content validity.

Methods

The 40-item SE-LC19 instrument was developed based on patient-relevant empirical evidence from scientific literature and clinical guidelines that reported symptoms specific to long COVID. A 2-part mixed-method approach was employed. Part 1: Qualitative interviews with a purposive sample of 41 patients with confirmed long COVID were conducted for the content validation of SE-LC19. During cognitive debriefing interviews, patients were asked to describe their understanding of the instrument’s instructions, specific symptoms, response options, and recall period to ensure its relevance and comprehensiveness. Five clinicians of different medical specialties who regularly treated patients with long COVID were also interviewed to obtain their clinical expert opinions on SE-LC19. Part 2: Exploratory Rasch Measurement Theory (RMT) analysis was conducted to evaluate the psychometric properties of the SE-LC19 data collected during the interviews.

Results

Overall, patients reported that the instructions, questions, recall period, and response options for SE-LC19 were comprehensive and relevant. Minor conceptual gaps reported by patients captured nuances in the experience of some symptoms that could be considered in future studies. Some patients suggested a revision of the recall period from 24 h to 7 days to be able to capture more symptoms given the waxing and waning nature of some symptoms. Clinicians found the instrument comprehensive with minimal suggestions regarding its content. Exploratory RMT analyses provided evidence that the SE-LC19 questionnaire performed as intended.

Conclusion

The present mixed-methods study in patients with confirmed long COVID supports the content validity and applicability of the SE-LC19 instrument to evaluate the symptoms of patients with long COVID. Further research is warranted to explore the psychometric properties of the instrument and refine a meaningful and robust patient-relevant endpoint for use in different settings such as clinical trials and clinical practice to track the onset, severity, and recovery of long COVID.
Trends in incidence of self-harm, neurodevelopmental and mental health conditions among university students compared with the general population: nationwide electronic data linkage study in Wales
Authors: John Ann , Rouquette Olivier Y. , Lee Sze Chim , Smith Jo , del Pozo Baños Marcos
Published: August 2024

Background

Concern that self-harm and mental health conditions are increasing in university students may reflect widening access to higher education, existing population trends and/or stressors associated with this setting.

Aims

To compare population-level data on self-harm, neurodevelopmental and mental health conditions between university students and non-students with similar characteristics before and during enrolment.

Method

This cohort study linked electronic records from the Higher Education Statistics Agency for 2012–2018 to primary and secondary healthcare records. Students were undergraduates aged 18 to 24 years at university entry. Non-students were pseudo-randomly selected based on an equivalent age distribution. Logistic regressions were used to calculate odds ratios. Poisson regressions were used to calculate incidence rate ratios (IRR).

Results

The study included 96 760 students and 151 795 non-students. Being male, self-harm and mental health conditions recorded before university entry, and higher deprivation levels, resulted in lower odds of becoming a student and higher odds of drop-out from university. IRRs for self-harm, depression, anxiety, autism spectrum disorder (ASD), drug use and schizophrenia were lower for students. IRRs for self-harm, depression, attention-deficit hyperactivity disorder, ASD, alcohol use and schizophrenia increased more in students than in non-students over time. Older students experienced greater risk of self-harm and mental health conditions, whereas younger students were more at risk of alcohol use than non-student counterparts.

Conclusions

Mental health conditions in students are common and diverse. While at university, students require person-centred stepped care, integrated with local third-sector and healthcare services to address specific conditions.