bluuebunny/crossref_metadata_2025 huggingface dataset:
An Adaptive Pacing Intervention for Adults Living With Long COVID: A Narrative Study of Patient Experiences of Using the PaceMe app
Authors: Meach Rachel , Carless David , Sanal-Hayes Nilihan E. M. , Mclaughlin Marie , Hayes Lawrence D. , Mair Jacqueline L. , Ormerod Jane , Hilliard Natalie , Ingram Joanne , Sculthorpe Nicholas F.
Published: November 2024

Adaptive pacing (AP) is a self-management technique which seeks to balance energy and rest in individuals with chronic health conditions. Adaptive pacing can help people with myalgic encephalomyelitis/chronic fatigue syndrome learn how to manage their energy expenditure thereby reducing their risk of post-exertional malaise (PEM) and other symptoms. Given some symptom similarity, AP also has rehabilitation potential for people experiencing disability from long COVID. The purpose of this study was to explore patient experiences of an AP intervention (the “PaceMe” app) to determine its value for individuals experiencing long COVID. Twenty-five participants each took part in two narrative interviews (at intervention start point and at 3-6 months). Data were analyzed using narrative thematic analysis. Our analysis identified 4 themes relating to key benefits of the PaceMe app: (1) PEM management, (2) Support, (3) Validation, and (4) Control and Agency. By illuminating the critical facts and centring patient voices, these findings contribute a better understanding of the experiences and needs of those with long COVID and highlight the value of a digital health intervention as a vital component of rehabilitation.
The efficacy and safety of continuous blanket suture for severe recurrent pterygium with symblepharon
Authors: Ma Huixiang , Shen Jiahui , Chen Xuhao , Ye Xianfeng , Xu Shuxia , Zhang Zongduan
Published: November 2024

Background:

Managing recurrent pterygium combined with symblepharon presents significant challenges in ophthalmology. Clinicians aim to reconstruct the ocular surface, alleviate eye movement restrictions, and minimize recurrence risks.

Objective:

Evaluation of efficacy and safety of continuous blanket sutures (CBS) for fixation of large autologous conjunctival grafts in patients with severe recurrent pterygium with symblepharon.

Methods:

Retrospective, observational case series. Thirty-nine patients (40 eyes) were included, all with severe recurrent pterygium with symblepharon. During surgery, CBS was employed to affix large autologous conjunctival grafts to the exposed sclera, aiming to restore the ocular surface to smoothness as much as possible. All patients were followed up for more than one year. Main outcome measures include the rate of recurrence, improvement of eye movement, and intraoperative and postoperative complications.

Results:

Nearly all patients exhibited a smooth ocular surface and largely restored physiological structures during the follow-up period. There were no graft loss or contraction cases until the last follow-up, with only three eyes experiencing a pterygium recurrence (recurrence rate 7.5%, 3/40). Preoperative eye movement limitations improved significantly from 2.10 ± 0.71 (range 1–3) to 0.33 ± 0.53 (range 0–2; p < 0.001) post-surgery. Other postoperative complications included varying degrees of corneal scarring and a single instance of conjunctival granulomatous hyperplasia (1 eye, 2.5%).

Conclusion:

When addressing severe recurrent pterygium with Symblepharon, using CBS to secure large autologous conjunctival grafts during surgery can achieve favorable postoperative outcomes. This surgical method is safe and feasible and effectively rebuilds a smooth ocular surface, improves the appearance of the ocular surface, and reduces the recurrence rate of pterygium after excision.
Zeal Spillovers: The Adversarial Bias in Simulated Pre-Trial Decision Making
Authors: Simon Dan , Melnikoff David E.
Published: November 2024

The adversarial legal procedure is one of the defining characteristics of Anglo-American law. Adversarialism is lauded for its capacity to discover the factual truth, which is said to be revealed by the clash between zealous advocates. This study further explores the proposition that adversarial contests trigger a bias that pervades adversarial actors’ judgments, beliefs, motivations, and emotions, and thus skews how they perceive and approach their cases. Specifically, we set out to extend prior research by testing whether the adversarial bias could spill over to skew simulated pre-trail prosecutorial tasks: the decision to seek an indictment and forming judgments in advance of the plea negotiation. In a simulation with lay people, we find that the adversarial bias does indeed skew pre-trial decisions. This result is troubling because the epistemic justification of adversarialism has little to contribute to these decisions, as indictment decisions are made unilaterally by prosecutors, and plea negotiations take place under heavily lopsided power and access to information. It follows that while adversarial zeal has little to contribute to pre-trial decisions, it can readily infest them with zeal. While ecological validity considerations abound, this study demonstrates the psychological plausibility that the adversarial bias results in heightened levels of indictment and stiffer punishments, thus highlighting prosecutors’ potential contribution to the exceptionally high rate of people sent to prison in the US.
Managing Stability and Change in Interorganizational Projects: The Ambiguous Role of Digital Tools for Relational Dynamics
Authors: Braun Timo , Ekstedt Eskil , Lundin Rolf A. , Sydow Jörg
Published: November 2024

Focusing on relational dynamics among collaborating organizations, we ask how inter-organizational projects respond to digitalization and ensure that the dynamics remain manageable. Digital tools, such as Building Information Modeling (BIM) in the construction industry, can help to manage relational dynamics but may also cause additional ones. Considering the theorizing of stability and change as a duality, the practice-based perspective adopted, and the empirical evidence from two comparable construction projects investigated, these dynamics are not only mitigated, but also maintained, or even mobilized. With its focus on relationally embedded interorganizational projects, and additional relational dynamics triggered and managed by BIM in face of the recursive interplay between stability and change, the study provides a nuanced manageability framework. With this it contributes not only to project management scholarship, but also to management research more broadly, which is increasingly interested in forms of temporary organizing.
Utility of patient-derived xenografts to evaluate drug sensitivity and select optimal treatments for individual non-small-cell lung cancer patients
Authors: Wang Xiaoqing , Zhu Ju , Li Lingling , Zhao Qilin , Huang Yutang , Wen Chunjie , Chen Dan , Wu Lanxiang
Published: November 2024

Background

Patient-derived xenograft (PDX) is currently considered a preferred preclinical model to evaluate drug sensitivity, explore drug resistance mechanisms, and select individualized treatment regimens.

Methods

Histopathological examination, immunohistochemistry and whole-exome sequencing confirmed similarity between our PDX tumors and primary tumors in terms of morphology and genetic characteristics. The drug reactivity of the PDX tumor was validated in vivo. The mechanisms of acquired resistance to Osimertinib PDX tumors were investigated by WES and WB.

Results

We successfully established 13 NSCLC-PDXs derived from 62 patients, including eight adenocarcinomas, four squamous-cell carcinoma, and one large-cell neuroendocrine carcinoma. Histological subtype and clinical stage were significant factors affecting the successful PDXs establishment. The treatment responses to conventional chemotherapy in PDXs were entirely consistent with that of their corresponding patients. According to the genetic status of tumors, more appropriate targeted agents were selected in PDXs for their corresponding patients as alternative treatment options. In addition, a PDX model with acquired resistance to osimertinib was induced, and the overactivation of RAS mitogen-activated protein kinase (MAPK)-extracellular signal-regulated kinase (ERK) signaling pathway caused by the dual-specificity phosphatase 6 (DUSP6) M62I mutation was found to play a key role in the development of osimertinib resistance. Trametinib, a specific inhibitor of the MAPK-ERK pathway significantly slowed down the tumor growth in osimertinib-resistant PDX models, providing an alternative treatment in patients after osimertinib failure.
Thinking on your feet: potentially enhancing phylogenetic tree learning accessibility through a kinaesthetic approach
Authors: Laurentino Telma G. , Scheller Meike , Glover Gillian , Proulx Michael J. , de Sousa Alexandra A.
Published: November 2024

Background

Phylogenetics is one of the main methodologies to understand cross-cutting principles of evolution, such as common ancestry and speciation. Phylogenetic trees, however, are reportedly challenging to teach and learn. Furthermore, phylogenetics teaching methods traditionally rely solely on visual information, creating inaccessibility for people with visual impairment. Sensory learning style models advocate for tailoring teaching to individual preferred sensory learning style. However, recent research suggests that optimal learning, independently of preferred learning style, depends on the types of transmitted information and learning tasks. The lack of empirically-supported education into the effectiveness of teaching phylogenetics through alternative sensory modalities potentially hinders learning. The aim of this study was to determine whether phylogenetic trees could be better understood if presented in kinaesthetic or multisensory teaching modalities.

Results

Participants (N = 52) self-assessed personal learning style and were randomly assigned to: visual, kinaesthetic or multisensory learning conditions. Phylogeny reading performance was better for both kinaesthetic and multisensory teaching conditions, compared to the visual teaching condition. There was no main effect and no interaction effect of personal learning style.

Conclusions

This study establishes a baseline for further research by suggesting that easy-to-implement kinaesthetic teaching modalities might support phylogenetic tree learning and reading. This has practical implications for evolution education and accessibility for students with visual impairment, underscoring the need to shift from vision-centric teaching paradigms towards evidence-based instructional strategies that accommodate sensory diversity.
Comparative transcriptomic analyses of thymocytes using 10x Genomics and Parse scRNA-seq technologies
Authors: Filippov Igor , Philip Chinna Susan , Schauser Leif , Peterson Pärt
Published: November 2024

Background

Single-cell RNA sequencing experiments commonly use 10x Genomics (10x) kits due to their high-throughput capacity and standardized protocols. Recently, Parse Biosciences (Parse) introduced an alternative technology that uses multiple in-situ barcoding rounds within standard 96-well plates. Parse enables the analysis of more cells from multiple samples in a single run without the need for additional reagents or specialized microfluidics equipment. To evaluate the performance of both platforms, we conducted a benchmark study using biological and technical replicates of mouse thymus as a complex immune tissue.

Results

We found that Parse detected nearly twice the number of genes compared to 10x, with each platform detecting a distinct set of genes. The comparison of multiplexed samples generated from 10x and Parse techniques showed 10x data to have lower technical variability and more precise annotation of biological states in the thymus compared to Parse.

Conclusion

Our results provide a comprehensive comparison of the suitability of both single-cell platforms for immunological studies.
Co-existence of antibiotic resistance and virulence factors in carbapenem resistant Klebsiella pneumoniae clinical isolates from Alexandria, Egypt
Authors: El-kholy Aya T. , El-Kholy Mohammed A. , Omar Hoda , Aboulmagd Elsayed
Published: November 2024

Background

The emergence and spread of carbapenem resistance among Enterobacteriaceae, particularly Klebsiella pneumoniae, constitute a serious threat to public health, since carbapenems are the last line of defense in the treatment of life-threatening infections caused by drug-resistant Enterobacteriaceae. The current study investigated the co-existence of different virulence factors and carbapenemases in carbapenem-resistant Klebsiella pneumoniae clinical isolates from Alexandria, Egypt.

Results

Phenotypic characterization of virulence factors indicated that 41.5% of the isolates were strong biofilm producers, while hypermucoviscosity was detected in 14.9% of the isolates. All isolates harbored five or more virulence factor encoding genes. entB, ycfM, mrkD and fimH were detected in all isolates, while only one isolate was negative for ybtS. uge, iutA, rmpA and kpn were detected in 61 (64.8%), 55 (58.5%), 41 (43.6%) and 27 (28.7%) isolates, respectively, while all isolates lacked magA and k2A. Phenotypic detection of carbapenemases was explored by performing CarbaNP and mCIM/eCIM. CarbaNP test showed positive results in 98.9% of the isolates and positive mCIM tests were observed in all isolates, while 68 (72.3%) isolates showed positive eCIM tests. blaNDM was the most prevalent carbapenemase encoding gene (92.5%) followed by the blaOXA−48 (51.1%), while blaKPC was detected in only one (1.06%) isolate. blaVIM, blaIMP and blaGES were not detected in any of the tested isolates.

Conclusions

The widespread of carbapenem-resistant Klebsiella pneumoniae represents a major problem in health care settings. A significant association between certain virulence factors and carbapenemase-encoding genes was observed. Antibiotic stewardship programs and infection control policies should be effectively implemented especially in hospitals to limit the spread of such highly virulent pathogens.
A systematic literature review on public health and healthcare resources for pandemic preparedness planning
Authors: Beishuizen Berend H. H. , Stein Mart L. , Buis Joeri S. , Tostmann Alma , Green Caroline , Duggan Jim , Connolly Máire A. , Rovers Chantal P. , Timen Aura
Published: November 2024

Background

Generating insights into resource demands during outbreaks is an important aspect of pandemic preparedness. The EU PANDEM-2 project used resource modelling to explore the demand profile for key resources during pandemic scenarios. This review aimed to identify public health and healthcare resources needed to respond to pandemic threats and the ranges of parameter values on the use of these resources for pandemic influenza (including the novel influenza A(H1N1)pdm09 pandemic) and the COVID-19 pandemic, to support modelling activities.

Methods

We conducted a systematic literature review and searched Embase and Medline databases (1995 – June 2023) for articles that included a model, scenario, or simulation of pandemic resources and/or describe resource parameters, for example personal protective equipment (PPE) usage, length of stay (LoS) in intensive care unit (ICU), or vaccine efficacy. Papers with data on resource parameters from all countries were included.

Results

We identified 2754 articles of which 147 were included in the final review. Forty-six different resource parameters with values related to non-ICU beds (n = 43 articles), ICU beds (n = 57), mechanical ventilation (n = 39), healthcare workers (n = 12), pharmaceuticals (n = 21), PPE (n = 8), vaccines (n = 26), and testing and tracing (n = 19). Differences between resource types related to pandemic influenza and COVID-19 were observed, for example on mechanical ventilation (mostly for COVID-19) and testing & tracing (all for COVID-19).

Conclusion

This review provides an overview of public health and healthcare resources with associated parameters in the context of pandemic influenza and the COVID-19 pandemic. Providing insight into the ranges of plausible parameter values on the use of public health and healthcare resources improves the accuracy of results of modelling different scenarios, and thus decision-making by policy makers and hospital planners. This review also highlights a scarcity of published data on important public health resources.
The ‘STRICT’ framework for promoting effective malaria control in Ghana
Authors: Ampomah Irene G. , Devine Susan , Ampomah Genevieve A. , Emeto Theophilus I.
Published: November 2024

Background

Malaria remains a significant public health burden, necessitating evidence-based strategies to reduce prevalence and associated morbidity. This study explores the potential of integrated healthcare, encompassing both modern and traditional herbal medicine (THM), for malaria control in Ghana.

Methods

Employing a qualitative approach, semi-structured interviews were conducted with medical doctors, pharmacists, and THM providers. Thematic analysis approach was utilized to inductively analyse interview data and integrate participants’ lived experiences and suggestions.

Results

Six themes emerged: Standardization of THM practice; Training on THM broadened; Research on THM expanded; Increasing awareness of THM integration hospitals and inclusion of THM in national health insurance scheme; Constant supply of certified herbal medications; and Tax relief provision. These recommendations form the ‘STRICT’ framework for developing functional health system for promoting an effective malaria control through integrated healthcare in Ghana.

Conclusion

It was evident that the ‘STRICT’ framework can potentially transform healthcare delivery and improve service quality for malaria patients. Policymakers, healthcare providers, and managers can utilize these insights to advocate for and implement integrated healthcare strategies, ultimately enhancing service delivery for all Ghanaians, particularly those suffering from malaria.
IAMSAM: image-based analysis of molecular signatures using the Segment Anything Model
Authors: Lee Dongjoo , Park Jeongbin , Cook Seungho , Yoo Seongjin , Lee Daeseung , Choi Hongyoon
Published: November 2024

Spatial transcriptomics is a cutting-edge technique that combines gene expression with spatial information, allowing researchers to study molecular patterns within tissue architecture. Here, we present IAMSAM, a user-friendly web-based tool for analyzing spatial transcriptomics data focusing on morphological features. IAMSAM accurately segments tissue images using the Segment Anything Model, allowing for the semi-automatic selection of regions of interest based on morphological signatures. Furthermore, IAMSAM provides downstream analysis, such as identifying differentially expressed genes, enrichment analysis, and cell type prediction within the selected regions. With its simple interface, IAMSAM empowers researchers to explore and interpret heterogeneous tissues in a streamlined manner.
Lifestyle intervention improves cardiometabolic profiles among children with metabolically healthy and metabolically unhealthy obesity
Authors: Wan Mohd Zin Ruziana Mona , Jalaludin Muhammad Yazid , Md Zain Fuziah , Hong Janet Yeow Hua , Ahmad Kamil Nur Zati Iwani , Mokhtar Abdul Halim , Wan Mohamud Wan Nazaimoon
Published: November 2024

Background

In recent years, there has been a surge of interest in the metabolic phenotype among children with obesity characterized by the absence of associated cardiometabolic risk factors (CRFs), known as metabolically healthy obesity (MHO), as opposed to those with metabolically unhealthy obesity (MUO). This study investigated the effect of lifestyle intervention on CRFs among children with MHO and MUO.

Methods

A total of 102 school-aged children with obesity (54 girls and 48 boys) aged 8–16 years completed a 16-week school-based lifestyle modification intervention program, MyBFF@school Phase I. The intervention consisted of physical activity, healthy eating promotion, and psychological empowerment. MHO and MUO statuses were defined based on the 2018 consensus-based criteria. Fasting venous blood collection, body composition measurement, clinical assessment and physical fitness testing were conducted at baseline and at the end of week 16.

Results

After the intervention, the CRFs of the children with MUO improved with significant decreases in systolic (p < 0.001) and diastolic (p = 0.01) blood pressure and a significant increase in high-density lipoprotein cholesterol (HDL-C) (p = 0.005), while the CRFs of the children with MHO had a significant decrease in uric acid (p = 0.04). Additionally, 51.6% of the children with MHO transitioned to the MUO, while 26.8% of the children with MUO crossed over to the MHO at the end of the intervention. Furthermore, the odds of having high systolic blood pressure among children with MUO were 59% lower at week-16 than at baseline (OR = 0.41 (95% CI = 0.18, 0.92), p = 0.03).

Conclusions

Our findings demonstrated that CRFs improved more prominently among children with MUO following the intervention. More importantly, our findings indicate that MHO in children is transient, hence, strategies to protect children against MUO are warranted.

Trial registration: ClinicalTrials.gov NCT02212873.
Soil microbial carbon use efficiency and the constraints
Authors: Dang Run , Liu Jian , Lichtfouse Eric , Zhou Lifeng , Zhou Meng , Xiao Leilei
Published: November 2024

Background

Microbial contributions to soil organic carbon formation have received increasing attention, and microbial carbon use efficiency is positively correlated with soil organic carbon storage.

Mainbody

This work reviews the impact on microbial carbon use efficiency from six constraints, including plant community composition and diversity, soil pH, substrate quality, nutrient availability and stoichiometric ratios, soil texture and aggregates, water and thermal constraints, and external nutrient inputs. In general, the response of microbial carbon use efficiency showed large uncertainty to above constraints, including positive-, negative-, or non-correlation. However, some factors are biased, more likely to promote or inhibit carbon use efficiency. For example, external nutrient input (N, P, K, Ca) tended to promote carbon use efficiency, while climate warming showed more negative influence.

Conclusion

Further, overwhelming works focused on single constraint, we suggest the importance to consider the synergistic influence of multiple environmental variables on microbial carbon use efficiency, special for the regulation mechanism of biological-environmental interactions.
Geochemical and zircon 18O–Hf–U/Pb isotopic study of volcanic rocks from Lutao Island in the northern Luzon magmatic arc
Authors: Chen Nancy Hui-Chun
Published: November 2024

Lutao is an islet off the eastern coast of the main island of Taiwan and is composed of pyroclastic agglomerates, volcanic breccias, lava flows, and dykes. There have been no reports of SIMS zircon oxygen isotopic data from Lutao Island so far, which has significantly hampered further understanding of its magmatic processes, such as crystallization, evolution, and generation of magma. In this study, we use zircon U–Pb dating, Lu–Hf and O isotopic analysis to constrain the age, origin, and magmatic processes of the volcanic rocks from Lutao Island. Integration of our new U–Pb and Hf–O isotope data with available published data allows us to better assess the timing and magmatic processes of Lutao Island in the context of the northern Luzon arc system. This work is the first report of SIMS zircon oxygen isotopic data of volcanic rocks from Lutao island. This study shows that the volcanic rocks from Lutao Island were generated by mantle-derived magma associated with high-T° hydrothermal alteration by seawater-derived fluids.
Fatigue performance of the Deeply Embedded Ring Anchor
Authors: Qin Song , Lee Junho , Aubeny Charles P.
Published: November 2024

Existing anchor solutions are limited in their applicability to the floating offshore wind industry, which demands prolonged load endurance in extreme weather conditions and varied seabed soils. This limitation restricts project feasibility and increases costs. In order to address these challenges, the Deeply Embedded Ring Anchor (DERA) is proposed to achieve substantial reductions in anchor costs through efficiency enhancements. Ensuring the long-term safety and reliability of the DERA, especially considering a minimum operational period of 25 years, necessitates a comprehensive understanding of fatigue damage. Induced by repetitive loading below material yield strength, fatigue poses a significant threat to structures exposed to waves and currents. Anchors, vital for station keeping, are susceptible to fatigue damage, particularly in the padeye area. This paper conducts a fatigue analysis, focusing on factors such as the wall thickness of the ring anchor, inner stiffeners, and stiffener thickness, to evaluate the performance of DERA in this context. The results showed that the stiffener significantly affects the elongation of the total life of the anchor. In conclusion, this paper focuses on advancing innovations like DERA, enabling the efficient utilization of offshore wind resources, and addressing safety concerns through meticulous fatigue analysis.
Geothermo-mechanical energy conversion using shape memory alloy heat engine
Authors: A. Abubakar R. , I. Nuhu
Published: November 2024

The shift towards renewable energy sources like geothermal energy has become desirable due to the recurrent energy crisis and global warming challenges influenced by fossil fuels. Geothermo-mechanical energy conversion using shape memory alloy (SMA) heat engines presents a novel and sustainable approach for harnessing geothermal energy. Shape memory alloys, known for their ability to undergo reversible phase transformations driven by temperature changes, are ideal for thermal-to-mechanical energy conversion. This paper explores the design and performance of an SMA heat engine that utilizes geothermal heat sources to drive mechanical work. The engine operates by cycling between the high-temperature geothermal environment and a cooler sink, exploiting the shape memory effect to generate mechanical motion. By integrating geothermal energy and SMA technology, this system offers a potential solution for renewable energy generation, with applications in remote or off-grid locations. The paper also investigates output power and the thermodynamic efficiency. A model is formulated and the engine behavior is simulated. A series of experiments are conducted for engine output power and efficiency. The model is compared to the experimental data for validation. The engine developed a maximum power of 3.5, 8.5, and 11.5 watts at 60, 80, and 90 °C respectively. The proposed SMA-based geothermo-mechanical energy conversion system offers a promising solution for efficient, reliable, and scalable geothermal energy harvesting. This research contributes to the development of innovative, efficient geothermal energy conversion technologies, supporting global renewable energy goals and reducing greenhouse gas emissions. This innovative energy conversion mechanism could play a key role in the future of sustainable power generation.
The enhanced-view totally extraperitoneal repair of abdominal bulge after DIEP flap breast reconstruction for breast cancer: a case report
Authors: Yako Masami , Imai Yoshiro , Suzuki Yusuke , Kimura Kosei , Asakuma Mitsuhiro , Tomiyama Hideki , Iwamoto Mitsuhiko , Lee Sang-Woong
Published: November 2024

Background

The deep inferior epigastric perforator (DIEP) flap for autologous breast reconstruction is associated with higher patient satisfaction and fewer abdominal morbidities at the donor site than the transverse rectus abdominis myocutaneous flap. However, abdominal bulging occurs at a certain frequency, and there is no established treatment. Here, we present a case of laparoscopic hernia repair using the enhanced-view totally extraperitoneal (eTEP) method in a patient with a lower abdominal bulge after DIEP flap reconstruction.

Case presentation.

A 53-year-old woman underwent left nipple-sparing mastectomy, left axillary lymph node dissection, and breast reconstruction with a DIEP flap for left breast cancer 3 years previously. We performed an eTEP method for an abdominal bulge. The absence of a hernia sac facilitated dissection of the retrorectal space, and a left-sided transversus abdominis release was performed, followed by mesh placement. No postoperative abdominal bulging was observed.

Conclusions

Using the eTEP method for repairing an abdominal bulge after DIEP flap reconstruction is advantageous because it facilitates a relatively straightforward dissection of a wide area of the retrorectal space without a hernia sac.
Robot-assisted laparoscopic hepatectomy for liver metastasis from clitoral malignant melanoma: a case report
Authors: Iwasaki Hitoshi , Itoh Shinji , Iseda Norifumi , Tsutsui Yuriko , Izumi Takuma , Bekki Yuki , Yoshiya Shohei , Ito Takamichi , Toshima Takeo , Nakahara Takeshi , Yoshizumi Tomoharu
Published: November 2024

Introduction

Malignant melanomas occur most commonly in the skin, mucous membranes, or choroid. Clitoral malignant melanomas are extremely rare. Stage IV malignant melanomas have a poor prognosis, and molecularly targeted agents or immune checkpoint inhibitors are recommended. However, surgical resection is reportedly a valid option for improving the prognosis of patients with oligometastases, defined as a small number of metastases that can be completely resected. In this report, we describe hepatic resection for a recurrent liver metastasis in a patient who had undergone removal of a clitoral malignant melanoma 9 years previously.

Case presentation

An 82 year-old woman presented with a black nodule on her clitoris. Total resection of the nodule resulted in a diagnosis of clitoral malignant melanoma (pT4bN0M0, pStage IIC; UICC 8th edition). A follow-up computed tomography scan 4 years later revealed a single 5 mm mass in the lower lobe of the right lung, prompting partial resection of the right lung. Pathological examination of the operative specimen revealed a pulmonary metastasis of malignant melanoma. The patient was treated with pembrolizumab monotherapy as adjuvant chemotherapy for 1 year. A follow-up computed tomography scan 9 years after surgical removal of the primary lesion revealed an 18 mm mass in segment II of the liver, prompting robot-assisted laparoscopic left lateral sectionectomy. The provisional diagnosis of metastatic malignant melanoma in the liver was confirmed by histopathological examination of the operative specimen. The patient was treated with pembrolizumab monotherapy as postoperative adjuvant chemotherapy for 1 year. No further recurrence was detected at the 1.5 year follow-up.

Conclusion

We performed hepatectomy for oligometastasis of clitoral malignant melanoma, an extremely rare entity. Surgery has the potential to prolong the prognosis of patients with oligometastasis.
Motivations in transition: destination choices of inter-provincial migration among Chinese older adults
Authors: Li Sen , Pan Zehan
Published: November 2024

Despite the growing interest in the migration of older adults in China, the intricacies linking migration motivations with destination choices remain insufficiently explored. Drawing from China’s unique context, we categorize inter-provincial older migrants into three types: employment-led, dependent, and lifestyle. Using microdata from the Sixth Population Census of 2010 and the 1% Population Sampling Survey of 2015, we examine their evolving motivations and corresponding shifts in destination preferences. The analysis shows an increase in lifestyle-oriented migration and a decrease in dependent migration, while employment-led migration has remained stable relative to the total. Older migrants seeking employment tend to favor destinations further south, prioritizing regional economic conditions. In contrast, those motivated by lifestyle factors exhibit a broader range of destination choices, largely due to their preference for amenities. Dependent older adult migrants consider both job-related and amenity-related factors and demonstrate a stronger tendency to relocate to the east. Amenity-related factors have increasingly influenced the destination choices across all three types of migration over time. Our findings provide deeper insights into the intricacies of migration in old adulthood and highlight the need for tailored policymaking.
Using polymerase chain reaction cycle threshold (PCR Ct) values for predicting and managing cholera outbreaks: potential, challenges, and future directions
Authors: Akingbola Adewunmi , Adewole Olajumoke , Soyemi Toluwalashe , Jombo Paul , Ojo Olajide
Published: November 2024

Background

Cholera continues to be a major public health threat, especially in regions with poor sanitation and limited access to clean water. Accurate prediction and management of cholera outbreaks are essential to reduce mortality and morbidity. This review focuses on the potential of polymerase chain reaction (PCR) cycle threshold (Ct) values as an innovative tool for early detection and control of cholera outbreaks, specifically highlighting its utility in predicting outbreaks and guiding public health responses.

Main body of abstract

PCR Ct values offer a significant advantage in the early detection of Vibrio cholerae, the pathogen responsible for cholera, in both clinical and environmental samples. By providing quantitative data on bacterial load, lower Ct values indicate a higher concentration of the pathogen, signaling the potential for increased disease transmission. These values allow for more precise, real-time monitoring of cholera outbreaks and aid in targeting intervention strategies such as water sanitation improvements, vaccination campaigns, and antibiotic treatments. Moreover, the application of Ct values in environmental surveillance, particularly in monitoring water sources, offers a proactive approach to prevent the spread of cholera by identifying contamination risks before human cases arise. However, the implementation of PCR in low-resource settings faces significant challenges, including high costs, the need for advanced laboratory infrastructure, and a lack of technical expertise. Addressing these barriers through cost-effective innovations and capacity building initiatives is crucial for optimizing the use of PCR Ct values in cholera management.

Conclusion

PCR Ct values hold great promise for improving cholera outbreak prediction and control. Despite challenges in adopting this technology in resource-limited settings, the integration of Ct value monitoring into public health frameworks can enhance early detection efforts and contribute to more effective cholera management strategies.
Recent development of integrated design and improving methods of waverider and inlet
Authors: Gong Tianyu , Long Yaosong , Cheng Zhongtao , Li Yiqing
Published: November 2024

For its outstanding aerodynamic capabilities, the integrated design of the waverider and inlet is widely accepted in hypersonic aircraft. Three aspects of the integrated design of the waverider and inlet since 2020 are mainly described in this paper. Firstly, the advantages and shortcomings of the conventional integrated design are examined. Then, different layouts of integrated design are proposed, and the aerodynamic performance optimization methods of the waverider, inlet, and their coupling are introduced. Besides, a series of methods for increasing the calculating accuracy of the waverider and inlet are presented, and the focus of attention is to consider the lateral flow problem.
Breast metastasis from large cell neuroendocrine carcinoma of the lung: a case report
Authors: Alshafeiy Taghreed I. , Hamza Hazwa Karathanathodi , Al-Mazroui Reem , Al-Qassabi Badriya , Al-Aghbari Suad
Published: November 2024

Background

Primary breast carcinoma is far more common than breast metastases. Common breast metastases usually come from lymphoma, leukemia, melanoma, and ovarian cancers. Breast metastases from neuroendocrine carcinomas are considered an exceeding rare entity. It has been reported in the literature that the pathological presentation of this particular metastatic tumor is very challenging as it shares many morphological characteristics with primary breast carcinoma.

Case presentation

We report a case of a patient with large cell neuroendocrine carcinoma of the lung metastasizes to both breasts. The patient was initially presented with brain metastasis of unknown origin. Further radiological imaging workup showed multiple bilateral breast masses and bilateral lymphadenopathy, which raised concern for secondary lymphoma of the breast. The histopathology of this case was challenging, particularly when triple negative invasive ductal carcinoma diagnosis had been made. Multidisciplinary meetings between medical oncologists, radiologists, and pathologists profoundly helped confirming the diagnosis of metastatic large cell neuroendocrine tumor to the breast.

Conclusion

Large cell neuroendocrine carcinoma of the lung is a relatively uncommon diagnosis with generally poor prognosis. Large cell neuroendocrine carcinoma that metastasizes to the breast is even scarcer. Correlation between clinical assessment, radiological imaging, and pathological evaluation is the key in making such an unusual and complex diagnosis. Additionally, radiologists should be aware of metastatic presentations of the breast and avoid confusion with mimicking benign entities or primary breast carcinomas.
Knowledge and perception of physiotherapy students and lecturers about the involvement of simulated patients in clinical examinations at physiotherapy training institutions in South-West, Nigeria
Authors: Odole Adesola C. , Odunaiya Nse A. , Ojo Omoniyi S. , Fatoye Francis , Mbada Chidozie E. , Fatoye Clara F. , Fafolahan Abiola O. , Akinpelu Aderonke O.
Published: November 2024

Background

Medical educators in Nigeria are beginning to incorporate the use of simulated patients (SPs) in clinical examinations. This study was designed to investigate and compare the knowledge and perception of physiotherapy students and lecturers about the involvement of SPs in clinical examinations at physiotherapy training institutions in South-West, Nigeria.

Methods

This study used a mixed-method approach, combining cross-sectional analysis and focus group discussions. A validated questionnaire assessed the knowledge and perception of physiotherapy students and lecturers regarding SP involvement in clinical exams. Quantitative data were analyzed with descriptive statistics, chi-square, and Mann–Whitney U tests (p < 0.05). Qualitative data were analyzed using thematic analysis.

Results

Two hundred and seven clinical students (83 males, 124 females, average age 22.02 ± 1.65 years) and 37 physiotherapy lecturers (25 males, 12 females, average age 48.27 ± 7.49 years) participated in this study. Among the students, 151 were aware of SP involvement in clinical exams: 35.1% had poor knowledge, 53.0% had fair knowledge, and 11.9% had good knowledge. The majority of lecturers (70.3%) demonstrated good knowledge. Most students (147, 71.0%) and lecturers (32, 86.5%) had positive perceptions of SP involvement in exams. Qualitative analysis indicated insufficient training for SPs in clinical examinations at physiotherapy training institutions in South-West Nigeria. Reported drawbacks included a preference for using models, familiarity with SPs, and limitations in the conditions that SPs can simulate.

Conclusion

Physiotherapy students at physiotherapy training institutions in South-West Nigeria had fair knowledge about the involvement of SPs in clinical examinations while lecturers had good knowledge about the involvement of SPs in clinical examinations. However, both students and lecturers had a positive perception about the involvement of SPs in clinical examinations though the concept of SPs should be differentiated from the use of models.
Visual grading of valvular regurgitation is inferior to measurement – results from the VIAVA-study (VIsual Assessment of VAlvular Regurgitation)
Authors: Demirel Ozan , Di Stefano Paolo , Boxhammer Elke , Wuppinger Thomas , Granitz Christina , Goebel Björn , Hoppe Uta C. , Lichtenauer Michael , Mirna Moritz
Published: November 2024

While the visual estimation of systolic left ventricular function by experienced examiners closely aligns with quantitative methodologies, the accuracy of visual estimation in determining the severity of valvular regurgitation using colour flow Doppler assessment of native heart valves remains largely unexplored. This study analysed the ability of 262 physicians to visually estimate the severity of 12 native valve regurgitations by grading colour Doppler transthoracic echocardiography loops in an online questionnaire. The assessments of the participants were compared to standardized quantitative evaluations conducted by certified echocardiography experts. Of the three valves to assess, evaluations by the participants showed the best correlation (Rs = 0.75, p < 0.0001) and agreement (percent agreement: 66.4%) with those of the experts in mitral valve regurgitation (MR). High agreement was observed for mild regurgitation across all valves (MR 94.5%, AR 80.3% and TR 88.7%), while consensus diminished in moderate (MR 55.9%, AR 49.5% and TR 55.0%) and severe regurgitation (MR 57.6%, AR 67.4%, TR 14.6%). The study underscores the potential utility of visual estimation of valvular regurgitation in clinical settings for identifying clinically relevant regurgitations. However, our findings also highlight the importance of integrating visual estimation with quantitative methods, particularly in moderate and severe cases of regurgitation.
Exploring the long-term impact of a nurse-midwife mentorship intervention in Neno district, Malawi: a secondary data analysis of maternal and neonatal complications
Authors: Rouse Miranda , Mphande Isaac , Mwale Nelson , Kapira Sitalire , Sayenda Mphatso , Mvula Mc Geofrey , Openshaw Maria , Kapito Esnath , Kutsamba Martha , Maweu Daniel , Mitchell Ashley , Dandu Madhavi , Muller Anna , Blair Alden Hooper , Baltzell Kimberly
Published: November 2024

Background

There is critical need to strengthen the global nursing and midwifery workforce. This is especially true in Malawi where they are the primary providers of obstetric and neonatal care. In Neno district, Malawi, in 2017, we implemented an intensive training and longitudinal bedside mentorship intervention for nurses and midwives. From inception, there was a pre-planned project target completion after 5 years, including a staged handover to local ownership after 3 years. The objective of this study was to assess differences in reported maternal and neonatal complications following project completion and handover to local leadership.

Methods

The project was a partnership between an academic institution and local nongovernmental organization. In October 2020, the intervention was handed over and maintained by the local organization with limited support from the academic institution. Data from January 2019 to May 2023 were extracted from the Malawi District Health Information Software 2. Bivariate analyses explored differences in the pre- and post-handover periods for all government-collected, birth-related variables. The “pre-handover” period encompassed January 2019 to September 2020 and “post-handover” from October 2020 to May 2023. Multivariate linear regression explored outcomes while controlling for health facility.

Results

Data were collected from 10 health facilities in the district and included a total of 23,259 births. Overall, there were few significant changes between periods. Exceptions were in reporting of antepartum hemorrhage (p < 0.01), maternal sepsis (p = 0.01), and manual removal of the placenta (p < 0.01), where we observed decreases in reporting. There was a significant decrease in the reporting of neonatal sepsis (p = 0.01) in the bivariate analysis, which remained only borderline significant in the multivariate model (p = 0.05). Where differences occurred, they were associated with improvements in reported identification of complications and provision of associated emergency care.

Conclusions

Few differences in reported maternal and neonatal complications between the periods suggest positive impact of the intervention was sustained following project handover and transition of activities to local leadership. These findings strengthen support for longitudinal mentorship as a pivotal component for skill retention after training. Transparent partnerships which include pre-determined end points and time for handover of activities to local ownership are crucial components for sustainability.
Impaired Bone Tissue Quality Associated With Inflammation in HIV-immunological Nonresponders: A Cross-sectional Analysis
Authors: Rins-Lozano Oriol , Rodríguez-Morera Jaime , Arrieta-Aldea Itziar , González-Mena Alicia , Rodríguez-Mercader Sergi , Suaya Lucía , Pascual-Aranda Mariano , Cañas-Ruano Esperanza , Fernandez-Quiroga María José , Canepa Cecilia , Du Juan , Marcos Agustín , Knobel Hernando , García-Giralt Natalia , Güerri-Fernández Robert
Published: November 2024

Introduction

People with HIV (PWH) with poor immune response despite adequate antiretroviral treatment (ART) are susceptible to non-AIDS-related health issues. This study seeks to evaluate bone quality in immunological nonresponders (INRs) in comparison to those with proper immune response (IRs) using in vivo microindentation to quantify bone quality, in addition to conventional bone mineral density (BMD) evaluations.

Methods

A cross-sectional study was conducted at Hospital del Mar in Barcelona from January 2019 to June 2023. Participants were matched in a 1:2 ratio (INRs:IR) based on age, sex, body mass index, and antiretroviral treatment. Participants underwent bone quality assessment using in vivo microindentation, BMD, and analysis of bone turnover and inflammation markers. Statistical analyses involved multivariable regression to adjust for potential confounding variables.

Results

A total of 159 PWH were included, 53 INRs and 106 IRs. INRs had worse bone quality, with lower median bone material strength index compared to IRs (79 [76-87] vs 86 [82-89]; P < .001), and similar BMD. INRs shown increased high-sensitive C-reactive protein levels with lower 25-(OH)-vitamin D3. A significant negative correlation between inflammation and bone quality was found, especially in INRs. Multivariable linear regression shown that INR status is a major predictor of decreased bone quality, regardless of conventional risk factors.

Conclusion

INRs’ condition is significantly associated with higher inflammatory levels, which may contribute to a deleterious effect on bone quality as measured by in vivo microindentation. Further studies are needed to confirm these results and to focus on non-AIDS comorbidities in this subgroup of PWH.