bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of Membranous Nephropathy in Chinese Patients: Comparison of Rituximab and Intravenous Cyclophosphamide with Steroids
Authors: Hu Xiaofan , Ren Hong , Xu Jing , Gao Chenni , Wu Yifan , Ouyang Yan , Lin Li , Li Xiao , Liu Na , Wang Weiming , Xie Jingyuan , Chen Nan
Published: July 2024

Introduction: Previous studies have shown that rituximab (RTX) and cyclic oral corticosteroid-cyclophosphamide (CTX) regimens have similar effects on primary membranous nephropathy (PMN). However, no studies have compared RTX with an intravenous CTX regimen, which is more commonly used in China and requires fewer cumulative CTX doses. Methods: We prospectively assigned 141 PMN patients with baseline proteinuria ≥4 g/24 h, serum albumin <30 g/L, and eGFR ≥30 mL/min × 1.73 m2 despite at least 3 months of treatment with ACEI and/or ARB to the RTX group (375 mg/m2 per injection per week × 4 injections) or to the CTX group (prednisone 0.8 mg/kg/day and intravenous CTX 500 mg/m2 per month until the total dose reached 6–8 g). The primary endpoint was defined as a combination of partial remission or complete remission at 12 months. Results: By the end of 12 months, 43 of 70 patients (61.43%) in the RTX group and 54 of 71 patients (76.06%) in the CTX group reached the primary endpoint (p = 0.06). Significantly fewer patients in the RTX group achieved complete remission than the CTX group (14.29% vs. 33.80%, p = 0.01). The adverse events rate was similar between the RTX group and the CTX group (28.57% vs. 40.85%, p = 0.13). In subgroup analysis, we found that fewer patients from the RTX group achieved the primary endpoint than the CTX group (48.65% vs. 74.29%, p = 0.03) among patients with massive proteinuria (urine protein ≥8 g/24 h). During the observational phase, 61 patients in the RTX group and 58 in the CTX group completed 24 months of follow-up, exhibiting similar remission rates (RTX vs. CTX: 75.41% vs. 68.97%, p = 0.54). Conclusions: Our results show that the intravenous CTX regimen has similar safety and efficacy with higher rates of early complete remission than RTX in the treatment of PMN patients.
Fast Itch Relief during Dupilumab Predicts Clinical Efficacy in Bullous Pemphigoid: A Retrospective Cohort Study
Authors: Thevan Jeivicaa , Schmauch Eloi , Nilsson Jakob , Guillet Carole Florence , Boesch Andrea , Krähenbühl Lukas , Meier-Schiesser Barbara , Schmid-Grendelmeier Peter , Kündig Thomas , Kolios Antonios G.A.
Published: July 2024

Introduction: Dupilumab has emerged as a promising treatment option for bullous pemphigoid (BP). Rapid identification of responders could avoid the need for additional immunosuppressive treatments that are associated with increased morbidity and mortality. Methods: To investigate the course of itch as an early indicator of treatment response, data of 12 BP patients treated with dupilumab at the University Hospital of Zurich were retrospectively evaluated. Disease severity was assessed by bullous pemphigoid disease area index (BPDAI) and pruritus by a numeric rating scale (NRS, 0–10) at baseline; days 1, 3, 14; months 1, 2; and the last follow-up. Results: A total of 8/12 patients (67%) had complete response, and 4/12 patients (33%) had partial response during dupilumab treatment. Notably, a highly significant reduction of pruritus (p < 0.0001) was observed already on day 1 with further improvement at later time points. Moreover, fast relief of itch could predict treatment response with a significant correlation to clinical response on day 14 (Spearman correlation R 0.70, p value 0.025), with a positive but non-significant trend on day 3 (R 0.63, p value 0.091). Additionally, 92% (11/12 patients) were on dupilumab monotherapy at the last follow-up without any concomitant systemic or topical treatment for BP. Conclusions: The rapid and significant decline in BP-associated pruritus observed with dupilumab correlated significantly with disease remission. Early evaluation of pruritus response could change how BP is treated in the future and avoid additional immunosuppressive treatment in BP.
Rita Von Hunty: visibilidade Drag nas revistas Claudia e TRIP Para Mulher (TPM)
Authors: Santos Tarcyanie Cajueiro , Sirtori Francisco
Published: July 2024

This paper aims to conduct an exploratory study on drag queen Rita Van Hunty, seeking to understand how she is viewed in the media. In this way, we are inspired by the analysis of Foucault's discourse in the contents of reports published about her on the internet in two women's magazines of different profiles: Claudia and TRIP for Women (TPM ). The theoretical framework was based on gender studies from Butler (2003) and Louro (2018). The ways in which Rita is viewed in the media are varied. While Claudia magazine presents a more in good standing version of drag, Trip for Women (TPM) explores themes dear to the LGBTQIA + community, without, however, going beyond the question of identity.
The Regional Climate Center Program—Past, Present, and Future: Reflections from 40 Years of Regional Climate Services
Authors: Umphlett Natalie A. , Brown Timothy J. , Konrad Charles E. , Wall Tamara U. , Hall Beth L. , DeGaetano Arthur T. , Nielsen-Gammon John W. , Mahmood Rezaul , Houston Tamara G.
Published: July 2024

Since its inception in 1983, NOAA’s Regional Climate Center (RCC) Program has been providing timely, customized climate services for decision making across all climate-sensitive sectors. Through this 40-yr period, the RCC Program has not only seen but also has played an active role in, the evolution of climate services from the days of climate data libraries—where books of data were consulted to fulfill simple data requests—to coproduced tools that can calculate sectoral-specific, on-the-fly climate analyses in a matter of seconds. With new technologies emerging, the RCC Program is poised to build on its reputation as a trusted climate service provider by incorporating advanced methods for climate service delivery to continue to meet the needs of the nation. This publication will provide a look back at the evolution of regional climate services over the past 40 years, along with a vision for the future.
Imprint of Diabatic Processes in the Waviness of the Jet Stream: An Analysis of Local Wave Activity Budget
Authors: Lee Hung-I , Nakamura Noboru
Published: July 2024

Given the widespread presence of clouds in the midlatitudes, one expects significant effects of condensational and radiative processes on the large-scale circulation of the atmosphere, but these diabatic effects are hard to constrain from observation. The authors propose a simple method to estimate the diabatic effects on the waviness of the jet stream based on the observed column-mean budget of Rossby wave activity. Wave activity in the midlatitudes is maintained by injection due to surface baroclinicity and/or diabatic sources, downstream transport due to advection and wave radiation, and eventual dissipation through mixing and thermal damping. Once the diabatic sources of wave activity are identified from the residual of the budget, one can suppress them and recompute the budget assuming that the transport velocity and damping rate do not change and thereby assess the impact of the diabatic sources. For the Northern Hemisphere, we found significant positive values of the residual in regions coincident with high column cloud water, suggesting that there are diabatic sources of wave activity associated with clouds. In winter, maritime diabatic sources contribute to wave activity over the Atlantic and the Pacific by about 33% and 30%, respectively, while in summer, the numbers are lower. The estimates are based on the assumptions that the perturbed wave sources do not alter the flow and that sources and sinks are geographically separated. For the Southern Hemisphere, this last assumption is questionable, and therefore, the confidence level of the estimates is low.
Recognising dying in motor neurone disease: A scoping review
Authors: Abbey Elizabeth , Ali Maimoona , Cooper Matthew , Taylor Paul , Mayland Catriona R
Published: July 2024

Introduction:

Timely identification of dying in motor neurone disease enables optimal care, yet we know that healthcare professionals can fail to recognise when death is approaching. Clinical factors help predict the end of life in other terminal conditions. Examining these principles in motor neurone disease would help guide more accurate recognition of this critical phase.

Aim:

To examine and map out what is known about dying in patients with motor neurone disease, and the recognition of dying by healthcare professionals.

Design:

A scoping review was conducted following the Arksey and O’Malley methodological framework.

Data sources:

Four electronic databases (MEDLINE, Scopus, PsycINFO and CINAHL) and grey literature were searched on the 10th May 2023. Reference lists and citations were also reviewed.

Results:

From 1512 articles, 13 studies were included. Dyspnoea, anxiety and pain were the most common symptoms associated with the dying phase. Worsening respiratory function, the development of specific new symptoms and deteriorating symptom control suggested approaching death. No studies reported changes in vital signs or biomarkers associated with dying. Barriers to the recognition of dying by healthcare professionals included a rapid and unpredictable terminal decline.

Conclusions:

Dying in motor neurone disease is associated with patterns of symptoms and signs, however evidence is limited compared with other terminal conditions and requires further exploration. The characteristic sudden and unpredictable terminal decline is a key barrier to recognition of dying by healthcare professionals. Optimising advance care planning is one approach to navigate these complex, unpredictable clinical situations.
Installing new additional blades arrangement for improving Savonius rotor performance
Authors: Nasef Mahmoud Hassan , Asaad Awad Bishoy Nabil , EL-Askary Wageeh Ahmed
Published: July 2024

Savonius rotor is a vertical axis wind rotor that has a good attention due to its lower fabrication cost and receives air from any direction. In the present computational work, various arrangements will be introduced for the blades of Savonius rotor with the aim of improving the performance. Two-dimensional simulations are performed using ANSYS with the presence of the SST k-ω as a suitable turbulence model to analyze the flow around the rotor. The computational results include 12 different arrangements namely rotor 1 to rotor 12. The difference between all the studied rotors is the arrangement of an additional shape to the original blade of Savonius rotor. The addition of a flipper with a radius of curvature equivalent to 1.73 of the radius of the blade generates the best performance with an improvement of 38.5% in the power coefficient compared to the traditional rotor. The best design (known as case 1) has a pair of blades with a distance of 15% of the blade radius, which improves the performance by 28.3% compared to the traditional rotor.
Evaluation of a Load Cell-Based Bridge Weigh-in-Motion System
Authors: Shi Shengyi , Yarnold Matthew , Hurlebaus Stefan , Mander John
Published: July 2024

A bridge weigh-in-motion (B-WIM) system utilizes an instrumented bridge to obtain the axle information (weights, number, and spacings) and weight information (axle and gross) of vehicles that cross the structure. Traditional B-WIM systems are based on strain measurements and utilize the Moses algorithm. A wide array of additional measurement types and algorithms have been explored by researchers. However, load cells have rarely been used for B-WIM systems. This paper proposes a B-WIM system using load cells to measure the reaction force at the supports. Full-scale field tests were conducted on a slab-beam bridge instrumented with load cells to evaluate the effectiveness and accuracy of the proposed B-WIM system. The second derivative of the load cell data was used to accurately find the axle information of the trucks. Two weight calculation methods, the reaction force method and the area method, were utilized with the field test data. The results were then quantitatively compared. Overall, load cells show promise for use in future B-WIM systems given the reasonable accuracies determined in this study.
Synchronization of heterogeneous discrete-time fractional-order quaternion-valued neural networks with time delay and parameter uncertainty using the impulsive method
Authors: Zhang Xingpeng , Li Yuru , Guo Peng , Gao Meilin
Published: July 2024

This paper presents theoretical results on the impulsive synchronization of discrete-time fractional-order quaternion-valued neural networks (DFQVNNs) with time delay and parameter uncertainty. First, a useful assumption for parameter uncertainty is put out, predicated on the observation that it is typically brought about by a very tiny disruption. Next, we realize impulsive synchronization for DFQVNNs with the same structure by utilizing the nabla discrete Mittag–Leffler function. We put out a novel synchronization theory for more intricate scenarios in which the architectures of the DFQVNNs are heterogeneous. Finally, the applicability of the theoretical results is demonstrated through numerical examples.
Influence of TP53 gene mutations and their allelic status in myelodysplastic syndromes with isolated 5q deletion
Authors: Montoro Maria Julia , Palomo Laura , Haferlach Claudia , Acha Pamela , Chan Onyee , Navarro Víctor , Kubota Yasuo , Schulz Felicitas Isabel , Meggendorfer Manja , Briski Robert , Al Ali Najla , Xicoy Blanca , López-Cadenas Félix , Bosch Francesc , González Teresa , Eder Lea Naomi , Jerez Andrés , Wang Yu-Hung , Campagna Alessia , Santini Valeria , Bernal del Castillo Teresa , Such Esperanza , Tien Hwei-Fang , Diaz Varela Nicolás , Platzbecker Uwe , Haase Detlef , Díez-Campelo María , Della Porta Matteo , Garcia-Manero Guillermo , Wiseman Daniel H. , Germing Ulrich , Maciejewski Jaroslaw P. , Komrokji Rami S. , Sole Francesc , Haferlach Torsten , Valcárcel David
Published: July 2024

Mutations in the TP53 gene, particularly multihit alterations, have been associated with unfavorable clinical features and prognosis in patients diagnosed with myelodysplastic syndrome (MDS). Despite this, the role of TP53 gene aberrations in MDS with isolated deletion of chromosome 5 [MDS-del(5q)] remains unclear. This study aimed to assess the impact of TP53 gene mutations and their allelic state in patients with MDS-del(5q). To that end, a comprehensive analysis of TP53 abnormalities, examining both TP53 mutations and allelic imbalances, in 682 patients diagnosed with MDS-del(5q) was conducted. Twenty-four percent of TP53-mutated patients exhibited multihit alterations, whereas the remaining patients displayed monoallelic mutations. TP53-multihit alterations were predictive of an increased risk of leukemic transformation. The impact of monoallelic alterations was dependent on the variant allele frequency (VAF); patients with TP53-monoallelic mutations and VAF <20% exhibited behavior similar to TP53 wild type, and those with TP53-monoallelic mutations and VAF ≥20% presented outcomes equivalent to TP53-multihit patients. This study underscores the importance of considering TP53 allelic state and VAF in the risk stratification and treatment decision-making process for patients with MDS-del(5q).
Serum immunoglobulin concentrations and risk of type 2 diabetes mellitus in adults: a prospective cohort study from the TCLSIH study
Authors: Zhang Li , Li Yuanbin , Wang Honglei , Guo Yirui , Wang Xiaotong , Wu Hongmei , Zhang Qing , Liu Li , Meng Ge , Zhang Shunming , Sun Shaomei , Zhou Ming , Jia Qiyu , Song Kun , Stubbendorff Anna , Gu Yeqing , Niu Kaijun
Published: July 2024

Type 2 diabetes mellitus (T2DM) is a metabolic disorder characterized by hyperglycemia resulting from defects in insulin secretion and/or insulin action. Increasing evidence suggests that inflammation played an important role in the pathogenesis of T2DM. Prospective studies on the link between immunoglobulins concentrations and the risk of T2DM in adults are limited. We developed a cohort study including 7,093 adults without T2DM history. The incidence of T2DM was 16.45 per 1,000 person-years. Compared with the lowest quartiles, the hazard ratios (95% confidence intervals) of T2DM for the highest quartiles of IgG, IgE, IgM and IgA were 0.64 (0.48–0.85), 0.94 (0.72–1.23), 0.68 (0.50–0.92) and 1.62 (1.24–2.11) (P for trend was < 0.01, 0.84, 0.02 and < 0.0001), respectively, suggesting that serum IgG and IgM concentrations were inversely associated with the incidence of T2DM, and IgA levels were positively associated with the risk of T2DM in a general adult population.
Grassland degradation affected vegetation carbon density but not soil carbon density
Authors: Zhou Chan , Xia Hainan , Yang Tingting , Zhang Zhuo , Zheng Guobin
Published: July 2024

Background

With the profound changes in the global climate, the issue of grassland degradation is becoming increasingly prominent. Grassland degradation poses a severe threat to the carbon cycle and carbon storage within grassland ecosystems. Additionally, it will adversely affect the sustainability of food production. The grassland ecosystem in the northwest region of Liaoning Province, China, is particularly vulnerable due to factors such as erosion from the northern Horqin Sandy Land, persistent arid climate, and issues related to overgrazing and mismanagement of grassland. The degradation issue is especially pronounced in this ecological environment. However, previous research on the carbon density of degraded grasslands in Northeast China has predominantly focused on Inner Mongolia, neglecting the impact on the grasslands in the northwest of Liaoning Province. Therefore, this experiment aims to assess the influence of grassland degradation intensity on the vegetation and soil carbon density in the northwest of Liaoning Province. The objective is to investigate the changes in grassland vegetation and soil carbon density resulting from different degrees of grassland degradation.

Methodology

This study focuses on the carbon density of grasslands at different degrees of degradation in the northwest of Liaoning Province, exploring the variations in vegetation and soil carbon density under different levels of degradation. This experiment employed field sampling techniques to establish 100 × 100 m plots in grasslands exhibiting varying degrees of degradation. Six replications of 100 × 100 m plots per degradation intensity were sampled. Vegetation and soil samples were collected for analysis of carbon density.

Results

The results indicate that in the context of grassland degradation, there is a significant reduction in vegetation carbon density. Furthermore, it was found that root carbon density is the primary contributor to vegetation carbon density. In comparison to mildly degraded grasslands, moderately and severely degraded grasslands experience a reduction in vegetation carbon density by 25.6% and 52.6%, respectively. However, with regard to the impact of grassland degradation on soil carbon density, it was observed that while grassland degradation leads to a slight decrease in soil carbon density, there is no significant change in soil carbon density in the short term under the influence of grassland degradation.

Conclusions

Therefore, grassland degradation has exerted a negative impact on aboveground vegetation carbon density, reducing the carbon storage of above-ground vegetation in grasslands. However, there was no significant effect on grassland soil carbon density.
Comparison between intravenous lidocaine and dexamethasone in reducing postoperative sore throat after endotracheal extubation at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia; a prospective cohort study
Authors: Ayalew Samuel Belay , Daniel Tinbite , Samuel Hirbo , Endeshaw Amanuel Sisay , Bayu Habtu Tsehayu
Published: July 2024

Background

Post-operative sore throat is the common complaint and uncomfortable side effect in patients receiving general anesthesia with endotracheal intubation. Drugs with analgesic and anti-inflammatory properties, like steroids and local anesthetics, are the best options for postoperative sore throat prophylaxis. Therefore, this study aimed to compare the effects of intravenous lidocaine and dexamethasone in reducing postoperative sore throat following endotracheal extubation at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, from January 1 to March 30, 2023 G.C.

Methods

A prospective cohort study was carried out at Tikur Anbessa Specialized Hospital. Data from 50 patients in the lidocaine (1.5 mg/kg), 50 in the dexamethasone (8 mg), and 49 in the control groups were analyzed. The data were collected using observation based on structured questionnaires. A systematic random sampling technique was applied to select respondents. The data were entered into EpiData version 4.6.0.6 and transferred to STATA version 17 statistical software for analysis. A comparison of continuous data among the groups were performed using a one-way ANOVA test for parametric data. The Kruskal–Wallis rank test was used for non-parametric data. Associations between variables were tested using chi-squared test, Fisher’s exact test, and binary logistic regression. Bivariable and multivariable logistic regression was used to determine degree of association.

Results

The incidence of POST was 40%, 32%, and 57.1% in the lidocaine, dexamethasone, and control groups, respectively (P = .0356). Dexamethasone reduced the incidence of POST during the first 24 h (AOR: 0.374, 95% CI: 0.149–0.939). However, no difference was observed in the severity of POST at 3 h (p = 0.130), 6 h (p = 0.096), 12 h (p = 0.313), and 24 h (p = 0.525) of the post-extubation period among the three groups. IV lidocaine did not effectively reduce the incidence and severity of postoperative sore throat at different time intervals.

Conclusion and recommendation

Intravenous dexamethasone is more effective than intravenous lidocaine in reducing the incidence of postoperative sore throat among the groups. Based on these findings, intravenous dexamethasone is recommended to decrease the incidence of postoperative sore throat.
Incidence and predictors of adverse outcomes in patients with rheumatic mitral stenosis following percutaneous balloon mitral valvuloplasty: a study from a tertiary center in Thailand
Authors: Songduang Kamonnart , Kaolawanich Yodying , Karaketklang Khemajira , Ratanasit Nithima
Published: July 2024

Background

Rheumatic mitral stenosis (MS) remains a common and concerning health problem in Asia. Percutaneous balloon mitral valvuloplasty (PBMV) is the standard treatment for patients with symptomatic severe MS and favorable valve morphology. However, studies on the incidence and predictors of adverse cardiac outcomes following PBMV in Asia have been limited. This study aims to evaluate the incidence and predictors of adverse outcomes in patients with rheumatic MS following PBMV.

Methods

A retrospective cohort study was conducted on patients with symptomatic severe MS who underwent successful PBMV between 2002 and 2020 at a tertiary academic institute in Thailand. Patients were followed up to assess adverse outcomes, defined as a composite of cardiac death, heart failure hospitalization, repeat PBMV, or mitral valve surgery. Univariable and multivariable analyses were performed to identify predictors of adverse outcomes. A p-value of < 0.05 was considered statistically significant.

Results

A total of 379 patients were included in the study (mean age 43 ± 11 years, 80% female). During a median follow-up of 5.9 years (IQR 1.7–11.7), 74 patients (19.5%) experienced adverse outcomes, with an annualized event rate of 2.7%. Multivariable analysis showed that age (hazard ratio [HR] 1.03, 95% confidence interval [CI] 1.008–1.05, p = 0.006), significant tricuspid regurgitation (HR 2.17, 95% CI 1.33–3.56, p = 0.002), immediate post-PBMV mitral valve area (HR 0.39, 95% CI 0.25–0.64, p = 0.01), and immediate post-PBMV mitral regurgitation (HR 1.91, 95% CI 1.18–3.07, p = 0.008) were independent predictors of adverse outcomes.

Conclusions

In patients with symptomatic severe rheumatic MS, the incidence of adverse outcomes following PBMV was 2.7% per year. Age, significant tricuspid regurgitation, immediate post-PBMV mitral valve area, and immediate post-PBMV mitral regurgitation were identified as independent predictors of these adverse outcomes.
USP9X regulates the proliferation, survival, migration and invasion of gastric cancer cells by stabilizing MTH1
Authors: Xu Wenji , Zhang Yaping , Su Yingrui , Li Libin , Yang Xinxia , Wang Lixing , Gao Hongzhi
Published: July 2024

Background

MutT homolog 1 (MTH1) sanitizes oxidized dNTP pools to promote the survival of cancer cells and its expression is frequently upregulated in cancers. Polyubiquitination stabilizes MTH1 to facilitate the proliferation of melanoma cells, suggesting the ubiquitin system controls the stability and function of MTH1. However, whether ubiquitination regulates MTH1 in gastric cancers has not been well defined. This study aims to investigate the interaction between MTH1 and a deubiquitinase, USP9X, in regulating the proliferation, survival, migration, and invasion of gastric cancer cells.

Methods

The interaction between USP9X and MTH1 was evaluated by co-immunoprecipitation (co-IP) in HGC-27 gastric cancer cells. siRNAs were used to interfere with USP9X expression in gastric cancer cell lines HGC-27 and MKN-45. MTT assays were carried out to examine the proliferation, propidium iodide (PI) and 7-AAD staining assays were performed to assess the cell cycle, Annexin V/PI staining assays were conducted to examine the apoptosis, and transwell assays were used to determine the migration and invasion of control, USP9X-deficient, and USP9X-deficient plus MTH1-overexpressing HGC-27 and MKN-45 gastric cancer cells.

Results

Co-IP data show that USP9X interacts with and deubiquitinates MTH1. Overexpression of USP9X elevates MTH1 protein level by downregulating its ubiquitination, while knockdown of USP9X has the opposite effect on MTH1. USP9X deficiency in HGC-27 and MKN-45 cells causes decreased proliferation, cell cycle arrest, extra apoptosis, and defective migration and invasion, which could be rescued by excessive MTH1.

Conclusion

USP9X interacts with and stabilizes MTH1 to promote the proliferation, survival, migration and invasion of gastric cancer cells.
Neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio associated with 28-day all-cause mortality in septic patients with coronary artery disease: a retrospective analysis of MIMIC-IV database
Authors: Li Xicong , Chen Yubiao , Yuan Qi , Zhou Hongya , Lu Lifei , Guo Ruiwei
Published: July 2024

Background

High Neutrophil-to-Lymphocyte Ratio (NLR), Monocyte-to-Lymphocyte Ratio (MLR), Platelet-to-Lymphocyte Ratio (PLR) were associated with worse prognosis of patients with sepsis. In-hospital mortality has been reported to be higher in patients with coronary artery disease (CAD) and sepsis than those with sepsis alone. However, the relationship between NLR, MLR, PLR and mortality in septic patients with coronary artery disease (CAD) remains unclear. The study aimed to explore the association between NLR, MLR, PLR and 28-day all-cause mortality in septic patients with CAD.

Methods

We performed an observational cohort study of septic patients with CAD from the Medical Information Mart for Intensive Care (MIMIC)-IV database between 2008 and 2019. The patients were categorized by three group (Q1: low levels, Q2: medium levels, Q3: high levels) based on tertiles of NLR, MLR, and PLR. The associations between NLR, MLR, PLR and 28-day all-cause mortality were examined using the Cox proportional hazards model. Subsequently, we applied receiver operating characteristic (ROC) analysis for predicting 28-day mortality in septic patients with CAD by combining NLR, MLR and PLR with the modified sequential organ failure assessment (mSOFA) scores.

Results

Overall 1,175 septic patients with CAD were included in the study. Observed all-cause mortality rates in 28 days were 27.1%. Multivariate Cox proportional hazards regression analysis results showed that 28-day all-cause mortality of septic patients with CAD was significantly related to rising NLR levels (adjusted hazard ratio [aHR]: 1.02; 95% confidence interval [CI]: 1.01–1.02; P < 0.001), MLR levels (aHR: 1.29; 95%CI: 1.18–1.41; P < 0.001), and PLR levels (aHR: 1.0007; 95%CI: 1.0004–1.0011; P < 0.001). Meanwhile, the higher levels (Q3) group of NLR, MLR, and PLR also had a higher risk of 28-day all-cause mortality than the lower (Q1) group. The area under the ROC curve of NLR, MLR, PLR, and mSOFA score were 0.630 (95%CI 0.595–0.665), 0.611 (95%CI 0.576–0.646), 0.601 (95%CI 0.567–0.636) and 0.718 (95%CI 0.689–0.748), respectively. Combining NLR, MLR, and PLR with mSOFA scores may improve ability of predicting 28-day mortality (AUC: 0.737, 95%CI 0.709–0.766).

Conclusion

Higher levels of NLR, MLR and PLR were associated with 28-day all-cause mortality in septic patients with CAD. Further investigation will be needed to improve understanding of the pathophysiology of this relationship.
SGLT-2 inhibitors in chronic peritoneal dialysis patients: a follow-up study
Authors: Lai Jia-Wen , Wang Charles C.N. , Chou Che-Yi
Published: July 2024

Background

Sodium-glucose transporter-2 inhibitors (SGLT-2i) are recommended for use in patients with type 2 diabetes comorbid atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease. Limited reports are currently available for their use in dialysis patients. In an observational, retrospective follow-up study, we reported the clinical characteristics of chronic peritoneal dialysis (PD) patients on SGLT-2i.

Methods

We enrolled 50 diabetic chronic PD patients, and 11 continued SGLT-2i after PD treatment. We reported the patients’ ultrafiltration, HbA1c, urinary tract infection episodes, and venous CO2 during follow-up and compared the differences in these factors between patients with and without SGLT-2i.

Results

The mean age of the patients was 65 ± 15 years, and 16 (32%) patients were female. The age, gender, heart failure, and primary kidney disease were not different between patients with and without SGLT-2i at enrollment. In an average of 31 months follow-up, patients with SGLT-2i had higher ultrafiltration (1322 ± 200 ml/day vs. 985 ± 415 ml/day, p = 0.013), hemoglobin (11.2 ± 1.7 vs. 10.2 ± 1.7 g/dl), white blood cell count (9.2 ± 3.7 vs. 7.4 ± 2.1 109/L), and a lower venous CO2 (p = 0.036). The urine amount, the overall survival, the technical survival, and the chance of UTI were not different between patients with and without SGLT2i.

Conclusion

SGLT-2i may increase ultrafiltration volume and hemoglobin levels in chronic PD patients. SGLT-2i did not increase urinary tract infection but was linked to subclinical metabolic acidosis.

What was known

The effect of SGLT-2i in chronic PD patients is not clear?

This study adds

SGLT-2i is associated with increased ultrafiltration, hemoglobin, white blood cell counts, and a decreased CO2 in PD patient.

Potential impact

SGLT-2i may increase ultrafiltration in PD patients.
Adequate housing as a social determinant of the health of international migrants and locals in Chile between 2013 and 2022
Authors: Blukacz Alice , Oyarte Marcela , Cabieses Báltica
Published: July 2024

Background

Adequate housing is a fundamental right and a social determinant of health. It also represents a historically contentious topic in Latin America. Migratory flows to Chile have become increasingly precarious in the past few years, limiting opportunities for adequate housing, with potential repercussions on the health of international migrants and the general population. This study aims to analyse adequate housing as a social determinant of health among international migrants and locals between 2013 and 2022 in Chile.

Methods

Observational cross-sectional study based on repeated versions of the nationally representative Socioeconomic Characterization Survey in Chile. Adequate housing indicators adapted from the United Nations Housing Rights Programme guidelines were analyzed with relation to individual health, distinguishing between the local and international migrant populations. Logistic regression models were fitted for housing indicators with migration as the main independent variable and for short-term and long-term healthcare needs in locals and immigrants with housing as the main dependent variables. Models were adjusted for sociodemographic variables and considered the complex sample design.

Results

Descriptive findings indicated higher availability of services and infrastructure among international migrants, and a disadvantage for habitability, location, and affordability by quintiles compared to locals. Logistic regression models, adjusting for demographic variables, revealed significant associations between migration status and overcrowding (OR 6.14, 2022), poor housing materiality (OR 5.65, 2022) and proximity to healthcare centres (OR 1.4, 2022) compared to locals. Experiencing hazardous situations consistently predicted short-term healthcare needs in both migrants (OR = 1.4, 2022) and locals (OR = 2.8, 2022). Overcrowding predicted both long and short-term healthcare needs among locals across the years and long term needs among migrants in 2013 and 2015.

Conclusions

We found significant inequities in adequate housing between migrant populations and locals in Chile, and some inequities among both populations based on structural socioeconomic deprivation. Experiencing hazardous situations emerged as a social determinant of health among international migrants in 2022, potentially suggesting growing challenges related to social exclusion in urban areas. However, limitations such as exclusion criteria of the survey and sample sizes for data on the migrant population potentially suggest that housing challenges and their impact on health are underestimated.
Anterior cervical corpectomy and fusion-derived adjacent segment disease managed via channel-repairing anterior endoscopic transcorporeal cervical discectomy: a case report
Authors: Qin Jianpu , Qian Hu , Xin Zhijun , Liu Guangyi , Ao Jun , Liao Wenbo
Published: July 2024

Background

Management of anterior cervical corpectomy and fusion (ACCF)-derived adjacent segment disease (ASD) represented a challenge facing the surgeons.

Methods

A 41-year man diagnosed as C3-4 level ASD derived from C5-level ACCF surgery 13 years ago was admitted to the hospital for numbness and pain in the right shoulder and upper limb. Percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) was performed, and pre- and postoperative clinical and imaging data were collected.

Results

The operation was completed within 70 min, and no clinical or radiological complication was reported. The visual analog scale (VAS) score decreased from preoperative 5 points to postoperative 1 point. Numbness was relieved postoperatively and disappeared completely at postoperative 3 months. Imaging data indicated sufficient spinal cord decompression, good channel repairing and cervical alignment.

Conclusions

Channel-repairing PEATCD was successfully performed to treat ACCF-derived ASD, nevertheless, the long-term efficacy remained tracing and further clinical trials were needed to validate its efficacy.
Does krill oil enhancing the new bone formation in orthopedically expanded median palatal suture in rat model? A micro-CT and immunohistochemical analysis
Authors: Simsek Doga , Gok Gulay Dumanli , Delipinar Sibel Demirci
Published: July 2024

Background

The purpose of this study was to assess the effects of systemically given krill oil (KO) on the development of new bone formation in the sutura palatina media following rapid maxillary expansion (RME).

Methods

28 4–5 week-old male Wistar albino rats were randomly divided into 4 groups: Control (C), Only Expansion (OE) (no supplement but undergoing expansion and retention), KE (supplemented during both the expansion and retention phases), Krill Oil Nursery Group (KN) (supplemented during the 40-day nursery phase as well as during the expansion and retention phases). A 5-day RME was followed by a 12-day retention period. All rats were euthanized simultaneously. Micro-computerized tomography (Micro-CT), hemotoxylen-eosin (H&E) staining, and immunohistochemical analysis were conducted. Kruskal-Wallis and Dunn tests with Bonferonni corrrection were applied (p < 0.05).

Results

Expansion and KO supplementation did not cause a statistically significant change in bone mineral density (BMD), bone volume fraction (BV/TV), spesific bone surface (BS/BV) and trabecular thickness (Tb.Th). While the expansion prosedure increased the trabecular seperation (Tb.Sp), KO supplemantation mitigated this effect. The KE group exhibited a statistically significantly increase in trabecular number (Tb.N) compared to the OE group. Although receptor activator of nuclear factor-kappa-Β ligand (RANKL)/osteoprotegerin (OPG) ratios did not show significant differences between groups, the KE and OE groups demonstrated the lowest and highest value, respectively. KE showed a reduced amount of tartrate-resistant acid phosphatase (TRAP) compared to the OE.

Conclusion

KO positively affected the architecture of the new bone formed in the mid-palatal suture. In this rat model of RME, results support the idea that administering of KO during the expansion period or beginning before the RME procedure may reduce relapse and enhance bone formation within the mid-palatal suture.
Implementation of a hospital-based end-of-life and bereavement care program in a latin American middle-income country. A source of light and compassion in the midst of cloudy times
Authors: Garcia-Quintero Ximena , Pedraza Eddy Carolina , Cuervo-Suarez María Isabel , Correa^ Isabel , Baker Justin N. , McNeil Michael J
Published: July 2024

Background

The death of a child is one of the most devastating events a family can face, resulting in significant physical and psychosocial morbidity. Bereavement support programs have been developed in high-income contexts to address this need. However, little is known about implementing bereavement programs in low-and middle-income countries (LMICs). Here, we describe the implementation of a bereavement program for parents whose children died due to cancer or other catastrophic illnesses.

Methods

We conducted a retrospective analysis to describe the implementation of a hospital-based End of Life (EoL) care and bereavement program. This program was developed in several stages, including an assessment of bereaved families, development program guidelines, staff training, piloting of the program, refinement, and standardization. The program was developed between 2019 and 2021 in a nonprofit, teaching hospital and referral center for southwestern Colombia.

Results

Several tools were developed as key components of the bereavement program: a virtual bereavement course; guidance for EoL and bereavement communication and care, memory making, and follow-up calls; a condolence letter template, and group support workshops. A total of 956 healthcare professionals were trained, 258 follow-up calls to bereaved parents were made, 150 individual psychological follow-ups to parents with complicated grief occurred, 79 condolence letters were sent, and 10 support group workshops were carried out. Challenges were identified and overcome, such as limited resources and staff, and cultural perceptions of death. In 2021, this program received an award by the hospital as the Best Strategy to Humanize Healthcare.

Conclusions

This study highlights the feasibility of developing and implementing EoL and bereavement care programs for parents and families within hospitals in LMICs. Lack of resources, staff, and training are some of the identified challenges to implementation. Utilizing methodological tools allows us to identify facilitator factors and deliverable outcomes of our EoL and bereavement program. This model provides a valuable framework for resource-limited settings.
Nurses’ perception of thirst in patients within palliative home care: a qualitative study
Authors: Lythell Caroline , Schaller Anne Söderlund , Jaarsma Tiny , Friedrichsen Maria
Published: July 2024

Background

Thirst is the body’s natural urge to replenish fluids in response to a deficiency in hydration. Patients at the end of life gradually lose their independence and reach a point where they become unable to express their needs and can no longer drink on their own. In palliative care, the main advice is to provide regular oral care to relieve symptoms such as dry mouth and thirst. However, according to previous studies the prevalence of thirst and dry mouth remains.

Aim

The aim of this study was to describe palliative care, nurses’ views and experiences of thirst in end-of-life care in specialist palliative care units.

Methods

A qualitative interview study with an inductive approach was conducted. Eighteen nurses working in six different specialist palliative care units in different hospitals in Sweden were interviewed. The interviews were transcribed and analysed with a content analysis approach according to Graneheim and Lundman.

Results

When nurses discuss thirst, they perceive thirst as a problem for the patient. This is attributable to various factors, including the patient breathing with an open mouth, a reduced level of awareness, and negligence on the part of the nursing staff. Signs of thirst are dry mouth, and frequently and intense sucking on the oral care stick during oral care. It also emerged that not all nurses perceived that dying patients experienced thirst. They believe that thirst is something that is reduced in the dying patient in the same way as hunger. The most important thing to them is to relieve the dry mouth by providing good oral care. Several issues, such as a lack of guidelines paired with the patient’s reduced consciousness and hence his/her lack of communication, make assessing thirst problematic.

Conclusion

Nurses have different thoughts and experiences about thirst, where some perceive patients as thirsty while others perceive them as having a dry mouth. Nurses expressed that both evidence and guidelines are lacking.
Relationship between family function and anxiety among nurses during the COVID-19 pandemic: a mediating role of expressive suppression
Authors: Bu Tianyi , Peng Chundi , Zhang Jili , Wan Bowen , Kong Lingbin , Xie Danni , Owura Boakye Kwame , Zhou Jiawei , Hu Xiaomeng , Ke Siyuan , Qiao Kexin , Qiao Zhengxue , Yang Yanjie
Published: July 2024

Background

The aims of the present study were to investigate the incidence of nurses who suffered anxiety during the COVID-19 pandemic and to explore how expressive suppression influences the relationship between family function and anxiety.

Methods

This study used cross-sectional research and simple random sampling. A total of 300 questionnaires were distributed and 254 questionnaires were qualified after invalid questionnaires were proposed, thus a total of 254 female nurses from a tertiary hospital were included in this study. The measurement included General demographic questionnaires, the Self-Scale Anxiety, Scale (SAS), Emotion Regulation Strategies Questionnaire (ERQ), and Family Function Assessment (FAD). T-test, nonparametric Wilcoxon or Kruskal-Wallis test, χ2 test, Pearson or Spearman correlation analysis, multiple stepwise regression and bootstrap methods was performed to analyze the data.

Results

In this study, 22.4% of the nurses exhibited anxiety symptoms, with 17.7% eliciting mild anxiety symptoms, 4.3% showing moderate anxiety symptoms and 0.4% with severe anxiety symptoms. Family function and expressive suppression were positively associated with anxiety severity. And family function influenced anxiety among nurses via direct and indirect (Expressive suppression -mediated) pathways.

Conclusions

Expressive suppression partially mediated the influence of family function on anxiety symptom. To this end, nurse administrators should establish a robust mental health support system encompassing psychological counseling and emotional support groups. Furthermore, nurse administrators should consistently inquire about nurses’ family situations, encourage nurses to articulate their emotions and needs candidly, both within the domestic sphere and the workplace, while refraining from excessive self-repression.
Costs of the COVID-19 vaccination programme: estimates from the West Rand district of South Africa, 2021/2022
Authors: Edoka Ijeoma , Matsela Lineo Marie , Modiba Khumo , Luther Yolandie , Govender Sharlene , Maotoe Thapelo , Brahmbhatt Heena , Pisa Pedro T. , Meyer-Rath Gesine , Miot Jacqui
Published: July 2024

Background

The COVID-19 vaccination programme in South Africa was rolled out in February 2021 via five delivery channels- hospitals, primary healthcare (PHC), fixed, temporary, and mobile outreach channels. In this study, we estimated the financial and economic costs of the COVID-19 vaccination programme in the first year of roll out from February 2021 to January 2022 and one month prior, in one district of South Africa, the West Rand district.

Methods

Financial and economic costs were estimated from a public payer’s perspective using top-down and ingredient-based costing approaches. Data were collected on costs incurred at the national level and from the West Rand district. Total cost and cost per COVID-19 vaccine dose were estimated for each of the five delivery channels implemented in the district. In addition, we estimated vaccine delivery costs which we defined as total cost exclusive of vaccine procurement costs.

Results

Total financial and economic costs were estimated at US$8.5 million and US$12 million, respectively; with a corresponding cost per dose of US$15.31 (financial) and US$21.85 (economic). The two biggest total cost drivers were vaccine procurement which contributed 73% and 51% to total financial and economic costs respectively, and staff time which contributed 10% and 36% to total financial and economic costs, respectively. Total vaccine delivery costs were estimated at US$2.1 million (financial) and US$5.7 million (economic); and the corresponding cost per dose at US$3.84 (financial) and US$10.38 (economic). Vaccine delivery cost per dose (financial/economic) was estimated at US$2.93/12.84 and US$2.45/5.99 in hospitals and PHCs, respectively, and at US$7.34/20.29, US$3.96/11.89 and US$24.81/28.76 in fixed, temporary and mobile outreach sites, respectively. Staff time was the biggest economic cost driver for vaccine delivery in PHCs and hospitals while per diems and staff time were the biggest economic cost drivers for vaccine delivery in the three outreach delivery channels.

Conclusion

This study offers insights for budgeting and planning of COVID-19 vaccine delivery in South Africa’s public healthcare system. It also provides input for cost-effectiveness analyses to guide future strategies for maximizing vaccination coverage in the country.