bluuebunny/crossref_metadata_2025 huggingface dataset:
A Wearable Hip Exoskeleton for Anaerobic Exercise in Healthy Adults
Authors: Kim Eunmi , Lee Su-Hyun , Kim Dongwoo , Yu Jungpil , Lee Hwang-Jae , Kim Yun-Hee
Published: April 2024

Guidelines encouraging social distancing, limited outings, and remote work due to COVID-19 have increased sedentary periods and reduced levels of physical activity. These habits increase the risk of metabolic diseases, obesity, cardiovascular disease, and diabetes mellitus. The World Health Organization recommends muscle-strengthening exercises as well as regular physical activity to promote overall health. This study investigates the effect of a wearable hip exoskeleton on muscle activity and heart rate during anaerobic exercise in 40 healthy adults (mean age of 40.00 ± 11.51 years; n = 20 females). Bot Fit, a wearable hip-type robotic exoskeleton, was developed by Samsung Electronics Co., Ltd. (Suwon, Republic of Korea) to enhance the effects of both aerobic and anaerobic exercise. All study participants performed a fitness exercise protocol, including knee-ups, good mornings, squats, mountain climbs, kick-backs, reverse lunges, and split jacks, with and without a Bot Fit. To evaluate the effect of anaerobic exercise with the Bot Fit, muscle activity and heart rate were measured during the performance of fitness exercises with and without a Bot Fit. Measured muscles included the rectus abdominis (RA), erector spinae (ES), rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM), biceps femoris (BF), tibialis anterior (TA), gastrocnemius medialis (GCM), and gluteus maximus (GM). During anaerobic exercises with the Bot Fit, there was a significant increase in muscle activity compared to exercising without the Bot Fit. Muscle activity increased significantly in the RA, RF, VL, BF and TA muscles during knee-ups; in the ES, BF, and GM during good mornings; in the RF, VL, VM, BF, and GM during squats; in RA, RF, VL, VM, and GM during mountain climbs; in the RA and BF during kick-backs; in the RF, BF, and GCM during reverse lunges; and in the RF and VL during split jacks (p < 0.05). Heart rates showed a statistically significant increase during good mornings, mountain climbs, and reverse lunge exercises while wearing the Bot Fit (p < 0.05). This study demonstrated that anaerobic exercises by healthy adults using a Bot Fit led to enhanced activation of abdominal and lower-limb muscles as well as an improved heart rate, maximizing the effect of anaerobic exercise compared with the same exercise protocol without a Bot Fit. This suggests that use of a Bot Fit can increase the effectiveness of anaerobic exercise in healthy adults.
Phosphogypsum as Fertilizer: Impacts on Soil Fertility, Barely Yield Components, and Heavy Metals Contents
Authors: OUTBAKAT M BARKA , Bouray Moussa , Choukr‑Allah Redouane , Gharous Mohamed El , Omari Kamal El , Mejahed Khalil El
Published: April 2024

Fertilization is a critical input factor in crop production and food security achievement. However, there is room for improvement in the application of fertilizers in certain regions. Thus, using low-cost fertilizers, such as phosphogypsum (PG), could enhance farmers' access to these essential inputs. A two-years field experiment was conducted using two Moroccan PG products applied at four rates (0, 1.5, 3, and 4.5 t/ha). The aim was to assess the impact of PG source and rate on barley crop, including yield component, nutrients uptake, and heavy metals content. The study's findings revealed that as the rate of PG application increased, there were significant enhancements in the number of spikes, tillers, grains, total biomass, grain yield, and thousand grains weight. In fact, when compared to the control, the application of 1.5, 3, and 4.5 t/ha of PG led to a remarkable increase in grain yield by 21%, 34%, and 39%, respectively. Furthermore, the uptake of nutrients by the shoots and grains was significantly influenced by the PG application rates, with higher rates resulting in greater nutrient uptake. Notably, the application of PG had no impact on the heavy metal content in shoots, grains, or soil.
A Pilot Study of Implementing Patient Reported Outcome Measures in the Australasian Pelvic Floor Procedure Registry
Authors: Ruseckaite Rasa , Jayasinghe Randi , Merenda Michelle , Mudunna Chethana , O’Connell Helen E. , Gallagher Elizabeth , King Jennifer , Keck James , Yin Jessica , Ahern Susannah
Published: April 2024

The Australasian Pelvic Floor Procedure Registry (APFPR) records information about procedures for stress urinary incontinence and pelvic organ prolapse. This study aimed to test the feasibility of capturing Patient Reported Outcome Measures (PROMs) in women with pelvic floor disorders (PFDs) identified via the APFPR. We administered the Australian Pelvic Floor Questionnaire (APFQ) in women with PFDs prior to surgery (baseline) and six months post-surgery through a combination of email, postal mail, SMS and telephone. Results were reported descriptively, as number and proportion for PROMs response rates and data completeness, and as a mean and standard deviation (SD) for the APFQ scores. The APFQ was administered to 140 patients at baseline and to 112 post-surgery. The baseline PROMs response rates were high (75%), but decreased to 56% at follow up. The overall APFQ completeness was ~98%. The APFQ dysfunction scores revealed a significant improvement at six months (mean (SD) score at baseline=14.5 (5.7), six months=11.4 (6.5), p≤0.001). Significant improvement in the bladder and prolapse domains (p≤0.001) were particularly observed. The results showed an overall improvement in quality of life scores at follow up, suggesting that the APFQ was a suitable instrument for the APFPR.
Impact of cerebellar tumors and surgery on cognitive function in adult patients
Authors: Yajima Hirohisa , Otani Ryohei , Kawamura Shinji , Shimizu Sakura , Yamada Ryoji , Tsukada Masanobu , Yorimitsu Miyuki , Shinoura Nobusada
Published: April 2024

Background
The cognitive dysfunction associated with cerebellar tumors in adults is not well understood. We herein evaluated the effect of cerebellar tumors and surgery on cognitive function in adult patients before and after resection.
Methods
Eighteen patients who underwent resection of a cerebellar tumor at the study center between 2016 and 2022 were retrospectively analyzed. Their clinical characteristics, surgical complications, and neuropsychological test scores were thoroughly reviewed.
Results
Of the 18 patients, nine were male, and the median age at surgery was 73 years. A high tumor volume (> 10 cm3) was associated with significantly low preoperative cognitive function scores on the Frontal Assessment Battery (FAB) (P = 0.024), the copying task on the Rey-Osterrieth Complex Figure Test (P = 0.020), and the verbal sequential commands on the Standard Language Test of Aphasia (SLTA) (P = 0.030). The preoperative scores for the verbal sequential commands on the SLTA improved postoperatively in patients with a high tumor volume (P = 0.04). A negative correlation was found between tumor volume and the preoperative score on the FAB (r = -0.50) and the verbal sequential commands on the SLTA (r = -0.58). The difference between the postoperative and preoperative scores for the verbal sequential commands on SLTA positively correlated with tumor volume (r = 0.57).
Conclusion
The present study found that the executive function, visuospatial cognitive function, and part of the language function were able to be influenced by cerebellar tumors in adult patients.
Assessment Of Burnout and Quality of Life Among Nursing Professionals in The Ashanti Region of Ghana
Authors: Bonsu George Wireko Brobby , Vetsi Oscar , Kuadzi Francis Atsu , Kwantwi-Barima Francis , Boakye Kingsley , Boateng Daniel
Published: April 2024

Introduction:
Burnout among nursing professionals is problematic for the nursing workforce, considering its effect on their Quality of Life (QoL) and the global shortage of nurses. There is a dearth of literature on the effect of burnout on the QoL of the practice of nursing in Ghana. Hence, this study sought to estimate the prevalence of burnout and its effect on the QoL of nursing professionals in two district hospitals in Ghana.
Methods
An analytical cross-sectional study was conducted among three hundred and forty-three nursing professionals in two district hospitals in the Ashanti Region, Ghana. Data on participants' socio-demographic characteristics, work-related factors, burnout, and QoL were collected using a pretested structured questionnaire. The Maslach Burnout Inventory (MBI) and the World Health Organization Quality of Life (WHOQOL) questionnaire were used to assess burnout levels and QOL among study participants, respectively. Linear regression analysis was conducted to examine the burnout and the relationship between the dimensions of burnout and participants’ QoL.
Result
Out of the 343 participants, the prevalence of burnout was 2.9%. The mean age of study participants was 29.6 (± 5.4) years. About 20.7%, 83.6%, and 61.5% of the participants presented with high emotional exhaustion, depersonalization, and personal accomplishment, respectively. The study revealed that night shift (β: 6.06, 95%CI: 1.52, 11.60, p = 0.032) was associated with emotional exhaustion, while full day shift (β: -7.69, 95%CI: -13.48, -1.89, p = 0.010) and rank of nursing/midwifery officer (β:3.57, 95%CI: 1.71, 6.43, p = 0.015) were associated with depersonalization. The personal accomplishment dimension was predicted by casual employment (β: 5.72, 95%CI: 1.13, 11.31, p = 0.045). The mean score of the overall QoL score of study participants was 78.1 (± 8.6). A significant association was observed between moderate burnout for emotional exhaustion (β: − 4.59, 95%CI: -4.59, -0.46, p = 0.017), high burnout for personal accomplishment (β: -6.28, 95%CI: -8.65, -3.91, p < 0.001), and QoL of nursing professionals.
Conclusion
The total prevalence of burnout among nurse practitioners was low which is influenced by a multiplicity of factors: participants’ rank, type of shift, and type of employment. Burnout has a negative effect on the QoL of nursing professionals. Interventions to reduce the incidence of burnout can target reducing the number of night shifts and instituting incentives for casual/contract nurses.
Analyzing Collimator Rotation Angle Influence on Half-beam VMAT Outcomes for Prostate Cancer: A Comparative Approach Using Statistical and Machine Learning Methods
Authors: Kim Myeongsoo , Kim Byungyong , Choi Euncheol , Shin Yun Sung , Park Seung Gyu , Oh Young Kee , Byun Sang Jun
Published: April 2024

Purpose
This study explores the impact of Collimator Rotation Angle (CRA) settings in Half beam Volume Modulated Arc Therapy (HVMAT) for prostate cancer treatment, focusing on dose distribution and treatment efficacy.
Materials and Methods
Treatment plans (Total 240) for 20 prostate cancer patients were developed using HVMAT. Different CRA settings (n = 12) were employed, specifically comparing 2-arcs and 4-arcs techniques. Data were analyzed using statistical methods and machine learning models, assessing the Mean Relative Error (MRE) across varying CRA settings.
Results
The analysis revealed no significant impact of CRA settings on the conformity and homogeneity of radiation distribution to the target volume. All treatment plans met the average V95% target for the prescribed dose in the Planning Target Volume (PTV). Machine learning analysis showed consistent predictive accuracy across different CRA settings, with the MRE variance within 2%. Statistical tests further supported these findings, showing no significant differences in treatment plan outcomes based on CRA variations.
Conclusion
The study demonstrates that CRA settings in HVMAT can be selected with considerable flexibility without compromising the effectiveness of prostate cancer treatment. The results emphasize the importance of employing multi-faceted analysis, including both traditional statistical methods and advanced machine learning techniques, in optimizing HVMAT treatment plans. Although limited by a small sample size and a specific focus on prostate cancer, the findings provide valuable insights into the clinical application of HVMAT and its potential in treatment plan optimization.
Factors influencing utilization of postnatal care services among postpartum mothers of Vijayanagara district,Karnataka, India
Authors: H Sunitha N , Muktamath Vinutha
Published: April 2024

India has made tremendous progress in reducing MMR by 92 per cent since 2020, but still efforts are required to achieve the new SDG target. Vijayanagara district of Karnataka is a district of Kalyan Karnataka with poor maternal and infant health practices according to National family health survey V report. Hence the present study was conducted with the objective to assess the utilization of post-natal services (PNC) and study the factors influencing utilization of postnatal care services. A community based cross sectional study was conducted in the year 2021-23 in Vijayanagar district on a sample of 810 mothers within 3 months of delivery. Pre-tested questionnaire was used to elicit the information on utilization of postnatal care services and demographic information. SES scale by Agarwala et al. 2005 was used. Data was analyzed using SPSS package Version 26. Results revealed that the overall prevalence of utilization of postnatal care services was 32.46 per cent out of 810 mothers. Mothers between 29 to 32 years had utilized postnatal care services, mothers from middle SES (46.50 %) group, who had ANC attendance, who had knowledge on PNC services (36.30 %) were utilized all the recommended PNC services. Socioeconomic status, age of mother, number of ANC visits and knowledge on postnatal care services were found to be significant factors affecting postnatal care services utilization. The study revealed low level of utilization of postnatal care services among mother (32.46 %). This emphasizes the need to educate pregnant and lactating mothers regarding the importance of PNC services.
Quadrature method and extrapolation algorithm for solving the boundary integral equations of the acoustic wave scattering problems
Authors: Guo Hong , Huang Jin , Li Hu , Li Zhaoxing
Published: April 2024

This paper studies the time domain acoustic wave scattering problems of a bounded obstacle or a smooth open arc in the unbounded domain, where the obstacle has the smooth and closed boundary. Due to the potential theories, the first kind retarded single-layer potential boundary integral equations of the above problems can be obtained and they are solved by two steps, we get the temporal discretization by the convolution quadrature method firstly, and then the first kind boundary integral equations in space are solved by the quadrature method. Meanwhile, the scattered field can be computed in terms of the trapezoidal rule. The existence and uniqueness of the numerical solution are proved, the convergence of the approximate solution is also analysed and the error bound is got. The asymptotic expansion of the error in space shows that the convergence rate is O(h3). Moreover, the extrapolation algorithm is used to improve the accuracy of the numerical solution. The posteriori error estimate is also obtained, which is helpful for designing the self-adaptive algorithm. Some numerical experiments are implemented to show the effectiveness of our method.
Exploration of the effect and mechanism of Shexiang Tongxin Dropping Pill on coronary microvascular dysfunction
Authors: LI Xiaojun , Xuan Yue , LI Shuai , LI Yan , Chen Lan , Chen Yijun , Wang Wei
Published: April 2024

Coronary microvascular dysfunction(CMVD) refers to a clinical syndrome of myocardial ischemia caused by abnormal microvascular structure or function of coronary arteries with a diameter less than 500µm.It is closely related to adverse cardiovascular events,and its treatment remains a clinical challenge. Shexiang Tongxin Dropping Pill(SXDP) shows the effect of improving coronary microvascular perfusion, but the underlying mechanism remains largely unclear.In this study,we aims to observe the effects of SXDP on enhancing coronary blood flow in coronary artery disease(CAD) patients undergoing percutaneous coronary intervention (PCI) treatment and coronary microvascular embolism(CME) mice model while investigating potential mechanisms linked to oxidative stress and inflammatory responses.Firstly, we selected 62 patients with angina pectoris who were negative for cardiac troponin and randomly divided them into control group and SXDP group, with 31 cases in each group. The control group was given aspirin, statin, ACEI, and β-receptor blocker, the SXDP group added the SXDP on the basis of the above drugs. Both groups took the medicine for three consecutive days, coronary angiography(CAG) and(or) PCI were performed on the the fourth day,two hours before surgery, the control group received 300mg of aspirin and 300mg of clopidogrel, while the SXDP group received 10 pills of SXDP in addition to the aforementioned medication, Subsequently implemented CAG to observe the corrected TIMI frame count(CTFC) value of coronary blood flow, as well as the TC, LDL-C, Lp-PLA2,FIB and hs-CRP in serum. Secondly,we utilized electrocardiogram recordings, laser speckle imaging, and histological examination to assess the enhancement of coronary blood flow in CME mice model induced by autologous blood clot particles following SXDP treatment. Additionally, an in vitro model of oxygen-glucose deprivation (OGD) was established using human umbilical vein endothelial cells(HUVECs) to investigate the impact of SXDP on lncRNA H19 and P66shc DNA methylation. In clinical trials, we observed that SXDP can increase coronary CTFC values and reduce the serum levels of TC, LDL-C, Lp-PLA2, FIB and hs- CRP to varying degrees.And in the CME mice model, SXDP was found to enhance myocardial blood supply, decrease thrombosis and myocardial micro- infarctions, and improve coronary microvascular endothelial function. In vitro experiments, we observed SXDP enhances p66shc DNA methylation through the inhibition of lncRNAH19 expression, leading to a reduction in oxidative stress and inflammatory responses in coronary microvessels. Our findings suggested that SXDP can effectively improve coronary microvascular blood flow in patients with CAD and CME model mice,Simultaneously, lncRNAH19 is a key molecule in SXDP's regulation of P66shc,we should focus on lncRNAH19 as potential values for evaluating CMVD.
Clinical study of aneurysmal subarachnoid hemorrhage complicated with neurogenic pulmonary edema
Authors: Yao Lin , Wang Qiuyun , Liu Yongsheng , Xiong Yun , Zhou Zihao , Yu Tao , Feng Ming
Published: April 2024

Purpose
To study the clinical performance, imaging findings, pathological characteristics, treatment and prognosis of aneurysmal subarachnoid hemorrhage (aSAH) complicated with neurogenic pulmonary edema (NPE).
Methods
36 aSAH patients complicated with NPE were retrospectively studied. These patients were divided into the good prognosis group (Glasgow Outcome Scale [GOS] ≥ 4) and poor prognosis group (GOS ≤ 3). All patients underwent preoperative computed tomography (CT) and Computed Tomographic Angiography (CTA) or digital subtraction angiography (DSA), 26 patients had anterior circulation aneurysms, and 10 patients had posterior circulation aneurysms. All patients were monitored for brain natriuretic peptide (BNP) and high-sensitivity cardiac troponin I (hs-cTnI) for 3 consecutive days after admission.
Results
All patients underwent aneurysm embolization or aneurysm clipping after admission. There were statistically significant differences in the Glasgow Coma Scale (GCS) score, Acute Physiology and Chronic Health Evaluation (APACHE) II score, HCO3−, Base Excess (BE), BNP, hs-cTnI and CT difference between the groups with good and poor prognosis (P < 0.05). The ROC curve results indicate that the cardiac biomarkers and related chest CT examination indicators can predict patients prognosis well.
Conclusion
The key to recognising aSAH is typical pulmonary edema with bilateral lung infiltrates and no evidence of left atrial hypertension; the main principles of treatment are to rapidly reduce the patient's intracranial pressure and support the respiratory system. The cardiac biomarkers can predict the prognosis of aSAH patients complicated with NPE.
Cooperative control of NNMPL-SMC and integral EPH methods for a class of overdamping uncertainnonlinear system
Authors: Zhu Aiyun , Yu Haisheng , Meng Xiangxiang , Yang Qing , Xu Tao
Published: April 2024

A cooperative control strategy is designed to achieve fast dynamicand accurate steady-state performances for a class of overdamping uncertainnonlinear systems. The strategy combines the advantages of sliding mode control (SMC) based on neural network minimum parameter learning (NNMPL) and integral error port-controlled Hamiltonian (EPH) methods. Firstly, theNNMPL-SMC uses radial basis function neural network (NN) to estimatethe unknown function of the system, and the minimum parameter learningmethod is used instead of NN weights to design SMC adaptive law, simplifiedthe adaptive algorithm and accelerated the convergence speed of the NN. Atthe same time, the observer of NNMPL-SMC subsystem is developed to estimate the uncertain parameters and external disturbances of the subsystem.Secondly, an integral EPH controller with disturbance attenuation is designed,and the observer is developed to estimate the uncertain parameters and external disturbances of the EPH subsystem. Finally, the cooperative control of NNMPL-SMC and integral EPH methods is achieved for overdamping uncertain nonlinear systems. Simulation and experiments verify the superiority and feasibility of the cooperative control strategy.
Spatial distribution characteristics and source analysis of groundwater nitrate pollution in an agricultural area at the southern foot of Qinling Mountain in China
Authors: Gong Wenqiang , Zhao Hao , Sun Jianwei , Li Xinbing , Zhao Chao , Yue Haiyang , Han Chaohui
Published: April 2024

In order to study the source of nitrate pollution in shallow groundwater in the agricultural area, surface water, groundwater and soil samples were collected, and the conventional chemical indicators and nitrogen and oxygen isotopes were analyzed. The method of combining nitrate δ15N and δ18O was used to identify the source of nitrate pollution. The results show that the concentration of NO3−(N) in the groundwater is between 3.18mg/L and 10.32mg/L, and the water quality of BC203, TCQ3020 and TCQ3029 wells belongs to Class III(5mg/L). From the perspective of spatial distribution, the pollution degree of water quality in the upper reaches is stronger than that in the lower reaches, that in the tributaries is stronger than that in the main stream, and it gradually decreases along the flow direction; vertically, the soil nitrate content decreases with the increase of depth, and suddenly increases at -1 meter, indicating that the groundwater nitrate pollution depth in this area has risen to -1 meter. The δ15N and δ18O values of nitrate ranged from 7.2‰ to 14.6‰ and from-8.31‰ to-7.39‰, respectively. Combined with the field survey, it was determined that the main sources of nitrate were animal manure and domestic sewage(MS), soil nitrogen(SN).
Assessment of attitudes towards antihypertensive medication among Hungarian patients with hypertension using the Beliefs About Medicines Questionnaire: a validation and cross- sectional study
Authors: Varga Mihály , Bíró Klára , Dombrádi Viktor , Kovács Nóra , Nagy Attila , Bányai Gábor , Boruzs Klára
Published: April 2024

Background: Assessing the beliefs of hypertensive patients about medications is crucial for appropriate and preventive drug treatments. The key to effective hypertension care is the patient's proper cooperation, which is why it is important to examine their beliefs regarding antihypertension medication use. The aims of the study were to validate the Hungarian translation of the Beliefs about Medicines Questionnaire (BMQ) and to identify possible factors that might influence the attitude of patients with hypertension towards medications.
Methods: Data was collected in Hungary using the BMQ. 1,067 adult patients with chronic hypertension and taking their prescribed medications took part in the research. Statistical analysis was done to validate the questionnaire and to identify which sociodemographic factors influence the different aspects of attitudes toward medicine.
Results: The translation showed good reliability and validity. Furthermore, respondents who worked in the healthcare were more likely to feel the need to take antihypertensive drugs than those who did not (p<0.001). Also, participants who reported a good or very good (p<0.001) and fair (p=0.021) financial status were more concerned about antihypertensive treatment than those who reported a poor or very poor financial situation. Of those respondents, who answered living in towns of less than 1,000 people were more likely to think that antihypertensive treatment was harmful than those living in towns of more than 100,000 people (p=0.007).
Conclusions: For the identified groups, more attention is needed to ensure that the medication is taken correctly. This requires the promotion of good doctor-patient communication.
RBM15 is a novel prognostic biomarker and correlates with immune cell infiltration in lung adenocarcinoma
Authors: Ma Mingsheng , Wang Wei , Li Li , Wang Xiaoyan , Huang Qiubo , Zhou Chen , Ye Lianhua
Published: April 2024

Background and Aims: This study aimed to evaluate RBM15 gene expression and the potential effects as a biomarker in LUAD progression.
Materials and Methods: The RNA sequencing (RNA-seq) data and clinical data of patients with LUAD were acquired from The Cancer Genome Atlas (TCGA) databases. Kaplan-Meier (K-M) curves were generated to investigate the relationship between RBM15 and the prognosis of patients with LUAD. Gene Ontology (GO) and Reactome enrichment analyses were performed using the “cluster Profiler” R package. Finally, the Tumor Immune Estimation Resource (TIMER)database and CIBERSORT algorithm were used to assess the correlations between RBM15 expression and immune infiltration in LUAD.
Results: RBM15 was upregulated in tumor tissue, and it was regarded as an independent prognostic factor in LUAD. The genes co-expressed with RBM15 were closely related to cell cycle checkpoints and M phase signaling pathways. Furthermore, there was a significant correlation between RBM15 gene expression and immune infiltration in LUAD.
Conclusion: Our data suggested that RBM15 is critical in LUAD progression, is associated with tumor immune infiltration and served as a valuable potential diagnostic biomarker in patients.
Evaluating the implementation of the blood pressure monitoring program based on smart wearable devices (BPMP-SWD) of intravenous thrombolysis for acute ischemic stroke: Protocol for a randomized controlled trial
Authors: Li Suai , Zhao Jie , Liu Mengrao , Ma Gaoting , Han Jinming , Tian Siying , Wang Yuxin , Yang Ting , Chang Hong
Published: April 2024

Background
It is recommended that blood pressure (BP) in patients with acute ischemic stroke (AIS) should be monitored closely before and until 24 hours after thrombolysis. The guideline adherence to BP monitoring in clinical practice can be influenced by a variety of factors. Interventions integrated with knowledge on influencing factors have been widely used to improve guideline adherence.
Aim
To evaluate if the BP monitoring program based on smart wearable devices (BPMP-SWD) can improve the adherence of intravenous thrombolytic (IVT) care in patients with AIS.
Methods
This study is a prospective, open-label, endpoint-blinded, single-center, randomized controlled trial, randomized in a 1:1 ratio to either the control or intervention group at a comprehensive stroke center. The BP in the control group will be monitored using a conventional bedside monitoring device and the intervention group will be monitored using a smart wearable device. The primary outcome is the guideline adherence to BP monitoring for IVT. The secondary outcomes include the feasibility, fidelity and acceptance of smart wearable devices. Based on pilot data, a total of 160 patients with AIS undergoing IVT will be recruited.
Discussion
This study may provide novel evidence on improving the adherence to intravenous thrombolytic BP monitoring and support the wider implementation of smart wearable devices-based intervention to promote evidence-based practice.
Trial registration
The Chinese Clinical Trial Registry ChiCTR2300069063 (Date of registration 03.06.2023)
Mapping the threads: Geospatial Exploration of Shared Modifiable Tuberculosis Disease Risks in a clinic-based population
Authors: Asare-Baah Michael , Luong Tan M. , Afriyie-Mensah Jane , Kwarteng Ernest , Domotey Charles , Arthur Nellie , Zoungrana Magalie , Mireku-Apah Sheila , Ganu Honesty , Omari Michael Amo , Sackey Adelaide , Kwara Awewura , Séraphin Marie Nancy
Published: April 2024

Background In emerging economies experiencing rapid sociodemographic transitions and historically high tuberculosis (TB) prevalence, effective TB control requires acknowledging the evolving socio-behavioral characteristics of diverse patient populations shaping community-level TB risk. This study aimed to explore the spatial distribution and clustering of shared modifiable clinical and social risk factors for TB in a clinic-based population in Accra, Ghana.Methods We prospectively enrolled new and previously treated TB patients between June 2022 and July 2023. At diagnosis, patients provided informed consent to collect their residential coordinates and completed a questionnaire assessing their demographic and modifiable clinical and social risks for TB. We used geospatial scan statistics to describe the spatial distribution of cases and PERMANOVA to examine the correlation between spatial proximity and shared socio-behavioral risks, with a 1.5 square kilometer threshold defining significant residential proximity.Results The study population (N = 150) was predominantly male (68.0%) and of working age (80.0% aged 25–64 years), with half the sample engaged in unskilled labor (51.3%). Approximately one-third reported heavy alcohol (36.0%) and recreational drug use (26.7%) in the past year. Fifteen percent were HIV-positive, of whom more than 80% were diagnosed at the time of TB diagnosis. Local Moran's I statistics revealed spatial clusters of TB cases in separate sections of the study area. Unskilled labor, recreational drug use, and a history of cough in patients’ social contacts were significantly associated with residential proximity, explaining 1.26% of the variance in our model (F = 1.89, R^2 = 1.3%, p = 0.004).Conclusions Shared modifiable risks, including unskilled labor, recreational drug use, and close contact with TB, exhibited spatial clustering, suggesting their potential to enhance TB disease progression and transmission in this setting. Targeted interventions addressing these socio-behavioral risks within identified hotspots may improve TB control efforts.
Supporting shared-decision making for anticoagulation initiation in people with advanced kidney disease
Authors: Parker Kathrine , Needham Abigail , Thachil Jecko , Mitra Sandip , Lewis Penny
Published: April 2024

Background
Patients with chronic kidney disease are at increased risk of thrombotic and bleeding episodes making anticoagulant treatment decisions challenging. Currently, there are no decision support tools for patients with CKD regarding anticoagulant therapy. This work aimed to co-produce patient materials to support shared-decision making of anticoagulant use in advanced chronic kidney disease.
Methods
Focus groups were used to explore the views of kidney patients towards anticoagulant prescribing. Data was thematically analysed based on Makoul and Clayman’s model of shared-decision making. Co-production was used to develop patient material in conjunction with kidney patients over three meetings.
Results
A list of questions, to be used by patients when initiated on an anticoagulant, were co-produced. These questions were based upon participants’ experiences of the various stages of shared-decision making within the context of anticoagulant use in advanced chronic kideny disease, EGFR < 30ml/min/1.73m2. Of particular importance to participants was the provision of information relating to treatment risks and follow up arrangements.
Conclusion
Shared-decision making is important when initiating medication to ensure the best outcomes for patients, yet it can be difficult to engage in shared-decision making without prompts or guidance This co-produced patient guide could be used to support shared-decision making for anticoagulant initiation in patients with advanced chronic kidney disease.
Endothelial and neuronal engagement by AAV-BR1 alleviates cholesterol deposition in a mouse model of Niemann-Pick type C2
Authors: Rasmussen Charlotte Laurfelt Munch , Heegaard Christian Würtz , Thomsen Maj Schneider , Hede Eva , Laczek Bartosz , Körbelin Jakob , Thomsen Louiza Bohn , Schwaninger Markus , Moos Torben , Burkhart Annette
Published: April 2024

Background Patients with the genetic disorder Niemann-Pick type C2 disease (NP-C2) suffer from lysosomal accumulation of cholesterol causing both systemic and severe neurological symptoms. In a murine NP-C2 model, otherwise successful intravenous Niemann-Pick C2 protein (NPC2) replacement therapy fails to alleviate progressive neurodegeneration as infused NPC2 is unable to cross the blood-brain barrier (BBB). Genetic modification of brain endothelial cells (BECs) is thought to enable secretion of recombinant proteins thereby overcoming the restrictions of the BBB. We hypothesized that BBB-directed gene therapy using the AAV-BR1-NPC2 vector would transduce both BECs and neurons in a mouse model of NP-C2 (Npc2-/-).Methods Six weeks old Npc2-/- mice were intravenously injected with the AAV-BR1-NPC2 vector. Post-mortem analyses included gene expression analyses, determination of NPC2 transduction in the CNS, and co-detection of cholesterol with NPC2 in neurons.Results The vector exerted tropism for BECs and neurons resulting in a widespread NPC2 distribution in the brain with a concomitant reduction of cholesterol in adjacent neurons, presumably not transduced by the vector.Conclusion The data suggests cross-correcting gene therapy to the brain via delivery of NPC2 from BECs and neurons.
Factor associated with women’s choice for place of delivery in a selected municipality of Madesh Province, Nepal
Authors: Yadav Neelima , Paneru Damaru Prasad , Shrestha Niranjan , Yadav Rajiv Ranjan
Published: April 2024

Background
Maternal mortality from pregnancy and childbirth remains a major public health problem in Nepal. Government of Nepal has been continuously making effort to reduce maternal mortality through its different programs, policies, and incentives schemes. Evidence suggests that the reasons for slow progress in MNH outcomes are partly contributed by equity gaps in access to services, and utilization of poor-quality health services. Thus, this study aims to assess the preference and the reasons for choices of delivery place among the women in Rautahat.
Methods
A quantitative, cross-sectional study was carried out among 278 married women of reproductive age group in Paroha Municipality who had given at least one birth within past 12 months. Face to face interview was conducted using structured questionnaire after obtaining ethical approval from IRC Pokhara university, health section of Paroha Municipality and written consent from participants. Epi-data for data entry and SPSS was used for further analysis. Univariate, bivariate and multivariate analysis were carried out in order to obtain results.
Results
The study found that 89.6% women preferred health institution as ideal place of delivery. And 84.9% had institutional delivery. Similarly, factor such as women occupation (AOR = 5.901, 95% CI: 1.099–31.683) ANC visit (AOR = 8.491, 95% CI: 1.975–36.508), women preferred delivery place (AOR = 4.570, 95% CI: 0.614–5.972), husband preferred delivery place (AOR = 43.947, 95% CI: 8.573-225.279), delivery at preferred place (AOR = 8.927, 95% CI: 2.233–35.690) and use of nearest health facility (AOR = 5.473, 95% CI: 1.221–24.525) were major factor influencing place of delivery.
Conclusion
To ensure equitable and accessible services and improved utilization of institutional delivery it is important to identify what progress has been achieved, whether there are vulnerable and disadvantaged groups that need specific attention and the key factors affecting the utilization of institutional delivery services. Also, to promote institutional delivery and improve maternal and child health outcomes, healthcare systems should consider preferences and factors that could affect to ensure that quality of maternity care.
Control of CDH1 and IDH1mut glioblastoma cell cycle by D-2- hydroxyglutarate
Authors: You Meng-Qi , Xu Wei
Published: April 2024

Glioblastoma (GBM) is a prevalent and lethal primary brain tumor. Patients with the IDH1R132H (isocitrate dehydrogenase 1) mutation exhibit extended survival and aneuploidy, yet the underlying mechanisms are unclear. Here, we reveal that the accumulation of D-2-hydroxyglutarate (2-HG) produced by IDH1R132H mutation induces the degradation of Fizzy-related protein1(FZR1 or CDH1) by inhibiting prolyl hydroxylase EGLN2 activity. CDH1 levels are stabilized by α-KG and oxygen, independent of HIF-1α, through EGLN2-mediated hydroxylation. This novel mechanism represents the first instance of prolyl hydroxylation stabilizing a protein. The 2-HG-EGLN2-CDH1 axis induces mitotic arrest and cell growth inhibition, potentially contributing to the extended survival observed in patients with IDH1R132H mutant GBM.
Association between vitamin D levels and physical activity: A cohort study
Authors: Javid Mohammadreza , Joukar Farahnaz , Emamhadi Amirreza , Faraji Niloofar , Zeinali Tahereh , Maroufizadeh Saman , Naghipour Mohammadreza , Mansour-Ghanaei Fariborz
Published: April 2024

Introduction:
A surprisingly high prevalence of vitamin D (vit D) deficiency has recently been reported worldwide. This study investigated the association between vit D levels and physical activity in the Prospective Epidemiological Research Studies in (PERSIAN) cohort study.
Methods
This cross-sectional study has been conducted on 9522 participants aged 35 to 70. The serum vit D concentrations were measured, and participants were divided into three tertiles of low, moderate, and high levels according to the metabolic equivalent of task (MET). The cutoff level for vit D deficiency was considered ≤ 12 ng/ml. All data were analyzed using SPSS version 26 with a significant level of less than 0.05.
Results
About 4428 participants were male, and the mean age of participants was 51.46 ± 8.91 years. The prevalence of vit D deficiency was 22.8% and more common in women than men (23.8% vs. 21.7%). The prevalence of vit D deficiency decreased with increasing physical activity (P < 0.001). Vit D deficiency is significantly associated with increasing body mass index (BMI) (P < 0.05). In the adjusted model for vit D supplements and sociodemographic characteristics, the participants with low physical activity had a higher risk of vit D deficiency than participants with high physical activity.
Conclusions
According to our findings, vit D deficiency was associated with a reduced frequency of participation in all forms of physical activity.
A survey on the attitude and willingness of Chinese cancer patients toward a COVID-19 booster vaccine
Authors: Yao Man , Wang Peng , Wang Meng , Zheng Sheng-qi , Xu Xiao-wan , Zhang Qing-mei , Yu Qin , Qin Hao-ran , Meng Yong-bin , Hong Jing
Published: April 2024

Objective
The 2019 novel coronavirus is still rapidly mutating and spreading worldwide, posing a great global health challenge, especially vulnerable groups, including cancer patients. Studies comparing the clinical outcomes of cancer patients receiving or not receiving the 2019 coronavirus disease (COVID-19) vaccines have not yet shown significant benefits. Therefore, this study mainly focused on the attitudes and willingness of cancer patients toward COVID-19 booster vaccines and to distinguish independent predictors that may impact the vaccination of cancer patients.
Methods
An online cross-sectional study was conducted between July 1 2022 and January 1 2023 in China. Patients were selected using a convenience sampling method, and a self-reporting questionnaire was developed based on a literature review to evaluate the attitude of cancer patients towards the intensive use of COVID-19 vaccines and the willingness of patients to accept the COVID-19 vaccine. Independent predictors associated with accepting a COVID-19 booster vaccine were determined through multivariate logistic regression.
Results
A total of 1055 participants were included in this study. The vaccine acceptance rate was 56.11% (592/1055), while the hesitancy rate was 43.89% (463/1055). Frequent smoking, those who had received two doses of the COVID-19 vaccine, belief that the COVID-19 booster vaccine was necessary, belief that the COVID-19 booster vaccine was safe and effective, willingness to pay for the COVID-19 booster vaccine, and recommendation of COVID-19 booster vaccine by friends and family were contributing factors for vaccine acceptance.
Conclusion
This study recommends developing healthcare policies appropriate for cancer patients to facilitate their acceptance of vaccines, such as publishing the safety and effectiveness of vaccines, providing individualized treatment options after adequate risk assessment and developing specific COVID-19 vaccines suitable for cancer patients.
Death anxiety and its relationship with the perception of aging in older adults visiting comprehensive healthcare centers: Evidence from a cross-sectional study in southern Iran
Authors: Ahmadidarrehsima Sudabeh , Rafati Foozieh , Shafiei Shohreh , Mehni Esmeil Barkhori , Abbasi Mohsen , Mashayekhi Fatemeh , Salari Nasibeh
Published: April 2024

Background and Aim:
Death anxiety is one of the most important developments in old age, which reduces the general functioning and psychological well-being of older adults and changes people’s perception of aging. The present study aimed to examine death anxiety and its relationship with the perception of aging in older adults visiting comprehensive healthcare centers in southern Iran.
Materials and Methods
This study was conducted using a correlational cross-sectional design. The research population included all elderly people over 60 years old supported by a university of medical sciences and medical services in southern Iran in 2021. The participants in the research sample were 231 older adults selected using cluster sampling. The data were collected using the Templer Death Anxiety Scale (DAS) and Aging Perception Questionnaire (APQ). The collected data were analyzed using descriptive statistics and t-test, ANOVA, Spearman’s correlation test, Mann-Whitney U test, and Kruskal-Wallis test with SPSS software (version 23). A significance level of less than 0.05 was considered in this study.
Results
The participants’ mean age was 72.56 ± 9.04 years. Besides, most of the participants (129 persons (55.8%) were female, 177 persons (76.6%) were married, 118 persons (51.1%) were illiterate, and more than half of them had a monthly income level of less than one million Tomans. The mean score of death anxiety and perception of aging was 6.39 ± 4.06 and 110.29 ± 18.40, respectively. Moreover, there was a positive and significant relationship between death anxiety and perception of aging (r = 0.23; P < 0.05) in older adults. The data also indicated that death anxiety and perception of aging had a significant relationship with the place of residence, age, and the number of children (P < 0.05).
Conclusion
The present study showed that the older adults in this study experienced a moderate level of death anxiety. Furthermore, since death anxiety had a direct and significant relationship with the perception of aging, innovative interventions can be conducted to educate older adults to cope directly with their death anxiety and improve their mental health. In addition, the related authorities need to devise effective plans and policies to reduce death anxiety and improve positive perceptions of older adults about aging.
Staphylococcus aureus-expressed acetolactate synthase enhances the biosynthesis of branched-chain amino acids and is linked to insulin resistance in type 2 diabetes in South China
Authors: Liang Tingting , Jiang Tong , Liang Zhuang , Li Longyan , Wu Lei , Gao He , Zhao Hui , Zhang Ni , Dong Bo , Xie Xinqiang , Wu Qingping , Gu Bing
Published: April 2024

Background An increase in branched-chain amino acid (BCAA) levels can result in insulin resistance at different stages of type 2 diabetes (T2D), however, the causes of this increase are unclear.
Methods We performed metagenomics and metabolomics profiling in patients with prediabetes (PDM), newly diagnosed diabetes (NDDM), and post-medication type 2 diabetes (P2DM) to investigate whether altered gut microbes and metabolites could explain the specific clinical characteristics of different disease stages of T2D.
Results Here we identify acetolactate synthase (ALS) a BCAA biosynthesis enzyme in Staphylococcus aureus as a cause of T2D insulin resistance. Compared with healthy peoples, patients with PDM, NDDM, and P2DM groups, especially in P2DM group, have increased faecal numbers of S. aureus. We also demonstrated that insulin administration may be a risk factor for S. aureus infection in T2D. The presence of ALS-positive S. aureuscorrelated with the levels of BCAAs and was associated with an increased fasting blood glucose (FBG) and insulin resistance. Humanized microbiota transplantation experiment indicated that ALS contributes to disordered insulin resistance mediated by S. aureus. We also found that S. aureus phage can reduced the FBG levels and insulin resistance in db/db mice.
Conclusions Above all results suggest that the BCAAs biosynthesis increasing bacteria and ALS enzymes are potential intervention targets for the glucose homeostasis in T2D insulin resistance, opening a new therapeutic avenue for the prevention or treatment of diabetes.
miR-1, miR-133a, miR-29b and Skeletal Muscle Fibrosis in Chronic Limb-Threatening Ischaemia.
Authors: Keane Alan , Nogues Clara Sanz , Jayasooriya Dulan , Creane Michael , Chen Xizhe , Lyons Caomhán , Sikri Isha , Goljanek-Whysal Katarzyna , O'Brien Timothy
Published: April 2024

Chronic limb-threatening ischaemia (CLTI), the most severe manifestation of peripheral arterial disease (PAD), is associated with a poor prognosis and high amputation rates. Despite novel therapeutics approaches being investigated, no significant clinical benefits habe been observed yet. Understanding the molecular pathways of skeletal muscle dysfunction in CLTI is crucial for designing successful treatments. This study aimed to identify miRNAs dysregulated in muscle biopsies from PAD cohorts. Using MIcroRNA ENrichment TURned NETwork (MIENTURNET) on a publicly accessible RNA-sequencing database of PAD cohorts, we identified a list of miRNAs that were over-represented among the upregulated differentially expressed genes (DEGs) in CLTI. Next, we validated the altered expression of these miRNAs and their targets in mice with hindlimb ischaemia (HLI). Our results showed a significant downregulation in miR-1, miR-133a, and miR-29b leves in the ischaemic limbs versus the contralateral non-ischaemic limbs. A miRNA target protein-protein interaction network identified extracellular matrix components, including collagen-1a1, -3a1, and − 4a1, fibronectin-1, fibrin-1, matrix metalloproteinase-2 and − 14, and Sparc, which were upregulated in the ischaemic muscle of mice. This is the first study to identify miR-1, miR-133a, and miR-29b as potential contributors to fibrosis and vascular pathology in CLTI muscle, which supports their potential as novel therapeutic agents.