bluuebunny/crossref_metadata_2025 huggingface dataset:
Defining the Relationship Between Ovarian Adult Granulosa Cell Tumors and Synchronous Endometrial Pathology: Does Ovarian Tumour Size Correlate With Endometrial Cancer?
Authors: Tokalioglu Abdurrahman Alp , Oktar Okan , Sahin Mustafa , Ozturk Cagatayhan , Erdogan Ozgur , Yildirim Hande Esra Koca , Ucar Yesim , Kilic Fatih , Ersak Burak , Yalcin Necim , Ozmen Fatma , Alci Aysun , Bas Sevda , Gorgulu Goksen , Selcuk Ilker , Ucar Gokhan , Kocak Ozgur , Cakir Caner , Kilic Cigdem , Comert Gunsu Kimyon , Ureyen Isin , Toptas Tayfun , Narin Mehmet Ali , Tasci Tolga , Taskin Salih , Boran Nurettin , Ozdal Bulent , Sanci Muzaffer , Uncu Dogan , Korkmaz Vakkas , Tekin Ozlem Moraloglu , Ustun Yaprak , Ortac Fırat , Turan Taner
Published: September 2023

Objective:The main feature of adult granulosa cell tumours (AGCT) is their capacity to secrete hormones, with nearly all of them capable of synthesizing oestradiol. Endometrial pathology is caused granulosa cell-produced oestrogen. The primary goal of this study is to identify synchronised endometrial pathologies, particularly endometrial cancer, in AGCT patients who had undergone a hysterectomy. The secondary objective is to define the factors related to synchronised endometrial cancer in AGCT.
Materials and Methods: The study cohort comprised retrospectively of 316 AGCT patients from ten tertiary gynaecological oncology centres. AGCT surgery consisted of bilateral salpingo-oophorectomy, hysterectomy, peritoneal cytology, omentectomy and the excision of any suspicious lesion. Endometrial hyperplasia was categorised as simple hyperplasia without atypia, complex hyperplasia without atypia, complex hyperplasia with atypia or endometrial intraepithelial neoplasia (EIN). The median tumour size value was used to define the relationship between tumour size and endometrial cancer. The relationship between each value and endometrial cancer was evaluated.
Results:EIN or hyperplasia with complex atypia was detected in 7.7% of patients and endometrial cancer in 3.2% of patients. The relationship between tumour size and endometrial cancer was evaluated by taking the tumour size as a cut-off value of 150 mm. Four patients with a tumour size of ≤150 mm (3.2%), and four patients with a tumour size >150 mm (12.1%) had endometrial cancer. (p=0.036). Tumour size was statistically significant in relation to endometrial cancer in menopausal AGCT patients.
Conclusion: Our present study determined that 7.3% of patients had complex hyperplasia with atypia or EIN, and 3.1% of patients had endometrial carcinoma. During the menopausal period, endometrial cancer risk was 4.5%. The study revealed that the likelihood of developing endometrial cancer increased to 12% from 3.2% when the size of the tumour was >150 mm in menopausal patients.
Phenol degradation and Cu2+ dissolution behaviors of Cu/Al2O3 catalyzed advanced oxidation processes in water
Authors: Zhang Wumin , Zhuang Huimin , Guo Yu , Chi Hua , Ding Qiuyue , Wang Lu , Xi Yanyan , Lin Xufeng
Published: September 2023

Catalytic wet peroxide oxidation (CWPO) has become an important deep oxidation technology for organics removal in wastewater treatments. Supported Cu-based catalysts belong to an important type of CWPO catalyst. In this paper, two Cu catalysts, namely, Cu/Al2O3-air and Cu/Al2O3-H2 were prepared and evaluated through catalytic degradation of phenol. It was found that Cu/Al2O3-H2 had an excellent catalytic performance (TOC removal rate reaching 96%) and less metal dissolution than the Cu/Al2O3-air case. Moreover, when the organic removal rate was promoted at a higher temperature, the metal dissolution amounts was decreased. Combined with hydroxyl radical quenching experiments, a catalytic oxidation mechanism was proposed to explain the above-mentioned interesting behaviors of the Cu/Al2O3-H2 catalyst for CWPO. The catalytic test results as well as the proposed mechanism can provide better guide for design and synthesis of good CWPO catalysts.
Radiation source terms analysis and the classification of radioactive waste for the decommissioning of the first HWRR nuclear reactor in China
Authors: Guo Yaping , Nie Peng , Li Ruizhi , Zhang Lijun , Zhao Zelong
Published: September 2023

Nuclear reactor will face the problem of decommissioning due to the high radioactivity of their components and the consideration of environmental safety when the operating period ends. The Heavy Water Research Reactor (HWRR) is the first large-scale research reactor to be decommissioned in China. The second phase of decommissioning involves the highly radioactive reactor block, so the source terms of the main reactor internals need to be evaluated. Based on the operating history, the complex three-dimensional geometry, materials and other information of HWRR reactor, this paper calculates and analyzes the activity of radionuclides of reactor internals. The results indicate that 14C, 54Mn, 55Fe, 60Co, 63Ni, and 152Eu are the main radioactive nuclides. The total activity of radioactive nuclides was 2.36E + 15Bq at the safe shutdown time at the end of 2007, 4.27E + 13Bq at the end of 2021, and 1.83E + 13Bq at the end of 2025. In addition, the ratio of the theoretical activity values to the sampling results is within 2.5 times and is conservative. The inner shell, outer shell, cooling water tank, sand layer, and heavy concrete shielding layer are all low-level waste. These data can provide reference for the preparation of the second phase of HWRR reactor decommissioning and the subsequent disposal of radioactive waste.
Testing the critical waters: replication, further refinement and validation of the Critical Social Justice Attitudes scale
Authors: Lahtinen Oskari
Published: September 2023

Objectives: The present study set out to refine and further validate a scale for assessing critical social justice attitudes as well as replicate results from a previous study. This study assessed the reliability, factor structure, model fit, and both convergent and divergent validity of the scale. The study examined the prevalence of critical social justice attitudes in different subpopulations and probed the scale’s correlations with well-being and other variables.
Methods: Participants were a nationwide sample (n = 5030) of people aged 15-84. 5 new candidate items for the scale were introduced and after analyses, 4 were included in the final version of the critical social justice attitudes scale (CSJAS; 11 items).
Results: The final CSJAS scale had high reliability and good model fit as well as convergent and divergent validity. Overall, the study sample rejected critical social justice propositions, with strong rejection from men but cautious support from women (gender difference: d = 1.16). CSJAS was correlated with depression, anxiety, and (lack of) happiness, but not more so than being politically left was.
Conclusions: The Critical Social Justice Attitude Scale was successfully constructed and validated. It had good reliability and model fit.
Digital Support for Wellbeing: Addressing COVID-19-Related Mental Health Challenges in a Developing Country via Web-Based Telehealth
Authors: Ghiasi Nasrin , Babashahi Mashallah , Saeidnia Hamid Reza , Lotfata Aynaz , Karajizadeh Mehrdad , Hassanzadeh Mohammad
Published: September 2023

Background
Mental disorders pose a significant global challenge, particularly accentuated by the escalated prevalence during the COVID-19 pandemic outbreak. In addressing this critical issue, the utilization of web-based telehealth systems emerges as a promising solution to provide essential healthcare services to individuals grappling with mental disorders. In light of this, the primary objective of this study is to share the experience of designing and developing a web-based telehealth system tailored for deployment within a developing country.
Method
Using a three-phase model, we conducted interviews with 8 clinical psychologists and 8 general psychologists in the Concept Identification phase, extracting content to alleviate COVID-19-related mental health burdens. In the System Design phase, we collaborated with 24 experts recruited from social media to develop a final prototype for a web-based telehealth system's user interface. The third phase, Pre- and Post-Implementation Assessments, engaged 120 participants. Using the COVID-19 Stress Scale (CSS), we measured stress levels before and after participation. Data analysis employed comprehensive statistical tests, calculating Standard Deviation and Mean for an overview, and conducting analytical tests (independent sample t-test, one-way ANOVA, Tukey's post hoc test) for deeper insights.
Results
Depression, drug use, stress, anxiety, and sleep problems emerged as shared concerns among all participating psychologists. Data indicated an initial stress score of 128 for participants before engaging with the web-based telehealth. Subsequently, stress scores progressively decreased over quarters: 85 in the first, 44 in the second, and 62 in the third. Significantly, repeated measures analysis of variance highlighted a substantial stress reduction within the COVID-19-affected group.
Conclusion
Traditional in-person mental health care encounters barriers in these situations. In contrast, web-based telehealth presents a solution that overcomes geographical constraints, reduces travel complexities, and eases the financial burden of seeking care. Moreover, it offers increased flexibility in appointment scheduling, enhancing the overall convenience of mental health support. A key advantage of web-based telehealth is its potential to maintain a continuum of care for individuals managing mental health challenges.
Development of Occlusal Canting Identifying Tool: Verification, Reliability and Validation Assessment
Authors: Alhuwaish Hessah A. , Almoammar Khalid A. , Fakhouri Abdulaziz S.
Published: September 2023

Introduction: Occlusal cant (OC) is a malocclusion trait that lacks accurate clinical assessment methods. The occlusal canting identifying tool (OCIT) was invented and patented as a clinical tool to accurately identify and quantify the degree of maxillary OC. This study aimed to 1) develop a prototype of the OCIT, 2) verify the functionality of the OCIT and 3) assess the validity and reliability of the OCIT.
Materials and Methods: A patented OCIT design was revised, and the dimensions were finalized, followed by a three-dimensional conceptual prototype design that was reviewed and approved by the inventors. Verification was performed using a digital angle gauge to determine the accuracy of the bubble level as well as the angle between the bite plate and the protractor. For laboratory validation, 40 orthodontists measured the simulated OC at (0°, 2°, 4°, 6° and 8°) on five phantom heads using the OCIT. A reliability assessment of the tool was performed in three occasions by one orthodontist using the same laboratory settings.
Results: The OCIT was prototyped from a medical-grade stainless steel alloy (316 L). Verification assessment revealed that the accuracy error of the bubble level (0.316° ± 0.028°) was statistically significant but clinically insignificant, while that of the angle between the bite plate and protractor (0.100° ± 0.050°) was statistically insignificant. Validation assessment showed high validity of the OCIT with no statistically significant difference between the OCIT and the reference values, having more errors in identifying smaller OC degrees compared to larger OC degrees. The intraclass correlation coefficient indicated the high reliability of the OCIT.
Conclusion: The OCIT was verified and proven to be a valid and reliable clinical tool that accurately evaluates the degree of OC.
Dual Intra-articular injections of corticosteroid and hyaluronic acid are more effective than corticosteroid alone for ankle osteoarthritis
Authors: Woo Inha , Lee Jung-Min , Hyeon Jo Seong , Baek Jongyoon , Park Chul Hyun
Published: September 2023

An intra-articular corticosteroid injection is commonly administered to relieve pain for ankle osteoarthritis (OA). Corticosteroid effects are short-lived, whereas, hyaluronic acid (HA) has longer effects. We hypothesized that intra-articular injections of corticosteroid and HA would be more effective than corticosteroid alone. A randomized controlled trial was decided to investigate the hypothesis. 135 patients with OA were gathered to an intra-articular corticosteroid injection group (CS group, n = 61) or dual HA plus corticosteroid injection group (CS + HA group, n = 74). The CS group received a corticosteroid injection of 1 ml once, and the CS + HA group received 2 ml of HA and 1 ml corticosteroid on the first week, followed by 2 ml of HA on the second and third weeks. Clinical evaluations were performed before injection (baseline), 6 and 12 weeks after first injections. The Ankle Osteoarthritis Scale (AOS) was used as the primary outcome measure, and the Visual Analog Scale (VAS), Short Form health survey (SF-36), and complications used as secondary outcomes. The CS + HA group had better primary outcomes than the CS group. Remarkable secondary outcomes improvements were obtained in both groups. No complications were reported. We conclude that the corticosteroid and HA combination injection is more effective in relieving pain for ankle OA than corticosteroid alone.
Unraveling the adverse Impacts of Nano-scale Carbon Exposure on Nitrogen Metabolism during Early Seedling Establishment in Zea mays L. Roots
Authors: zhang di , Sun Qi , Zhang Ruixue , Lu Lei , Wang Junwei , Fang Xiaojie
Published: September 2023

Background and aims
Elucidating the relationship between extraneous nano-scale carbon properties and the metabolomic response of early Zea mays L. seedling establishment roots is crucial to reveal nano-carbon regulation and nutrient transport mechanisms.
Methods
Herein, humic acid and graphite nanoplatelets represented typical organic and inorganic morphologies of nano-scale carbon. We used equimolar exogenous carbon inputs (0.4, 2, 4 mol C kg−1) to investigate the regulation of nitrogen metabolism using LC-MS, phenotype and physiology of root, nitrogen metabolism-related enzyme activities and endogenous hormones.
Results
Our findings demonstrate that humic acid and graphite nanoplatelets promote root thickening and branching. The most prominent effects on root vitality, injury intensity, and total active absorption area were observed with 2 mol C kg−1 graphite nanoplatelets and 4 mol C kg−1 humic acid. The trend of nitrogen metabolism activity remained consistent, involving the assimilation of NR and NiR and the primary synergistic regulation of GO and GOGAT. Notably, 2 mol C kg−1 graphite nanoplatelets induced the dynamic and selective up-regulation of pyruvic acid and down-regulation of tyramine and methyl phosphate, resulting in changes in energy metabolism and a small subset of amino acid metabolism. 4 mol C kg−1 humic acid resulted in the down-regulation of the amino acids (L-asparagine, pyruvic acid, L-aspartic acid, L-glutamine, fumaric acid), which are involved in nitrogen metabolism-related processes.
Conclusion
Overall, these findings highlight additional graphite nanoplatelets regulated nitrogen assimilation and protein synthesis pathways to improve nitrogen availability. Nano-carbon showed a potential role in reprogramming the agricultural traits.
Brief psychotic disorder caused by areca nut use: a case report
Authors: Li Sixun , Li Zhe , Li Zhixiong , Chen Juan , Wang Feng , Ou Ying , Huang Yi
Published: September 2023

Background: Areca Nut (AN) is the fourth most commonly abused drug after nicotine, ethanol, and caffeine, due to its psychoactive properties provided by bioactive substances. Although previous studies have demonstrated AN’s anxiolytic-like activity and potential benefits in ameliorating symptoms of depression and schizophrenia, there remains limited awareness regarding its association with brief psychotic disorder.
Case Presentation: This case report presents the clinical profile of a 30-year-old male patient with a history of betel nut chewing for the past 2 years, who exhibited sudden onset delusions, hallucinations, and disorganized speech and behavior upon increasing the dosage of betel nut consumption. The patient displayed a positive response to antipsychotic treatment, and symptoms resolved upon discontinuation of betel nut consumption. However, one month after discharge, the patient experienced a recurrence of auditory hallucinations upon resuming betel nut chewing. Through counseling and support, the importance of abstaining from betel nut use and maintaining medication compliance was emphasized, resulting in no recurrence of psychotic symptoms during the six-month follow-up.
Conclusion: This case report highlights the potential role of betel nut in triggering brief psychotic disorder, especially when the chewing dosage is abruptly increased. It underscores the importance of considering betel nut as a potential precipitant of acute psychiatric disorders in clinical settings.
Gender-based association between high-density lipoprotein cholesterol and adverse outcomes after coronary artery bypass grafting
Authors: Namin Sara Monrazeri , Moradi Ali , Tavolinejad Hamed , Farahani Ali Vasheghani , Jalali Arash , Pashang Mina , Sadeghian Saeed , Bagheri Jamshid , Mansourian Soheil , Mehrani Mehdi , Hosseini Kaveh , Rashedi Sina , Tajdini Masih
Published: September 2023

Background
High-density lipoprotein cholesterol (HDL-C) is shown to be an independent protective factor against coronary artery diseases (CAD). Yet there are limited studies focusing on the association between HDL-C and coronary artery bypass graft (CABG) surgery outcomes.
Hypothesis
Low levels of HDL-C are associated with higher incidence of adverse outcomes in patients undergoing CABG.
Methods
This registry-based study included 17,772 patients who underwent elective isolated CABG between 2007 and 2017. Participants were assigned into low and optimal HDL-C groups based on serum HDL-C levels at admission and were followed for one year after surgery. Cox proportional hazard models were performed to evaluate the association between HDL-C levels and incidence of mortality as well as major adverse cardiovascular and cerebrovascular events (MACCE), while adjusting for potential confounders. Moreover, participants were stratified based on gender and the association was also investigated in each subgroup separately.
Results
No significant difference was found between the groups regarding incidence of both mortality and MACCE, after adjusting with IPW [HR (95%CI): 1.109 (0.815–1.509) and HR (95% CI): 1.192 (0.995–1.428), respectively]. According to the gender-based subgroup analysis, low HDL-C group exhibited higher MACCE incidence solely in the male subgroup, after adjusting with IPW.
Conclusion
The association between perioperative HDL-C level and incidence of MACCE during 1-year post-CABG surgery in the male subgroup suggests HDL-C level as a possible prognostic factor in this population. Further studies are warranted to clarify the role of HDL-C level in predicting the prognosis of patients undergoing CABG.
Treatment of Sanders type II and III calcaneal fractures involving posterior superior calcaneal body with lateral straight “three-window” incision combined with a microvariable-angle locking plate
Authors: xu jinglei , Chang Ning , bai xue , xu chenyang , Ma Xianzhong
Published: September 2023

Background: We compared the therapeutic outcomes of patients operated on via the three-window lateral straight approach (TWLSA) and sinus tarsi approach (STA) with a microvariable-angle locking plate for the treatment of Sanders type II and III calcaneal fractures involving the posterior superior calcaneal body.
Methods: We reviewed 100 patients with Sanders II or III calcaneal fractures involving the posterior superior calcaneal body from February 2018 to February 2021. Sixty patients were treated with the TWLSA, and 40 were treated with the STA. The Böhler angle, Gissane angle, height, width, and length were evaluated preoperatively, immediately after surgery and at the last follow-up. The operation time and fluoroscopy times were recorded. The American Orthopedic Foot and Ankle Society (AOFAS) scorewas used to evaluate foot function and record complications.
Results: Pre- and postoperative radiologic parameters were significantly different in both groups (both P＜0.05). Neither the postoperative nor the last follow-up radiologic parameters differed significantly between the 2 groups (both P > 0.05). The operation time and fluoroscopy times in the TWLSA group were significantly lower than those in the STA group (both P<0.05). At the last follow-up, the AOFAS scores averaged 92 (83-99) inthe TWLSA group and 91 (81-99) in the STA group, but this difference was not statistically significant. Sural nerve injury occurred in 6 cases of TWLSA and 4 cases of STA, and this difference was not statistically significant. Incision infections did not occur in either group.
Conclusions: Compared with the STA, the TWLSA afforded comparable radiological results, clinical outcomes and complications for the treatment of Sanders II and III calcaneal fractures involving the posterior superior calcaneal body but reduced operation time and fluoroscopic times.
Landscape epidemiology to understand the distribution of Amblyomma spp. (Acari: Ixodidae) in the state of Pará, Eastern Amazon, Brazil
Authors: Araújo Izabela Mesquita , Martins Thiago Fernandes , Nascimento Kelly Karoline Gomes do , Barbieri Amália Regina Mar , Guimarães Ricardo José de Paula Souza e , de Oliveira Ana Cristina Mendes , Labruna Marcelo Bahia , Abel Ísis
Published: September 2023

This study investigated the diversity and abundance of questing ticks in three forest fragments in the state of Pará, Brazil. A model to predict species distribution for all territory of the state was developed. Ticks were collected using the flannel drag technique, flannel leggings and a CO2 attractive trap. Species richness and relative abundance were calculated and a non-metric multidimensional scaling was used to assess the similarity across ticks species collected in areas. The potential distribution of tick species was predicted using the MaxEnt software. In total, 2921 ticks were captured, distributed in eight species: Amblyomma varium, Amblyomma humerale, Amblyomma naponense, Amblyomma cajennense sensu stricto, Amblyomma oblongoguttatum, Amblyomma ovale, Amblyomma calcaratum and Amblyomma pacae. Non-metric multidimensional scaling indicated that humans and domestic animals living around fragments do not need to enter the wild environment to be exposed to these ticks. Five species, A. cajennense s.s., A. calcaratum, A. humerale, A. naponense and A. varium, were used to predict spatial distribution in the state of Pará. These species seem to be distributed in Pará regions that presents types of climate classified as Af or Am: northeast, metropolitan area of Belém, Marajó, and the upper southeastern state. This study also showed that most ticks have a predilection for lower areas. This study presents the first ecological data required to understand the spatial distribution of ticks of the Amblyomma genus in the state of Pará. However, further studies are necessary to investigate especially southwest Pará state and lower amazon.
Exposing Shared Connections: Genetic Correlations between Esophageal Cancer and Lung Cancer
Authors: Zhang Dengfeng , Zhao Fangchao , Guo Pengfei , Li Shujun
Published: September 2023

Background
Lung carcinoma and esophageal carcinoma stand as prevailing malignancies, exhibiting an ascending trajectory in global incidence and mortality rates. Notwithstanding the discernment of particular environmental and behavioral determinants entwined with the evolution of these neoplasms, the enigma of genetic contributions to their progression persists. The present inquiry aspires to scrutinize the intricate genetic affinities underscoring lung carcinoma and esophageal carcinoma, thereby delving into the intertwining comorbidity of these maladies.
Methods
Employing the linkage disequilibrium score regression (LDSC) framework, we dissected the genetic congruity uniting esophageal carcinoma and lung carcinoma. Subsequently, we harnessed a medley of methodologies, encompassing pleiotropic analysis under the composite null hypothesis (PLACO), multi-marker analysis of genomic annotation (MAGMA), cis-expression quantitative trait loci (eQTL) analysis, and a panoramic cancer appraisal, to unearth pleiotropic loci and genes. Culminating in a bidirectional Mendelian randomization (MR) paradigm, we gauged the causal interplay between these malignancies.
Results
Inceptive findings divulged a conspicuous genetic correlation between esophageal carcinoma and lung carcinoma via the LDSC methodology. Subsequent endeavors unearthed shared gene loci – namely PGBD1, ZNF323, and WNK1 – through the PLACO scrutiny. Within the realm of MAGMA, pathways of significance were enriched, unmasking nine pleiotropic genes, including HIST1H1B, HIST1H4L, and HIST1H2BL. Leveraging eQTL insights from esophageal and lung tissues, alongside whole blood, unveiled 26 gene connections, enlisting TERT, NKAPL, RAD52, BTN3A2, GABBR1, CLPTM1L, and TRIM27. Further, a pan-cancer exploration of the consolidated genes was undertaken. Ultimately, wielding MR analysis, our appraisal of the causal nexus between esophageal carcinoma and lung carcinoma underscored the absence of a bidirectional causal affiliation.
Conclusions
This inquiry furnishes profound insights into the intricate genetic nexus uniting lung carcinoma and esophageal carcinoma. Through the prism of LDSC for genetic correlation, an intricate analysis delineating loci and genes, and a bidirectional MR schema for causal evaluation, we unveil shared genetic propensities and regulatory substrates. These revelations proffer nascent prompts and targets, beckoning a deeper foray into the genetic underpinnings of lung carcinoma and esophageal carcinoma, thus catalyzing the evolution of prophylactic and remedial strategies.
Facilitators and Barriers to Home Blood Pressure Monitoring Among Pregnant Women in Ghana: A Mixed-Methods Analysis of Patient Perspectives
Authors: Newman Noah , Beyuo Titus K. , Nartey Betty A. , Segbedzi-Rich Elorm , Pangori Andrea , Moyer Cheryl A. , Lori Jody R. , Oppong Samuel A. , Lawrence Emma R.
Published: September 2023

Background
The benefit of home blood pressure monitoring during pregnancy and in low-resource settings is incompletely understood. The objective of this study was to explore the experiences, barriers, and facilitators of home blood pressure monitoring among pregnant women in Ghana.
Methods
This concurrent triangulation mixed-methods study was conducted at an urban tertiary hospital in Ghana. Participants were recruited from adult pregnant women presenting for routine antenatal care. Upon enrollment, participants’ demographics and history were collected. At the next study visit, participants received audiovisual and hands-on training on using an automatic blood pressure monitor; they then monitored and logged their blood pressure daily at home for 2–4 weeks. At the final study visit, verbally administered surveys and semi-structured interviews assessed participant’s experiences. Quantitative data were analyzed using R version 4.2.2, and frequencies and descriptive statistics were calculated. Qualitative data were imported into DeDoose 9.0.78 for thematic analysis.
Results
Of 235 enrolled participants, 194 completed surveys; of those, 33 completed in-depth interviews. Participants’ mean age was 31.6 (SD 5.3) years, 32.1% had not previously given birth, and 31.1% had less than a senior high school education. On a 4-point Likert scale, the majority reported they “definitely” were able to remember (n = 134, 69.1%), could find the time (n = 124, 63.9%), had the energy (n = 157, 80.9%), could use the blood pressure monitor without problems (n = 155, 79.9%), and had family approval (n = 182, 96.3%) while engaging in home blood pressure monitoring. 95.88% (n = 186) believed that pregnant women in Ghana should monitor their blood pressure at home. Qualitative thematic analysis demonstrated that most participants liked home blood pressure monitoring because of increased knowledge of their health during pregnancy. While most participants found measuring their blood pressure at home doable, many faced challenges. Participants’ experiences with five key factors influenced how easy or difficult their experience was: 1) Time, stress, and daily responsibilities; 2) Perceived importance of BP in pregnancy; 3) Role of family; 4) Capability of performing monitoring; 5) Convenience of monitoring.
Conclusions
Among pregnant women in urban Ghana, home blood pressure monitoring was perceived as positive, important, and doable; however, challenges must be addressed.
Patient and provider perceptions of the relationship between alcohol use and TB and readiness for treatment: a qualitative study in South Africa
Authors: Kulkarni Suchitra , Weber Sarah E. , Buys Chane , Lambrechts Tersius , Myers Bronwyn , Drainoni Mari-Lynn , Jacobson Karen R. , Theron Danie , Carney Tara
Published: September 2023

Background: Unhealthy alcohol use is widespread in South Africa and has been linked to tuberculosis (TB) disease and poor treatment outcomes. This study used qualitative methods to explore the relationship between TB and alcohol use during TB treatment.
Methods: Focus groups (FGs) were conducted with 34 participants who had previous or current drug-susceptible TB and self-reported current alcohol use. Eight interviews were conducted with healthcare workers who provide TB services in Worcester, South Africa.
Results: In this rural setting, heavy episodic drinking is normalized and perceived to be related to TB transmission and decreased adherence to TB medication. Both healthcare workers and FG participants recommended the introduction of universal screening, brief interventions, and referral to specialized care for unhealthy alcohol use. However, participants also discussed barriers to the provision of these services, such as limited awareness of the link between alcohol and TB. Healthcare workers also specified resource constraints while FG participants or patients mentioned widespread stigma towards people with alcohol concerns. Both FG participants and health providers would benefit from education on the relationship between TB and unhealthy alcohol use as well and had specific recommendations about interventions for alcohol use reduction. Healthcare workers also suggested that community health worker-delivered interventions could support access to and engagement in both TB and alcohol-related services.
Conclusion: Findings support strengthening accessible, specialized services for the identification and provision of interventions and psychosocial services for unhealthy alcohol use among those with TB.
The influence of institutional quality on the environmental degradation in sub-Saharan Africa: Evidence from panel threshold model
Authors: Amoaning Felix , Obeng Camara Kwasi , Cantah William Godfred , Vondolia Godwin Kofi
Published: September 2023

Human progress, poverty reduction, and environmental sustainability are core indicators target to be achieved by 2030. Substantial interaction resulting from anthropogenic activities with the intent of fostering prosperity is surging climate change. However, in order not to be entangled with the ubiquitous impending risk associated with human interactions and ecological risks, this study employed the Hansen (1999) threshold regression model to examine the existing differences between human progress and environmental quality owning to different levels of institutional quality by employing data from 2004 to 2019 in 32 sub-Saharan Africa countries. Using carbon dioxide as a measure of environmental degradation and poverty and human development as core explanatory variables, the empirical results confirmed evidence of pollution haven. Further, rule of law, effective governance and quality regulations prove to be an inhibitor of CO2 emissions even under the influence of activities to enhance human progress. The study suggests that efforts to elevate human progress need to be accompanied by strong governance, regulations and laws.
A PSMA PET/CT based risk model for prediction of concordance between targeted biopsy and combined biopsy in detecting prostate cancer
Authors: An Chaoli , Qiu Xuefeng , Liu Beibei , Song Xiang , Yang Yu , Shu Jiaxin , Fu Yao , Wang Feng , Zhao Xiaozhi , Guo Hongqian
Published: September 2023

Backgroud
mpMRI-TB improves the clinically significant prostate cancer (csPCa) detection rate. However, there has been none consensus regarding the avoidance of systematic biopsy (SB) with more biopsy cores in patients undergoing mpMRI-TB. Thus, this study is to investigate the diagnostic value of 68Ga-PSMA-11 in predicting the concordance between mpMRI-TB and combined biopsy (CB) in detecting PCa.
Methods
115 consecutive men with 68Ga-PSMA-11 PET/CT prior to prostate biopsy were included for analysis. PSMA intensity, quantified as maximum standard uptake value (SUVmax), minimum apparent diffusion coefficient (ADCmin) and other clinical characteristics were evaluated relative to biopsy concordance by using univariate and multivariate logistic regression analyses. A prediction model was developed based on the identified parameters.
Results
concordance between mpMRI-TB and CB occurred in 76.5% (88/115) of the patients. Multivariate logistic regression analyses performed that SUVmax (OR = 0.952; 95% CI: 0.917–0.988; p = 0.010) and ADCmin (OR = 1.006; 95% CI: 1.003–1.010; p = 0.001) were independent risk factors for biopsy concordance. The developed model showed a sensitivity, specificity, accuracy and AUC of 0.67, 0.78, 0.81 and 0.78 in the full sample.
Conclusions
The developed prediction model based on SUVmax and ADCmin showed practical value in guiding the optimization of prostate biopsy pattern. Lower SUVmax and Higher ADCmin values are associated with greater confidence in implementing mono-TB and safely avoiding SB, effectively balancing benefits and risks.
Association Between Maternal Hypertension and Infant Neurodevelopment in Extremely Preterm Infants
Authors: Dayan Natalie , Abdelmageed Wael , Lapointe Anie , Brown Richard , Gorgos Andreea , Luu Thuy Mai , Beltempo Marc , Altit Gabriel
Published: September 2023

Objective: To examine the association between maternal hypertension during pregnancy and neurodevelopmental impairment (NDI) at 24 months post-menstrual age in extremely preterm infants.
Study Design: Using data from two tertiary neonatal units (2011-2017) for infants born at 23+0 to 28+6 weeks, we investigated outcomes of NDI related to maternal hypertension and small-for-gestational-age (SGA) status.
Results: Of 1019 pre-term infants, 647 had complete data and were included in the analysis. Ninety-six (15%) had maternal hypertension exposure; 25 (4%) were also SGA. Infants with maternal hypertension showed a higher odds of any NDI (aOR: 2.29, 95% CI=1.36-3.87) and significant NDI (aOR: 2.01, 95% CI=1.02-3.95). The combination of hypertension and SGA further elevated this risk (aOR for any NDI: 4.88, 95% CI=1.80-13.22; significant NDI: 6.91, 95% CI=2.50-19.12).
Conclusion: Maternal hypertension during pregnancy elevates the risk of NDI in extremely preterm infants, more so when combined with SGA.
Predictive value of number of metastatic lymph nodes and lymph node ratio for prognosis of patients with FIGO 2018 stage IIICp cervical cancer: A multi-center retrospective study
Authors: Ye Yanna , Li Zhiqiang , Chen Xiaolin , Huang Yahong , Yao Jilong , Lu Anwei , Lang Jinghe , Liu Ping , Chen Chunlin , Lian Rui
Published: September 2023

Background
To identify the cut-off values for the number of metastatic lymph nodes (nMLN) and lymph node ratio (LNR) that can predict outcomes in patients with FIGO 2018 IIICp cervical cancer (CC).
Methods
Patients with CC who underwent radical hysterectomy with pelvic lymphadenectomy were identified for a propensity score-matched (PSM) cohort study. A receiver operating characteristic (ROC) curve analysis was performed to determine the critical nMLN and LNR values. Five-year overall survival (OS) and disease-free survival (DFS) rates were compared using Kaplan–Meier and Cox proportional hazard regression analyses.
Results
This study included 3,135 CC patients with stage FIGO 2018 IIICp from 47 Chinese hospitals between 2004 and 2018. Based on ROC curve analysis, the cut-off values for nMLN and LNR were 3.5 and 0.11, respectively. The final cohort consisted of nMLN ≤ 3 (n = 2,378) and nMLN > 3 (n = 757) groups and LNR ≤ 0.11 (n = 1,748) and LNR > 0.11 (n = 1,387) groups. Significant differences were found in survival between the nMLN ≤ 3 vs the nMLN > 3 (post-PSM, OS: 76.8% vs 67.9%, P = 0.003; hazard ratio [HR]: 1.411, 95% confidence interval [CI]: 1.108–1.798, P = 0.005; DFS: 65.5% vs 55.3%, P < 0.001; HR: 1.428, 95% CI: 1.175–1.735, P < 0.001), and the LNR ≤ 0.11 and LNR > 0.11 (post-PSM, OS: 82.5% vs 76.9%, P = 0.010; HR: 1.407, 95% CI: 1.103–1.794, P = 0.006; DFS: 72.8% vs 65.1%, P = 0.002; HR: 1.347, 95% CI: 1.110–1.633, P = 0.002) groups.
Conclusions
This study found that nMLN > 3 and LNR > 0.11 were associated with poor prognosis in CC patients.
Systematic review and meta-analysis of single-stage vs two-stage revision for periprosthetic joint infection: A call for a prospective randomized trial
Authors: Zhao Yong , Fan Shaohua , Wang Zhangfu , Yan Xueli , Luo Hua
Published: September 2023

Background
Periprosthetic joint infection (PJI) is a severe complication of joint arthroplasty that causes significant pain and economic loss. This study aimed to determine whether the current evidence supports single-stage revision for PJI based on reinfection and reoperation rates.
Methods
We searched the PubMed, EBSCO, Medline, and Cochrane Library databases from inception to 30 May 2023 to identify studies that compared sing-stage revision and two-stage revision for PJI. Data on reinfection and reoperation rates were pooled.
Results
This meta-analysis included a total of 40 studies with 8641 patients. Overall, there was no significant difference between single- and two-stage revision regarding the postoperative reinfection rate and reoperation rate. Subgroup analysis of different surgical sites revealed that the reinfection rate was significantly lower after single-stage revision than after two-stage revision for knee PJI, but no difference with hip or shoulder. For patients with PJI of the knee or hip or shoulder, there was no difference between the single- and two-stage revision groups in the reoperation rates. Subgroup analysis by surgery period revealed no difference between the two groups in the reinfection and reoperation rates.
Conclusions
There was no difference in the reinfection and reoperation rates after single- versus two-stage revision for PJI. Based on the available evidence, we recommend single-stage revision for PJI in patients without relative contraindications.
Influence of gender on physical activity types and behaviour during and pre-COVID-19 pandemic among school-age children living in Saudi Arabia
Authors: Alghadier Mshari , Basuodan Reem M. , Gmmash Afnan S , Albesher Reem Abdulrahman
Published: September 2023

Introduction
The detrimental effects of COVID-19 pandemic may have a long-lasting effect on the children’s physical health. Previous studies showed that the children’s participation in physical activity (PA) have declined during the pandemic. This study examined the effect of COVID-19 pandemic on PA types and influence of gender on PA participation.
Methods
Parent of Saudi children (ages 6-9 years) were recruited through convenience sampling and completed an online survey between 24 July – 5 August 2020. The parent-reported survey included demographics, PA types and behaviour across three time periods (pre COVID-19, during COVID-19 lockdown, and after lockdown where social distancing applied, but no lockdown). Additionally, parent rated the types of PA participation such as swimming, walking, football, virtual gaming, and playground activity, etc. during the different periods of time.
Results
Parent reported that children (n=361), mean age 7.7 ± 1.1 years, participated in PA pre COVID-19 pandemic more often than during COVID-19 lockdown in different PA types such as; swimming (50% vs 38%), jumping (29% vs 19%) bicycle (38% vs 28%), football (42% vs 18%) and running (27% vs 16%). Additionally, PA type participation was shown to be influenced by gender according to the multiple regression models conducted to different PA types.
Conclusion
The result of this study shows that children’s participation in PA has declined following the pandemic. In addition, the children’s gender affects their level of participation as males participated in PA more than females. These findings suggest that more efforts should be directed toward investigating the reasons for these differences and encouraging equal participation.
Escalating Carbon Leakage via International Trade from 1990 to 2019 — Based on a New Method Measuring Consumption-based Carbon Emissions of 161 Countries
Authors: Ji Haoyang , Tang Huaqing , Tao Xueran , Si Yaqing , Shi Junyi
Published: September 2023

Sustainable development remains a pivotal global priority, however, escalating carbon emissions present considerable challenges. One such challenge, carbon leakage –the transference of emissions via international trade –has been largely overlooked by current policies. This oversight may contribute to the difficulty in achieving carbon emission reduction. Using macroeconomic and trade data, this study proposes a new method named Emission Coefficient Multi-equation Method (ECMM) to quantify carbon leakage and consumption-based carbon emissions (CBCE) across 161 countries from 1990 to 2019. The results reveal that: a) The United States stands as the world's largest carbon consumer and importer, whereas China tops the list as the principal carbon producer and exporter. b) Since the Kyoto Protocol's implementation, developed countries with emission reduction commitments have successfully regulated their territorial carbon emissions. Yet, global carbon emissions continue to ascend. c) The decoupling of carbon emissions between consumption and production sites is intensifying, and substantial carbon transfers via international trade are evident.
In light of these findings, we propose the compilation of a carbon emissions inventory pertaining to international trade. Furthermore, future international emissions reduction policies should emphasize regulating carbon consumption in addition to carbon production.
Major depression disorder may have no causality on the atrial fibrillation risk: Evidence from the Mendelian randomization study
Authors: Li Feng , Wu Yan-Ni , Geng Chi , Zhang You , Peng Si-Liang , Zhang Yao-Ting , Li Hui
Published: September 2023

Background:
Accumulated studies have indicated that depression was significantly associated with the atrial fibrillation (AF) risk. However, the causal effect of major depressive disorder (MDD) on the risk of AF was elusive.
Methods:
We performed a two-sample Mendelian randomization (MR) analysis using two genetic instrument tools for MDD to assess the potential causal effect of MDD on the AF risk, including a training dataset (37 single-nucleotide polymorphisms (SNPs) significantly associated with MDD) and a validation dataset (11 SNPs robustly associated with MDD). Inverse-variance weighted method (IVW), weighted median method, MR-Egger, MR-Pleiotropy REsidual Sum and Outlier (MR-PRESSO) test, pleiotropy test, and leave-one-out sensitivity analysis were performed for MR analyses.
Results:
We first performed MR analysis for a training data using multiple data processing steps, including removing SNPs related with AF risk factors, removing one outlier with MR-PRESSO, and tighten instrument P value threshold. The final MR estimates suggested that MDD had no causality on AF incidence (IVW method, OR = 1.04, 95%CI = 0.79–1.36, P value = 0.785; weighted median, OR = 1.15, 95%CI = 0.90–1.46, P value = 0.268; MR-Egger, OR = 1.00, 95%CI = 0.35–2.85, P value = 0.999). Moreover, a consistent result was displayed in MR estimates using a validation data. Pleiotropy test and leave-one-out sensitivity analysis revealed that our results were robust.
Conclusions:
Our MR analysis suggested that MDD may have no causality on the AF risk.
Psychometric assessment of the US person-centered prenatal and maternity care scales in a low-income predominantly Latinx population in California
Authors: Afulani Patience A. , Coleman-Phox Kimberly , Leon-Martinez Daisy , Fung Kathy Z. , Martinez Erica , Garza Mary A. , McCulloch Charles E , Kuppermann Miriam
Published: September 2023

Objectives
To assess psychometric properties of two scales developed to measure the quality of person-centered care during pregnancy and childbirth in the United States—the Person-Centered Prenatal Care (PCPC-US) and Person-Centered Maternity Care (PCMC-US) scales—in a low-income predominantly Latinx population in California.
Methods
Data were collected from October 2020 to January 2023 from surveys of low-income pregnant and birthing people in Fresno, California, participating in the “Engaging Mothers and Babies; Reimagining Antenatal Core for Everyone (EMBRACE) trial. Research staff administered the 26-item PCPC-US scale at 30–34 weeks’ gestation (n = 315) and the 35-item PCMC-US scale at 10–14 weeks after birth (n = 286), using the language preferred by the participant (English or Spanish). We assessed construct, criterion, and known group validity and internal consistency of the scales.
Results
78% of respondents identified as Latinx. Factor analysis identified one dominant factor for each scale that accounted for over 60% of the cumulative variance, with most items loading at > 0.3. The items also loaded adequately on sub-scales for “dignity and respect,” “communication and autonomy,” and “responsive and supportive care.” Cronbach’s alpha for the full scales were > 0.9 and between 0.70 and 0.87 for the sub-scales. Summative scores range from 0 to 100, with higher scores indicating higher PCMC. Correlations with scores on scales measuring prenatal care quality and birth experience provided evidence for criterion validity, while associations with known predictors provided evidence for known-group validity.
Conclusions
The PCPC-US and PCMC-US scales, which were developed using a community-engaged process and found to have good psychometric properties in a largely high-income sample of Black women, were shown to also have good psychometric properties in a sample of low-income primarily Latinx women. Both scales provide valid and reliable tools to measure person-centered care experiences among minoritized communities to support efforts to reduce existing birth inequities.