bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving relationship-centered care through evaluation meetings with the resident-family-caregiver triad in nursing homes: a qualitative study
Authors: Rutten Johanna E. R. , Backhaus Ramona , Verbeek Hilde , de Vries Erica , Hamers Jan P. H. , Sion Katya Y. J.
Published: February 2025

Background

Providing and improving relationship-centered care has gained increased importance in long-term care. However, quality improvement strategies are predominantly based on quantitative quality measures for care professionals. Therefore, the aim of this study was to explore how narrative data collected with Connecting Conversations is used in evaluation meetings to improve RCC.

Methods

A qualitative approach using structured observations was used. The participants were care professionals, residents and family members from two nursing home wards. The participating wards organized evaluation meetings to discuss the experienced quality of care based on narrative data collected with Connecting Conversations. To analyze the process of improving RCC, the organization of these meetings and the content were observed by independent researchers, and detailed notes were taken. The data were analyzed thematically by using conventional content analysis.

Results

In total, three evaluation meetings were organized. Primarily, care professionals were invited to discuss the results of the interviews. One ward organized a meeting for care professionals, residents and family members, and the other decided not to invite them. The discussion of themes related to experienced quality of care within the evaluation meetings was less profound than during the interviews. In total, 12 overarching themes concerning experienced quality of care were discussed in the Connecting Conversations' interviews. Nine themes were also mentioned in one or more evaluation meetings (i.e., activities for residents, personalized attention and preferences of residents, feeling at home and communication within the care triad).

Conclusion

When using narrative data on quality of care to improve relationship-centered care, the full potential of narrative data is underutilized as discussions focussed on incidental problem solving rather than deeper reflections on the meaning of events in providing relationship-centered care. Establishing trust within the care triad of care professionals, family members, and residents is essential to improve relationship-centered care collaboratively.
Comparative Efficiency Analysis of OECD Health Systems: FDH vs. Machine Learning Approaches with Efficiency Analysis Trees (EAT and RFEAT)
Authors: Joo Yejin
Published: February 2025

Background

As health expenditure continues to rise due to income growth, technological advancements, and an aging population, it has become increasingly important to accurately measure and improve the efficiency of health systems. This is because financial resources are limited, and the allocation of resources can significantly influence the quality of health systems and health outcomes.

Methods

This study applies machine learning techniques—Efficiency Analysis Trees (EAT) and Random Forest for Efficiency Analysis Trees (RFEAT)—to evaluate the efficiency of health systems in 36 OECD countries, comparing the results with those from the traditional free disposal hull (FDH) method.

Results

Analysis shows high discrimination power in the order of RFEAT, EAT, and FDH. The correlation in efficiency rankings shows more than 80% similarity between RFEAT and EAT, while both show less than 80% similarity with FDH. According to RFEAT estimates, the countries with the highest efficiency are South Korea, Switzerland, and Costa Rica, whereas the United States, Lithuania, and Latvia are identified as the least efficient. The group-level analysis reveals that Asian countries, on average, perform more efficiently followed by Oceania, Europe, and the Americas. The groups with higher out-of-pocket healthcare expenditures per capita tend to show slightly better efficiency and the group with the smallest elderly population proportion exhibits the highest average health system efficiency.

Conclusion

Traditional methods like FDH are prone to inefficiency underestimation, especially in small samples with multiple variables. This study demonstrates the potential of machine learning approaches like EAT and RFEAT to provide more reliable efficiency estimates. These methods can help policymakers make better resource allocation decisions by mitigating inefficiency underestimation and offering greater discrimination power.
Reassessing socioeconomic inequalities in mortality via distributional similarities
Authors: Gómez-Ugarte Ana C. , Basellini Ugofilippo , Camarda Carlo G. , Janssen Fanny , Zagheni Emilio
Published: February 2025

Commonly used measures of socioeconomic inequalities in mortality, such as the slope and the relative index of inequality, are based on summary measures of the group-specific age-at-death distributions (e.g. standardized mortality rate or life expectancy). While this approach is informative, it ignores valuable information contained in the group-specific distributions. A recent approach applied a measure of distributional dissimilarity (the non-overlap index) to measure lifespan stratification. In this paper, we rigorously evaluate and further implement the multi-group extension of the non-overlap index (

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) to measure socioeconomic inequalities in mortality across a number of groups, and assess whether differences across countries and over time are driven by mortality or compositional changes in two applications with different data availability: educational groups (Sweden and Denmark) and groups defined by an area-level deprivation measure (England). Our findings suggest that the multi-group

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is sensitive not only to changes in the means or variances, but also to broader mortality changes that affect distributional shapes. The method can be employed to any context where mortality rates by age are available by sub-groups. Furthermore, levels and trends in mortality inequalities computed with the multigroup

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often differ compared to other conventional summary-based measures. Moreover, we find that the contribution of mortality changes to changes in inequalities is generally greater than that of the changes in the population composition. Whereas levels and trends of inequalities may depend on whether life expectancy- or lifespan variation-based measures are employed, the multi-group

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provides a holistic perspective by capturing both dimensions simultaneously.
Toward digitally supported self-assessment of patients with idiopathic inflammatory myopathies
Authors: Seese Felix Kurt , Roscher Pia , Coppers Birte , Greenfield Julia , Grahammer Manuel , Kuhn Sebastian , Gupta Latika , Schett Georg , Knitza Johannes , Liphardt Anna-Maria
Published: February 2025

Background

Manual muscle testing (MMT8), the current gold standard for assessing muscle function in patients with idiopathic inflammatory myopathies (IIM), has notable limitations. This study had three aims (1) to compare MMT8 with inertial sensor-based gait analysis, (2) to evaluate patient-performed functional tests guided by shared decision-making (SDM), and (3) to investigate adherence to electronic patient-reported outcomes (ePROs).

Methods

Gold standard muscle function assessment (MMT8) was performed at baseline (T0) and three months (T1). Additionally, inertial-sensor-based gait analysis was completed at T0 and two standardized upper extremity (Modified Barré test; 10-time arm lift test) and two lower extremity muscle endurance tests (60-second Sit-to-Stand (STS) test; Mingazzini test) were presented to patients to choose from. Through shared decision-making, each patient selected one test for lower and upper extremities and opted to record weekly results on paper or through a medical app. Correlations between gait parameters, functional tests, and MMT8 were analyzed, while agreement between patient- and healthcare professional (HCP)-recorded results at T0 and T1 was assessed. Responsiveness to change was also evaluated.

Results

A total of 28 IIM patients (67.9% female; mean age 57.4 ± 12.9 years) were enrolled. Moderate correlations were observed between gait parameters and MMT8, such as walking speed (r = 0.545, p = 0.004) and stride length (r = 0.580, p = 0.002). All patients selected the Modified Barré test for assessing upper extremity function and 60.7% of patients chose the Mingazzini test for lower extremity function. Agreement between patient- and HCP-recorded functional test results was excellent at baseline and after three months (ICC 0.99–1.00). Functional tests demonstrated strong correlations with MMT8, particularly for the Mingazzini test (r = 0.762, p = 0.002). Patients preferred app-based recording (82.1%) over paper-based methods and weekly ePROs were completed on average 6.9 out of 12 weeks (57.5%).

Conclusion

Patient-performed functional tests are reliable, scalable alternatives to MMT8, with gait analysis providing complementary insights. Digitally supported self-assessments can enhance clinical workflows, remote monitoring, and treat-to-target strategies, empowering patients and improving disease management.
Enhanced exosome secretion regulated by microglial P2X7R in the medullary dorsal horn contributes to pulpitis-induced pain
Authors: Zhang Jing , Yu Zhuo , Wang Mingjun , Kang Xiaoning , Wu Xiaoke , Yang Fengjiao , Yang Lu , Sun Shukai , Wu Li-an
Published: February 2025

Background

Pulpitis is a prevalent oral disease characterized by severe pain. The activation of microglia in the medullary dorsal horn (MDH) is reportedly essential for the central sensitization mechanism associated with pulpitis. The P2X7 receptor (P2X7R) on microglia can trigger the secretion of exosomes enriched with IL-1β, which is involved in inflammation. Thus, we hypothesized that the enhanced exosome secretion regulated by microglial P2X7R in the MDH contributes to pulpitis-induced pain.

Methods

An experimental pulpitis model was established in male SD rats to observe pain behaviors. Immunofluorescence staining, western blotting and quantitative real-time PCR were used to analyze the expression of IL-1β and Rab27a, a key protein secreted by exosomes during nociceptive processes. The effects of the exosome inhibitor GW4869 and the P2X7R antagonist Brilliant Blue G (BBG) on microglial P2X7R, exosome secretion and inflammation in the pulpitis model were analyzed. In vitro, microglial cells were cultured to collect exosomes, and stimulation with lipopolysaccharide (LPS), oxidized ATP (oxATP) and GW4869 altered the secretion of exosomes containing IL-1β.

Results

In the experimental pulpitis model, the microglial exosome secretion and inflammatory factor release in the MDH were both correlated with the extent of pulpitis-induced pain, with the highest expression occurring on the 7th day. GW4869 and BBG inhibited Rab27a and IL-1β expression, reducing pulpitis-induced pain. In addition, exosomes were successfully extracted by ultracentrifugation in vitro, wherein LPS treatment promoted exosome secretion but GW4869 had the opposite effects on the secretion of exosomes and the IL-1β. Moreover, P2X7R inhibition by oxATP diminished exosome secretion, leading to a reduction in inflammatory responses.

Conclusion

This study highlights the regulatory role of microglial P2X7R in increased exosome secretion, indicating the potential utility of P2X7R as a promising target for pulpitis therapy. Our research highlights a new pulpitis mechanism in which exosomes enriched with IL-1β contribute to pulpitis-induced pain, suggesting the crucial roles of exosomes as pain biomarkers and harmful signaling molecules during pulpitis.
Unlocking opportunities to transform patient care: an expert insight on limitations and opportunities in patient monitoring
Authors: Cecconi Maurizio , Hutanu Ana L. , Beard John , Gonzalez-Pizarro Patricio , Ostermann Marlies , Batchelor Anna , Latour Jos M. , Grensemann Jörn , Mondino Michele Giovanni , Caballero Jesus , Blobner Manfred , Radtke Finn M.
Published: February 2025

Background

Current patient monitoring technologies are crucial for delivering personalised and timely care and are critical in achieving the best health outcomes while maintaining high care standards. However, these technologies also present several challenges affecting patients and healthcare professionals.

Information overload

Healthcare providers often deal with excess data, making it challenging to identify the most critical patient information quickly. This may lead to delays in necessary interventions and potentially poorer patient outcomes.

Alarm fatigue

Many patient monitoring systems trigger frequent false alarms. This high incidence can cause healthcare providers to become desensitised, potentially leading to slower response times or overlooked important alerts.

Integration challenges

Current systems often need more seamless integration with other healthcare technologies, making it difficult for healthcare providers to have a cohesive view of the patient’s health. This lack of integration can impair care coordination and increase workloads. This paper presents the findings from a group of experts who described the state of the art of patient monitoring and discussed potential solutions and new pathways for developing these technologies.
Modeling and prediction of embankment dam displacement under earthquake loading using artificial neural networks and swarm optimization algorithm
Authors: Mostafaei Yashar , Soleimani Kutanaei Saman
Published: February 2025

Evaluation of embankment dam displacement (D) under earthquake loading can contribute to the safe design of the dam. Due to the complexities of modeling this problem, soft computing is an appropriate solution for predicting the embankment dam displacement under earthquake loading. In this research, Artificial Neural Networks (ANN) and Swarm Optimization Algorithm (PSOA) were integrated in an attempt to present a relationship for predicting the displacement of embankment dam (D). For this purpose, data from 102 real cases was utilized. Input parameters included the height (H) and natural period of the dam (Td), minimum required yield acceleration to slide a block of the dam body (ay), magnitude (Mw), dominant frequency (Tp), and peak acceleration (amax) of the earthquake. It was figured out that PSOA-ANN outperforms PSOA in estimating earthquake-induced dam displacement. Compared to other soft-computing methods for predicting embankment dam displacement under earthquake loading, the hybrid PSOA-ANN is more powerful and suitable.
Contrast-enhanced photon-counting detector CT for discriminating local recurrence from postoperative changes after resection of pancreatic ductal adenocarcinoma
Authors: Alagic Zlatan , Duran Carlos Valls , Svensson-Marcial Anders , Koskinen Seppo K.
Published: February 2025

Background

We evaluated the diagnostic capability of photon-counting detector computed tomography (PCD-CT) spectral variables in late arterial phase (LAP) and portal venous phase (PVP) to discriminate between local tumor recurrence (LTR) and postoperative changes (POC) after pancreatic ductal adenocarcinoma (PDAC) resection.

Methods

Seventy-three consecutive PCD-CT scans in 73 patients with postoperative soft-tissue lesions (PSLs) were included, 42 with POC and 31 with LTR. Regions of interest were drawn in each PSL, and spectral variables were calculated: iodine concentration (IC), normalized IC (NIC), fat fraction, attenuation at 40, 70, and 90 keV, and slope of the spectral curve between 40–90 keV. Multivariable binary logistic regression models were constructed. Diagnostic performance was assessed for LAP and PVP using receiver operating characteristic analysis.

Results

In LAP, all variables except fat fraction showed significant differences between LTR and POC (p ≤ 0.025). In PVP, all variables except NIC and fat fraction demonstrated significant differences between LTR and POC (p ≤ 0.005). Logistic regression analysis included NIC and 70 keV in the LAP-based model and IC and 90 keV in the PVP-based model. Both models achieved a higher area under the curve (AUC) than individual spectral variables in each phase. The LAP-based model achieved an AUC of 0.919 with 94% sensitivity, 84% specificity, and 87% accuracy, while the PVP-based model reached 0.820, 71%, 88%, and 81%, respectively.

Conclusion

Spectral variables from PCD-CT help distinguish between LTR and POC in LAP and PVP post-PDAC resection. Multivariable logistic regression improves diagnostic performance, especially in LAP.

Relevance statement

Measuring normalized iodine concentration and attenuation at 70 keV in late arterial phase, or iodine concentration and attenuation at 90 keV in portal venous phase, and incorporating these values into a logistic regression model can help differentiate between local tumor recurrence and postoperative changes after pancreatic ductal adenocarcinoma resection.

Key Points

Distinguishing recurrence from postoperative changes on CT after pancreatic ductal adenocarcinoma resection is challenging.

PCD-CT spectral variable values differed significantly between local tumor recurrence (LTR) and postoperative changes (POC).

Logistic regression of spectral variables can help distinguish LTR from POC.

The late arterial phase-based model reached an AUC of 0.919 with 94% sensitivity and 84% specificity.

Graphical Abstract
Evaluation of cannabidiol-based products in Brazil: how can current regulations influence their labeling quality?
Authors: Gallassi Andrea Donatti , de Oliveira André Wagner Carvalho , Mendes Nathália Silva , Filev Renato , Nakano Eduardo Yoshio
Published: February 2025

There is concern about the quality of cannabis-based products used in Brazil, mainly cannabidiol (CBD). This study aimed to evaluate the quality of labeling on CBD products marketed in Brazil authorized by two regulations – N660/2022 on imported products and N327/2019 on products with temporary trade permits – and whether there were differences between them concerning four domains: prescription, good manufacturing practices (GMP), laboratory tests, and safety of use. Determined labeling quality was based on a score of 45 criteria divided per domain and weights from 1 to 3 (according to the relevance for users' and prescribers' safety) built by public information provided by product manufacturers/representatives on websites and e-mail consultations. The quality score was classified as very satisfactory, satisfactory, or not very satisfactory, represented in median and interquartile range. Between the N327 and N660 products, the quality scores were compared using the Mann–Whitney U-test. All tests considered two-tailed hypotheses and a significance level of 5%. After applying the inclusion criteria, from 148 products selected, 105 were evaluated. Most of the evaluated CBD products were classified as satisfactory (47), followed by not very satisfactory (39) and very satisfactory (19). The N327 products presented information that was more accessible than the N660 products. Similarly, there was a significant difference between the two groups concerning the domains of prescription and safety of use; products in the N327 showed better results than those in the N660. This study contributes to the urgent debate on the quality of labeling and the risks of CBD widely marketed in Brazil.
Impact of the COVID-19 pandemic on brain death detection in German hospitals: a state-wide analysis of health data
Authors: Schoene Daniela , Roessler Martin , Eder Katharina , Günther Albrecht , Pleul Konrad , Rahmel Axel , Barlinn Kristian
Published: February 2025

Background

The low rate of organ donation in Germany has been linked to a deficit in the detection of patients with brain death (BD) in hospitals. It is unclear how crisis-related health system disruptions, such as the COVID-19 pandemic, affect this detection deficit.

Methods

Secondary data analysis of anonymized data from deceased patients with acute brain injury from Saxony, Saxony-Anhalt and Thuringia during the pre-pandemic and pandemic period (01/2019–12/2022). Pandemic phases were stratified according to the predominant SARS-CoV-2 variant. Logistic multilevel models were employed to assess outcomes including diagnosis of BD, deceased organ donations, missed cases with potential BD and organ donation-related interactions with the German Organ procurement organization. Models accounted for regional COVID-19 incidence and first-dose vaccination rates, as well as age, gender and types of brain injuries.

Results

A total of 11,100 deceased individuals from 136 hospitals were analyzed. An inverse association was observed between COVID-19 incidence and the determination of BD (adjusted odds ratio [aOR] 0.94, 95%CI [0.91; 0.97]; p < 0.001) as well as deceased organ donation (aOR 0.94, 95%CI [0.90; 0.98]; p = 0.001). When stratified by pandemic phases, this inverse association was evident for both BD determination (aOR 0.92, 95%CI [0.87; 0.99]; p = 0.02) and deceased organ donation (aOR 0.90, 95%CI [0.83; 0.97]; p = 0.01) during the initial wild-type phase. In the alpha phase, the association was observed only for BD determination (aOR 0.76, 95%CI [0.59; 0.98]; p = 0.03). No association was found in subsequent pandemic phases.

Conclusion

The initial impact on BD detection during the pandemic highlights the importance of the health system's adaptive capacity in times of crisis.
Mind the guideline gap: emergent CT in patients with epilepsy for trauma rule-out—A retrospective cohort study
Authors: Szabo Kristina , Obertacke Udo , Sandikci Vesile , Ghanayem Sarah , Alonso Angelika , Rink Johann S. , Marzina Annika , Platten Michael , Hoyer Carolin
Published: February 2025

Background

Patients with epileptic seizures represent a significant proportion of emergency department (ED) admissions and are often referred for cranial imaging due to suspected or observed trauma. Neurological guidelines provide limited advice on indications for imaging in this scenario, and traumatological clinical decision rules on the use of CT in mild traumatic brain injury explicitly exclude patients with seizures preceding the trauma. This gap in recommendations may contribute to overimaging for trauma rule-out after a seizure.

Methods

We analysed medical records of patients with known epilepsy admitted to our ED after a seizure between January 2022 and March 2024. Using clinical data including the findings from cranial CT and risk factors for traumatic brain injury, we re-assessed the need for CT imaging by application of the Canadian CT head rule (CCHR) or in the context of head trauma under anticoagulation.

Results

During the observational period, 683 patients with known epilepsy were referred to our hospital due to a seizure (mean age 48.8 years, 57.7% male). A head CT scan was obtained in 337 (49.3%) of all encounters. In only two patients, CT diagnosed an acute seizure-related traumatic lesion, one focal subarachnoid haemorrhage and one skull base fracture. Twenty-six cases (3.8%) with seizure-related trauma were reassessed as requiring a CT for trauma-related injury evaluation. Particularly in the absence of head impact or risk factors, a high degree of variability regarding CT ordering practice was observed.

Conclusions

Our results demonstrate frequent use and low diagnostic yield of CT in ED seizure patients with respect to trauma-related head injury. Circumstantial factors, clinical signs or symptoms and medical risk factors variedly impact on clinicians’ decision to perform imaging. The absence of clear recommendations regarding imaging for trauma apparently provokes frequent diagnostic rule-out even in patients with low risk for traumatic brain injury. We suggest an approach to identify patients not requiring a head CT by considering the CCHR, presence of anticoagulation and appreciating the postictal state as a feature specific to patients with seizures.
Adoptive transfer of natural killer cells in therapeutic treatment of COVID-19 patients
Authors: Alamri Abdulaziz
Published: February 2025

Background

Natural killer (NK) cells are crucial constituents of innate immunity, playing a vital role in the early defense against viral infections and cancer. Their antiviral capabilities stem from direct cytotoxic activity against infected cells and immunoregulatory functions that modulate adaptive immune responses. In the context of Coronavirus disease (COVID-19), NK cells contribute to controlling viral replication and limiting excessive inflammatory responses.

Aims

This review highlights the mechanisms underlying NK cell-mediated antiviral activity, focusing on their interactions with severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2). We discuss potential sources of NK cells for adoptive transfer therapy, critical factors influencing their therapeutic efficacy, and considerations for clinical translation in COVID-19 treatment.

Methods

Various NK cell sources for adoptive therapy are discussed, including peripheral blood, cord blood, and genetically engineered NK cells. Key factors influencing the therapeutic efficacy and safety of NK cell-based therapies are analyzed, including cytokine modulation, NK cell subset selection, and delivery methods.

Conclusion

Understanding the mechanisms underlying NK cell-mediated antiviral activity and the factors that influence the success of adoptive NK cell therapy can inform the design of more effective immunotherapies for COVID-19 patients. Strategies for improving NK cell function, such as genetic modification and optimizing therapy protocols, are highlighted to enhance therapeutic outcomes.

Graphical Abstract

NK cells neutralize SARS-CoV-2 by releasing cytotoxic granules, inhibiting replication, and modulating inflammation. They originate from peripheral blood, cord blood, and genetic engineering. Therapeutic strategies include adoptive transfer, cytokine modulation, and optimized delivery. Inflammation is controlled, reducing excessive immune responses.
Fire-resistance design and experimental research for the stay cables of super-long span cable-stayed bridge
Authors: Shen Kongjian , Jiang Zhenxiong , Zhao Jun , Zhou Zhubing , Wu Qiong , Qiang Qiang , Wang Hongchao
Published: February 2025

The cables are crucial to the service life of cable supported bridges. Fire accidents involving bridge cables may cause severe damage, impacting the structural integrity and performance of bridges, and therefore requires thorough attention and research. This research mainly focuses on the key technologies for the fire resistance of stay cables, including the structural system design of fire-resistant stay cables, selection of fireproof materials, and experimental verification of fire-resistant performance and qualification of the proposed system. The results show that the multiple wrapped composite structures with fire resistance are suitable for the fire-resistant design of stay cables in the Changtai Yangtze River Bridge. The fire-resistant structure of the stay cables is designed as one layer of flame barrier layer using 316L matte stainless steel, one layer of fire retardant layer using modified ceramic fiber cloth and two layers of insulation layer using aluminum foil glass fiber cloth. Moreover, the fire-resistant performance of the structural system is experimentally validated to meet the design requirements that the fire-resistant time of the stay cables should not be less than 60 min, and the temperature of the internal steel wire should not exceed 300 °C. Meanwhile, tensile testing under high temperature demonstrates that the designed stay cable can resist the applied load for 60 min under a high temperature of 300 °C at the surface of cable without slip or failure of anchorage components. The development of fireproof stay cable products, as applied in the Changtai Yangtze River Bridge project, provides a valuable reference for fire resistance design of bridge cables and contributes significant economic and social benefits.
Study on the mineral processing technology of copper-nickel sulfide ore
Authors: Gao Xichao
Published: February 2025

This paper briefly introduces the research status of mineral processing and mineral processing agents and summarizes the mineral processing technical difficulties of copper-nickel sulfide ore into five points: the difficulties in dissociation of copper-nickel mineral monomer, magnesium-containing silicate minerals have a great influence on flotation, the separation process of copper and nickel easily leads to the mixing of nickel and copper, effects of certain ions on flotation, and the recovery of associated precious metal elements. The key technical problems for beneficiation of copper-nickel sulfide ore are discussed and pointed out that the embedding particle size, embedding relationship, and gangue mineral type determine the formulation of the mineral processing process. Based on process mineralogy research, developing a scientific and reasonable comprehensive mineral processing process is the key to doing a good job of copper-nickel processing technology indexes, comprehensive recovery of various valuable metals, and improved economic benefits.
Pounding along expansion joints in steel moment resisting frames
Authors: Osman Ashraf , Salem Abu baker
Published: February 2025

In steel framed structures having large footprints or variable heights, expansion/ settlement joints are usually introduced by structural designers to minimize the straining actions developed within buildings structural elements. These joints separate the buildings into parts which are self-standing. During severe earthquake events, these parts vibrate differently causing pounding which result in damage to buildings structural elements. To overcome such problem, design codes suggested widening these expansion joints to avoid collision between building parts. However, such wide joints pose as challenge to architects since they affect buildings architectural appearance and internal use. This study examines the impact of minimizing the width of the expansion joints on the level of damage experienced by steel framed buildings during earthquakes. For such purpose, hypothetical porotype building having expansion joint between its parts were developed. The main lateral load resisting system for this building was characterized as limited ductile steel moment resisting frame according to Egyptian seismic code which is corresponding to Intermediate moment resisting frames in International codes. The parts of the building were having different number of floors and spans, so they can vibrate differently during earthquake. The building was subjected to seven different time histories with different a/v ratio (ground acceleration to ground velocity ratios). Non-linear inelastic analyses were performed to this building utilizing different expansion joint widths. The recurrence of pounding between buildings' parts in terms of locations and magnitude of pounding forces was identified for each analysis case and evaluated. In addition, the variation in beams & columns straining actions and the spread of plastic hinges within them was recorded and examined. From the obtained results it was concluded that the effect of pounding can be mitigated in this case if expansion joint width set equal to 0.5 the square root of the sum of the squares of the building parts inelastic displacements at collided floors provided the concept of strong column-weak beam is applied to the building.
Perioperative assessment and management of frailty in elderly patients: a national survey of Italian anesthesiologists
Authors: Greco Massimiliano , Luca Ersilia , Chiumiento Fernando , Behr Astrid U. , Bettelli Gabriella , Bignami Elena , Antonelli Massimo , Cecconi Maurizio , Aceto Paola
Published: February 2025

Background

The prevalence of frailty is increasing as the global population continues to age. Frailty is associated with poor perioperative outcomes including increased morbidity and mortality. The purpose of this study is to examine current practices and perspectives of anesthesiogists in Italy on the provision of care for elderly surgical patients with frailty.

Methods

We conducted a national survey. Data were collected via an online questionnaire distributed by the Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI). Responses were collected over 24 weeks between October 2022 and March 2023.

Results

Seven-hundred thirteen anesthetists completed the survey. A total of 39.8% (277) of respondents were working in university hospitals. Frailty scoring was routinely performed in 51.8% of care settings. Only 26.3% of organizations surveyed had a dedicated pathway for perioperative management of frail elderly patients. The most common method for frailty assessment was the subjective assessment by the anesthesiologist (58.3%). More than half of the participants reported the use of ERAS items in most cases. Almost half of respondents reported the use of postoperative screening tools for delirium (45% of respondents).

Discussion

While these results point to the resistance to clinical implementation of frailty assessment, they also highlight the perceived need for careful management. This can help in identifying elderly patients who may require targeted perioperative management and in ensuring the preservation of cognitive and functional status.
Endocrine adverse reactions of tyrosine kinase inhibitors in combination with immune checkpoint inhibitors
Authors: Shao Wen , Yang Kaiwei , Lu Difei , Gao Ying , Zhang Junqing , Zhang Yang
Published: February 2025

Background

Tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) were recognized to cause endocrine adverse reactions (EARs). However, combination therapy-associated EARs are still unclear.

Methods

This was a retrospective study based on FDA Adverse Event Reporting System. We identified 938,464 cases of all adverse events related to three types of treatments. A total of 22,275 cases were EARs and divided into TKIs (n=9,181), ICIs (n=11,363) and TKIs+ICIs group (n=1,731).

Results

The incidence of EARs was the highest in TKIs+ICIs followed by ICIs and TKIs group. TKIs+ICIs group had a higher risk of hypothyroidism than in ICIs group (OR 1.47, 95% CI [1.28-1.69]), while a lower risk compared to TKIs group (OR 0.68, 95% CI [0.58-0.79]). TKIs+ICIs group presented a higher risk of type 1 diabetes mellitus compared to TKIs group (OR 26.61, 95% CI [18.60-38.07]), but a lower risk compared to ICIs group (OR 0.63, 95% CI [0.47-0.84]). The risk of hypoglycaemia was approximately 2.77 times greater in TKIs+ICIs group than in ICIs group (OR 2.77, 95% CI [1.95-3.95]) and was also higher in TKIs group compared to ICIs group (OR 3.44, 95% CI [2.93-4.03]). Compared to ICIs group, TKIs+ICIs group did not display a higher risk of pituitary dysfunction and primary adrenal insufficiency. The mortality risk of TKIs+ICIs group was comparable to ICIs groups, but significantly lower than TKIs group.

Conclusions

EARs were more common in TKIs+ICIs therapy. The distribution of EARs in different glands varied among combination therapy and monotherapy. Combination therapy-associated EARs did not increase the risk of mortality.
HEPNET Position Statement-I, Case Definition, Classification, Screening & Diagnosis of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) in Pakistan: A Resource for Primary and Secondary Care Physicians
Authors: Ali Bushra , Kamani Lubna , Salim Adnan , Alam Altaf , Zuberi Bader Faiyaz , Farooqi Javed Iqbal , Naqvi Altaf Baqir , Ali Zeeshan , Majid Shahid , Hashmi Zahid Yasin , Choudhry Asad A , Salih Muhammad , Khan Anwaar Ahmed , Syed M. Zahid Azam  , Abbas Zaigham , Siddiq Masood , Nawaz Arif Amir
Published: February 2025

The Hep-Net position paper comes at a significant time in the history of Metabolically Associated Fatty Liver Disease (MAFLD) due to the rapid rise in this disease entity in the past decade. Metabolically Associated Fatty Liver Disease, by its very name, encompasses several common metabolic disease entities, top among those being diabetes and obesity. For Pakistan, the situation is serious as it is among the top 10 countries globally regarding the prevalence of obesity and number one in terms of diabetes, with over a quarter of adults affected. There remains slight ambiguity as regards the nomenclature of MAFLD, with western societies preferring to remove the word “fatty” and substitute with `’steatotic” i.e. MASLD.
Regardless of names/titles the metabolic nature of the disease and its management remains the same and fortunately, that is something where universal consensus is present. Under the umbrella of Hep-Net, eminent hepatologists from all over Pakistan have pooled their efforts to formulate guidelines that are specifically tailored to the Pakistani population, its specific lifestyle and relevant interventions that are needed to treat fatty/steatotic liver disease. By virtue of its multi-systemic consequences, metabolic fatty liver disease represents the most significant and expensive disease entity, globally. Prevention, through public education and timely intervention in diagnosed cases will serve to avert a healthcare storm that will far outweigh viral hepatitis.
doi: https://doi.org/10.12669/pjms.41.3.10081
How to cite this: Ali B, Kamani L, Salim A, Alam A, Zuberi BF, Farooqi JI, et al. HEPNET Position Statement-I, Case Definition, Classification, Screening & Diagnosis of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) in Pakistan: A Resource for Primary and Secondary Care Physicians. Pak J Med Sci. 2025;41(3):929-938. doi: https://doi.org/10.12669/pjms.41.3.10081
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Barriers of conducting and completing research in Pakistan among doctors: A cross-sectional survey
Authors: Khan Zainab Aqeel , Muzzamil Umaimah , Ahsan Khubab , Khan Aiman , Jawaid Masood
Published: February 2025

Objectives: To identify the barriers encountered while conducting and completing research among doctors in Pakistan.
Methods: This cross-sectional study was conducted from November 2023 to March 2024 to identify research barriers among medical doctors working in different hospitals of Pakistan. All graduated doctors who at least had six months of postgraduate clinical experience were included. Participants who provided incomplete response or refused to participate were excluded. The data was collected on pre-designed questionnaire. The survey consisted of demographics, information about research experience and publications and perception about research barriers. P-value <0.05 was considered significant.
Results: Out of 1,000 doctors included for study, only 380 of them responded to the survey with a response rate of 38%. The mean age of all participants was 29.3 ± 7.3. Almost 58% of the participants were female. Almost 62.6% of the participants considered lack of training as the main barrier in conducting research, followed by inadequate financial support (53.1%), inadequate support from institute (53.1%), inadequate support from mentors (48.1%), lack of statistical work support (47.3%), insufficient time (45.5%) and difficulty in obtaining ethical approval (30.7%). There was statistically significant association found for inadequate financial support barrier between participants who had research publication and who did not (P < 0.001).
Conclusion: The lack of training and inadequate financial and institutional support is identified as main barriers for conduction and completion of research in Pakistan among doctors.
doi: https://doi.org/10.12669/pjms.41.3.10424
How to cite this: Khan ZA, Muzzamil U, Ahsan K, Khan A, Jawaid M. Barriers of conducting and completing research in Pakistan among doctors: A cross-sectional survey. Pak J Med Sci. 2025;41(3):886-890. doi: https://doi.org/10.12669/pjms.41.3.10424
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Effect of 0.8mg/ml Losartan on Corneal Opacities
Authors: Fawad Aisha , Waqar Muzaffar  , Unnab Anjum  , Mahad Naseer Amer
Published: February 2025

Losartan, commonly used as an angiotensin receptor II inhibitor for hypertension, has recently revealed additional therapeutic properties. Studies demonstrate its potential in treating liver fibrosis, mitigating heart disease secondary to radiation, reducing skin scar formation, and even reversing renal cortical fibrosis. In a specific case, a female patient suffering from persistent bilateral nummular keratitis and corneal opacities experienced significant improvement in her left eye after using 0.8mg/ml Losartan eye drops. Untreated right eye showed no change. Based on the positive outcome, patient was offered same treatment in her right eye as well with monthly follow-ups, which she happily accepted. The stark contrast between the treated and untreated eye highlights the promising role of Losartan in treating corneal opacities.
doi: https://doi.org/10.12669/pjms.41.3.11237
How to cite this: Fawad A, Muzaffar W, Anjum U, Amer MN. Effect of 0.8mg/ml Losartan on Corneal Opacities. Pak J Med Sci. 2025;41(3):926-928.   doi: https://doi.org/10.12669/pjms.41.3.11237
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Association between fatty liver disease and risk of microvascular complications in Type-2 diabetes mellitus: A systematic review and meta-analysis
Authors: Shao Jiawei , Zhou Mi , Xie Xiaoqing , Lan Shaobo
Published: February 2025

Objective: To summarize the existing evidence on the association between non-alcoholic fatty liver disease (NAFLD) and the probability of microvascular complications in Type-2 diabetes mellitus (T2DM).
Methods: PubMed, EMBASE and Scopus databases search (from inception until October 31, 2023) was done for reports with cross-sectional, cohort or case-control design that included adult participants with T2DM and a documented NAFLD status. The selected studies were required to report on at least one microvascular outcome. Studies reporting adjusted associations were included. Random-effects models were used for all analysis. The pooled effect sizes for the associations were reported as odds ratio (OR) with 95% confidence intervals (CI).
Results: Sixteen studies were analysed. T2DM patients with associated NAFLD had similar risk of neuropathy (OR 1.08, 95% CI: 0.97, 1.21), compared to those without NALFD. NAFLD was associated with slightly lower risk of retinopathy (OR 0.86, 95% CI: 0.75, 0.98; N=10, I2=82.6%) an increased incidence of nephropathy (OR 1.21, 95% CI: 1.14, 1.29; N=12, I2=82.5%), compared to patients with T2DM but no NAFLD.
Conclusion: Diagnosis of NAFLD in patients with T2DM appears to increase the incidence of nephropathy and decrease the risk of retinopathy. Future studies are needed to confirm these observations.
doi: https://doi.org/10.12669/pjms.41.3.11362
How to cite this: Shao J, Zhou M, Xie X, Lan S. Association between fatty liver disease and risk of microvascular complications in Type-2 diabetes mellitus: A systematic review and meta-analysis. Pak J Med Sci. 2025;41(3):902-909. doi: https://doi.org/10.12669/pjms.41.3.11362
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Lower urinary tract symptoms and hematuria in Rheumatoid arthritis (LUTH-RA) study
Authors: Wagan Abrar Ahmed , Paras
Published: February 2025

Objective: To determine the frequency of hematuria and lower urinary tract problems in rheumatoid arthritis cohort.
Method: This cross sectional prospective study was conducted at department of Rheumatology Indus Medical College Tando Mohammad Khan from August 1, 2022 to March 3, 2023. Total 229 patients were selected after written and informed consent; demographic details were taken. Bristol Female Lower Urinary Tract Questionaries’ (BFLUTS) was filled and all male participants were asked for ultrasound scan of prostate and freshly voided midstream urine was collected for microscopic hematuria.
Results: In this study the prevalence of Lower Urinary Tract Symptoms (LUTS) was (77.3%) and microscopic hematuria (34.5%). Major symptoms of LUTS were: nocturia (69%), bladder pain (35.4%), leaking before going to toilet (40.6%), frequency of incontinence (24.5%), nocturnal incontinence (27.9%), sex life spoiled due to urinary symptoms (22.7%), avoid situation where no toilet (30.1%) and overall interference of life (32.8%) cases. A significant association of DAS-28 with LUTS and microscopic hematuria was seen (p<0.01).
Conclusion: Lower urinary tract problems and microscopic hematuria are common in both genders, and severity of RA, increases LUTS and affects quality of life.
doi: https://doi.org/10.12669/pjms.41.3.8316
How to cite this: Wagan AA, Paras. Lower urinary tract symptoms and hematuria in Rheumatoid arthritis (LUTH-RA) study. Pak J Med Sci. 2025;41(3):876-879. doi: https://doi.org/10.12669/pjms.41.3.8316
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Penerapan Asas Itikad Baik dalam Transaksi Jual-Beli Tanah (Studi Putusan Nomor 13/Pdt.G/2018/PN Bar)
Authors: Asshidiq Muhammad , Alwajdi Muhammad Farid
Published: February 2025

The purpose of this study is to find out how the application of the principles of good faith in land transactions, and be more specific to analyze how the application of a good faith principle between the seller and the buyer on rule number 13/ PDT. G/2018/ pn bar.The method of research used was normative-law research, with law enforcement approaches and case approaches. The research uses primary and secondary and tesier legal sources. This study the authors concluded that in land transactions in case number 13/ PDT. G/2018/ pn bar raised the issue because one party had deviated from the principle of good faith in buying and selling, when one party of the agreement already applied its good faith in carrying out a covenant.
The effect of virtual reality-based intervention programs on cognitive function improvement in patients with mild cognitive impairment and dementia: A systematic review and metaanalysis
Authors: Baek Gyuli , Jin Juhyun
Published: February 2025

Purpose: This study aims to evaluate the effectiveness of virtual reality intervention programs for improving cognitive function among individuals with mild cognitive impairment and dementia, using a systematic review and meta-analysis. Methods: Literature published up to September 2024 and indexed in academic journals was reviewed. International databases, including CINAHL, PubMed, EMBASE, and Cochrane, were utilized alongside domestic databases such as RISS, KISS, and DBpia. A total of four studies meeting the inclusion and exclusion criteria were selected for the final analysis. Statistical analyses, including effect size and heterogeneity calculations, were performed using R version 4.0.2. Results: The findings revealed a large effect size (0.90) for the improvement of cognitive function through virtual reality intervention programs, with statistical significance (p < .001). These results provide valuable evidence supporting the development and implementation of virtual reality-based simulation programs tailored to specific intervention goals, reflecting the differences and characteristics of cognitive function. Conclusion: This study highlights the potential of virtual reality interventions to enhance the quality of life and rehabilitation of individuals with mild cognitive impairment and dementia. The results are expected to contribute to the establishment of more systematic and effective intervention strategies in clinical and research settings.