bluuebunny/crossref_metadata_2025 huggingface dataset:
The protective effect of Nostoc commune Vauch. polysaccharide on alcohol‐induced acute alcoholic liver disease and gut microbiota disturbance in mice
Authors: Yang Yiting , Liu Su , Li Hailong , Liu Yue , Ren Ping , Liu Yingying , Liu Shuming , Guan Lili
Published: September 2023

Background

In recent years, the incidence of alcoholic liver disease (ALD) has gradually increased, the development of ALD is attached great attentions. Nostoc commune Vauch. polysaccharide (NCVP) is beneficial to maintain the gut health, but the protective effect of NCVP on the liver has not been reported yet.

Purpose

To study the protective effect and the underlying mechanisms of NCVP on ALD, a mouse model of acute ALD was established.

Study design and methods

We built an acute ALD mouse model and explored the protective effect of NCVP through the detection of cytokines, histological examination, determination of short chain fatty acids, and 16S rRNA analysis of gut microbiota.

Results

NCVP had hepatoprotective effects on acute alcohol‐induced mice by improving antioxidant capacity, reducing oxidative stress and the serum cytokine levels (IL‐1β, IL‐6, and TNF‐α). Simultaneously, histopathological changes in liver indicated that NCVP could inhibit local hepatocyte necrosis, cytoplasmic vacuolation and inflammatory cell infiltration induced by alcohol. NCVP also increased the level of total short‐chain fatty acids of acute ALD mice. In addition, NCVP could significantly decrease the Firmicutes/Bacteroidetes ratio and the abundance of Patescibacteria, Helicobacter, and Actinomycetes and increase the abundance of Lachospiraceae, Prevotellaceae‐UCG‐003, Lactobacillaceae, and Desulfovibrio.

Conclusion

Our study proved that NCVP had in vivo hepatoprotective effect on acute ALD mice and provided scientific evidences that NCVP might be a promising drug candidate for the prevention and treatment of ALD.
Lidocaine ameliorates intestinal barrier dysfunction in irritable bowel syndrome by modulating corticotropin‐releasing hormone receptor 2
Authors: Wang Yanrong , Qiao Mingbiao , Yao Xue , Feng Zhonghui , Hu Ruiqi , Chen Jianguo , Liu Lei , Liu Jinbo , Sun Yueshan , Guo Yuanbiao
Published: September 2023

Background

Intestinal barrier dysfunction is a prevalent pathogenic factor underlying various disorders. Currently there is no effective resolution. Previous studies have reported the potential anti‐inflammatory properties of lidocaine and its ability to alleviate visceral hypersensitivity in individuals with irritable bowel syndrome (IBS). Therefore, our study will further verify the effect of lidocaine on intestinal barrier dysfunction in IBS and investigate the underlying mechanisms.

Methods

In this study, we investigated the role of lidocaine by assessing visceral hypersensitivity, body weight, inflammatory factors, fluorescein isothiocyanate‐dextran 4000 (FD4) flux, tight junctions (TJs) and spleen and thymus index in rats subjected to water avoidance stress (WAS) to mimic intestinal barrier dysfunction in IBS with and without lidocaine. In vitro, we investigated the role of corticotropin‐releasing hormone receptor 2 (CRHR2) in lidocaine‐treated Caco2 cells using small interfering RNA (siRNA) targeting CRHR2.

Key Results

In WAS rats, lidocaine significantly restored weight loss, damaged TJs, spleen index and thymus index and inhibited abdominal hypersensitivity as well as blood levels of markers indicating intestinal permeability, such as diamine oxidase (DAO), D‐lactic acid (D‐Lac) and lipopolysaccharide (LPS). Consequently, the leakage of FD4 flux from intestine was significantly attenuated in lidocaine group, and levels of intestinal inflammatory factors (IL‐1β, IFN‐γ, TNF‐α) were reduced. Interestingly, lidocaine significantly suppressed corticotropin‐releasing hormone (CRH) levels in lamina propria cells, while the CRH receptor CRHR2 was upregulated in intestinal epithelial cells. In vitro, lidocaine enhanced the expression of CRHR2 on Caco‐2 intestinal epithelial cells and restored disrupted TJs and the epithelial barrier caused by LPS. Conversely, these effects were diminished by a CRHR2 antagonist and siRNA‐CRHR2, suggesting that the protective effect of lidocaine depends on CRHR2.

Conclusions and Inferences

Lidocaine ameliorates intestinal barrier dysfunction in IBS by potentially modulating the expression of CRHR2 on intestinal epithelial cells.
Oral mucosal disease recognition based on dynamic self‐attention and feature discriminant loss
Authors: Xie Fei , Xu Pengfei , Xi Xinyi , Gu Xiaokang , Zhang Panpan , Wang Hexu , Shen Xuemin
Published: September 2023

Objectives

To develop a dynamic self‐attention and feature discrimination loss function (DSDF) model for identifying oral mucosal diseases presented to solve the problems of data imbalance, complex image background, and high similarity and difference of visual characteristics among different types of lesion areas.

Methods

In DSDF, dynamic self‐attention network can fully mine the context information between adjacent areas, improve the visual representation of the network, and promote the network model to learn and locate the image area of interest. Then, the feature discrimination loss function is used to constrain the diversity of channel characteristics, so as to enhance the feature discrimination ability of local similar areas.

Results

The experimental results show that the recognition accuracy of the proposed method for oral mucosal disease is the highest at 91.16%, and is about 6% ahead of other advanced methods. In addition, DSDF has recall of 90.87% and F1 of 90.60%.

Conclusions

Convolutional neural networks can effectively capture the visual features of the oral mucosal disease lesions, and the distinguished visual features of different oral lesions can be extracted better using dynamic self‐attention and feature discrimination loss function, which is conducive to the auxiliary diagnosis of oral mucosal diseases.
Making sense of things: Moral inquiry as hermeneutical inquiry
Authors: Sliwa Paulina
Published: September 2023

We are frequently confronted with moral situations that are unsettling, confusing, disorienting. We try to come to grips with them. When we do so, we engage in a distinctive type of moral inquiry: hermeneutical inquiry. Its aim is to make sense of our situation. What is it to make sense of one's situation? Hermeneutical inquiry is part of our everyday moral experience. Understanding its nature and its place in moral epistemology is important. Yet, I argue, that existing accounts of moral inquiry do not give us the resources to do so. This paper develops a positive account of hermeneutical inquiry. I argue that when we engage in hermeneutical inquiry, we search for an apt perspective on our situation.
Similar improvements in 5‐km performance and maximal oxygen uptake with submaximal and maximal 10‐20‐30 training in runners, but increase in muscle oxidative phosphorylation occur only with maximal effort training
Authors: Skovgaard Casper , Christiansen Danny , Martínez‐Rodríguez Alejandro , Bangsbo Jens
Published: September 2023

Objective

The aim of the present study was to examine whether 10‐20‐30 training (consecutive 1‐min intervals consisting of 30 s at low‐speed, 20 s at moderate‐speed, and 10 s at high‐speed), performed with submaximal effort during the 10‐s high‐speed runs, would lead to improved performance as well as increased maximum oxygen uptake (VO2‐max) and muscle oxidative phosphorylation (OXPHOS). In addition, to examine to what extent the effects would compare to 10‐20‐30 running conducted with maximal effort.

Design

Nineteen males were randomly assigned to 10‐20‐30 running performed with either submaximal (SUBMAX; n = 11) or maximal (MAX; n = 8) effort, which was conducted three times/week for 6 weeks (intervention; INT). Before and after INT, subjects completed a 5‐km running test and a VO2‐max test, and a biopsy was obtained from m. vastus lateralis.

Results

After compared to before INT, SUBMAX and MAX improved (p < 0.05) 5‐km performance by 3.0% (20.8 ± 0.4 (means±SE) vs. 21.5 ± 0.4 min) and 2.3% (21.2 ± 0.4 vs. 21.6 ± 0.4 min), respectively, and VO2‐max was ~7% higher (p < 0.01) in both SUBMAX (57.0 ± 1.3 vs. 53.5 ± 1.1 mL/min/kg) and MAX (57.8 ± 1.2 vs. 53.7 ± 0.9 mL/min/kg), with no difference in the changes between groups. In SUBMAX, muscle OXPHOS was unchanged, whereas in MAX, muscle OXPHOS subunits (I‐IV) and total OXPHOS (5.5 ± 0.3 vs 4.7 ± 0.3 A.U.) were 9%–29% higher (p < 0.05) after compared to before INT.

Conclusion

Conducting 10‐20‐30 training with a non‐maximal effort during the 10‐s high‐speed runs is as efficient in improving 5‐km performance and VO2‐max as maximal effort exercise, whereas increase in muscle OXPHOS occur only when the 10‐s high‐speed runs are performed with maximal effort.
Damped harmonic oscillator revisited: The fastest route to equilibrium
Authors: Lelas Karlo , Poljak Nikola , Jukić Dario
Published: September 2023

Theoretically, solutions of the damped harmonic oscillator asymptotically approach equilibrium, i.e., the zero energy state, without ever reaching it exactly, and the critically damped solution approaches equilibrium faster than the underdamped or the overdamped solution. Experimentally, the systems described with this model reach equilibrium when the system's energy has dropped below some threshold corresponding to the energy resolution of the measuring apparatus. We show that one can (almost) always find an optimal underdamped solution that will reach this energy threshold sooner than all other underdamped solutions, as well as the critically damped solution, no matter how small this threshold is. We also comment on one exception to this for a particular type of initial condition, when a specific overdamped solution reaches the equilibrium state sooner than all other solutions. We experimentally confirm some of our findings.
Treating disorder in introductory solid state physics
Authors: Martínez Dunkan , Baba Yuriko , Domínguez-Adame Francisco
Published: September 2023

Introductory textbooks in solid state physics present solvable models for illustrating the occurrence of allowed bands and forbidden gaps in the energy spectrum of Bloch electrons. However, the quantum mechanical description of electrons in non-periodic solids, such as amorphous materials, is beyond the scope of introductory courses because of its intrinsic complexity. The tight-binding approximation can account for such a scenario by letting the atomic levels vary at random from lattice site to site. We theoretically tackle the study of the average properties of the energy spectrum by introducing a transfer matrix method that allows us to obtain closed expressions for the so-called coherent potential. The coherent potential is energy-dependent and constant in space. It replaces the actual atomic random potential, thus generating a periodic effective medium with the same average properties as the non-periodic solid. We demonstrate that the average density of states can be calculated within this framework without relying on heavy mathematical machinery. Thus, our approach is suitable for introductory courses in solid state physics and materials science.
All objects and some questions
Authors: Lineweaver Charles H. , Patel Vihan M.
Published: September 2023

We present an overview of the thermal history of the Universe and the sequence of objects (e.g., protons, planets, and galaxies) that condensed out of the background as the Universe expanded and cooled. We plot (i) the density and temperature of the Universe as a function of time and (ii) the masses and sizes of all objects in the Universe. These comprehensive pedagogical plots draw attention to the triangular regions forbidden by general relativity and quantum uncertainty and help navigate the relationship between gravity and quantum mechanics. How can we interpret their intersection at the smallest possible objects: Planck-mass black holes (“instantons”)? Does their Planck density and Planck temperature make them good candidates for the initial conditions of the Universe? Our plot of all objects also seems to suggest that the Universe is a black hole. We explain how this depends on the unlikely assumption that our Universe is surrounded by zero density Minkowski space.
Metabolic control of antitumor immunity
Authors: Pouikli Andromachi , Frezza Christian
Published: September 2023

Mitochondrial metabolite reduces melanoma growth by boosting antigen presentation
Genetic engineering strategy for generating a stable dsRNA virus vector using a virus-like codon-modified transgene
Authors: Kanai Yuta , Onishi Misa , Yoshida Yukino , Kotaki Tomohiro , Minami Shohei , Nouda Ryotaro , Yamasaki Moeko , Enoki Yasutaka , Kobayashi Takeshi
Published: September 2023

Deletion or truncation of transgenes encoded in RNA virus vectors frequently occur. Genetic instability of transgenes is the primary obstacle to establishing RNA virus vectors as tractable gene transduction tools. To improve transgene stability, we designed codon-modified genes that imitated codon usage bias in the genomes of rotavirus (RV) and mammalian orthoreovirus (MRV), both of which have segmented double-stranded (ds) RNA genomes. Synthesized, codon-modified NanoLuc, ZsGreen, AsRed, and Akaluc genes, which had RV genome-like and/or MRV genome-like codon usage biases, were used as transgenes in RV and MRV vectors. Here, we show that the genetic stabilities of these codon-modified genes in RV and MRV vectors were dramatically increased relative to their respective parental genes. Because genetic stabilities were improved independent of transgenes and insertion sites within the viral genome, virus-like codon modification could be essential for constructing dsRNA virus vectors and overcome the primary obstacle of transgene genetic instability.

IMPORTANCE

The stabilities of transgenes in RNA virus vectors differ between the genes of interest, but the molecular mechanisms determining genetic stability remain unknown. This study demonstrated that the stability of a transgene was affected by the nucleotide composition, and altering the codon usage of transgenes to resemble that of the viral genome significantly increased transgene stability in double-stranded RNA virus vectors. The virus-like codon modification strategy enabled generation of stable rotavirus and mammalian orthoreovirus vectors, which could be developed as machinery for gene delivery to the intestines and/or respiratory organs. This technology has further potential to be expanded to other RNA viruses.
Zika virus infection leads to hormone deficiencies of the hypothalamic-pituitary-gonadal axis and diminished fertility in mice
Authors: Liu Li-Bo , Yang Wei , Chang Jia-Tong , Fan Dong-Ying , Wu Yan-Hua , Wang Pei-Gang , An Jing
Published: September 2023

Zika virus (ZIKV) infection in pregnant women during the first trimester can cause congenital malformations including microcephaly, which has focused global attention on this emerging pathogen. By contrast, ZIKV infection in pregnant women during the third trimester can cause neurodevelopmental delays and cryptorchidism in newborns without microcephaly. Here, we evaluated the long-term fertility consequences of ZIKV infection in male suckling mice, which is equivalent to congenital ZIKV infection in children, from multiple perspectives including the hypothalamic-pituitary-gonadal axis, testis, sperm, and social behaviors. We observed the persistence of ZIKV in the hypothalamus of mice, which caused long-term hormone deficiencies of the hypothalamic-pituitary-gonadal axis. Hormone deficiencies led to limited delays in testicular development, a decrease in sperm quality and quantity, and abnormal social abilities. These damages could progress to diminished fertility in male mice, as judged by lower pregnancy rate, prolonged time to delivery, and decreased offspring quality. Currently, the extent to which these observations in mice translate to humans remains unclear, but longitudinal studies of hormone levels and reproductive health in ZIKV-exposed children seem warranted.

IMPORTANCE

Zika virus (ZIKV) infection in pregnant women during the third trimester can cause neurodevelopmental delays and cryptorchidism in children without microcephaly. However, the consequences of congenital ZIKV infection on fertility in these children remain unclear. Here, using an immunocompetent mouse model, we reveal that congenital ZIKV infection can cause hormonal disorders of the hypothalamic-pituitary-gonadal axis, leading to reduced fertility and decreased sexual preference. Our study has for the first time linked the hypothalamus to the reproductive system and social behaviors after ZIKV infection. Although the extent to which these observations in mice translate to humans remains unclear, these findings did suggest that the reproductive health and hormone levels of ZIKV-exposed children should receive more attention to improve their living quality.
Surface growth of
Pseudomonas aeruginosa
reveals a regulatory effect of 3-oxo-C
12
-homoserine lactone in the absence of its cognate receptor, LasR
Authors: de Oliveira Pereira Thays , Groleau Marie-Christine , Déziel Eric
Published: September 2023

Successful colonization of a multitude of ecological niches by the bacterium
Pseudomonas aeruginosa
relies on its ability to respond to concentrations of self-produced signal molecules. This intercellular communication system known as quorum sensing (QS) tightly regulates the expression of virulence determinants and a diversity of survival functions, including those required for social behaviors. In planktonic cultures of
P. aeruginosa
, the transcriptional regulator LasR is generally considered on top of the QS circuitry hierarchy; its activation relies on binding to 3-oxo-C
12
-homoserine lactone (3-oxo-C
12
-HSL), a product of LasI synthase. Transcription of
lasI
is activated by LasR, resulting in a positive feedback loop. Few studies have looked at the function of QS during surface growth even though
P. aeruginosa
typically lives in biofilm-like communities under natural conditions. Here, we show that surface-grown
P. aeruginosa
, including prototypical strain PA14, produces 3-oxo-C
12
-HSL in the absence of LasR. This phenotype is commonly observed upon surface association in naturally occurring environmental and clinical LasR-defective isolates, suggesting a conserved alternative function for the signal. Notably, in surface-grown cultures, 3-oxo-C12-HSL reaches higher levels than planktonic cells, and there is a delayed timing of its production. Accordingly, 3-oxo-C
12
-HSL upregulates the autologous expression of pyocyanin and LasR-controlled virulence determinants in neighboring cells even in the absence of the cognate regulator LasR. This highlights a possible role for 3-oxo-C
12
-HSL in shaping community responses and provides a possible evolutive benefit for mixed populations to carry LasR-defective cells, a common feature of natural populations of
P. aeruginosa
.

IMPORTANCE

The bacterium
Pseudomonas aeruginosa
colonizes and thrives in many environments, in which it is typically found in surface-associated polymicrobial communities known as biofilms. Adaptation to this social behavior is aided by quorum sensing (QS), an intercellular communication system pivotal in the expression of social traits. Regardless of its importance in QS regulation, the loss of function of the master regulator LasR is now considered a conserved adaptation of
P. aeruginosa
, irrespective of the origin of the strains. By investigating the QS circuitry in surface-grown cells, we found an accumulation of QS signal 3-oxo-C
12
-HSL in the absence of its cognate receptor and activator, LasR. The current understanding of the QS circuit, mostly based on planktonic growing cells, is challenged by investigating the QS circuitry of surface-grown cells. This provides a new perspective on the beneficial aspects that underline the frequency of LasR-deficient isolates.
First Results of U–Th/He Dating of Epigenetic Pyrite from Rocks of the Bazhenov Formation, Western Siberia
Authors: Yakubovich O. V. , Vasilyeva N. A. , Vasilyeva K. Yu. , Anosova M. O. , Kotov A. B. , Podolskaya M. M. , Gorokhovskiy B. M.
Published: September 2023

The U–Th/He method has been applied for the first time to determine the age of epigenetic pyrite from the oil source rocks of the Bazhenov Formation, Western Siberia. The possibility to date the post-sedimentation processes in a sedimentary basin by authigenic pyrite using the U–Th/He method is shown. The U–Th/He isochrone age of pyrite (n = 7) from the dolomites of the Bazhenov Formation within the Frolovskaya megadepression is much younger than the sedimentation age and corresponds to the Santonian–Cenomanian stages of the Upper Cretaceous (90 ± 8 Ma).
Bauxites of the Tatarka Deposit (Yenisei Ridge, Russia): The First Evidence of a Contact-Karst Origin
Authors: Boeva N. M. , Slukin A. D. , Makarova M. A. , Shipilova E. S. , Melnikov Ph. P. , Vnuchkov D. A. , Zhegallo E. A. , Zaitseva L.V. , Bortnikov N. S.
Published: September 2023

The Tatarka bauxite deposit on the territory of the Russian Federation was formed as a result of sedimentation of the products of denudated lateritic weathering crusts of amphibolites in contact-karst depressions. Detailed mineralogical studies of bauxites made it possible to reconstruct reliably the conditions for their formation. As it turned out, the initial rocks and rocks, weathered before, have been denudated due to the close location of the areas of alimentation and accumulation. At the same time, chemical processes have been continued in karst depressions. For the first time, the presence of nanoparticles of amorphous aluminum oxide was revealed in contact-karst bauxites. This specific feature of the form of alumina precipitation is associated with the subsequent cessation of lateritization and their attenuation with depth. The presence of amorphous aluminum monohydrate must be taken into account when choosing a scheme for bauxite enrichment.
Haemophagocytic syndrome caused by disseminated nontuberculous mycobacterial infection
Authors: Baldovino Chiquillo Laura , Rico Daniela Lucía , Leal Drixie Dalyla , Romero Martha
Published: September 2023

A female patient in her 30s presented to the emergency department with a 10-day history of fever, weakness and diaphoresis. Subsequent investigations revealed a diagnosis of haemophagocytic syndrome, secondary to disseminated non-tuberculous mycobacterial infection affecting the bone marrow, lungs, lymph nodes and skin. The bone marrow culture confirmed the presence ofMycobacterium aviuminfection. The patient’s haemophagocytic syndrome was managed using the HLH-2004 chemoimmunotherapy, andM. aviuminfection was treated with a combination of clarithromycin, ethambutol, rifampicin, ciprofloxacin and amikacin. Throughout her hospitalisation, the patient faced several serious complications arising from both the medications and the prolonged hospital stay (lasting 12 months). However, these complications were promptly identified and effectively managed through a multidisciplinary and comprehensive approach. This approach was crucial in achieving a favourable patient outcome and successful recovery.
Ki67 is a better marker than PRAME in risk stratification of BAP1-positive and BAP1-loss uveal melanomas
Authors: Donizy Piotr , Spytek Mikołaj , Krzyziński Mateusz , Kotowski Krzysztof , Markiewicz Anna , Romanowska-Dixon Bozena , Biecek Przemyslaw , Hoang Mai P
Published: September 2023

Background

Accurate risk stratification of uveal melanoma (UM) patients is important for determining the interval and frequency of surveillance. Loss of BAP1 expression has been shown to be strongly associated with UM-related death and metastasis.

Methods

In this study of 164 enucleated UMs, we assessed the prognostic role of preferentially expressed antigen in melanoma (PRAME) expression and Ki67 proliferation index measured by digital quantitation using QuPath programme in patients with BAP1-positive and BAP1-loss UMs.

Results

In univariate analyses with log-rank tests and Kaplan-Meier curves, PRAME further stratified only overall survival (OS) in BAP1-positive and BAP1-loss tumour groups. However, Ki67 further stratified both OS and disease-free survival (DFS) in BAP1-positive and BAP1-loss tumour groups. In multivariate analyses, Ki67 percentage and BAP1 were independent survival predictors for both OS and DFS, whereas PRAME was not a significant covariate. In model comparisons, combined Ki67 and BAP1 performed better than combined PRAME and BAP1 in risk-stratifying patients for both OS and DFS. Ki67 was better than PRAME in risk stratification of BAP1-positive UMs. Low Ki67 index correlated with significantly prolonged DFS in BAP1-loss UMs.

Conclusion

A panel of Ki67 and BAP1 could be a helpful risk stratification strategy for UM.
Quality of reporting of adverse events in clinical trials of covid-19 drugs: systematic review
Authors: Madi Karima , Flumian Clara , Olivier Pascale , Sommet Agnès , Montastruc François
Published: September 2023

Objective

To assess the quality of reporting of adverse events in clinical trials of covid-19 drugs based on the CONSORT (Consolidated Standards of Reporting Trials) harms extension and according to clinical trial design, and to examine reporting of serious adverse events in drug trials published on PubMed versus clinical trial summaries on ClinicalTrials.gov.

Design

Systematic review.

Data sources

PubMed and ClinicalTrials.gov registries were searched from 1 December 2019 to 17 February 2022.

Eligibility criteria for selecting studies

Randomised clinical trials evaluating the efficacy and safety of drugs used to treat covid-19 disease in participants of all ages with suspected, probable, or confirmed SARS-CoV-2 infection were included. Clinical trials were screened on title, abstract, and text by two authors independently. Only articles published in French and English were selected. The Cochrane risk of bias tool for randomised trials (RoB 2) was used to assess risk of bias.

Results

The search strategy identified 1962 randomised clinical trials assessing the efficacy and safety of drugs used to treat covid-19, published in the PubMed database; 1906 articles were excluded after screening and 56 clinical trials were included in the review. Among the 56 clinical trials, no study had a high score for quality of reporting of adverse events, 60.7% had a moderate score, 33.9% had a low score, and 5.4% had a very low score. All clinical trials with a very low score for quality of reporting of adverse events were randomised open label trials. For reporting of serious adverse events, journal articles published on PubMed under-reported 51% of serious adverse events compared with clinical trial summaries published on ClinicalTrials.gov.

Conclusions

In one in three published clinical trials on covid-19 drugs, the quality of reporting of adverse events was low or very low. Differences were found in the number of serious adverse events reported in journal articles versus clinical trial summaries. During the covid-19 pandemic, risk assessment of drugs in clinical trials of covid-19 drugs did not comply with good practice recommendations for publication of results.

Systematic review registration

European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (ENCePP) EUPAS45959.
What are the perspectives of adults aged 18–40 living with type 2 diabetes in urban settings towards barriers and opportunities for better health and well-being: a mixed-methods study
Authors: Croke Sarah , Volkmann Anna-Maria , Perry Catherine , Atkinson Ross A , Pruneddu Alessio , Morris Lydia , Bower Peter
Published: September 2023

Objectives

Delivered as part of the global assessment of diabetes in urban settings, this study explores different aspects of living with type 2 diabetes, for adults aged 18–40. Primary questions were as follows: (1) can we identify subgroups of adults under 40 years old sharing specific perspectives towards health, well-being and living with type 2 diabetes and (2) do these perspectives reveal specific barriers to and opportunities for better type 2 diabetes prevention and management and improved well-being?

Design

The study employed a mixed-method design with data collected through demographic questionnaires, Q-sort statement sorting exercises, focus groups discussions and individual interviews.

Setting

Primary care across Greater Manchester, UK.

Participants

Those aged between 18 and 40, with a confirmed type 2 diabetes diagnosis, and living in Greater Manchester were eligible to participate. A total of 46 people completed the Q-sort exercise and 43 were included in the final analysis. Of those, 29 (67%) identified as female and 32 (75%) as white. Most common time since diagnosis was between 5 and 10 years.

Results

The Q-sort analysis categorised 35 of the 43 participants (81%) into five subgroups. Based on average statement sorts for each subgroup, perspectives were characterised as: (1) stressed and calamity coping (n=13), (2) financially disadvantaged and poorly supported (n=12), (3) well-intentioned but not succeeding (n=5), (4) withdrawn and worried (n=2) and (5) young and stigmatised (n=3). Holistic analysis of our qualitative data also identified some common issues across these subgroups.

Conclusions

Adults under 40 with type 2 diabetes are not a homogeneous group, but fall into five identifiable subgroups. They also experience issues specific to this age group that make it particularly difficult for them to focus on their own health. More tailored support could help them to make the necessary lifestyle changes and manage their type 2 diabetes better.
Comparing the accuracy of positive and negative indocyanine green staining in guiding laparoscopic anatomical liver resection: protocol for a randomised controlled trial
Authors: Alomari Malek Abdallah Muflih , Wakabayashi Taiga , Colella Marco , Mishima Kohei , Fujiyama Yoshiki , Ababneh Ebaa , Wakabayashi Go
Published: September 2023

Introduction

Knowledge of the clinical liver anatomy has evolved with advanced imaging modalities and laparoscopic surgery. Therefore, precise anatomical resection knowledge has become the standard treatment for primary and secondary liver cancer. Segmentectomy, a parenchymal-preserving approach, is regarded as an option for anatomical resections in patients with impaired liver. Indocyanine green (ICG) staining is a promising method for understanding the anatomical borders of the liver segments. There are two methods of ICG staining (positive and negative), and the superiority of either approach has not been determined to date.

Methods and analysis

This is a prospective randomised controlled superiority clinical trial performed in a single centre tertiary hospital in Japan. A comparison between the accuracy of positive and negative ICG staining in guiding laparoscopic anatomical liver resection is planned in this study. Possible candidates are patients with liver malignant tumours in whom laparoscopic monosegmentectomy or subsegmentectomy is planned. Fifty patients will be prospectively allocated into the following two groups: group A, ICG-negative staining group, and group B, ICG-positive staining group. The optimal dose of ICG for positive staining will be determined during the preparation phase. To assess the ability of the ICG fluorescence guidance in anatomical resection, the primary endpoint is the success rate of ICG staining, which consists of a subjective optical scoring (SOS) based on three components: superficial demarcation in the liver surface, visualisation of the parenchymal borders and consistency with the preoperative three-dimensional simulation. The secondary endpoints are the evaluation of short-term surgical outcomes and recurrence-free survival.

Ethics and dissemination

The study was approved by Ageo Central General Hospital Clinical Research Ethical Committee (No: 1044) and it carried out following the Declaration of Helsinki (2013 revision). Informed consent will be taken from the patients before participating. The findings will be disseminated through peer-reviewed publications, scientific meetings and conferences.

Trial registration number

UMIN000049815.
Obstetric referrals, complications and health outcomes in maternity wards of large hospitals during the COVID-19 pandemic: a mixed methods study of six hospitals in Guinea, Nigeria, Uganda and Tanzania
Authors: Beňová Lenka , Semaan Aline , Afolabi Bosede Bukola , Amongin Dinah , Babah Ochuwa Adiketu , Dioubate Nafissatou , Harissatou Niane , Kikula Amani Idris , Nakubulwa Sarah , Ogein Olubunmi , Adroma Moses , Anzo Adiga William , Diallo Abdourahmane , Diallo Ibrahima Sory , Diallo Lamine , Cellou Diallo Mamadou , Maomou Cécé , Mtinangi Nathanael , Sy Telly , Delvaux Thérèse , Delamou Alexandre , Nakimuli Annettee , Pembe Andrea Barnabas , Banke-Thomas Aduragbemi Oluwabusayo
Published: September 2023

Objectives

The COVID-19 pandemic affected provision and use of maternal health services. This study describes changes in obstetric complications, referrals, stillbirths and maternal deaths during the first year of the pandemic and elucidates pathways to these changes.

Design

Prospective observational mixed-methods study, combining monthly routine data (March 2019–February 2021) and qualitative data from prospective semi-structured interviews. Data were analysed separately, triangulated during synthesis and presented along three country-specific pandemic periods: first wave, slow period and second wave.

Setting

Six referral maternities in four sub-Saharan African countries: Guinea, Nigeria, Tanzania and Uganda.

Participants

22 skilled health personnel (SHP) working in the maternity wards of various cadres and seniority levels.

Results

Percentages of obstetric complications were constant in four of the six hospitals. The percentage of obstetric referrals received was stable in Guinea and increased at various times in other hospitals. SHP reported unpredictability in the number of referrals due to changing referral networks. All six hospitals registered a slight increase in stillbirths during the study period, the highest increase (by 30%–40%) was observed in Uganda. Four hospitals registered increases in facility maternal mortality ratio; the highest increase was in Guinea (by 158%), which had a relatively mild COVID-19 epidemic. These increases were not due to mortality among women with COVID-19. The main pathways leading to these trends were delayed care utilisation and disruptions in accessing care, including sub-optimal referral linkages and health service closures.

Conclusions

Maternal and perinatal survival was negatively affected in referral hospitals in sub-Saharan Africa during COVID-19. Routine data systems in referral hospitals must be fully used as they hold potential in informing adaptations of maternal care services. If combined with information on women’s and care providers’ needs, this can contribute to ensuring continuation of essential care provision during emergency.
CheckPOINT: a simple tool to measure Surgical Safety Checklist implementation fidelity
Authors: Moyal-Smith Rachel , Etheridge James C , Turley Nathan , Lim Shu Rong , Sonnay Yves , Payne Sarah , Smid-Nanninga Henriette , Kothari Rishabh , Berry William , Havens Joaquim , Brindle Mary E
Published: September 2023

Introduction

The WHO Surgical Safety Checklist (SSC) is a communication tool that improves teamwork and patient outcomes. SSC effectiveness is dependent on implementation fidelity. Administrative audits fail to capture most aspects of SSC implementation fidelity (ie, team communication and engagement). Existing research tools assess behaviours during checklist performance, but were not designed for routine quality assurance and improvement. We aimed to create a simple tool to assess SSC implementation fidelity, and to test its reliability using video simulations, and usability in clinical practice.

Methods

The Checklist Performance Observation for Improvement (CheckPOINT) tool underwent two rounds of face validity testing with surgical safety experts, clinicians and quality improvement specialists. Four categories were developed: checklist adherence, communication effectiveness, attitude and engagement. We created a 90 min training programme, and four trained raters independently scored 37 video simulations using the tool. We calculated intraclass correlation coefficients (ICC) to assess inter-rater reliability (ICC>0.75 indicating excellent reliability). We then trained two observers, who tested the tool in the operating room. We interviewed the observers to determine tool usability.

Results

The CheckPOINT tool had excellent inter-rater reliability across SSC phases. The ICC was 0.83 (95% CI 0.67 to 0.98) for the sign-in, 0.77 (95% CI 0.63 to 0.92) for the time-out and 0.79 (95% CI 0.59 to 0.99) for the sign-out. During field testing, observers reported CheckPOINT was easy to use. In 98 operating room observations, the total median (IQR) score was 25 (23–28), checklist adherence was 7 (6–7), communication effectiveness was 6 (6–7), attitude was 6 (6–7) and engagement was 6 (5–7).

Conclusions

CheckPOINT is a simple and reliable tool to assess SSC implementation fidelity and identify areas of focus for improvement efforts. Although CheckPOINT would benefit from further testing, it offers a low-resource alternative to existing research tools and captures elements of adherence and team behaviours.
Small numbers, big impact: making a utilitarian case for the contribution of inclusion health to population health in England
Authors: Zhang Claire X , Lewer Dan , Aldridge Robert W , Hayward Andrew C , Cornaglia Carlotta , Trussell Peta , Lillford-Wildman Charlotte , Castle Joanna , Gommon Jake , Campos-Matos Ines
Published: September 2023

Inclusion health groups make up a small proportion of the general population, so despite the extreme social exclusion and poor health outcomes that these groups experience, they are often overlooked in public health investment and policy development. In this paper, we demonstrate that a utilitarian argument can be made for investment in better support for inclusion health groups despite their small size. That is, by preventing social exclusion, there is the potential for large aggregate health benefits to the whole population. We illustrate this by reframing existing published mortality estimates into population attributable fractions to show that 12% of all-cause premature deaths (95% CI 10.03% to 14.29%) are attributable to the circumstances of people who experience homelessness, use drugs and/or have been in prison. We also show that a large proportion of cause-specific premature deaths in the general population can be attributed to specific inclusion health groups, such as 43% of deaths due to viral hepatitis (95% CI 30.35% to 56.61%) and nearly 4000 deaths due to cancer (3844, 95% CI 3438 to 4285) between 2013 and 2021 attributed to individuals who use illicit opioids. Considering the complexity of the inclusion health policy context and the sparseness of evidence, we discuss how a shift in policy framing from ‘inclusion health vs the rest of the population’ to ‘the impact of social exclusion on broader population health’ makes a better case for increased policy attention and investment in inclusion health. We discuss the strengths and limitations of this approach and how it can be applied to public health policy, resource prioritisation and future research.
Ectogenesis rescue case: a reply to Hendricks
Authors: Simkulet William
Published: September 2023

Hendricks set out to construct an antiabortion version of Jeff McMahan’s Embryo Rescue case in which you have two choices—(1) save a woman from an unwilling pregnancy or (2) save a fetus from being killed. In his Pregnancy Rescue case, he contends we ought to choose (2), which he thinks shows abortion is immoral. However, I argue the Pregnancy Rescue case is a false dilemma because you can save both. I propose an alternative, more elegant dilemma, the Ectogenesis Rescue case with the same choices (1) and (2). Hendricks also believes his case can serve as an antiabortion version of Thomson’s Violinist case, showing that abortion is immoral even if a fetus is not a person. However, while Thomson’s Violinist substitutes the fetus with a person, Hendricks fails to substitute the fetus with something that is not a person. I propose an alternative, the Snakebite Rescue case, which does this.
Single-lead arrhythmia detection through machine learning: cross-sectional evaluation of a novel algorithm using real-world data
Authors: Mitchell Henry , Rosario Nicole , Hernandez Carme , Lipsitz Stuart R , Levine David M
Published: September 2023

Background

Computer-assisted interpretation of single-lead ECG is the preliminary method for clinicians to flag and further evaluate an arrhythmia of clinical importance for acutely ill patients. Critical scrutiny of novel detection algorithms is lacking, particularly in external real-world data sets. This study’s objective was to evaluate a hybrid machine learning model’s ability to classify eight arrhythmias from a single-lead ECG signal from acutely ill patients.

Methods

This cross-sectional external retrospective evaluation of a previously trained hybrid machine learning model against an ECG reading team in the setting of home hospital care (acute care delivered at home substituting for traditional hospital care) draws from patients admitted at two hospitals in Boston, Massachusetts, USA between 12 June 2017 and 23 November 2019. We calculated classifier statistics for each arrhythmia, all arrhythmias and strips where the model identified normal sinus rhythm.

Results

The model analysed 2 680 162 min of single-lead ECG data from 423 patients and identified 691 478 arrhythmias. Patients had a mean age of 70 years (SD, 18), 60% were female and 45% were white. For any arrhythmia, the model had a sensitivity of 98%, a specificity of 100%, an accuracy of 98%, a positive predictive value of 100%, a negative predictive value of 93% and an F1Score of 99%. Performance was best for pause (F1Score, 99%) and worst for paroxysmal supraventricular tachycardia (F1Score, 92%). The model’s false positive rate for any arrhythmia was 0.2%, ranging from 0.4% for pause to 7.2% for paroxysmal supraventricular tachycardia. The false negative rate for any arrhythmia was 1.9%.

Conclusions

A hybrid machine learning model was effective at classifying common cardiac arrhythmias from a single-lead ECG in real-world data.
Investigating the effect of laser surface melting process parameters on thermal efficiency by reverse analysis and experimental design
Authors: Afshari Mahmoud , Khandaei Mehrdad , Razavi Reza Shoja , Barekat Seyed Masoud
Published: September 2023

In this paper, the effect of the process parameters such as laser power, shielding gas flow and scanning velocity on the actual laser power reaching the surface and thermal efficiency is investigated. For this purpose, the response surface methodology was used to investigate the effect of the process parameters at three levels. In order to measure the data from a 316L stainless steel, four k-type thermocouples are installed in different positions relative to the motion of the laser beam. The actual power was calculated by reverse analysis using the simulated annealing technique and the temperature history was measured by the thermocouples. The thermal model used is an optimized Rosenthal model, which is considered variable with temperature. The results show that for all thermocouples, the highest values of actual power that reached the surface were obtained at laser power of 200[Formula: see text]W, scanning velocity of 2[Formula: see text]mm/s and shielding gas flow of 30[Formula: see text]Lit/min. In addition, by increasing the laser power from 100 to 200[Formula: see text]W, the thermal efficiency decreases by about 4% to 12%. The thermal efficiency also decreases by about 8%, when the scanning velocity increased from 1 to 3[Formula: see text]mm/s. Moreover, the increase of the shielding gas flow from 25 to 35[Formula: see text]Lit/min initially improved the thermal efficiency and then decreased it. The models obtained from the analysis of variance in the heating cycle are in good agreement with the experimental results, but in the cooling cycle, the accuracy of this model decreases.
On the Frontline During the COVID-19 Pandemic: Gender Inequality and Experiences of Healthcare Workers in Pakistan
Authors: Haroon Rukhshan , Naeem Ayesha , Sajjad Priya Fatima , Uzmi Zartash Afzal
Published: September 2023

This mixed methods study investigates the experiences of healthcare workers (HCWs) along gender lines during the COVID-19 pandemic in Lahore, the second most populous city in Pakistan. In-person semi-structured interviews (
n
= 62) and researcher-administered surveys (
n
= 631) were conducted with doctors and nurses in five private and public hospitals. The findings reveal that male and female HCWs shared experiences related to increased working hours, psychological burdens, and adverse financial impacts. However, female HCWs struggled more than male HCWs, as their responsibilities at home and in the workplace increased. Additionally, more female HCWs than their male peers reported experiencing occupational stress due to transportation issues, working during pregnancy, and discriminatory attitudes of the patients toward them. Building on the results from our study, we propose several technological and policy initiatives that can be adopted by governments and organizations, especially in countries like Pakistan, where women account for most of the healthcare workforce but continue to bear a heavier burden when balancing work and family.
Exploring Structure Incentive Domain Adversarial Learning for Generalizable Sleep Stage Classification
Authors: Ma Shuo , Zhang Yingwei , Chen Yiqiang , Xie Tao , Song Shuchao , Jia Ziyu
Published: September 2023

Sleep stage classification is crucial for sleep state monitoring and health interventions. In accordance with the standards prescribed by the American Academy of Sleep Medicine, a sleep episode follows a specific structure comprising five distinctive sleep stages that collectively form a sleep cycle. Typically, this cycle repeats about five times, providing an insightful portrayal of the subject’s physiological attributes. The progress of deep learning and advanced domain generalization methods allows automatic and even adaptive sleep stage classification. However, applying models trained with visible subject data to invisible subject data remains challenging due to significant individual differences among subjects. Motivated by the periodic category-complete structure of sleep stage classification, we propose a Structure Incentive Domain Adversarial learning (SIDA) method that combines the sleep stage classification method with domain generalization to enable cross-subject sleep stage classification. SIDA includes individual domain discriminators for each sleep stage category to decouple subject dependence differences among different categories and fine-grained learning of domain-invariant features. Furthermore, SIDA directly connects the label classifier and domain discriminators to promote the training process. Experiments on three benchmark sleep stage classification datasets demonstrate that the proposed SIDA method outperforms other state-of-the-art sleep stage classification and domain generalization methods and achieves the best cross-subject sleep stage classification results.