bluuebunny/crossref_metadata_2025 huggingface dataset:
Health-related quality of life in epilepsy and its associated factors among adult patients with epilepsy attending Mizan Tepi University Teaching Hospital, Southwest Ethiopia: a cross-sectional study
Authors: Yesuf Wudu , Hiko Desta , Alemayehu Eshetu , Kusheta Samuel , Shita Abel , Beyene Melkamu
Published: January 2024

Objective

To determine the mean score of health-related quality of life in epilepsy and its associated factors among adult patients with epilepsy.

Design

Institution-based cross-sectional study based on random case selection was conducted.

Setting

The study was carried out at Mizan-Tepi University Teaching Hospital located in Southwest Ethiopia.

Participants

A total of 346 patients with epilepsy who visited the psychiatric clinic for follow-up for at least 3 months and who were 18 years or older were included in the study.

Main outcome measure

Health-related quality of life in epilepsy measured using quality-of-life in epilepsy (QOLIE)-31 health survey evaluated as a dependent variable with simple and multivariable linear regressions.

Results

The overall weighted mean score of health-related quality of life was 55.6 (SD=20.9). Only 50.3% of patients scored above a total score of 50. Age (β=−0.35, 95% CI−0.46 to –0.23), anxiety (β=−6.79, 95% CI −9.26 to –4.32), depression (β=−7.36, 95% CI −10.16 to –4.55), low self-esteem (β=−5.29, 95% CI −8.07 to –2.51), perceived stigma (β=−3.62, 95% CI −6.30 to –0.94), taking medication two times or more times per day (β=−2.4, 95% CI −4.58 to –0.27), being illiterate (β=−4.1, 95% CI −6.87 to –1.31) and having more than two seizures for a year (β=−4.18, 95% CI −6.97 to –1.39) were negatively affecting health-related quality of life while income of >1000 birr per month (β=4.5, 95% CI 2.00 to 6.99), social support (β=0.34, 95% CI 0.27 to 0.40) and being free of seizure for a year (β=6.5, 95% CI 3.66 to 9.33) were positively affecting health-related quality of life.

Conclusions

Only half of the patients with epilepsy in the study area are leading a better quality of life and the overall mean health-related quality of life score is lower than the global mean score. Health-related quality of life was inversely associated with age, anxiety, depression, low self-esteem, perceived stigma, taking medication two times a day or more, being illiterate and experiencing more than two seizures in a year. Besides controlling seizures, public educational campaigns should be conducted to raise public awareness regarding the need for social support.
Association of carotid intima–media thickness and dyslipidaemia in patients with type 2 diabetes: a protocol for systematic review and meta-analysis
Authors: Mashaba Reneilwe Given , Phoswa Wendy , Maimela Eric , Mokgalaboni Kabelo
Published: January 2024

Introduction

Patients with diabetes mellitus (DM) often present with comorbidities such as hypertension, dyslipidaemia, insulin resistance, obesity and hyperglycaemia, which increases their risk of cardiovascular diseases (CVDs)-related mortality. Carotid intima–media thickness (CIMT), a biomarker for subclinical atherosclerosis, has been associated with overall CVD, especially in type 2 DM (T2DM). Hence, this protocol for systematic review and meta-analysis aims to review existing literature on the association of CIMT and dyslipidaemia in patients with T2DM.

Methods and analysis

The proposed systematic review and meta-analysis will be conducted according to an updated Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols guideline. A comprehensive search of peer-reviewed studies on Google Scholar, PubMed, Science Direct and Web of Sciences databases will be conducted up to 30 June 2023. A meta-analysis of data extracted from selected studies will be performed to explore the association between dyslipidaemia and CIMT in patients with diabetes. The effect estimates will be reported as standardised mean differences/Cohen’s d and 95% CIs. A random effect model will be used in case of high heterogeneity whereas fixed-effect model will be used in the absence of heterogeneity. All statistical analysis will be performed using SPSS V.29.0 software. In cases of high heterogeneity, subgroup analysis will be performed based on study design, countries of publication and body mass index to identify potential sources of heterogeneity. Publication bias will be assessed graphically via funnel plots and statistically using Egger’s regression test. Sensitivity analysis will also be performed to evaluate the stability of the overall effect size and the grading of recommendations assessment, development and evaluation will be used to grade the quality of analysed evidence.

Ethics and dissemination

As the proposed study will use secondary published data, approval will not be sought from the ethics committee.

PROSPERO registration number

CRD42023451731.
Upskilling programmes for unregulated care providers to provide diabetic foot screening for systematically marginalised populations: how, why and in what contexts do they work? A realist review
Authors: Hassan Samah , Rac Valeria E , Hodges Brian , Leake Patti , Cobbing Saul , Gray Catharine Marie , Bartley Nicola , Etherington Andrea , Abdulwasi Munira , Cheung Hei-Ching Kristy , Anderson Melanie , Woods Nicole N
Published: January 2024

Objective

We aimed to understand how, why and in what context upskilling programmes for unregulated care providers (UCPs) to provide foot screening for systematically marginalised groups living with diabetes were implemented.

Design

We used realist synthesis based on Realist And Meta-narrative Evidence Syntheses: Evolving Standards guidance.

Data sources

We searched the Medline, Embase, PsycINFO, CINAHL, ERIC, Web of Science Core Collection, and Scopus databases and the grey literature (Google Scholar, ProQuest Dissertations and Theses) up to November 2022.

Eligibility criteria

We included experimental and non-experimental articles in English that either described mechanisms or discussed expected outcomes for educational interventions for patients and family caregivers or healthcare providers, both regulated and unregulated. We also included articles that evaluated the impact of foot care programmes if the UCPs’ training was described.

Data extraction and synthesis

The lead author extracted, annotated and coded uploaded relevant data to identify contexts, mechanisms and outcome configurations using MAXQDA (a qualitative data analysis software). We used deductive and inductive coding to structure the process. Our team members double-reviewed and appraised a random sample of 20% of articles at all stages to ensure consistency.

Results

Our search identified 52 articles. Evidence suggested the necessity of developing upskilling foot screening programmes within the context of preventive care programmes that also provide education in diabetes, and early referrals for appropriate interventions. Multidisciplinary programmes created an ideal context facilitating coordination between UCPs and their regulated counterparts. Engaging patients and community partners, using a competency-based model, and incorporating cultural competencies were determinants of success for these programmes.

Conclusion

This review provides a realistic programme theory for the mechanisms used, the context in which these programmes were developed, and the expected outcomes to train UCPs to provide preventive foot care for systematically marginalised populations.

PROSPERO registration number

CRD42022369208.
NKG2A+CD8+T cells infiltration determines immunosuppressive contexture and inferior response to immunotherapy in clear cell renal cell carcinoma
Authors: Qiu Youqi , Liu Li , Jiang Wenbin , Xu Ziyang , Wang Jiahao , Dai Siyuan , Guo Jianming , Xu Jiejie
Published: January 2024

Background

Immunotherapy is gaining momentum, but current treatments have limitations in terms of beneficiaries. Clear cell renal cell carcinoma (ccRCC) harbors the highest expression of human leukocyte antigen E (HLA-E), ligand of NKG2A, among all solid tumors. In this study, we aim to investigate the role of NKG2A+CD8+T cells in tumor microenvironment and its potential as a novel target in ccRCC.

Methods

This study included four independent cohorts, including 234 patients from Zhongshan cohort (ZSHC) who underwent partial or radical nephrectomy at Zhongshan Hospital, and 117 metastatic patients from metastatic Zhongshan cohort (ZSHC-metastatic renal cell carcinoma) who were treated with immune checkpoint inhibitor or tyrosine kinase inhibitor alone. We also incorporated a cohort of 530 patients diagnosed with ccRCC from The Cancer Genome Atlas (referred to as TCGA-kidney renal clear cell carcinoma) and 311 patients from CheckMate cohort for bioinformatics exploration and hypothesis validation. Fresh surgical specimens from 15 patients who underwent ccRCC surgery at Zhongshan Hospital were collected for flow cytometry analysis. Another 10 fresh surgical specimens were used to investigate the therapeutic potential of NKG2A blockade after in vitro intervention. The infiltration of NKG2A+CD8+T cells was assessed using immunohistochemical staining, flow cytometry, and immunofluorescence staining in ZSHC cohort.

Results

Patients with higher infiltration of NKG2A+CD8+T cells in ccRCC exhibited shorter overall survival and resistance to immunotherapy. NKG2A+CD8+T cells expressed upregulated checkpoint molecules and displayed impaired effector functions, along with tissue-residency characteristics. Combination of programmed cell death protein-1 (PD-1) blockade and NKG2A blockade demonstrated an enhanced capability in reactivating CD8+T cells effector functions.

Conclusion

Intense infiltration of NKG2A+CD8+T cells were associated with poorer prognosis and response to immunotherapy. NKG2A blockade combined with current immunotherapy exhibited a robust ability to reactivate CD8+T cells effector functions.
Dynamic study of new soliton solutions of time-fractional longitudinal wave equation using an analytical approach
Authors: Naz Shumaila , Rani Attia , Ul Hassan Qazi Mahmood , Ahmad Jamshad , -Rehman Shafqat-Ur , Shakeel Muhammad
Published: January 2024

In this study, the modified exponential approach is used to investigate the fractional order longitudinal wave equation in a magneto-elastic circular rod, which represents the nonlinear interplay between dispersion and longitudinal wave velocity depending on the rod’s material and geometry. The time-fractional order is used in the standpoint of conformable derivative. Comprehensive and descriptive waveform solutions, including kink-shaped, bell-shaped, and bright bell-shaped solitons, are obtained. The produced soliton solutions are advanced, unique, developed, and crucial. To demonstrate the physical appearance of the obtained solutions, 2D, 3D, and contour graphs of some of the obtained solutions are plotted. The extracted solutions demonstrate the physical significance of the model and express the pressure and electrostatic potential for the longitudinal wave equation and can be used to elucidate more complicated nonlinear models of classical and fractional order. The obtained results are helpful in finding the amplitude of tsunami waves which is of great interest to researchers in the field of ocean engineering. If a tsunami extends across a large area, it becomes a manifestation of solitons. The comparison of the obtained solutions is also given in the form of remarks 1 and 2 which shows the novelty of our work.
Energies and radiative properties of 1s22l2l′ and 1s(2l)22l′ levels in tungsten ion, W70+
Authors: El-Maaref A. A. , Ezzeldien Mohammed , Hasaneen M. F.
Published: January 2024

Multiconfiguration Dirac–Hartree–Fock (MCDHF) calculations of energy levels, oscillator strengths and transition rates of open K-shell transitions in beryllium-like tungsten ion, W[Formula: see text], are performed using the fully relativistic GRASP2018 code. For only principal quantum number [Formula: see text], energy levels of 1[Formula: see text] 2[Formula: see text], 1[Formula: see text]2[Formula: see text], 1[Formula: see text]2[Formula: see text], 1[Formula: see text]2p, 1[Formula: see text] and 1[Formula: see text] at different angular momenta and parity ([Formula: see text] are presented. Excitations of up to four electrons from the ground level, 1[Formula: see text] 2[Formula: see text], to excited levels are allowed. Correlations up to 5l orbitals are included in the configuration state function (CSF), [Formula: see text], p, d, f and g. The fine-structure calculations of E1, E2, M1 and M2 oscillator strengths and radiative rates between intercombination transitions in W[Formula: see text] ions are evaluated. The accuracy of these results is estimated using different ways, such as the comparison with previously published results and calculating the uncertainty of the transition data. The uncertainty of the transition probabilities showed low values for most of transitions.
APPLICATION OF VARIATIONAL PRINCIPLE AND FRACTAL COMPLEX TRANSFORMATION TO (3+1)-DIMENSIONAL FRACTAL POTENTIAL-YTSF EQUATION
Authors: LU JUNFENG
Published: January 2024

This paper focuses on the numerical investigation of the fractal modification of the (3+1)-dimensional potential-Yu–Toda–Sasa–Fukuyama (YTSF) equation. A variational approach based on the two-scale fractal complex transformation and the variational principle is presented for solving this fractal equation. The fractal potential-YTSF equation can be transformed as the original potential-YTSF equation by means of the fractal complex transformation. Some fractal soliton-type solutions and fractal periodic wave solutions are provided by using the variational principle proposed by He, which are not touched in the existing literature. Some remarks about the variational formulation and the wave solutions for the original potential-YTSF equation by Manafian et al. [East Asian J. Appl. Math. 10(3) (2020) 549–565] are also given. Numerical results of the fractal wave solutions with different fractal dimensions and amplitudes are presented to show the propagation behavior.
Handling Massive Sparse Data in Recommendation Systems
Authors: Chetana V. Lakshmi , Seetha Hari
Published: January 2024

Collaborative filtering-based recommendation systems have become significant in various domains due to their ability to provide personalised recommendations. In e-commerce, these systems analyse the browsing history and purchase patterns of users to recommend items. In the entertainment industry, collaborative filtering helps platforms like Netflix and Spotify recommend movies, shows and songs based on users’ past preferences and ratings. This technology also finds significance in online education, where it assists in suggesting relevant courses and learning materials based on a user’s interests and previous learning behaviour. Even though much research has been done in this domain, the problems of sparsity and scalability in collaborative filtering still exist. Data sparsity refers to too few preferences of users on items, and hence it would be difficult to understand users’ preferences. Recommendation systems must keep users engaged with fast responses, and hence there is a challenge in handling large data as these days it is growing quickly. Sparsity affects the recommendation accuracy, while scalability influences the complexity of processing the recommendations. The motivation behind the paper is to design an efficient algorithm to address the sparsity and scalability problems, which in turn provide a better user experience and increased user satisfaction. This paper proposes two separate, novel approaches that deal with both problems. In the first approach, an improved autoencoder is used to address sparsity, and later, its outcome is processed in a parallel and distributed manner using a MapReduce-based [Formula: see text]-means clustering algorithm with the Elbow method. Since the [Formula: see text]-means clustering technique uses a predetermined number of clusters, it may not improve accuracy. So, the elbow method identifies the optimal number of clusters for the [Formula: see text]-means algorithm. In the second approach, a MapReduce-based Gaussian Mixture Model (GMM) with Expectation-Maximization (EM) is proposed to handle large volumes of sparse data. Both the proposed algorithms are implemented using MovieLens 20M and Netflix movie recommendation datasets to generate movie recommendations and are compared with the other state-of-the-art approaches. For comparison, metrics like RMSE, MAE, precision, recall, and F-score are used. The outcomes demonstrate that the second proposed strategy outperformed state-of-the-art approaches.
LEADING MODES AND FEATURE ZONES OF SEA ICE CONCENTRATION IN NORTH PACIFIC DURING SPRING SEASONS OF 2000–2020
Authors: XU LI , CRABBE M. JAMES C.
Published: January 2024

Under the influence of the Arctic amplification, sea ice variability in North Pacific is becoming a key indicator of global climate changes. Due to the widespread and complex impacts of North Pacific sea ice variations, the understanding of its dynamic changes, especially its spatial and temporal evolution patterns, has great significance. In this study, we used the rotated empirical orthogonal decomposition to divide the whole North Pacific into six feature zones on the evolution sea ice concentration under the recent global warming and highlighted the complexity and diversity of sea ice variations in the offshore waters.
SecEG: A Secure and Efficient Strategy against DDoS Attacks in Mobile Edge Computing
Authors: Huang Haiyang , Meng Tianhui , Guo Jianxiong , Wei Xuekai , Jia Weijia
Published: January 2024

Application-layer distributed denial-of-service (DDoS) attacks incapacitate systems by using up their resources, causing service interruptions, financial losses, and more. Consequently, advanced deep-learning techniques are used to detect and mitigate these attacks in cloud infrastructures. However, in mobile edge computing (MEC), it becomes economically impractical to equip each node with defensive resources, as these resources may largely remain unused in edge devices. Furthermore, current methods are mainly concentrated on improving the accuracy of DDoS attack detection and saving CPU resources, neglecting the effective allocation of computational power for benign tasks under DDoS attacks. To address these issues, this paper introduces SecEG, a secure and efficient strategy against DDoS attacks for MEC that integrates container-based task isolation with lightweight online anomaly detection on edge nodes. More specifically, a new model is proposed to analyze resource contention dynamics between DDoS attacks and benign tasks. Subsequently, by employing periodic packet sampling and real-time attack intensity predicting, an autoencoder-based method is proposed to detect DDoS attacks. We leverage an efficient scheduling method to optimize the edge resource allocation and the service quality for benign users during DDoS attacks. When executed in the real-world edge environment, our experimental findings validate the efficacy of the proposed SecEG strategy. Compared to conventional methods, the service rate of benign requests increases by 23% under intense DDoS attacks, and the CPU resource is saved up to 35%.
AI-assisted Blockchain-enabled Smart and Secure E-prescription Management Framework
Authors: Sai Siva , Chamola Vinay
Published: January 2024

Traditional medical prescriptions based on physical paper-based documents are prone to manipulation, errors, and unauthorized reproduction due to their format. Addressing the limitations of the traditional prescription system, e-prescription systems have been introduced in several countries. However, e-prescription systems lead to several concerns like the risk of privacy loss, the problem of double-spending prescriptions, lack of interoperability, and single point of failure, all of which need to be addressed immediately. We propose an AI-assisted blockchain-enabled smart and secure e-prescription management framework to address these issues. Our proposed system overcomes the problems of the centralized e-prescription systems and enables efficient consent management to access prescriptions by incorporating blockchain-based smart contracts. Our work incorporates the Umbral proxy re-encryption scheme in the proposed system, avoiding the need for repeated encryption and decryption of the prescriptions when transferred between different entities in the network. In our work, we employ two different machine learning models(Random Forest classifier and LightGBM classifier) to assist the doctor in prescribing medicines. One is a drug recommendation model, which is aimed at providing drug recommendations considering the medical history of the patients and the general prescription pattern for the particular ailment of the patient. We have fine-tuned the SciBERT model for adverse drug reaction detection. The extensive experimentation and results show that the proposed e-prescription framework is secure, scalable, and interoperable. Further, the proposed machine learning models produce results higher than 95%.
NeuralVDB: High-resolution Sparse Volume Representation using Hierarchical Neural Networks
Authors: Kim Doyub , Lee Minjae , Museth Ken
Published: January 2024

We introduce NeuralVDB, which improves on an existing industry standard for efficient storage of sparse volumetric data, denoted VDB [Museth2013], by leveraging recent advancements in machine learning. Our novel hybrid data structure can reduce the memory footprints of VDB volumes by orders of magnitude, while maintaining its flexibility and only incurring small (user-controlled) compression errors. Specifically, NeuralVDB replaces the lower nodes of a shallow and wide VDB tree structure with multiple hierarchical neural networks that separately encode topology and value information by means of neural classifiers and regressors respectively. This approach is proven to maximize the compression ratio while maintaining the spatial adaptivity offered by the higher-level VDB data structure. For sparse signed distance fields and density volumes, we have observed compression ratios on the order of 10× to more than 100× from already compressed VDB inputs, with little to no visual artifacts. Furthermore, NeuralVDB is shown to offer more effective compression performance compared to other neural representations such as Neural Geometric Level of Detail [Takikawa et al.2021], Variable Bitrate Neural Fields [Takikawa et al.2022a], and Instant Neural Graphics Primitives [Müller et al.2022]. Finally, we demonstrate how warm-starting from previous frames can accelerate training, i.e., compression, of animated volumes as well as improve temporal coherency of model inference, i.e., decompression.
Holistic Energy Awareness and Robustness for Intelligent Drones
Authors: Saxena Ravi Raj , Pal Joydeep , Iyengar Srinivasan , Chhaglani Bhawana , Ghosh Anurag , Padmanabhan Venkata N. , Venkata Prabhakar T.
Published: January 2024

Drones represent a significant technological shift at the convergence of on-demand cyber-physical systems and edge intelligence. However, realizing their full potential necessitates managing the limited energy resources carefully. Prior work looks at factors such as battery characteristics, intelligent edge sensing considerations, planning, and robustness in isolation. But a global view of energy awareness that considers these factors and looks at various tradeoffs is essential. To this end, we present results from our detailed empirical study of battery charge-discharge characteristics and the impact of altitude and lighting on edge inference accuracy. Our energy models, derived from these observations, predict energy usage while performing various manoeuvres with an error of 5.6%, a 2.5X improvement over the state-of-the-art. Furthermore, we propose a holistic energy-aware multi-drone scheduling system that decreases the energy consumed by 21.14% and the mission times by 46.91% over state-of-the-art baselines. To achieve system robustness in the event of link or drone failure, we observe trends in Packet Delivery Ratio to propose a methodology to establish reliable communication between nodes. We release an open-source implementation of our system. Finally, we tie all of these pieces together using a people-counting case study.
Knowledge, Attitude, and Practices on Food Safety among Food Handlers Working in Public Food Service Establishments in Lemi Kura Subcity, Addis Ababa, Ethiopia
Authors: Fekadu Yordanos , Kinde Mebrie Zemene , Dagnaw Gashaw Getaneh , Dessalegn Bereket , Dejene Haileyesus , Gessese Abebe Tesfaye
Published: January 2024

Foodborne diseases, resulting from poor food handling and sanitation practices, are common public health problems globally. The primary contributing factors to potential foodborne disease outbreaks are often attributed to the poor perception and practices of food handlers regarding food safety. This study is aimed at assessing the knowledge, attitude, and practices of food handlers working in public food service establishments in Lemi Kura subcity, Addis Ababa, Ethiopia. A cross-sectional study was conducted from December 2022 to September 2023, involving 400 food handlers from 20 randomly selected public food service establishments. Data were collected using a structured interview-administered questionnaire and an observational checklist. The collected data were entered into Microsoft Excel and then transferred to SPSS version 20 for analysis. Descriptive statistics were employed to summarize the data, and Pearson’s chi-square test was used to evaluate the association of sociodemographic factors with the knowledge, attitude, and practices of food handlers towards food safety. Of the 400 food handlers, 65.5% had good knowledge about food safety. All food handlers were knowledgeable that washing hand before handling food will reduce risk of poisoning, bacteria are the main cause of food poisoning, and temperature plays a big role in bacterial growth. This study also revealed that 65.3% of the food handlers had good attitude towards food safety and 55.3% of food handlers had good food handling practice. Based on the observation, 38.5% of food handlers had good food handling practice. Taking training, age, and work experience of food handlers have statistically significant (P<0.05) association with good attitude towards food safety. Additionally, taking training, educational level, employment, and work experience of food handlers have statistically significant (P<0.05) association with good practice towards food safety. However, there was no statistically significant association between all sociodemographic factors and knowledge about food safety. Good knowledge and attitude were also associated with good food handling practices of the respondents. Based on the observation, there was a statistically significant association between employment status and good food handling practice. In conclusion, the findings suggest the necessity for implementing formal educational and training programs aimed at positively influencing the knowledge and attitude of food handlers, subsequently improving their food handling practices.
Automatic Outer Contour Detection and Quantification of Vehicles Using Monocular Vision
Authors: Han Dayong , Zhang Chaodong , Wang Liang , Xu Xianglong , Liu Yingkai
Published: January 2024

Oversized vehicles have the potential to collide with walls or ceilings when passing through tunnels and bridges, posing a serious threat to the health of transportation infrastructure and public safety. Hence, it is crucial to accurately and immediately detect vehicle dimensions, including length, width, and height, to avoid such accidents. Using computer vision and view geometry, this study presents a framework for automatically detecting and quantifying the outer contours of vehicles through monocular vision. First, traffic scene images are captured which are then used to create a transformation matrix of the ground surface. Second, a modified Mask region‐based convolutional neural network (Mask R‐CNN) is constructed to detect and segment the vehicle instances from the video frames. Finally, a view geometry‐based algorithm was developed to detect the outer contours of passing vehicles and quantify their dimensions. In the field test, the accuracy of the vehicle segmentation and the identified vehicle dimensions was validated. In addition, the proposed method’s superiority was confirmed by comparing it with two other existing approaches. The comparison results show that the proposed method has better accuracy and is more convenient to use since it does not require a premeasured reference. In addition, the developed method can accurately identify not only the dimensions of vehicles parallel to the road but also vehicles that are changing lanes or making a U‐turn.
Trichinella spp. in Slaughtered Pigs of India: From Neglected Disease to an Emerging Food Safety Threat for Public Health
Authors: Kalambhe Deepali Gopal , Kaur Harpreet , Gill Jatinder Paul Singh
Published: January 2024

Background. In India, Trichinella nematode worm remains highly neglected due to the paucity of research. Recent trichinellosis outbreaks in humans associated with pork meal in north India have highlighted an emerging food safety concern due to this neglected parasite. Aim. This study aimed to ascertain the existence of Trichinella species and to identify them in slaughtered pigs intended for human consumption in the Punjab and Uttaranchal regions of North India. Materials and Methods. A total of 1,194 slaughter pig tongue samples were screened in 239 pools using the double separatory funnel method for recovery of Trichinella larvae. The species of recovered larvae were confirmed by multiplex PCR assay and sequencing. A phylogenetic tree was constructed to ascertain the closest lineage. Results. This study reported 3.77% and 1.26% Trichinella positivity in pooled and individual pig samples, respectively. Pigs slaughtered in Punjab reported higher positivity (1.73%) than pigs in Uttaranchal (0.81%). Among all places, Jalandhar recorded highest positivity of 5.66%, followed by 2.22% in Nainital and 0.8% in Patiala, whereas none of the pig samples from Chandigarh, Ludhiana, Bathinda, Tehri Garhwal, Pauri Garhwal, Kashipur, Haridwar was positive. Molecular confirmation by PCR and sequencing confirmed the recovered Trichinella larvae as T. britovi and T. nelsoni. Conclusion. Trichinella parasite remained highly neglected in India; however, the detection of sylvatic Trichinella species in pigs intended for human consumption indicated the emergence of zoonotic foodborne risk at wild animal‐domestic pig and human interfaces. To the best of our knowledge, this is the first study reporting T. britovi and T. nelsoni in pigs of North India. Trichinella positivity in slaughtered pigs is an early alarm for the emergence of foodborne risk from this neglected parasitic worm. Considering the importance of pigs as a source of meat and their role as a reservoir for Trichinella raised the food safety concern that warrants strict meat inspection and extensive studies on neglected parasites in India.
TABLE 1 from Associations Between Serum Iron Biomarkers and Breast Cancer Tumor Size
Authors: Von Holle Ann , Thompson Rachel L. , O'Brien Katie M. , Sandler Dale P. , Weinberg Clarice R.
Published: January 2024

Sample characteristicsa
Supplemental Table 4 from Associations Between Serum Iron Biomarkers and Breast Cancer Tumor Size
Authors: Von Holle Ann , Thompson Rachel L. , O'Brien Katie M. , Sandler Dale P. , Weinberg Clarice R.
Published: January 2024

Supplemental Table 4: Comparison of baseline iron values by breast cancer stage
Supplemental Table 2 from Associations Between Serum Iron Biomarkers and Breast Cancer Tumor Size
Authors: Von Holle Ann , Thompson Rachel L. , O'Brien Katie M. , Sandler Dale P. , Weinberg Clarice R.
Published: January 2024

Supplemental Table 2: Linear slope estimates for largest tumor sizea by iron measure and tumor subtype
Magnesium Decreases Urine Supersaturation but Not Calcium Oxalate Stone Formation in Genetic Hypercalciuric Stone-Forming Rats
Authors: Li Qiaoli , Krieger Nancy S. , Yang Lee , Asplin John , Bushinsky David A.
Published: January 2024

Background/Aims: Hypercalciuria is the most common identifiable risk factor predisposing to CaOx stone formation. Increased oral magnesium intake may lead to decreased CaOx stone formation by binding intestinal Ox leading to decreased absorption and/or binding urinary Ox to decrease urinary supersaturation. This study assessed the effect of oral magnesium on 24-h urine ion excretion, supersaturation, and kidney stone formation in a genetic hypercalciuric stone-forming (GHS) rat model of human idiopathic hypercalciuria. Methods: When fed the oxalate precursor, hydroxyproline, every GHS rat develops CaOx stones. The GHS rats, fed a normal calcium and phosphorus diet supplemented with hydroxyproline to induce CaOx, were divided into three groups of ten rats per group: control diet with 4.0 g/kg MgO, low MgO diet (0.5 g/kg), and high MgO diet (8 g/kg). At 6 weeks, 24-h urines were collected, and urine chemistry and supersaturation were determined. Stone formation was quantified. Results: The GHS rats fed the low and high Mg diets had a significant reduction and increase, respectively, in urinary Mg compared to those fed the control diet. Dietary Mg did not alter urine Ca excretion while the low Mg diet led to a significant fall in urinary Ox. Urine supersaturation with respect to CaOx was significantly increased with low Mg, whereas urine supersaturation was significantly decreased with high Mg. There was no effect of dietary Mg on stone formation within 6 weeks of treatment. Conclusion: Dietary magnesium decreases urine supersaturation but not CaOx stone formation in GHS rats.
In vitro Removal of Protein-Bound Retention Solutes by Extracorporeal Blood Purification Procedures
Authors: Schildboeck Claudia , Harm Stephan , Hartmann Jens
Published: January 2024

Introduction: When the kidneys or liver fail, toxic metabolites accumulate in the patient's blood, causing cardiovascular and neurotoxic complications and increased mortality. Conventional membrane-based extracorporeal blood purification procedures cannot remove these toxins efficiently. The aim of this in vitro study was to determine whether commercial hemoperfusion adsorbers are suitable for removing protein-bound retention solutes from human plasma and whole blood as well as to compare the removal to conventional hemodialysis. Methods: For in vitro testing of the removal of protein-bound substances, whole blood and plasma were spiked with uremic retention solutes (homocysteine, hippuric acid, indoxyl sulfate, 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid) and the toxins of liver failure (bilirubin, cholic acid, tryptophan, phenol). Subsequently, the protein binding of each retention solute was determined. The adsorption characteristics of the hemoperfusion adsorbers, Jafron HA and Biosky MG, both approved for the adsorption of protein-bound uremic retention solutes and Cytosorb, an adsorber recommended for adsorption of cytokines, were tested by incubating them in spiked whole blood or plasma for 1 h. Subsequently, the adsorption characteristics of the adsorbers were tested in a dynamic system. For this purpose, a 6-h in vitro hemoperfusion treatment was compared with an equally long in vitro hemodialysis treatment. Results: Hippuric acid, homocysteine, indoxyl sulfate, and tryptophan were most effectively removed by hemodialysis. Bilirubin and cholic acid were removed best by hemoperfusion with Cytosorb. A treatment with Jafron HA and Biosky MG showed similar results for the adsorption of the tested retention solutes and were best for removing phenol. 3-Carboxy-4-methyl-5-propyl-2-furanpropionic acid could not be removed with any treatment method. Discussion/Conclusion: A combination of hemodialysis with hemoperfusion seems promising to improve the removal of some toxic metabolites in extracorporeal therapies. However, some very strongly protein-bound metabolites cannot be removed adequately with the adsorbers tested.
GLI-12 Reference Values versus Fixed 0.7 Ratio for the Detection of Airflow Obstruction in the Presence of Lung Hyperinflation
Authors: Wahab Lora , Cornelissen Christian G. , Windisch Wolfram , Dreher Michael
Published: January 2024

Introduction: Airflow obstruction (AO) is evidenced by reduced forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) with the threshold for diagnosis often being set at <0.7. However, currently the ATS/ERS standards for interpretation of lung function tests recommend the lower limit of normal (LLN), calculated by reference equations of the Global Lung Initiative from 2012 (GLI-12), as a threshold for AO diagnosis. The present study aims to investigate phenotypes, with focus on hyperinflation, which influence AO prevalence defined by FEV1/FVC < LLN when compared to the fixed 0.7 threshold. Methods: Data from 3,875 lung function tests (56.4% men, aged 18–95) including 3,824 body plethysmography recordings performed from July 2021 to June 2022 were analysed. The difference between both classifiers was quantified, before and after stratification by sex, age, and hyperinflation. Results: AO diagnosis was significantly less frequent with the LLN threshold (18.2%) compared to the fixed threshold (28.0%) (p < 0.001) with discordance rate of 10.5%. In the presence of mild or moderate hyperinflation, there was substantial agreement (Cohen’s kappa: 0.616, 0.718) between the classifiers compared to near perfect agreement in the presence of severe hyperinflation (Cohen’s kappa: 0.896). In addition, subgroup analysis after stratification for sex, age, and hyperinflation showed significant differences between both classifiers. Conclusion: The importance of using the LLN threshold instead of the fixed 0.7 threshold for the diagnosis of AO is highlighted. When using the fixed threshold AO, misdiagnosis was more common in the presence of mild to moderate hyperinflation.
Differentiating ischemic optic neuropathy from glaucoma using diagnostic tests
Authors: Smeets Frédéric , Margot Astrid , Barbosa-Breda João , Stalmans Ingeborg , Lemmens Sophie
Published: January 2024

Introduction: Anterior ischemic optic neuropathy (AION) can mimic glaucoma and consequently cause difficulties in differential diagnosis. The purpose of this paper is to summarize differences in diagnostic tests that can help perform a correct diagnosis.
Methods: The search strategy was performed according to the PRISMA 2009 guidelines and four databases were used: Medline, Embase, Web of Science and Cochrane. 772 references were eligible; 39 were included after screening with respect to inclusion criteria that included English language and published in the 20 years before search date.
Results: Ninety percent (n=35) of included studies used optical coherence tomography (OCT). Glaucomatous eyes had a significantly greater cup area, volume and depth, cup-to-disc ratio, and a lower rim volume and area, and a thinner Bruch’s Membrane opening-minimum rim width. Retinal nerve fibre layer (RNFL) thinning in glaucomatous eyes occurred primarily at the superotemporal, inferotemporal and inferonasal sectors, while AION eyes demonstrated mostly superonasal thinning. Glaucoma eyes showed greater macular ganglion cell layer thickness, except at the inferotemporal sector. OCT-angiography measurements demonstrated a significant decrease in superficial and deep macular vessel density (VD) in glaucoma compared to AION with similar degree of visual field (VF) damage; and the parapapillary choroidal VD was spared in AION eyes compared to glaucomatous eyes.
Conclusion: By use of OCT imaging, optic nerve head (ONH) parameters seem most informative to distinguish between glaucoma and AION. Although both diseases affect the RNFL thickness, it seems to do so in different sectors. Differences in structure and vascularity of the macula can also help in making the differential diagnosis.
Exploring the Relationship between Liver Disease, Bacterial Translocation, and Dysbiosis: Unveiling the Gut-Liver Axis
Authors: Juanola Oriol , Francés Rubén , Caparrós Esther
Published: January 2024

Background: The global burden of liver disease and cirrhosis has been progressively increasing in the last decade. The interplay between gut microbiota and immune system and the bidirectional relationship with the liver, known as the gut-liver axis, has arisen as a fundamental aspect of liver disease. Summary: Alterations of the gut microbiome have been described and include both dysbiotic microbial signatures and intestinal bacterial overgrowth. The integrity of the intestinal epithelial barrier is essential for preventing the access of harmful substances and bacterial products into the host. Bacterial translocation due to altered host-microbiota interactions triggers local immune cell activation and facilitates a chronic inflammatory state that can ultimately lead to immune exhaustion, characteristic of cirrhosis. In cirrhosis, breakdown of the gut vascular barrier allows access of bacterial products to portal blood circulation and facilitates their influx into the liver, further contributing to disease progression. Key Messages: A better understanding of the contributing factors to pathological bacterial translocation and the impact of dysbiosis in liver disease will lead to achieve innovative therapeutic strategies in cirrhosis.
Two Decades of Stroke in the United States: A Healthcare Economic Perspective
Authors: Lorio Alexis , Garcia-Rodriguez Carlos , Seifi Ali
Published: January 2024

Introduction: Stroke is a leading cause of morbidity and mortality in the USA and has implications on the financial health of patients, families, and healthcare systems. The objective of this study aimed to determine the economic perspective of stroke on the national healthcare system for the past 2 decades. Methods: This retrospective study of inpatient subjects from 2000 to 2020 with stroke was collected from the Healthcare Cost and Utilization Project (HCUP). We queried patients admitted primarily for ischemic or hemorrhagic stroke. Patients were evaluated for demographics, length of stay (LOS), mortality, and hospital charges. Statistical Z-testing with a significance of p < 0.05 was conducted for the analysis. Results: During the study period, 12,158,747 stroke subjects were studied, with 51.9% female and a mean age of 70.08 (±0.16) years old. The mean rate of stroke discharges per 100,000 persons was 187.71 (±3.44), decreasing from 200 to 193 during the study (p = 0.16). The mean percentage of deaths was 8.78% (±0.17), which decreased from 10.96% to 6.81% (p = 0.00). The mean LOS was 6.28 days (±0.08), which increased from 6.70 to 7.15 (p = 0.00). During the study period, the aggregated national bill was USD 725 billion. The mean hospital charges per patient were USD 57,178 (±1,504), increasing from USD 19,647 to USD 121,765 per person during the study period (p = 0.00), while mean hospital costs per stay were USD 15,781 (±330). These data closely conform to an exponential growth pattern, and forecasting per patient charges for the next 10 years demonstrates a cost of USD 287,836 by 2030. Conclusions: Our data show that the rate and mortality of stroke have decreased, but its charges and costs are increasing. The improvement in outcomes could be multifactorial such as establishment of comprehensive stroke centers and evolving treatment modalities. Ironically, the charges per patient increased more than sixfold with a national bill almost equal to the annual Medicare budget. Thus, the significance of preventive medicine, such as controlling hypertension, diabetes, and smoking cessation, cannot be understated. With such a dramatically increasing financial burden, improvements in mitigating risk factors, educational programs, and access to care may be a more cost-effective option.
Excision and Reconstruction of Atypical Chest Dermatofibrosarcoma Protuberans Tumor: A Case Report and Literature Review
Authors: Ahmed Mohamed Badie , Al-Mohannadi Fatima Saoud , Ahmed Abdelrahman Badie , Althalathini Mahmoud , Alsherawi Abeer
Published: January 2024

Introduction: Dermatofibrosarcoma protuberans (DFSP) originated as keloid sarcoma, gaining its current designation in 1925. DFSP exhibits slow growth, categorizing it as a low- to intermediate-grade malignant sarcoma. Initially presenting as a small, firm, irregular skin nodule, it undergoes sudden, rapid growth, forming a prominent mass. While locally aggressive, distant metastasis is rare. DFSP affects mainly the torso then proximal extremities. Case Presentation: In this case study, we described a 57-year-old male individual who presented with a chest midline swelling that was progressing in size. A punch biopsy showed inconclusive results. Thus, a wide local excision was carried out along with sending the initial biopsy slides to Mayo Clinic for second opinion. A diagnosis of DFSP was confirmed, which is an uncommon and locally aggressive tumor affecting soft tissues. The primary histological diagnosis relies on immunohistochemical stains, enabling the distinction between DFSP and other fibrous tumors. Conclusion: Diagnosing DFSP is challenging due to its similarity to other skin lesions. A multidisciplinary approach is vital for accurate diagnosis and management.
Prognostic Factors of Adult Hemophagocytic Lymphohistiocytosis and Clinical Utility of HLH-2004 Diagnostic Criteria and HScore: A Real-World Multicenter Study from Thailand
Authors: Jongdee Pitchayaporn , Julamanee Jakrawadee , Rattarittamrong Ekarat , Mukura Sarita , Wanitpongpun Chinadol , Deoisares Rawisut , Surawong Anoree , Chajuwan Thunyamon , Chanswangphuwana Chantiya
Published: January 2024

Introduction: Adult hemophagocytic lymphohistiocytosis (HLH) is a rare disease with a dismal prognosis. Early diagnosis and prompt management are necessary for improved outcomes. Methods: This multicenter retrospective study investigated the etiologies, survival, and prognostic factors of HLH, including the utility of HLH-2004 criteria and HScore in real-life clinical practice. Results: A total of 147 HLH patients were identified by using a combination of hemophagocytosis identification in bone marrow and the HLH-related international classification disease-10. A total of 116 (78.9%) patients fulfilled the HLH diagnosis by HScore, while 91 (61.9%) patients fulfilled 5 of 8 HLH-2004 criteria. In Thailand, the clinical application of HLH-2004 criteria needed to be reduced from 8 to 6 due to a lack of sCD25 and natural killer cell activity tests. Using the adapted HLH-2004 with a cutoff value of 4 resulted in 132 (89.9%) cases meeting the diagnostic criteria. Among these 132 confirmed HLH patients by using adapted HLH-2004, HLH was triggered by infection (29.5%), autoimmune disease (12.9%), malignancy (40.9%), and unknown cause (16.7%). Median overall survival of HLH patients was extremely short (67 days). Ferritin >6,000 μg/L, HLH from infection, malignancy, and unknown etiology were demonstrated as independent prognostic factors for inferior survival (hazard ratio [HR] 2.47; 95% confidence interval [CI] 1.39–4.37, HR 4.69; 95% CI 1.38–15.92, HR 6.09; 95% CI 1.84–20.14, and HR 6.02; 95% CI 1.64–22.05, respectively). Conclusion: Ferritin is a helpful biomarker for HLH diagnosis and prognostic prediction. Autoimmune disease-triggered HLH has favorable outcomes. Future prospective study is required to verify the use of the adapted HLH-2004 criteria.