bluuebunny/crossref_metadata_2025 huggingface dataset:
Therapeutics of urticaria: Results from a hospital-based multicenter study in China
Authors: Wang Xin , Li Lin-Feng
Published: March 2024

Background: Therapeutics of urticaria in Chinese outpatients remain to be illustrated.

Objectives: To investigate clinical treatment of outpatients with urticaria, and provide real-world evidence for selection of medication regimens.

Methods: In this hospital-based multicenter study, urticaria outpatients filled in a questionnaire at initial visit and were followed-up (once per week, for 4 weeks).

Results: We recruited 1715 urticaria outpatients and 647 completed 4 week’s follow-up. Their total UAS7 was reduced (27.44 at baseline, 16.87 in 1 week, 12.39 in 2 weeks, 7.21 in 3 weeks, 4.2 in 4 weeks). 71.8% patients recovered from urticaria (therapy was highly effective in 11%, whereas effective in 14.2%). The second-generation H1 antihistamines (sgAHs) (at conventional dose) were the most commonly prescribed drugs, with ebastine, levocetirizine and olopatadine being the leading ones (41.1%, 36.2%, and 16%, respectively). Combinations of several antihistamines (649 cases, 37.8%) at conventional dose were far more common than a single drug at escalated dose (59 cases, 3.4%). The combination of ebastine with levocetirizine was the most frequent options (18.25%, 313 cases), followed by combination of ebastine with compound glycyrrhizin (18.2%, 312 cases). The usage rates of tripterygium glycoside (19.6%), hydroxychloroquine (17.2%) and system application glucocorticoids (5.5%) in angioedema were much higher than in symptomatic dermographism and chronic spontaneous urticaria.

Conclusions: This study identifies curative therapy for Chinese outpatients with urticaria. The sgAHs, especially ebastine, are the most commonly prescribed drugs. Olopatadine has fast-acting and curative effects. Compound glycyrrhizin holds potential as a versatile collaborator. Combinations of several antihistamines at conventional dose is common.
Mortality in patients with Dupuytren’s disease in the first 5 years after diagnosis: a population-based survival analysis
Authors: van den Berge Bente A. , Groenhof Feikje , Werker Paul M. N. , Furniss Dominic , Kuo Rachel , van den Heuvel Edwin R. , Broekstra Dieuwke C.
Published: March 2024

Previous studies suggest that Dupuytren’s disease is associated with increased mortality, but most studies failed to account for important confounders. In this population-based cohort study, general practitioners’ (GP) data were linked to Statistics Netherlands to register all-cause and disease-specific mortality. Patients with Dupuytren’s disease were identified using the corresponding diagnosis code and assessing free-text fields from GP consultations. Multiple imputations were performed to estimate missing values of covariates, followed by 1:7 propensity score matching to balance cases with controls on confounding factors. A frailty proportional hazard model was used to compare mortality between both groups. Out of 209,966 individuals, 2561 patients with Dupuytren’s disease were identified and matched to at least four controls. After a median follow-up of 5 years, mortality was found to be actually reduced in patients with Dupuytren’s disease. There was no difference in mortality secondary to cancer or cardiovascular disease. Future studies with longer average follow-up using longitudinal data should clarify these associations in the longer term.

Level of evidence: III
Brachial plexus birth injuries: a multi-speciality approach. Commentary and opinions
Authors: Zlotolow Dan A.
Published: March 2024

The management of brachial plexus birth injuries (BPBI) remains controversial and ever evolving. In this article, studies are examined to provide further insight into the ongoing controversies and debates surrounding BPBI. The articles are diverse and examine the topics of aetiology, demographics, reliability versus accuracy of measurements and surgical management. The management of BPBI may differ depending on resources. Outcome measures may also vary depending on geography. Future research should focus on developing consensus-validated measures and reproducible surgical techniques. These can then guide further population-based research and provide guidelines to minimize the incidence of BPBI.
Current concepts and new trends in management of isolated triangular fibrocartilage complex injuries
Authors: Lim Rebecca Q. R. , Lim Lincoln J. R. , Atzei Andrea , Liu Bo
Published: March 2024

The triangular fibrocartilaginous complex is made of multiple components, of which the palmar and dorsal radioulnar ligaments play an important role in distal radioulnar joint stability. The ulnar wrist ligaments may be injured during forearm and wrist trauma. There are several aspects of triangular fibrocartilaginous complex management that are still open to debate. The aim of the present study was to review the current concepts and discuss emerging trends to better elucidate and treat this important ligament complex.

Level of evidence: V
The etiological spectrum of miliary brain lesions: A systematic review of published cases and case series
Authors: Garg Ravindra Kumar , Paliwal Vimal , Suvirya Swastika , Malhotra Hardeep Singh , Verma Anoop
Published: March 2024

Objective

This systematic review aimed to evaluate the published cases with miliary brain lesions and their etiological factors, clinical manifestations, diagnostic procedures, and outcomes.

Methods

A comprehensive search of PubMed, Scopus, Embase, and Google Scholar was conducted using the specified search strategy. Eligibility criteria included cases with miliary lesions in the brain confirmed through neuroimaging and various diagnostic procedures. The PRISMA guidelines were followed, and the PROSPERO registration number for the protocol is CRD42023445849.

Results

Data from 130 records provided details of 140 patients. Tuberculosis was the primary cause in 93 cases (66.4%), malignancies in 36 cases (25.7%), and other causes accounted for the remaining 11% cases. Tuberculosis patients averaged 35.7 years old, while those with malignancies averaged 55.44 years. Tuberculosis symptoms primarily included fever, headache, and altered sensorium, whereas malignant cases often exhibited progressive encephalopathy, headache, and specific neurological deficits. Distinctive indicators for CNS tuberculosis were choroidal tubercles and paradoxical reactions. Additionally, 63 tuberculosis patients showed miliary lung shadows and 49 had abnormal CSF findings. For the malignancy group, 13 exhibited miliary lung lesions, and 8 had CSF abnormalities. Regarding outcomes, a significant mortality disparity was observed, with 58.3% in the malignancy group, compared to 10.8% in the tuberculosis group and 27.3% in other cases.

Conclusion

Miliary brain lesions are a crucial imaging abnormality that necessitates prompt work up. In an immunocompromised state, diagnostic possibilities of miliary brain lesions are more varied and often pose a bigger challenge.
A content-based review of mobile health applications for breast cancer prevention and education: Characteristics, quality and functionality analysis
Authors: Altmannshofer Stefanie , Flaucher Madeleine , Beierlein Milena , Eskofier Bjoern M , Beckmann Matthias W , Fasching Peter A , Huebner Hanna
Published: March 2024

Objective

Mobile Health apps could be a feasible and effective tool to raise awareness for breast cancer prevention and to support women to change their behaviour to a healthier lifestyle. The aim of this study was to analyse the characteristics and quality of apps designed for breast cancer prevention and education.

Methods

We conducted a systematic search for apps covering breast cancer prevention topics in the Google Play and Apple App Store accessible from Germany using search terms either in German or in English. Only apps with a last update after June 2020 were included. The apps identified were downloaded and evaluated by two independent researchers. App quality was analysed using the Mobile Application Rating Scale (MARS). Associations of app characteristics and MARS rating were analysed.

Results

We identified 19 apps available in the Google Play Store and seven apps available in the Apple App Store that met all inclusion criteria. The mean MARS score was 3.07 and 3.50, respectively. Functionality was the highest-scoring domain. Operating system, developer (healthcare), download rates and time since the last update were significantly associated with overall MARS score. In addition, the presence of the following app functions significantly influenced MARS rating: breast self-examination tutorial, reminder for self-examination, documentation feature and education about breast cancer risk factors.

Conclusions

Although most of the apps offer important features for breast cancer prevention, none of the analysed apps combined all functions. The absence of healthcare professionals’ expertise in developing apps negatively affects the overall quality.
Between Fundamentalist Anvil and Red Hammer: How the 1980s Sculpted Afghan Women Movement
Authors: Sulehria Farooq
Published: March 2024

The 1980s proved critical not merely for contemporary Afghan history but also for the women’s struggle in Afghanistan. Showcasing Afghan women’s struggles, this article argues that the 1980s proved crucial in shaping feminist debates in Afghanistan. Arguably, Afghan women’s lived experience from the 1980s drove home the conclusion that foreign occupation does not bring women freedoms, while religious tapestries to sugarcoat secular women’s demands reinforce patriarchy. They learnt in the 1980s that their struggles antecede and should succeed foreign interventions. It was, therefore, understandable that the first demonstration against the Taliban, when they re-entered Kabul in August 2021, was held by women.
Three complete chloroplast genomes from two north American Rhus species and phylogenomics of Anacardiaceae
Authors: Huang Lan , Xu Yujie , Valcárcel Virginia , Lutz Sue , Wen Jun , Ren Zhumei
Published: March 2024

Background

The suamc genus Rhus (sensu stricto) includes two subgenera, Lobadium (ca. 25 spp.) and Rhus (ca. 10 spp.). Their members, R. glabra and R. typhina (Rosanae: Sapindales: Anacardiaceae), are two economic important species. Chloroplast genome information is of great significance for the study of plant phylogeny and taxonomy.

Results

The three complete chloroplast genomes from two Rhus glabra and one R. typhina accessions were obtained with a total of each about 159k bp in length including a large single-copy region (LSC, about 88k bp), a small single-copy regions (SSC, about 19k bp) and a pair of inverted repeats regions (IRa/IRb, about 26k bp), to form a canonical quadripartite structure. Each genome contained 88 protein-coding genes, 37 transfer RNA genes, eight ribosomal RNA genes and two pseudogenes. The overall GC content of the three genomes all were same (37.8%), and RSCU values showed that they all had the same codon prefers, i.e., to use codon ended with A/U (93%) except termination codon. Three variable hotspots, i.e., ycf4-cemA, ndhF-rpl32-trnL and ccsA-ndhD, and a total of 152–156 simple sequence repeats (SSR) were identified. The nonsynonymous (Ka)/synonymous (Ks) ratio was calculated, and cemA and ycf2 genes are important indicators of gene evolution. The phylogenetic analyses of the family Anacardiaceae showed that the eight genera were grouped into three clusters, and supported the monophyly of the subfamilies and all the genera. The accessions of five Rhus species formed four clusters, while, one individual of R. typhina grouped with the R. glabra accessions instead of clustering into the two other individuals of R. typhina in the subgenus Rhus, which showed a paraphyletic relationship.

Conclusions

Comparing the complete chloroplast genomes of the Rhus species, it was found that most SSRs were A/T rich and located in the intergenic spacer, and the nucleotide divergence exhibited higher levels in the non-coding region than in the coding region. The Ka/Ks ratio of cemA gene was > 1 for species collected in America, while it was < 1 for other species in China, which dedicated that the Rhus species from North America and East Asia have different evolutionary pressure. The phylogenetic analysis of the complete chloroplast genome clarified the Rhus placement and relationship. The results obtained in this study are expected to provide valuable genetic resources to perform species identification, molecular breeding, and intraspecific diversity of the Rhus species.
SISTER OF FCA physically associates with SKB1 to regulate flowering time in Arabidopsis thaliana
Authors: Qiu Chunhong , Wang Tengyue , Wang Hui , Tao Zhen , Wang Chuanhong , Ma Jing , Li Shuai , Zhao Yibing , Liu Jifang , Li Peijin
Published: March 2024

Background

Proper flowering time is important for the growth and development of plants, and both too early and too late flowering impose strong negative influences on plant adaptation and seed yield. Thus, it is vitally important to study the mechanism underlying flowering time control in plants. In a previous study by the authors, genome-wide association analysis was used to screen the candidate gene SISTER OF FCA (SSF) that regulates FLOWERING LOCUS C (FLC), a central gene encoding a flowering suppressor in Arabidopsis thaliana.

Results

SSF physically interacts with Protein arginine methyltransferase 5 (PRMT5, SKB1). Subcellular co—localization analysis showed that SSF and SKB1 interact in the nucleus. Genetically, SSF and SKB1 exist in the same regulatory pathway that controls FLC expression. Furthermore, RNA-sequencing analysis showed that both SSF and SKB1 regulate certain common pathways.

Conclusions

This study shows that PRMT5 interacts with SSF, thus controlling FLC expression and facilitating flowering time control.
Causal association between helicobacter pylori and atherosclerosis: a two-sample Mendelian randomization
Authors: Zhang Xueyi , Shi Yue , Li Tielin , Chang Ke , Gan Yongyan , Feng Yue , Zhou Xianhua
Published: March 2024

Background

Helicobacter pylori (H. pylori), according to a number of recent observational studies, is connected to atherosclerosis (AS). However, the link between H. pylori and AS is debatable.

Methods

In order to calculate the causal relationship between H. pylori and AS, we employed a two-sample Mendelian randomization (MR) analysis. The data for H. pylori were obtained from the IEU GWAS database (https://gwas.mrcieu.ac.uk/datasets/) and the data for AS were obtained from the Finngen GWAS database (https://r5.finngen.fi/). We selected single nucleotide polymorphisms with a threshold of 5 × 10–6 from earlier genome-wide association studies. MR was performed mainly using the inverse variance weighted (IVW) method. To ensure the reliability of the findings, We performed a leave-one-out sensitivity analysis to test for sensitivity. F-value was used to test weak instrument.

Results

A positive causal relationship between H. pylori OMP antibody levels and peripheral atherosclerosis was shown by our two-sample MR analysis (odds ratio (OR) = 1.33, 95% confidence interval (CI) = 1.14–1.54, P = 0.26E-03) using IVW. Additionally, there was a causative link between coronary atherosclerosis and H. pylori VacA antibody levels (IVW OR = 1.06, 95% CI = 1.01–1.10, P = 0.016). All the F-values were above 10.

Conclusions

This MR study discovered a causal link between H. pylori and AS. Different antibodies have different effects, so future researches are needed to figure out the exact mechanisms behind this link.
Poly-ϵ-caprolactone scaffold as staple-line reinforcement of rectal anastomosis: an experimental piglet study
Authors: Petersen Laura Lovisa Køtlum , Dursun Martin Dennis , Madsen Gunvor , Le Dang Quang Svend , Möller Sören , Qvist Niels , Ellebæk Mark Bremholm
Published: March 2024

Purpose

Rectal anastomoses have a persisting high incidence of anastomotic leakage. This study aimed to assess whether the use of a poly-ϵ-caprolactone (PCL) scaffold as reinforcement of a circular stapled rectal anastomosis could increase tensile strength and improve healing compared to a control in a piglet model.

Method

Twenty weaned female piglets received a stapled rectal anastomosis and were randomised to either reinforcement with PCL scaffold (intervention) or no reinforcement (control). On postoperative day five the anastomosis was subjected to a tensile strength test followed by a histological examination to evaluate the wound healing according to the Verhofstad scoring.

Results

The tensile strength test showed no significant difference between the two groups, but histological evaluation revealed significant impaired wound healing in the intervention group.

Conclusion

The incorporation of a PCL scaffold into a circular stapled rectal anastomosis did not increase anastomotic tensile strength in piglets and indicated an impaired histologically assessed wound healing.
Clinical spectrum and long-term outcomes of mpox: a cohort study spanning from acute infection to six-month follow-up
Authors: Zeyen Christoph , Kinberger Maria , Kriedemann Helene , Pfäfflin Frieder , Tober-Lau Pinkus , Huang Leu , Corman Victor Max , Nast Alexander , Sander Leif Erik , Kurth Florian , Werner Ricardo Niklas
Published: March 2024

Background

Cases of mpox have been reported worldwide since May 2022. Limited knowledge exists regarding the long-term course of this disease. To assess sequelae in terms of scarring and quality of life (QoL) in mpox patients 4–6 months after initial infection.

Methods

Prospective observational study on clinical characteristics and symptoms of patients with polymerase chain reaction (PCR)-confirmed mpox, including both outpatients and inpatients. Follow-up visits were conducted at 4–6 months, assessing the Patient and Observer Scar Assessment Scale (POSAS), the Dermatology Life Quality Index (DLQI) and sexual impairment, using a numeric rating scale (NRS) from 0 to 10.

Results

Forty-three patients, age range 19–64 years, 41 men (all identifying as MSM) and 2 women, were included. Upon diagnosis, skin or mucosal lesions were present in 93.0% of cases, with 73.3% reporting pain (median intensity: 8, Q1-Q3: 6–10). Anal involvement resulted in a significantly higher frequency of pain than genital lesions (RR: 3.60, 95%-CI: 1.48–8.74). Inpatient treatment due to pain, superinfection, abscess or other indications was required in 20 patients (46.5%). After 4–6 months, most patients did not have significant limitations, scars or pain. However, compared to patients without such complications, patients with superinfection or abscess during the acute phase had significantly more extensive scar formation (median PSAS: 24.0 vs. 11.0, p = 0.039) and experienced a significantly greater impairment of their QoL (median DLQI: 2.0 vs. 0.0, p = 0.036) and sexuality (median NRS: 5.0 vs. 0.0, p = 0.017).

Conclusion

We observed a wide range of clinical mpox manifestations, with some patients experiencing significant pain and requiring hospitalization. After 4–6 months, most patients recovered without significant sequelae, but those with abscesses or superinfections during the initial infection experienced a significant reduction in QoL and sexuality. Adequate treatment, including antiseptic and antibiotic therapy during the acute phase, may help prevent such complications, and hence, improve long-term outcomes.
Novel PIP5K1C variant identified in a Chinese pedigree with lethal congenital contractural syndrome 3
Authors: Zhang Fang , Guo Hongmei , Zhou Xinlong , Deng Zhengxi , Xu Qiuhong , Wang Qingming , Yuan Haiming , Luo Jianhua
Published: March 2024

Background

Biallelic pathogenic variants in PIP5K1C (MIM #606,102) lead to lethal congenital contractural syndrome 3 (LCCS3, MIM #611,369), a rare autosomal recessive genetic disorder characterized by small gestational age, severe multiple joint contractures and muscle atrophy, early death due to respiratory failure. Currently, 5 individuals with LCCS3 were reported and 5 pathogenic variants in PIP5K1C were identified. Here, we reported the two fetuses in a Chinese pedigree who displayed multiple joint contractures and other congenital anomalies.

Methods

Trio-based whole-exome sequencing (WES) was performed for the parents and the recent fetus to detect the genetic cause for fetus phenotype.

Results

A novel variant, NM_012398.3: c.949_952dup, p.S318Ifs*28 and a previously reported variant, c.688_689del, p.G230Qfs*114 (ClinVar database) in PIP5K1C, were detected in the individuals, and these variants were inherited from the mother and father, respectively. We described the features of multiple joint contractures in our fetuses, including bilateral talipes equinovarus, stiffness in the limbs, extended knees, persistently closed hands and overlapping fingers, which have not been delineated detailedly in previously reported LCCS3 individuals. Furthermore, novel phenotype, bilateral dilated lateral ventricles, was revealed in one fetus.

Conclusions

These findings expanded the genetic variant spectrum of PIP5K1C and enriched the clinical features of LCCS3, which will help with the prenatal diagnosis and genetic counseling for this family.
Objectively measured the impact of ambient air pollution on physical activity for older adults
Authors: Cheng Jiali , Wu Yin , Wang Xiaoxin , Yu Hongjun
Published: March 2024

Background

Air pollution poses a significant health risk to the human population, especially for vulnerable groups such as the elderly, potentially discouraging their engagement in physical activity. However, there is a lack of sufficient objective and longitudinal data in current research on how air pollution affects physical activity among older adults. With these gaps, we aimed to explore the relationship between air pollution and objective measurement-based physical activity among older adults by engaging in a longitudinal study design.

Methods

A total of 184 older adults were recruited from three cities with varying levels of air quality. Mean daily minutes of physical activity were measured with 7 consecutive days of accelerometer monitoring (ActiGraph GT3X-BT). Corresponding air pollution data including daily PM2.5 (µg/m3), PM10 (µg/m3) and air quality index (AQI) were sourced from the China National Environmental Monitoring Centre at monitor locations close to older adults’ addresses. Associations between air quality and physical activity were estimated using a fixed effect model, adjusting for average daytime temperature, rain, age and weight.

Results

AQI and PM2.5 were observed to exhibit significant, inverse, and linear associations with mean daily walk steps, minutes of light physical activity (LPA), moderate physical activity (MPA) and moderate-to-vigorous physical activity (MVPA) in the single variable models. A one-level increase in AQI corresponded to a decline in 550.04 steps (95% [CI] = -858.97, -241.10; p < 0.001), 10.43 min (95% [CI] = -17.07, -3.79; p < 0.001), 4.03 min (95% [CI] = -7.48, -0.59; p < 0.001) and 4.16 min (95% [CI] = -7.77, -0.56; p < 0.001) in daily walking steps, LPA, MPA, and MVPA, respectively. A one-level increase in PM2.5 correlated with a decline in daily walk steps, LPA, MPA and MVPA by 361.85 steps (95% [CI] = -516.53, -207.16; p < 0.001), 8.97 min (95% [CI] = -12.28, -5.66; p < 0.001), 3.73 min (95% [CI] = -5.46, -2.01; p < 0.001,) and 3.79 min (95% [CI] = -5.59, -1.98; p < 0.001), respectively. However, PM10 displayed a significant negative association exclusively with LPA, with one-level increase in PM10 resulting in a 3.7-minute reduction in LPA (95% [CI] = -6.81, -0.59, p < 0.05).

Conclusion

Air pollution demonstrates an inverse association with physical activity levels among older adults, potentially discouraging their engagement in physical activity. Different air quality indicators may exert varying impacts on physical activity. Future studies are warranted to enhance policy interventions aimed at reducing air pollution and promoting physical activity.
Relation between the dash score and radiographic evaluation of the wrist in patients with wrist fracture
Authors: Hassoun Anthony , Haroun Rami , Hoyek Fadi , Lahoud Jean Claude , Tawk Charbel , Moussa Majd El Hajj , Khalil Rita , Mandour Joseph , Tannoury Boutros El
Published: March 2024

Traditionally, the assessment of distal radius fracture outcomes has been based on radiological measurements and self-evaluation scores. However, there is uncertainty regarding how accurately these measurements reflect the patient's perception of their outcome. In this study, we examined the correlation between radiological measurements and patient-perceived outcomes using the Disabilities of the Arm, Shoulder, and Hand outcome (DASH) score. 140 individuals who had recovered from a distal radius fracture. and had been treated with DVR, Kapandji, percutaneous pinning or closed reduction were included in the study. The retrospective assessment included 78 females and 62 males, with a mean DASH score of 3.54 points.

Except for the ulnar variance, the study found little to no significant association between the DASH score and the final radiological measurement.

In summary, the DASH score did not always indicate that a superior radiological result translated into a better patient-perceived outcome.
U-shaped kirschner wire transfixation: effective treatment for Skier’s thumb
Authors: Ma Shuwei , Zuo Jinzeng , Hu Yongcheng
Published: March 2024

Background

Skier’s thumb is a type of injury to the ulnar collateral ligament of the metacarpophalangeal joint of the thumb, which can result in bone fragmentation and joint instability.

Objective

The objective of this study was to compare the traditional Kirschner wire fixation method with the U-shaped Kirschner wire method for treating small bone fragments with displacement, rotation, or instability in skier’s fractures.

Method

A retrospective study was conducted on 30 patients with skier’s thumb who were treated at Tianjin Hospital from January 2019 to December 2021. Patients were divided into two groups: Group A received traditional Kirschner wire fixation, while Group B received U-shaped Kirschner wire fixation. Functional assessments and complications during the perioperative period were evaluated.

Results

Both surgical methods significantly reduced postoperative pain and increased joint range of motion. Group B had a lower incidence of pain during follow-up and showed significant functional improvement in Tip-pinch and Grip tests compared to Group A. U-shaped Kirschner wire fixation significantly reduced complications during the perioperative period.

Conclusion

The U-shaped Kirschner wire internal fixation is a safe and effective treatment for the thumb proximal phalanx base ulnar side avulsion fracture.
Clinical supervisors’ experience of a first-time application of entrustable professional activities in clinical supervision of medical students: findings from a Swedish pilot study
Authors: Pålsson Paul , Cederborg Anna , Johansson Monica , Hult Helena Vallo , Naredi Silvana , Jood Katarina
Published: March 2024

Background

Recently, all medical universities in Sweden jointly developed a framework for Entrustable Professional Activities (EPAs) for work-based training and assessment. This framework is now being introduced nationally in the new 6-year undergraduate medical programme that directly lead to a licence to practise. When EPAs are introduced, it is of central importance to gain clinical supervisors’ acceptance to apply the framework in their supervision of students. The aim of this study was therefore to investigate how clinical supervisors, not familiar with EPAs, experience clinical supervision using the framework for EPAs.

Methods

We used a purposive sampling to recruit clinical supervisors. They were given written information on EPAs with a selection of suitable EPAs and the Swedish observation rating scale for assessment of autonomy, and they were offered to attend a 30-minute introductory web course. The participants were informed that EPAs were to be tested, and the students were asked to participate. After the study period the clinical supervisors participated in semi-structured interviews. Inductive qualitative content analysis was used to analyse the transcribed interviews.

Results

Three general themes emerged in the qualitative analysis: Promoting Feedback, Trusting Assessments and Engaging Stakeholders. The participants described benefits from using EPAs, but pointed out a need for preparation and adaptation to facilitate implementation. The structure was perceived to provide structured support for feedback, student involvement, entrustment decisions, enabling supervisors to allow the students to do more things independently, although some expressed caution to rely on others’ assessments. Another concern was whether assessments of EPAs would be perceived as a form of examination, steeling focus from formative feedback. To understand the concept of EPA, the short web-based course and written information was regarded as sufficient. However, concern was expressed whether EPA could be applied by all clinical supervisors. Involvement and adaption of the workplace was pointed out as important since more frequent observation and feedback, with documentation requirements, increase the time required for supervision.

Conclusions

EPAs were accepted as beneficial, promoting structured feedback and assessments of the students’ autonomy. Preparation of supervisors and students as well as involvement and adaptation of the workplace was pointed out as important.
First molecular identification and phylogenetic illustration of Sarcocystis species infection in Red Sea shortfin mako shark (Isurus oxyrinchus Rafinesque, 1810)
Authors: Ahmed Nahla HE. M. , Ghallab Ahmed , Shaalan Mohamed , Saied Mahmoud , Mohammed Eman Sayed
Published: March 2024

Background

members of the genus Sarcocystis are intracellular obligate protozoan parasites classified within the phylum Apicomplexa and have an obligate heteroxenous life cycle involving two hosts. A more comprehensive understanding of the prevalence and geographic range of different Sarcocystis species in marine ecosystems is needed globally and nationally. Hence, the objective of this study was to document the incidence of Sarcocystis infection in sharks within the aquarium ecosystem of Egypt and to identify the species through the characterization of the SSU rDNA gene.

Methods

All organs of the mako shark specimen underwent macroscopic screening to detect the existence of a Sarcocystis cyst. Ten cysts were collected from the intestine and processed separately to extract the genomic DNA. The polymerase chain reaction (PCR) was accomplished by amplifying a specific 18S ribosomal RNA (rRNA) gene fragment. Subsequently, the resulting amplicons were subjected to purification and sequencing processes.

Results

Macroscopic examination of the mako shark intestinal wall sample revealed the presence of Sarcocystis cysts of various sizes and shapes, and sequencing of the amplicons from Sarcocystis DNA revealed a 100% nucleotide identity with the sequence of Sarcocystis tenella recorded from sheep in Iran; The mako shark sequence has been deposited in the GeneBank with the accession number OQ721979. This study presents the first scientific evidence demonstrating the presence of the Sarcocystis parasite in sharks, thereby documenting this specific marine species as a novel intermediate host in the Sarcocystis life cycle.

Conclusions

This is the first identification of Sarcocystis infection in sharks, and we anticipate it will be an essential study for future screenings and establishing effective management measures for this disease in aquatic ecosystems.
Cost effectiveness of malaria vector control activities in Sudan
Authors: HasapAla Sami M. , Azrag Rasha S. , Awad Osama M.
Published: March 2024

Background

Malaria vector control activities in Sudan rely largely on Long-Lasting Insecticidal Nets (LLINs), Indoor Residual Spray (IRS) and Larval Source Management (LSM). The present study attempted to determine cost effectiveness of inputs and operations of vector control interventions applied in different environmental settings in central and eastern Sudan, as well as their impact.

Methods

The inputs utilized and cost of each vector control activity, operational achievements and impact of the applied malaria vector control activities; IRS, LLINs and LSM were determined for eight sites in Al Gazira state (central Sudan) and Al Gadarif state (eastern Sudan). Operational costs were obtained from data of the National Malaria Control Program in 2017. Impact was measured using entomological indicators for Anopheles mosquitoes.

Results

The total cost per person per year was $1.6, $0.85, and $0.32 for IRS, LLINs and LSM, respectively. Coverage of vector control operations was 97%, 95.2% and 25–50% in IRS, LLINs and LSM, respectively. Vectorial capacity of malaria vectors showed statistically significant variations (P < 0.034) and ranged 0.294–0.65 in areas implemented LSM in comparison to 0.097–0.248 in areas applied IRS and LLINs, respectively. Both indoor and outdoor biting Anopheles mosquitoes showed noticeable increase that reached 3–12 folds in areas implemented LSM in comparison to areas implemented IRS and LLINs. Annual malaria prevalence was 13.1–21.1% in areas implemented LSM in comparison to 3.20%, 4.77% in areas implemented IRS and LLINs, respectively.

Conclusion

IRS and LLINs are cost effective control measures due to adequate inputs and organized process. However, the unit cost of LSM intervention per outcome and subsequently the impact is hugely affected by the low coverage. The very weak support for implementation of LSM which includes inputs resulted in weakness of its process and consequently its impact. Implementation of LSM by local government in urban settings is challenged by many factors the most important are maintenance of adequate stable level of funding, un-adequate number of well trained health workers, unstable political and administrative conditions and weak infrastructure. These challenges are critical for proper implementation of LSM and control of malaria in urban settings in Sudan.
Construction of in vitro liver-on-a-chip models and application progress
Authors: Liu Jie , Du Yimei , Xiao Xinxin , Tan Daopeng , He Yuqi , Qin Lin
Published: March 2024

The liver is the largest internal organ of the human body. It has a complex structure and function and plays a vital role in drug metabolism. In recent decades, extensive research has aimed to develop in vitro models that can simulate liver function to demonstrate changes in the physiological and pathological environment of the liver. Animal models and in vitro cell models are common, but the data obtained from animal models lack relevance when applied to humans, while cell models have limited predictive ability for metabolism and toxicity in humans. Recent advancements in tissue engineering, biomaterials, chip technology, and 3D bioprinting have provided opportunities for further research in in vitro models. Among them, liver-on-a-Chip (LOC) technology has made significant achievements in reproducing the in vivo behavior, physiological microenvironment, and metabolism of cells and organs. In this review, we discuss the development of LOC and its research progress in liver diseases, hepatotoxicity tests, and drug screening, as well as chip combinations. First, we review the structure and the physiological function of the liver. Then, we introduce the LOC technology, including general concepts, preparation materials, and methods. Finally, we review the application of LOC in disease modeling, hepatotoxicity tests, drug screening, and chip combinations, as well as the future challenges and directions of LOC.
Towards leaving no one behind in North Macedonia: a mixed methods assessment of barriers to effective coverage with health services
Authors: Koller Theadora Swift , Janeva Jelena Kjetkovikj , Ognenovska Elena , Vasilevska Ana , Atanasova Simona , Brown Chris , Dedeu Antoni , Johansen Anne
Published: March 2024

Background

The Government of North Macedonia’s Primary Health Care reform is committed to leaving no one behind on the path to Universal health Coverage (UHC). During mid-2022 to March 2023, the World Health Organization (WHO) collaborated with the Government and other national stakeholders for an assessment of barriers to effective coverage with health services experienced by adult citizens, with a specific focus on rural areas and subpopulations in situations of vulnerability.

Methods

This study constituted the piloting of a draft forthcoming WHO handbook on assessing barriers for health services, grounded in the Tanahashi framework for effective coverage with health services. In North Macedonia, the convergent parallel mixed methods study involved four sources. These were: a nationally representative Computer Assisted Telephone Interview Survey (1,139 respondents); 24 key informant interviews with representatives from government, professional associations, non-governmental and civil society organizations, and development partners; 12 focus groups in four regions with adults from vulnerable/high risk groups in rural areas and small urban settlements and an additional focus group with persons with disabilities; and a literature review. Instrument design was underpinned by the Tanahashi framework, which also orientated data triangulation and deductive analysis. The research team synergistically incorporated emerging themes in an inductive way. A key component of the assessment was participatory design of the study protocol with inputs from national stakeholders as well as participatory deliberation of the results and the ways forward.

Results

Despite considerable progress towards UHC in North Macedonia, the assessment elucidated remaining challenges. These included: insufficient numbers of health workers, in general and particularly in the more disadvantaged regions of the country; inadequate number of outpatient medicines covered by health insurance; distance and transportation obstacles, including indirect travel costs, particularly in rural areas; adverse gender norms and relations for both women and men inhibiting timely treatment seeking; perceived discrimination by providers on multiple grounds; bottlenecks including waiting times to get appointments for specialist referrals; and lack of patient adherence, due several factors including costs of medicines and health products.

Conclusions

The outputs from this study of barriers to effective coverage with health services for adult citizens of North Macedonia are feeding into the ongoing Primary Health Care reform, and provide evidence for equity-related actions in the forthcoming National Development Strategy.
Ethnopharmacology of five flowers herbal tea, a popular traditional beverage in Hong Kong and South China
Authors: Chan Kwun-Tin , Wu Hoi-Yan , Tin Wing-Yee , But Paul Pui-Hay , Cheung Sidney Chin-Hung , Shaw Pang-Chui
Published: March 2024

Background

It has been a long-standing tradition of using herbal tea for preventive and therapeutic healthcare in Hong Kong and South China and Five Flowers Tea is one of the most popular herbal teas. Based on the principle of traditional Chinese medicine, the pharmacological functions are to clear heat and dispel dampness in the body. Heat and dampness are thought to contribute to a range of health problems, especially during the hot and humid season in South China and Hong Kong. The most prevalent herbs in the formula contain bioactive compounds including flavonoids, alkaloids and terpenoids, which have a wide range of pharmacological properties including anti-inflammation, antivirus, antidiarrhoea, antibacteria, and antioxidation. However, with the composition varies widely, the ethnopharmacological benefits described may not be delivered uniformly. This study is to provide a comprehensive analysis on the composition of the Five Flowers Tea sold in Hong Kong and investigate the rationale behind the selection of herbs used in the formula. This study also provides information on the variation and quality of the Five Flowers Tea in the market.

Methods

Thirty-three Five Flowers Tea samples were collected from various locations in Hong Kong. The size, texture, colour and organoleptic properties were documented. Macroscopic and molecular authentication methods were employed to identify the individual components.

Results

Macroscopic identification revealed there were 23 herbs belonging to 18 plant families. The most prevalent herb was Bombax ceiba L., followed by Chrysanthemum morifolium. Ten adulterants and the existence of insect Lasioderma serricorne were confirmed by DNA barcoding techniques.

Conclusion

This study employed a comprehensive approach to authenticate the herbs in Five Flowers Tea samples collected from various locations in Hong Kong. Macroscopic and molecular methods were used to identify the herbs and adulterants. The findings revealed the varied composition in Five Flowers Tea and the occurrence of adulterants in some samples. This shows that quality assurance of Five Flowers Tea is essential for the effective use of this popular folk medicine.
FTO attenuates the cytotoxicity of cisplatin in KGN granulosa cell-like tumour cells by regulating the Hippo/YAP1 signalling pathway
Authors: Wang Rongli , Cheng Feiyan , Yang Xinyuan
Published: March 2024

Premature ovarian failure (POF) is a devastating condition for women under 40 years old. Chemotherapy, especially the use of cisplatin, has been demonstrated to promote the apoptosis of granulosa cells in primary and secondary follicles, leading to POF. Our previous studies demonstrated that fat mass- and obesity-associated (FTO) plays an essential role in protecting granulosa cells from cisplatin-induced cytotoxicity. Various studies have suggested that the Hippo/YAP signalling pathway plays a significant role in regulating cell apoptosis and proliferation. Additionally, YAP1 is the main downstream target of the Hippo signalling pathway and is negatively regulated by the Hippo signalling pathway. However, whether the Hippo/YAP signalling pathway is involved in the protective effect of FTO on granulosa cells has not been determined. In this study, we found that after cisplatin treatment, the apoptosis of granulosa cells increased in a concentration-dependent manner, accompanied by the downregulation of FTO and YAP1. Furthermore, overexpression of FTO decreased cisplatin-induced granulosa cell apoptosis, inhibited the Hippo/YAP kinase cascade-induced phosphorylation of YAP1, and promoted the entry of YAP1 into the nucleus. The downstream targets of YAP1 (CTGF, CYR61, and ANKRD1) were also increased. Si-RNA-mediated downregulation of FTO promoted cisplatin-induced granulosa cell apoptosis, activated the Hippo/YAP kinase cascade, and inhibited the YAP1 entry into the nucleus. These effects were completely reversed by the small molecule inhibitor of YAP1-verteporfin (VP). Taken together, these data suggested that FTO-YAP1 plays a positive role in regulating the proliferation of injured granulosa cells induced by cisplatin.
Effects of prone positioning on lung mechanical power components in patients with acute respiratory distress syndrome: a physiologic study
Authors: Boesing Christoph , Krebs Joerg , Conrad Alice Marguerite , Otto Matthias , Beck Grietje , Thiel Manfred , Rocco Patricia R. M. , Luecke Thomas , Schaefer Laura
Published: March 2024

Background

Prone positioning (PP) homogenizes ventilation distribution and may limit ventilator-induced lung injury (VILI) in patients with moderate to severe acute respiratory distress syndrome (ARDS). The static and dynamic components of ventilation that may cause VILI have been aggregated in mechanical power, considered a unifying driver of VILI. PP may affect mechanical power components differently due to changes in respiratory mechanics; however, the effects of PP on lung mechanical power components are unclear. This study aimed to compare the following parameters during supine positioning (SP) and PP: lung total elastic power and its components (elastic static power and elastic dynamic power) and these variables normalized to end-expiratory lung volume (EELV).

Methods

This prospective physiologic study included 55 patients with moderate to severe ARDS. Lung total elastic power and its static and dynamic components were compared during SP and PP using an esophageal pressure-guided ventilation strategy. In SP, the esophageal pressure-guided ventilation strategy was further compared with an oxygenation-guided ventilation strategy defined as baseline SP. The primary endpoint was the effect of PP on lung total elastic power non-normalized and normalized to EELV. Secondary endpoints were the effects of PP and ventilation strategies on lung elastic static and dynamic power components non-normalized and normalized to EELV, respiratory mechanics, gas exchange, and hemodynamic parameters.

Results

Lung total elastic power (median [interquartile range]) was lower during PP compared with SP (6.7 [4.9–10.6] versus 11.0 [6.6–14.8] J/min; P < 0.001) non-normalized and normalized to EELV (3.2 [2.1–5.0] versus 5.3 [3.3–7.5] J/min/L; P < 0.001). Comparing PP with SP, transpulmonary pressures and EELV did not significantly differ despite lower positive end-expiratory pressure and plateau airway pressure, thereby reducing non-normalized and normalized lung elastic static power in PP. PP improved gas exchange, cardiac output, and increased oxygen delivery compared with SP.

Conclusions

In patients with moderate to severe ARDS, PP reduced lung total elastic and elastic static power compared with SP regardless of EELV normalization because comparable transpulmonary pressures and EELV were achieved at lower airway pressures. This resulted in improved gas exchange, hemodynamics, and oxygen delivery.

Trial registration: German Clinical Trials Register (DRKS00017449). Registered June 27, 2019. https://drks.de/search/en/trial/DRKS00017449
Harary and hyper-Wiener indices of some graph operations
Authors: Balamoorthy S. , Kavaskar T. , Vinothkumar K.
Published: March 2024

In this paper, we obtain the Harary index and the hyper-Wiener index of the H-generalized join of graphs and the generalized corona product of graphs. As a consequence, we deduce some of the results in (Das et al. in J. Inequal. Appl. 2013:339, 2013) and (Khalifeh et al. in Comput. Math. Appl. 56:1402–1407, 2008). Moreover, we calculate the Harary index and the hyper-Wiener index of the ideal-based zero-divisor graph of a ring.
Strain Softening of High-Performance Fiber-Reinforced Cementitious Composites in Uniaxial Compression
Authors: Kwon Seung-Hee , Lee Jung-Soo , Koh Kyungtaek , Kim Hyeong-Ki
Published: March 2024

This study investigates the strain softening behavior of high-performance fiber-reinforced cementitious composites (HPFRCCs) under uniaxial compression. HPFRCC mixtures with different compressive strengths ranged from 120 to 170 MPa were prepared. The measurement method of feedback control on loading rate based transverse displacement was applied. Stress–strain and stress−inelastic displacement curves were plotted and analyzed with the results in the literature. It was found that the post-peak energy absorption of HPFRCC considering inelastic deformation was about 3–7 times higher than conventional concrete. Based on the experimental results in the present work, fitting models on post-peak stress–strain/−displacement curves were considering for different aspect ratios proposed.