bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of Subjects with Type 2 Diabetes Hospitalized in Internal Medicine Units: A Cluster-Randomized, Multicenter Study Before & After an Educational Program
Authors: Ceriello Antonio , Fontanella Andrea , Attardo Tiziana Marcella , Beltramello Giampietro , Fierro Aldo , Prattichizzo Francesco , Pellegrini Valeria , Fiore Maria Serena , De Menis Ernesto , Maffettone Ada , Magnani Luigi , Pastorelli Ruggero , Ventrella Francesco , Rondana Massimo , Maurantonio Mauro , Scanferlato Mauro , Finizzola Francesco , Salvia Maria Antonia , Nevola Riccardo , Prampolini Giorgia , Laccetti Marco , Mastroianni Franco , Cartabellotta Fabio , Zagarri Elisa , Dentali Francesco , Manfellotto Dario
Published: October 2024

Introduction: Few data are available relatively to the adherence to treatment guidelines in individuals with type 2 diabetes mellitus (T2DM) admitted to Internal Medicine Wards (IMW) while no information is available relatively to the possible efficacy of an educational intervention aimed at implementing adherence in this setting.
Methods: To explore guidelines adherence and the relative impact on glycemic control in subjects with T2DM hospitalized in IMW before and after an educational intervention, we conducted a 3-phase, cluster-randomized, multicenter study. During phase 1, we retrospectively collected data from patients with T2DM hospitalized for any cause in IMW for ≥ 5 days. In phase 2, an educational training, based on the method of the educational outreach visits (EOV), was developed in 36 out of the 54 centers involved. In phase 3, done 6 months after the training, we replicated the collection of data performed in phase 1.
Results: Overall, we analyzed data from 1909 and 1662 individuals with T2DM during the phase 1 and phase 3 of the study, respectively. No changes were observed in the difference between mean fasting glycemia levels at discharge vs at admission at Phase 3 comparing EOV vs NO EOV groups. A statistically significant increase in adherence to guidelines was observed from Phase 1 to Phase 3 and a trend of higher adherence was detected when comparing the EOV and the no EOV groups. A structured educational intervention improves adherence to guidelines for managing T2DM in individuals admitted to IMW but has no effect on short-term glycemic control.
Brief report: Immune Checkpoint inhibitors use in lung cancer:A Real-World Outcome study in a middle-income country.
Authors: benbrahim zineb , Siyouri Oumaima , fetohi mohamed , benchakroun nadia , ismaili nabil , Bahra Nassiba , tachfouti nabil , ghissassi brahim el , mrabet Fatima zahra el , belbaraka Rhizlane , tahri ali , Acharqi Abdelkader , mellas Nawfel
Published: October 2024

Introduction
Lung cancer is the leading cause of cancer death in the world and its treatment represents a major challenge. Treatment with immune checkpoint inhibitors (ICIs) uses cutting-edge technologies and mobilizes a large number of clinical research players. However, the cost may be a barrier to access to these treatments in developing countries. The objective of this study was to evaluate the use of ICIs in lung cancer and assess real-world data of this treatment in Morocco.
Methods
This is a retrospective, multicenter cohort study conducted in a Moroccan population diagnosed with lung cancer between January 2019 and January 2022 and treated with ICIs. Patients were recruited from public and private oncology centers of the whole kingdom. Agreement of the ethics committee has been obtained. Survival data, response rates and time till discontinuation of treatment were evaluated using the chi-square test and bivariate analyzes.
Results
We included 158 cases representing 5 % of the total number of patients with advanced lung cancer who were eligible for treatment with ICIs. The mean age of patients was 62.48 years and the sex ratio (male/female) was of 4.41. Seventy percent of patient had non-squamous cell carcinoma. EGFR status was mutated in 3.9% of the cases. In 34.2% of the cases, the PD-L1 expression status was not known. Forty-seven percent of patients were treated with ICIs monotherapy. Fifty-eight percent of ICIs prescription was in the frontline treatment of lung cancer. The median time to discontinuation of treatment, was 13.53 months. The 12-month overall survival rate was 71.1%.The median overall survival was 17 months. The objective response rate was 40% with 9.3% of patients having grade 3 or 4 toxicities.
Conclusion
ICIs have demonstrated very good tolerance with durability of response and survival in a first real-world study dedicated to lung cancer in a developing country.
Identifying Burnout and Turnover Risks in Canadian Healthcare Workers During the COVID-19 Pandemic
Authors: Orr Taylor , Cheung Ellie , Saha Monidipa , Balogun Temilola , Feng Cindy , Farag Marwa
Published: October 2024

Background/Objectives: The COVID-19 pandemic has tested health systems worldwide, exposing significant weaknesses and vulnerabilities, particularly its toll on healthcare workers (HCWs). This study aimed to identify risk factors leading Canadian HCWs to consider leaving their positions due to stress or burnout during the pandemic.
Methods: Data from the 2022 Survey on Healthcare Workers’ Experiences During the Pandemic (SHCWEP) were analyzed using the Shanafelt and Noseworthy (2017) framework for understanding clinician burnout. We hypothesized that factors such as workload, work-life balance, resource availability, social and community support at work, and job environment—including organizational culture, values, and flexibility—could influence HCWs' intentions to leave due to stress or burnout. Multivariable logistic regression models were employed to identify significant risk factors for each HCW group.
Results: The SHCWEP survey had a 54.9% response rate, with 12,139 HCWs participating. Of these, 3,034 HCWs (25%) expressed an intention to leave their current job, and within this group, 1,350 cited stress or burnout as their reason, representing 11% of the total participants and 44% of those intending to leave. Factors associated with HCWs considering leaving due to stress and burnout included younger to middle-age, heightened work stress, longer working hours, increased workload, financial difficulties, conflicts with colleagues or management, non-adherence to PPE/IPC protocols, and lack of professional emotional support.
Conclusion: The findings align with the recommendations of the Framework for a Systems Approach to Clinician Burnout and Professional Well-Being. Many factors contributing to HCWs' intentions to leave due to stress or burnout could be mitigated by policymakers and health organizations.
Associations between the Gut Microbiota and Sleep Disorder in Post-COVID-19 Patients Following Omicron Wave After Nearly 1-Year Recovery
Authors: Ming Xiaoping , Cai Wanyue , Zhou Aina , Sun Xiaoqi , Fang Lucheng , Hao Bin , Hu Yifan , Wu Jianghao , Cai Weisong , Chen Xiong
Published: October 2024

Background and objective:
The SARS-CoV-2 Omicron variant has exacerbated public health threats due to its notably increased transmission rate. Previous studies have suggested that the gut microbiota becomes impaired after infection. Given that impaired gut microbiota can trigger numerous neurological disorder and the sleep disorder is one of the most common symptoms post-COVID-19, we suggest that long-term sleep disorder symptoms of COVID-19 may be related to intestinal microbiota disorder in these patients. However, gut microbiota profiling in long-COVID patients, particularly those with sleep disorder in the outpatient setting, is still limited, and the impact of the Omicron variant on the recovery of the gut microbiota remains to be determined.
Methods
We performed metagenomic sequencing of the gut microbiota of eight patients who developed new-onset sleep disorder after Omicron infection, before and after the Omicron wave, to evaluate the impact of sleep disorder on gut recovery after SARS-CoV-2 Omicron variant infection.
Results
Our results suggest that the post-COVID-19 gut microbiota is characterized by a decrease in commensal microbes, an increase in opportunistic pathogens, and alterations in metabolic functions, particularly in amino acid metabolism.
Conclusion
These findings provide preliminary evidence that the gut microbiota may not be fully restored in post-COVID-19 patients with sleep disorder following the Omicron wave, even after nearly a year of recovery. This highlights the importance of continuously monitoring gut health in people who have recovered from the Omicron wave.
The Mediating Role of Sleep Disturbances in the Relationship Between Obsessive-Compulsive Symptoms and Suicidal Ideation: The Moderating Effect of Childhood Trauma
Authors: Wang shaoxia , Zhang Xiang , Wang Yanrong , Wu Chujun , Fang Jianqun
Published: October 2024

Objective: This study aims to investigate the relationships and underlying mechanisms among obsessive-compulsive symptoms, sleep disturbances, childhood trauma, and suicidal ideation in patients with obsessive-compulsive disorder (OCD).
Methods: The study employed the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Pittsburgh Sleep Quality Index (PSQI), Childhood Trauma Questionnaire (CTQ), and a self-assessment scale for suicidal ideation (SIOSS) to survey 107 patients with OCD.
Results: Obsessive-compulsive symptoms significantly positively affected sleep quality (β = 0.31, t = 10.67, p < 0.001). Both sleep disturbances (β = 0.20, t = 7.86, p < 0.001) and obsessive-compulsive symptoms (β = 0.39, t = 14.65, p < 0.001) significantly predicted suicidal risk. Further analysis revealed that sleep disturbances served as a significant mediator between obsessive-compulsive symptoms and suicidal ideation (mediation effect value = 0.08, 95% CI = [0.22, 0.28]). Childhood trauma moderated the mediating effect, intensifying the positive impact of obsessive-compulsive symptoms on sleep disturbances and suicidal ideation as levels of childhood trauma increased.
Conclusion: Sleep disturbances mediate the relationship between obsessive-compulsive symptoms and suicidal ideation, with this mediation significantly influenced by the presence of childhood trauma. These findings underscore the importance of considering early life experiences and psychophysiological backgrounds when assessing and intervening in the suicidal risk of OCD patients.
Action Perception, Motor Imagery and Execution of Hand Movements in Autistic and Non-Autistic Adults
Authors: Bai Ying , Brillinger Molly , Karlinsky April D. , Poliakoff Ellen , Welsh Timothy N. , Gowen Emma
Published: October 2024

Action perception, execution, and imagery share motor-cognitive processes. Given prevalent motor coordination difficulties in autism, the processes of action perception and imagery may also be altered. This study investigated whether autistic adults can engage in motor imagery by testing differences in executing, perceiving, and imagining hand movements between autistic and non-autistic adults. Twenty autistic individuals and twenty age- and IQ-matched controls completed execution, imagination, and perception tasks using a Fitts’ Law paradigm in an online session. For the execution and imagination tasks, participants performed or imagined making aiming movements between two targets. For the action perception task, participants indicated whether they could perform as accurately as the movements in presented videos. Target size and distance were manipulated into three difficulty levels and systematically varied across all tasks. Results showed a similar Fitts’ Law relationship for both groups, with significant positive correlations between movement times and difficulty level. Movement times were longest in the imagination task and shortest in the perception task for both groups. These findings suggest motor imagery processes are relatively intact in autistic adults, opening the possibility of using motor imagery as a therapy for motor coordination difficulties in autistic individuals.
Monolaurin inhibits Antibiotic-resistant Staphylococcus aureus in Patients with Atopic Dermatitis
Authors: Laowansiri Matchima , Suwanchote Supaporn , Wannigama Dhammika Leshan , Badavath Vishnu Nayak , Hongsing Parichart , Edwards Steven W , Suratannon Narissara , Chatchatee Pantipa , Lertpichitkul Pattamon , Rerknimitr Pawinee , Chantawarangul Karaked , Chatproedprai Susheera , Wananukul Siriwan , Thammahong Arsa , Plongla Rongpong , Chanachaithong Pattrarat , Chavasiri Warinthorn , Chatsuwan Tanittha , Chiewchengchol Direkrit
Published: October 2024

Frequent use of antibiotics increases the incidence of antimicrobial-resistant Staphylococcus aureus in atopic dermatitis (AD), which prompts the search for new treatments. Monolaurin is a chemical byproduct found in coconut oil and has anti-bacterial properties. This study aimed to investigate the inhibitory effect of monolaurin on antimicrobial-resistant S. aureus. Thirty children and thirty adults diagnosed with AD were recruited and swabbed at three different sites: lesion, non-lesion, and nasal mucosa. Methicillin resistance and high-level mupirocin resistance in S. aureus were identified using mecA and mupA PCR, respectively, whilst fusidic acid resistance were detected by fusA gene sequencing. The broth microdilution method and tetrazolium bromide assays were used for monolaurin susceptibility and cellular cytotoxicity, respectively. We show that S. aureus was frequently isolated from lesions of both children and adults with AD. One isolate of methicillin-resistant S. aureus (MRSA) harboring mecA, one isolate of mupirocin-resistant S. aureus harboring mupA, and four isolates of fusidic acid-resistant S. aureus with novel point mutations of fusA were found in the children group. In silico molecular docking showed that these mutants interacted weakly with fusidic acid, explaining the mechanism of drug resistance. Monolaurin inhibited these antimicrobial-resistant S. aureus isolates with a minimal inhibitory concentration of 2 µg/mL without cytotoxicity to cultured epidermal and dermal cells. These data show that monolaurin could potentially be used to inhibit antimicrobial-resistant S. aureus in AD patients.
LINC01432 binds to CELF2 in newly diagnosed multiple myeloma promoting short progression-free survival to standard therapy
Authors: Silva-Fisher Jessica , Mishra Richa , Thunuguntla Prasanth , Perkin Alani , Duraiyan Dhanusha , Bagwill Katelyn , Gonzales Savannah , Brizuela Vanessa , Daly Steve , Chang Yoon Jae , Abebe Mahdote , Rajana Yash , Wichmann Kelly , Bolick Catheryn , King Jaiyana , Fiala Mark , Fortier Julie , Jayasinghe Reyka , Schroeder Mark , Ding Li , Vij Ravi
Published: October 2024

Multiple Myeloma (MM) is an incurable form of cancer that arises from malignant plasma cells, with over 35,000 new cases diagnosed annually in the United States. While there are a growing number of approved therapies, MM remains incurable and nearly all patients will relapse and exhaust available treatments. Mechanisms for disease progression are unclear and little is known regarding the role of long non-coding RNAs (lncRNA) in mediating disease progression and response to treatment. Here, we used transcriptome sequencing to compare newly diagnosed MM (NDMM) patients who had short progression-free survival (PFS) to standard first-line treatment (PFS < 24 months) to patients who had prolonged PFS (PFS > 24 months). We identified 157 differentially upregulated lncRNAs with short PFS and focused our efforts on characterizing the most upregulated lncRNA, LINC01432. We investigated LINC01432 to show that its overexpression significantly increases cell viability and reduces apoptosis, while knockdown significantly reduces viability and increases apoptosis. Next, we show that LINC01432 directly interacts with the RNA binding protein, CELF2. Lastly, we showed that LINC01432-targeted locked nucleic acid antisense oligonucleotides reduce viability and increases apoptosis. In summary, this fundamental study identified lncRNAs associated with short PFS to standard NDMM treatment and further characterized LINC01432.
Association between C-reactive protein variability and cancer incidence: a longitudinal prospective cohort study
Authors: Chen Yue , Wang Yiming , Zheng Xin , Liu Tong , Liu Chenan , Lin Shiqi , Xie Hailun , Zhang Heyang , Shi Jinyu , Liu Xiaoyue , Ma Xiangming , Deng Li , Zhang Qingsong , Shi Hanping
Published: October 2024

Background
The association between inflammation and cancer has been widely studied, but research on the relationship between the magnitude of inflammatory fluctuations and cancer remains limited. Therefore, this study aims to investigate the association between C-reactive protein (CRP) variability and the occurrence of cancer.
Methods
A total of 42,514 participants were included, and their CRP levels were measured over a 4-year period. We used the coefficient of variation (CV) of CRP to quantify the variability in inflammation. Cox regression analysis was used to assess the association between CRP variability and cancer risk after adjusting for potential confounding factors.
Results
High CV of CRP significantly associated with reduced cancer risk (hazard ratio (HR) = 0.84; 95% CI: 0.75–0.94, P = 0.003). Participants with high CRP and low CV had a significantly increased risk of cancer (HR = 1.42; 95% CI: 1.18–1.70, P < 0.001). In the population with long-term stable CRP levels, there is a significant association between the CV and the risk of cancer (HR = 0.81; 95% CI: 0.72–0.92, P = 0.001). Furthermore, the association between the CV and lung cancer was most pronounced. Sensitivity analyses confirmed the stability of the association between CRP variability and cancer.
Conclusion
High CRP variability is significantly associated with reduced risk of cancer, particularly in the case of lung cancer. This provides a new perspective and evidence for exploring the relationship between inflammation and cancer.
Progression of Disease Within 24 Months (POD24) Based Prognostic Signature: A New Method for Personalized Risk Assessment in Patients with Mantle Cell Lymphoma
Authors: He Yizi , Wang Caiqin , Pan Tao , Cai Qingqing , Zhou Dehui , Zhang Huilai , Liang Rong , Zeng Dongfeng , Ye Haige , Liang Yun , Sun Xiuhua , Xiao Ling , Zhou Hui
Published: October 2024

Mantle cell lymphoma (MCL) exhibits significant biological and clinical heterogeneity, necessitating a refined prognostic model. According to the drawback of the models existed which are not truly define the complexity of the disease, we used the clinical and molecular data from nine medical centers of China to validate the predictive utility in progression of disease within 24 months (POD24), and also establish a novel prognostic risk model to predict the survival outcome of MCL patients. POD24 occurred in 37.7% of evaluable patients, with median over survival was 21 months (vs 122 months for those without POD24, P < 0.0001). The POD24-based risk model had the highest sensitivity to predict to predict survival with the most satisfying AUC value for risk score (AUC = 0.869). In conclusion, we confirm the obviously predictive performance of POD24 and established a novel risk model combined POD24 and clinical factors. Our new prognostic model might be helpful to effectively classify MCL patients with high-risk groups in terms of survival rate, which may help select high-risk MCL patients for more intensive treatment at time of relapse.
Early prediction of local tumor progression after ablation of colorectal liver metastases based on MRI radiomics
Authors: Zhu Xiucong , Zhu Jinke , Sun Chenwen , Zhu Fandong , Zhao Zhenhua
Published: October 2024

The aim of this study was to investigate a magnetic resonance imaging(MRI)-based model for early prediction of local tumor progression (LTP) after ablation of colorectal cancer liver metastases (CRLM).53 patients with CRLM ablation were enrolled in a total of 83 lesions. The lesions were divided into LTP group (n = 27) and non-LTP group (n = 56). Radiomics features were extracted from the patients' post ablation enhanced MRI arterial phase in the ablation zone, and around the ablation zone (0-5mm, 0-10mm, 5-15mm) to establish radiomics, clinical and combined models. Tumor size correlated with high LTP after ablation (p < 0.05). The 0–10 mm radiomics model around the ablation zone showed good performance, with an area under the curve (AUC) of 0.874 for the training set and 0.831 for the validation set. In addition, the diagnostic efficacy of the combined model of PAZ2 and AZ as well as the combined model of AZ-PAZ2 and clinical risk factors was superior, with an AUC of 0.896 and 0.919, respectively, for the training set, and AUC of 0.882 and 0.875, respectively, for the validation set. were 0.882 and 0.875 for the validation group, respectively. In conclusion, the combined postoperative ablation zone and peri-ablation zone radiomics model can early predict LTP after ablation in CRLM patients.
Ribosomal biogenesis factor, a novel biomarker for predicting progression-free survival in prostate cancer
Authors: Chen Zexiao , Fang Yutong , Zhang Jianhua
Published: October 2024

Background
Prostate cancer (PCa) is the second most common malignancy among men worldwide, with significant variability in incidence rates across different regions. Effective management of PCa is crucial, especially for advanced stages where the survival rates are notably low. Ribosome biogenesis (RB) plays a critical role in cancer cell proliferation, yet the specific function of the ribosomal biogenesis factor (RBIS) gene in PCa remains unexplored..
Methods
RNA sequencing data from the TCGA database and three GEO datasets were analyzed to assess RBIS expression in PCa. Clinicopathological features, survival rates, and drug sensitivity were evaluated in relation to RBIS expression. Gene co-expression and functional enrichment analyses were performed to investigate potential biological mechanisms. Additionally, immune cell infiltration and genetic alterations of RBIS were analyzed.
Results
RBIS expression was significantly elevated in PCa tissues compared to normal tissues. High RBIS expression correlated with adverse clinical outcomes, including advanced tumor stages and higher Gleason scores. Elevated RBIS levels were associated with poorer progression-free survival (PFS) and served as an independent prognostic marker. Co-expression analysis revealed that RBIS and its associated genes were involved in key cellular processes such as energy metabolism and protein synthesis. Furthermore, RBIS expression was linked to immune cell infiltration and drug sensitivity, indicating potential therapeutic implications.
Conclusion
RBIS emerges as a novel biomarker for the diagnosis and prognosis of PCa, with significant potential as a therapeutic target. Further research is needed to validate these findings and explore RBIS's role in clinical applications, aiming to improve PCa management and patient outcomes.
Hope and health promoting intention among stroke patients in China: the mediating role of self-efficacy
Authors: Chen Lei , Huang Tenjia , Cao Xi , Liu Yixin , Li Sheng , Qin Lihua
Published: October 2024

Introduction:
Stroke is one of the major diseases that threaten life and health globally, and reducing the risk of recurrence after stroke and promoting the recovery of physical and mental functions are significant challenges in solving the health problems of stroke patients. Compared to surgical and pharmacologic treatments, relatively few studies have focused on improving health promoting intention in stroke patients to enhance disease prognosis. This study aimed to explore the relationship between health promoting intention, hope, and self-efficacy.
Methods
From June 2023 to November 2023, a questionnaire survey was conducted among 521 stroke patients in the affiliated hospitals of Hunan University of Chinese Medicine using cluster sampling. The survey instruments included a general demographics questionnaire, Health-Promoting Lifestyle Scale II, General Self Efficacy Scale, and Herth Hope Index. Multiple regression analysis was used to explore the influencing factors of health promoting intention, and structural equation modeling was constructed to test the mediating role of self-efficacy between hope and health promoting intention.
Results
A total of 499 valid questionnaires were included. There was a significant positive correlation between health promoting intention, hope, and self-efficacy (p < 0.01). Hope (β = 2.812, p < 0.01), self-efficacy (β = 6.712, p < 0.001), and disease knowledge (β = 0.167, p < 0.001) significantly and positively influenced health promoting intention. Self-efficacy partially mediated the relationship between hope and health promoting intention [β = 0.258, 95%CI (0.126, 0.401)], with the indirect effect accounting for 41.55%.
Conclusion
This study confirmed the significant positive effect of hope on health promoting intention, with self-efficacy mediating between the two. Future research should explore other influences on health promoting intention to develop a comprehensive health promotion behavioral intervention program for stroke patients.
Trajectories of medical students’ empathy nowadays: A longitudinal study using a comprehensive framework of empathy
Authors: Carrard Valerie , Bourquin Céline , Berney Sylvie , Ranjbar Setareh , Schlegel Katja , Gaume Jacques , Bart Pierre-Alexandre , Mast Marianne Schmid , Preisig Martin , Berney Alexandre
Published: October 2024

Background. For more than a decade, the literature has been dominated by the notion that medical students may paradoxically lose their empathy during medical school. However, medical curricula have significantly evolved, and the question is whether this is still the case. The present study aimed to describe the trajectories of different dimensions of empathy from the beginning to the end of a six-year medical curriculum and explore the influence of different psychosocial and health-related factors.
Methods. In an open cohort design, all medical students at the University of Lausanne (Switzerland) were invited to complete four waves of yearly online questionnaires. Cognitive, affective, and behavioral empathy were measured with three validated instruments, and emotion recognition was assessed with a performance test. For each measure, linear mixed models including an array of psychosocial and health-related potential covariates were modelled. Different temporal variance-covariance structures and nonlinear trajectories were tested.
Results. The final sample included 3224 questionnaires completed by 1667 medical students. The cognitive and affective dimensions of empathy significantly increased in the first half of medical school, followed by a plateau, whereas behavioral empathy remained stable. For emotion recognition, a significant linear increase was observed. The only covariate with substantial influence was gender: students identifying as male presented similar trajectories of empathy and emotion recognition but with overall lower scores than students identifying as female or nonbinary.
Conclusions. This study revealed significant increases in cognitive empathy, affective empathy, and emotion recognition. Developments in today’s medical curricula may have contributed to the observed increase in empathy. Future multisite studies are warranted to identify the features of the educational environment that impact the trajectories of empathy during medical school.
Role of pharmacists in providing information on cancer genome medicine and patient decision making：open-label randomized controlled study
Authors: Saigo Orie , Nojiri Shuko , Asakura Kota , Koshiba Shoji , Saito Uki , Iwakawa Satoshi , Kimura Toshimi , Kato Shunsuke
Published: October 2024

Background
Cancer genome medicine based on genetic mutations is developing globally, and comprehensive genome profiling (CGP) are now routinely performed in Japan. Patient expectations are high for new treatment modalities based on genetic testing, but these are mostly unknown in Japan. The role of pharmacists in cancer genome medicine has not yet been established, but they can be a potential source of reliable information on cancer genome medicine, thus improving the health literacy of patients and supporting their decision making.
Methods
This was an open-label randomized controlled study. Subjects were randomly assigned 1:1 to the intervention and non-intervention groups, with treatment objective (preoperative and postoperative/advanced recurrence) as a stratification factor. In the non-intervention group, the pharmacist provided explanations about the drugs as done in usual care. In addition, the intervention group was provided with information on CGP. The primary endpoint was the impact of the pharmacist’s intervention on the patient’s decision making, measured by the Decisional Conflict Scale (DCS). As a secondary endpoint, factors influencing patient’s decision making were also analyzed.
Results
The analysis included responses from 180 patients. The pharmacist interview lasted 19.9 ± 6.9 and 10.4 ± 4.3 minutes for the intervention and non-intervention groups, respectively. The percentage of patients whose DCS scores decreased before and after the pharmacist interview was not significant between the intervention versus non-intervention groups (49.4% vs. 41.9%; p = 0.313, test of proportions). However, the DCS score of the intervention and non-intervention groups increased by 1.98 ± 16.5 and 3.61 ± 17.3, respectively. Both groups exhibited an increase in decisional conflict about receiving treatment, including CGP, but the change was significantly smaller in the intervention group (p = 0.026, unpaired t-test). Factors that influenced patient’s decision making through pharmacist intervention included age, chemotherapy being the primary treatment and having no history of nonsurgical treatment, such as chemotherapy, radiofrequency ablation, transcatheter arterial chemoembolization, and microwave ablation.
Conclusions
Increased conflicts is reduced when pharmacists provide information about CGP to patients undergoing cancer chemotherapy. This can help patients make informed decisions about their treatment choices.
Intrarater and Interrater Reliability of the Quantification of Knee Cartilage MR Relaxation Metrics
Authors: Liao Tzu-Chieh , Pang Yuxi , Yablon Corrie M. , Lewis Michaela K. , Hyun Jeongmin G.
Published: October 2024

Background
Magnetic resonance (MR) imaging is often used to study osteoarthritis (OA), as advanced MR imaging methods can provide a quantitative assessment of tissue biochemistry or composition. For example, the magnetic relaxation times T1ρ (i.e., 1/R1ρ) and T2 (i.e., 1/R2) of water molecules within articular cartilage have been demonstrated to be imaging biomarkers sensitive to the compositional changes associated with early OA. However, the outcome of MR imaging data analysis depends on relaxation data acquisition methods as well as assessor variability if manual segmentation is performed. Therefore, the goal of the current study was to evaluate the intra- and interrater reliability of established imaging protocols for performing quantitative cartilage MR relaxation metrics of the knee joint.
Methods
Right knee MR images were obtained from five healthy individuals (average age, 24.4 years; 3 females) via a 3.0T MRI scanner equipped with a 16-channel knee T/R coil. A double echo steady state (DESS) sequence was used for anatomical imaging, and the established MAPSS sequences were used for R1ρ and R2 mapping. One assessor performed manual segmentations of the knee cartilage on two separate occasions, whereas a second assessor performed segmentations once. Both the R1ρ and R2 mean values were then calculated for the tibial, patellar, femoral trochlear, central femoral condylar, and posterior femoral condylar cartilages. Intraclass correlation coefficients [ICC (3,1)] and ICCs (2,1) were used to evaluate intra- and interrater reliability, respectively. The standard error of measurement (SEM) was used to assess absolute reliability.
Results
The intrarater knee cartilage relaxation metrics demonstrated good to excellent reliability, ranging between 0.88 and 0.99, with SEMs ranging between 0.16 and 0.80. The interrater reliability similarly ranged from 0.79–0.97, with SEMs ranging between 0.27 and 1.10.
Conclusions
Manual segmentation of specific MR slices and known subregions is highly reliable and repeatable for the quantification of cartilage MR relaxation metrics. This validation paves the way for the large-scale application of this method in prospective trials that longitudinally monitor OA development and progression in the knee joint.
Diffusion-T2 correlated spectroscopy imaging to explore possible placental composition changes over gestation
Authors: Liu Xilong , Huang Chantao , Chen Sijin , Feng Jie , Qiao Wenjun , Liu Bo , Hu Wentao , Dai Yongming , Xu Yikai
Published: October 2024

Background
Placenta plays a vital role for fetal growth and development during pregnancy. Currently, antenatal noninvasive imaging techniques to directly evaluate placental function remains challenge. Diffusion-T2 correlated spectroscopy imaging (DT2SI) can provide compositional information for different organs in-vivo. The aim of this study was to investigate the use of DT2SI as a tool to elucidate the placental composition change over gestation in healthy pregnancy.
Methods
Forty healthy singleton pregnancies was retrieved from our placental MRI research database. MRI was performed at 23.1–36.0 weeks of gestational age (GA) in a 3.0T system. DT2SI measurements were performed using DWI sequence with 7 b-values combining 4 TEs. ROIs were manually defined inside placenta on five cross-sectional slices covering the most central part of placenta. D-T2 Spectra were constructed and segmented into 9 compartments: A1(low D, short T2), A2(low D, medium T2), A3(low D, long T2), B1(medium D, short T2), B2(medium D, medium T2), B3(medium D, long T2), C1(high D, short T2), C2(high D, medium T2), C3(high D, long T2). Volume fraction Vm of each compartment m was obtained voxel by voxel, and general Vm of whole ROI was calculated for each participant. The relationships of Vm to GA were assessed by Pearson correlation.
Results
Four to five peaks could be observed in the spectrum for most subjects. Strong correlation between DT2SI Vm and GA was found. VA1 (r = 0.633, p < 0.001) showed significant increase with GA. VA2 (r=-0.465, p = 0.002) and VA3 (r=-0.653, p < 0.001) showed moderate/remarkable decrease. The perfusion compartment VB1 (r = 0.358, p = 0.023), VC1 (r = 0.411, p = 0.008) illustrate a slight/moderate increase. Other compartments have low concentration (average V < 3%).
Conclusions
Comprehensive information on evolution of placenta composition with gestation could be provided by DT2SI, suggesting its unique value for assessing placental function during pregnancy.
Clinical and Surgical Outcomes of Pediatric Cushing's Disease Following Endoscopic Transsphenoidal Surgery
Authors: Sharifi Guive , Paraandavaji Elham , Nasab Mohammad Mehdi Mousavi , Mohammadi Esmaeil , Sadeghi Neginalsadat , Tehrani Mohammad Reza Mohajeri , Dilmaghani Nader Akbari
Published: October 2024

Background
Cushing's disease (CD) is characterized by hypercortisolism due to excessive adrenocorticotropic hormone (ACTH) secretion from a pituitary adenoma. Though more common in adults, pediatric cases constitute approximately 5% of those seen in adults. Early diagnosis and treatment are critical due to the severe impacts on growth and development in children. Endoscopic transsphenoidal surgery (ETSS) is the preferred first-line treatment for both children and adults.
Methods
From 2011 to 2024, 3,280 patients with pituitary adenoma underwent surgery using the ETSS technique at Loghman Hospital of Tehran, including 213 CD cases, of which 22 were pediatric (under 18 years old). This retrospective study analyzed clinical data such as age, gender, presenting symptoms, family and medical history, imaging characteristics, surgical findings, pathology, follow-up, and postoperative outcomes. Diagnostic criteria included biochemical tests, MRI imaging, and inferior petrosal sinus sampling.
Results
Out of 22 pediatric patients, 16 were females and 6 males, with an average age of 14.73 years. Obesity was the initial clinical manifestation in 59% of the patients. According to the Hardy-Wilson classification, 18.2% of patients were stage E, 9.09% stage C, and the rest (excluding MRI-negative patients) stage A. ETSS was performed on all patients, with total hypophysectomy in 18.2% and hemi-hypophysectomy in 9.09%. Postoperative complications included cerebrospinal fluid leakage in 13.63% of patients. Remission was achieved in 95.45% of patients, with a recurrence rate of 4.54%. Hormone imbalances post-surgery included hypocortisolism (50%), hypothyroidism (45.45%), and hypogonadism (13.63%).
Conclusion
ETSS is an effective and safe treatment for pediatric CD, achieving high remission rates and minimal complications. This study highlights the importance of specialized surgical care in managing pediatric CD and underscores the need for early diagnosis and intervention. Further studies are warranted to evaluate long-term outcomes and optimize treatment protocols.
The role of co-infections on cervical intraepithelial neoplasia prevalence in western Kenya
Authors: Onyango Calleb George , Ogonda Lilian , Guyah Bernard
Published: October 2024

Background
Screening for co-infections with HIV, HSV-2 and Chlamydia trachomatis (CT) among high-risk human papilloma virus (hr-HPV) positive women remains essential in alleviating high morbidity of cervical cancer (CC). The aim of this study was to determine the prevalence of cervical intraepithelial neoplasia (CIN) among women referred for CC screening at a referral hospital in Kisumu County, Kenya; and to establish the role of co-infection on CIN.
Method
In a cross-sectional study, we collected HPV, HIV, HSV-2 and CT data, cervical cytology results, and demographic information from 517 referrals. Blood samples were obtained for HIV and HSV-2 tests; urine for CT test and cervical swabs for hr-HPV test.
Results
The overall prevalence of CIN was 18.4% (95/517) with CIN1 observed in 56(29.6%), CIN2 in 27(`14.3%), CIN3 + in 12(6.3%) and normal biopsy in 94(49.7%) of the patients out of which high grade CIN2 and above (CIN2+) was 7.54% (39/517) equivalent to 32.5 per 100,000 women per year. HPV/HIV co-infection (infected vs. uninfected: OR 2.79; 95% CI 1.56–5.10, p < 0.001); HPV/HSV-2 co-infection (infected vs. uninfected: OR 2.41, 95% CI: 1.12–5.46, p < 0.024); HPV/CT co-infection (infected vs. uninfected: OR 3.83; 95% CI 1.84–8.51, p < 0.001) were found to be significantly associated with CIN.
Conclusion
Overall prevalence of CIN was high in the region although high-grade CIN2 + remained relatively lower as reported earlier. Age factor, widowhood and co-infections with HIV, HSV-2 or Chlamydia trachomatis were associated with increased risk of testing positive for CIN.
Saturated fatty acids-induced neutrophil extracellular traps contribute to exacerbation and biologic therapy resistance in obesity-related psoriasis
Authors: Tao Juan , Xia Yuting , Lan Jiajia , Yang Jing , Yuan Shijie , Xie Xiaorong , Du Qiuyang , Du Hongyao , Nie Wenjia , Jiang Biling , Zhao Liang , Cai Zhen , Zhang Xin , Xiong Yan , Li Yan , He Ran
Published: October 2024

Psoriasis patients with obesity tend to show a serious clinical manifestation and have poor responses to various biological agents in most cases. However, the mechanisms in obesity-exacerbated psoriasis remain enigmatic. In this study, we found that the abundance of systemic and localized cutaneous neutrophil extracellular traps (NETs) in obesity-induced aggravation of psoriasis was positively correlated with disease severity, and inhibition of NETs alleviated psoriatic dermatitis in obese mice. Mechanistically, we found that changes of fatty acid composition in obese subjects resulted in the deposit of saturated fatty acids (SFAs), which promoted the release of NETs via the TLR4-MD2/ROS signaling pathway. We further found that NETs potentiated IL-17 inflammation in obesity-exacerbated psoriasis, especially γδT17-mediated immune responses. Moreover, SFAs induced decreased response to anti-IL17A treatment in psoriasis-like mice, whereas inhibition of NETs improved the beneficial effects of anti-IL17A in psoriasis-like mice with lipid metabolism disorders. Our findings collectively suggest that SFAs-induced NETs play a critical role in the exacerbation of obesity-related psoriasis, and provide potential new strategies for the treatment of refractory psoriasis patients with lipid metabolism disorders clinically.
Enablers and Barriers to Preconception Dietary Behaviours: A Mixed Method Study with Women of Reproductive Age
Authors: Kandel Pragya , Lim Siew , Dever Michelle , Lamichhane Prabhat , Skouteris Helen , Currie Sinead , Hill Briony
Published: October 2024

Background
A healthy diet before conception (preconception) diet is associated with enhanced maternal health, improved cardiometabolic outcomes, reduced risk of pregnancy complications, and effective weight management. Yet, women of reproductive age frequently exhibit suboptimal dietary behaviours before conception. We aimed to investigate the enablers and barriers related to preconception diet among women of reproductive age.
Methods
Using sequential explanatory mixed methods, an online cross-sectional quantitative survey was followed by online qualitative interviews with women of reproductive age (18–45 years). Survey measures included the Healthy Eating Quiz (HEQ), and a pilot-tested new measure, the Preconception Diet Enablers and Barriers Scale (PDEBS) to evaluate barriers and enablers to diet. Linear regression analysed the relationship between Australian Recommended Food Score (ARFS) and barriers/enablers. Qualitative interviews were conducted to understand the reasons behind women’s (non)engagement in healthy dietary habits. A weaving approach, use of joint-display, and the Capability Opportunity Motivation Behaviour (COM-B) model were used to integrate and present the data.
Results
Seven hundred and eighty-eight non-pregnant women (mean [M] age 32.08 years, SD = 7.31) residing in Australia, India, and the US completed the survey. Qualitative interviews (M duration = 30 mins) were conducted with 13 women based in Australia. Women's capability to maintain a healthy preconception diet was influenced by their level of knowledge and awareness of its significance. Opportunities for a healthy preconception diet were shaped by social support, time availability, financial resources, and accessibility. Additionally, motivation to adhere to a healthful preconception diet was influenced by beliefs regarding its potential outcomes, alignment with personal goals, and emotional state.
Conclusion
Our findings advance understanding of the determinants influencing preconception dietary behaviours and provide valuable insights for designing effective interventions to promote healthy preconception dietary habits. By addressing the identified enablers and barriers comprehensively, policymakers, healthcare professionals, and researchers can work together to support women in adopting and maintaining healthy preconception dietary behaviours, ultimately improving maternal and child health outcomes.
Pathology-interpretable radiomic model for predicting clinical outcome in patients with osteosarcoma: a retrospective, multicentre study
Authors: Ren Qiuping , Zhang Xiao , Wu Xuewei , Zhao Heng , Zhang Yongxin , Yao Yubin , Leng Yinping , Zhang Xiaoyang , Liu Yumeng , Xiao Jijie , Liu Wenwen , Xie Xia , Pei Nana , He Rongfang , Tang Na , Wen Ge , Zhang Xiaodong , Zhang Shuixing , Zhang Bin
Published: October 2024

Background: Osteosarcoma is the most prevalent primary malignant bone tumor. Radiomic models demonstrate promise in globally evaluating the prognosis of osteosarcoma; however, they lack biological interpretability. We aimed to develop a radiomic model using MRI to predict disease-free Survival (DFS) in osteosarcoma patients, and to provide underlying pathobiology of the model.
Methods: This retrospective study included 270 patients (training set, n=166; external test set 1, n=56; external test set 2, n=48) with surgically treated and histology-proven osteosarcoma from 14 tertiary centres. A total of 1130 radiomic features were extracted from pre-treatment MRI. After dimensionality reduction, radiomic model was built on the training set and tested on the external test sets. Radiomics interpretability study leveraged the Hematoxylin and eosin (H&E) and Immunohistochemistry (IHC) stained whole slide images (WSIs) of patients from the testing sets. Ten types of nuclear morphological features were extracted from each nucleus in H&E WSIs and aggregated into 150 patient-level features. Moreover, five immune- and hypoxia-related IHC biomarkers—CD3, CD8, CD68, FOXP3, and CAIX—were quantified from IHC WSIs. The correlation between the radiomic features and histopathologic biomarkers was assessed using Spearman correlation analysis.
Results: The radiomic model including 12 features yielded a time-dependent AUC of 0.916 (95% CI: 0.893-0.939), 0.802 (95% CI: 0.763-0.840), and 0.895 (95% CI: 0.869-0.920) in the training set, external test set 1, and external test set 2, respectively. All 12 radiomic features exhibited significant correlations with 109-133 cellular features, totaling 1460 (81.1%) pairs. In detail, there were 574 pairs with absolute coefficient r (|r|) between 0 and 0.1, 516 pairs between 0.1 and 0.2, 241 pairs between 0.2 and 0.3, 99 pairs between 0.3 and 0.4, and 30 pairs exceeding 0.4. Six radiomic features were correlated with CAIX (|r| = 0.03-0.17), 10 features with CD3 (|r| = 0.02-0.71), eight features with CD8 (|r| = 0.05-0.42), nine features with FOXP3 (|r| = 0.01-0.55), 11 features with CD8 / FOXP3 ratio (|r| = 0.004-0.74), and 11 features with CD68 (|r| = 0.02-0.47).
Conclusions: The MRI-based radiomic model effectively predicts DFS in osteosarcoma patients. The correlation strength between radiomic features and histopathologic biomarkers varies.
Correlation between the first-trimester non-traditional lipid parameters with the risk of gestational diabetes mellitus in pregnancy
Authors: Xiang Junmiao , Bao Ruru , Pan Yundong , Cai Zhuhua
Published: October 2024

Introduction: Gestational diabetes mellitus (GDM) is a common complication in pregnancy, linked to adverse outcomes for mothers and infants. Elevated levels of non-traditional lipid parameters have been associated with metabolic disorders. This study investigates these lipid parameters' role in predicting GDM in the first trimester.
Methods: A retrospective study involving 1197 patients from The Third Affiliated Hospital of Wenzhou Medical University (January 2019 - August 2023) examined the correlation between non-traditional lipid parameters and GDM using logistic regression and stratified analyses. The diagnostic performance of the lipid parameters was evaluated using the area under the curve (AUC) method. Pearson correlation analysis clarified the relationship between non-traditional lipid parameters and neonatal birth weight, as well as their association with oral glucose tolerance test (OGTT) glycemic measures.
Results: Among 1197 participants, 201 were diagnosed with GDM. The GDM group exhibited significantly higher levels of non-traditional lipid parameters. Multivariate analysis identified these lipid measures, particularly Non-HDL-C with an AUC of 64.0% (95% CI: 59.6%-68.4%), as independent predictors of GDM across all models (P < 0.05), except for RC/HDL-C in model3. Most non-traditional lipid parameters demonstrated a linear relationship with GDM, with the exception of Non-HDL-C. Strong positive correlations were observed between fasting blood glucose levels and lipid ratios such as Non-HDL-C/HDL-C, LDL/HDL-C, TG/HDL-C, TC/HDL-C, and RC/HDL-C in patients with GDM. No significant differences were found in non-traditional lipid parameters among the single, double, and triple positive groups.
Discussion: First-trimester non-traditional lipid parameters are significant predictors of GDM, particularly when considering fasting blood glucose levels from the OGTT. These parameters offer potential value for early diagnosis.