bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigating the Determinants of IoT Device Continuance Intentions: An Empirical Study of Smart Speakers Through the Lens of Expectation-Confirmation Theory
Authors: Wang Ming Xing , Kim Ki Su , Kim Jeoung Kun
Published: September 2023

IoT device market has grown rapidly in recent years, with many researches have been done to investigate the IoT devices’ adoption factors. However, it is crucial to understand how to maintain the users’ continuance intention. This study, based on the post-acceptance model of the Expectation Confirmation Model (ECM), investigates the impact of early-stage users’ personal traits (personal innovativeness), social influence (normative and informational), and familiarity, on the social diffusion of IoT devices (in particular, smart speakers) measured by the continuation intention of smart speakers. We tested the research model and hypotheses using data from 364 smart speaker users, analyzed with partial least square technique using Smart-PLS. The data analysis results revealed that satisfaction has a very strong and positive impact on continuance intention. Perceived usefulness, confirmation, and personal innovativeness are positively associated with continuance intention via satisfaction. Social influence, represented by normative and informational social influence, showed a significant positive impact on continuance intention, a high degree of familiarity weakens the influence of normative social influence on continuance intention; however, familiarity has no impact on the relationship between informational social influence and continuance intention.
Predictive Value of Preoperative Short Form-36 Survey Scale for Postoperative Axial Neck Pain in Patients With Degenerative Cervical Myelopathy
Authors: Chen Rui , Liu Jiesheng , Zhao Yanbin , Diao Yinze , Chen Xin , Pan Shengfa , Zhang Fengshan , Sun Yu , Zhou Feifei
Published: September 2023

Study Design

Prospective observational study.

Objective

To evaluate the predictive value of the preoperative Short Form-36 survey (SF-36) scale for postoperative axial neck pain (ANP) in patients with degenerative cervical myelopathy (DCM) who underwent anterior cervical decompression and fusion (ACDF) surgery.

Methods

This study enrolled patients with DCM who underwent ACDF surgery at author’s Hospital between May 2010 and June 2016.

Results

Out of 126 eligible patients, 122 completed the 3-month follow-up and 117 completed the 1-year follow-up. The results showed that the preoperative social functioning (SF) subscale score of the SF-36 scale was significantly lower in patients with moderate-to-severe postoperative ANP than in those with no or mild postoperative ANP at both follow-up timepoints ( P < .05). ACDF at C4-5 level resulted in a higher ANP rate than ACDF at C5-6 or C6-7 level, both at 3-month ( P = .019) and 1-year ( P = .004) follow-up. Multivariate logistic regression analysis confirmed that the preoperative social functioning subscale score was an independent risk factor for moderate-to-severe postoperative ANP at 3 months and 1 year after surgery, and preoperative NRS was an independent risk factor at 1-year follow-up. No other demographic, clinical, or radiographic factors were found to be associated with postoperative ANP severity ( P < .05).

Conclusions

Preoperative social functioning subscale score of SF-36 scale might be a favorable predictive tool for postoperative ANP in DCM patients who underwent ACDF surgery.
How Does Spino-Pelvic Fixation Affect Post-Operative Compensatory Mechanisms in Adult Spinal Deformity?
Authors: Zhi Wang , Boubez Ghassan , Al-Shakfa Fidaa , Kamel Yousef , Liu Jia , Shedid Daniel , Yuh Sung Joo , Rizkallah Maroun
Published: September 2023

Study Design

Retrospective single-center multi-surgeon cohort study.

Objectives

Compare the post-operative changes in the compensatory mechanisms of the sagittal balance according to the type of pelvic fixation: S2-Alar-iliac screws (S2AI) vs iliac screws (IS) in patients with Adult spine deformity (ASD).

Methods

ASD patients who underwent spino-pelvic fixation and remained with a PI-LL >10° mismatch post-operatively were included. Pre-operative and 1-year-follow-up PI, Lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), thoracic kyphosis (TK), femur obliquity angle (FOA), knee flexion angle (KFA) and ankle flexion angle (AFA) were analyzed on EOS imaging. Patients were categorized based on their pelvic fixation type (S2AI vs IS), and the pre-operative to 1-year-post-operative changes (ΔX°) in the compensatory mechanisms were compared between groups.

Results

Patients with S2AI ( n = 53) and those with IS ( n = 26) screws were comparable at baseline. ΔSS averaged 9.87° in the S2AI compared to 13.2° in the IS ( P = .001), whereas the ΔKFA reached 6.01° in the S2AI as opposed to 3.06° in the IS ( P = .02). The ΔPT was comparable between both groups (6.35°[S2AI group] vs 5.21°[ISgroup], P = .42). ΔTK, ΔLL, ΔFOA and ΔAFA were comparable between both groups.

Conclusion

The type of pelvic fixation impacts significantly the post-operative compensatory mechanisms in patients with ASD. Patients with S2AI screws are more likely to compensate their remaining post-operative PI-LL mismatch through their knees and less likely through their pelvis compared to patients with IS, despite similar changes in PT. This could be explained by an increased SI joint laxity in ASD patient and the lower resistance of the iliac connectors to the junctional mechanical stresses, allowing for sacro-iliac joint motion in patients with IS.
Socio-demographic and antenatal risk factors of brain tumor in children and young people: A matched case-control study from Karachi, Pakistan
Authors: Zahid Nida , Enam Syed Ather , Urooj Faiza , Martins Russell Seth , Mårtensson Thomas , Mårtensson Andreas , Mushtaq Naureen , Kausar Faiza , Moochhala Mariya , Mughal Muhammad Nouman , Altaf Sadaf , Kirmani Salman , Brown Nick
Published: September 2023

Background:

Brain tumors are a common cause of morbidity, disability, cognitive deterioration and mortality in children, even after treatment. Little is know about the specific causes. The study aimed to assess potential socio-demographic and antenatal factors in primary brain tumor (PBTs) in children and young people (CYP) in Karachi, Pakistan.

Designs and methods:

A single center hospital based matched case control study in Karachi, Pakistan. Cases were defined as CYP aged between 5 and 21 years with any histological type and grade of primary brain tumor of any histology, stage or grade. Data were collected from parents of 244 patients at the selected center between 2017 and 2021 via telephonic interview. Controls were 5–21 years old CYP admitted with non-oncological diagnoses matched on age and sex. Matched Odds Ratios for predictors of brain tumor in children were derived. Those of statistical significance were included in a multivariable logistic regression model.

Results:

In the adjusted model, lower paternal education (matched adjusted odds ratio (maOR) 2.46; 95% CI 1.09–5.55), higher household monthly income (maOR 3.4; 95% CI 1.1–10.2), antenatal paternal use of addictive substances (maOR 19.5; 95% CI 2.1–179.8), and antenatal maternal use of analgesics during pregnancy (maOR 3.0; 95% CI 1.2–7.9) were all independently predictive of brain tumors.

Conclusion:

This matched case-control study found novel associations between maternal use of analgesics, paternal use of addictive substances, higher household income, and lower paternal education and Primary Brain Tumors in Children and Young People. Longitudinal multicenter studies will be required to test these associations prospectively.
Psychological Contract Violation and Turnover Intention: Do Trust and Organizational Commitment Matter?
Authors: Jeswani Saket , Satpathy Durgesh , Chavez Felix , Sharma Dinesh K.
Published: September 2023

This study aimed to investigate the relationship between psychological contract violation (PCV) and turnover intention among faculty members in selected AACSB-accredited B schools in India. Drawing on social exchange theory, the study examined the impact of transactional and relational psychological contracts on turnover intention, with trust and organizational commitment as potential mediators. Data were collected through an online structured questionnaire from 305 faculty members. The results revealed that PCV significantly influenced turnover intention, both directly and indirectly. Trust was found to mediate the relationship between PCV and turnover intention. However, organizational commitment did not act as a mediator in this context. Furthermore, the study highlighted the significance of the relational contract compared to the transactional contract. The relational contract had a stronger impact on turnover intention through its influence on trust. By exploring the direct and indirect relationships between PCVs and turnover intention, this study contributes to the existing knowledge within the framework of social exchange theory. It sheds light on the importance of trust as a mediator and emphasizes the role of the relational contract in understanding turnover intention.
The Social Relations of Ethnographic Fieldwork: Access, Ethics and Research Governance
Authors: Nepali Shobha , Einboden Rochelle , Rudge Trudy
Published: September 2023

The focus of this methodological paper is to discuss the challenges of conducting fieldwork, using reflections from our experiences of accessing a research site for ethnographic data collection. The research project aimed to explore nurses’ social relations in their workplace and the inequities between and within these relations among nurses of diverse social positions. Due to the sensitive nature of this topic, access to the research site posed several challenges and was further complicated by the bureaucratic ethics process that governs clinical sites in Australia. Although this study was considered a low and negligible risk research, negotiating the ethics process was full of hitches and hindrances resulting in the refusal of access. This paper offers ethnographers a reflection on challenges in accessing clinical sites to conduct research and a discussion of strategies that may be useful to navigate and counter these challenges by managing social relations in the field.
As the Elders Sang: Exploring the Continuity and Novelty in the Folk Musical Performances of Goa
Authors: Mendes Ninotchka
Published: September 2023

Music, society and culture are intimately linked with each other. Music not only fulfils its primary need as a source of entertainment but also serves as a powerful medium for human communication. Music today has come to represent more as a commercial product, thus transforming its role in the socio-cultural domain of society. This article aims to explore the folk musical performances of the Christian Gawda, with special focus on one form of folk performance locally known as ghumata vazop. While presenting in brief the ideas put forward by some sociologists on music, ethnomusicology and folk music, the article attempts at a conceptual clarification between the two tribal identities of Gawda and Kunbi. Lastly, it explores aspects of continuity and novelty in the folk musical traditions of the Gawdas.
Recorded and modeled response of the Thorndon Overbridge during multiple earthquakes
Authors: Chigullapally Pavan , Wotherspoon Liam , Stephens Max T , Hogan Lucas S
Published: September 2023

This article presents the recorded and modeled strong-motion response of a long (1.35 km) bridge located in Wellington, New Zealand during multiple sequential earthquakes. These were some of the first recordings of this kind for a New Zealand highway bridge and add to the limited database of bridge superstructure strong-motion responses recorded worldwide. The bridge experienced little damage during the earthquakes; however, analysis of the recorded responses showed the fundamental period of the bridge varied by up to 15% across these events, highlighting the system softening that can develop without any significant structural damage. Numerical models of a single bridge pier using a p-y spring foundation modeling approach were able to represent the changes in the recorded bridge pier response across the events based on multiple response metrics, suggesting that system softening was primarily due to nonlinear soil response and concrete cracking. A sensitivity analysis showed that concrete strength and the characteristics of the upper soil layers had the largest influence on the model response. Given the presence of several strong-motion stations in close vicinity to the bridge, the sensitivity to ground-motion input was also investigated. This was shown to have a more significant influence on the modeled response than the other modeling uncertainties evaluated here, with the variability in estimated deformations highlighting the difficulties involved in the back analysis of the response of structures.
New mechanisms and biomarkers of lymph node metastasis in cervical cancer: reflections from plasma proteomics
Authors: Han Sai , Liu Xiaoli , Ju Shuang , Mu Wendi , Abulikemu Gulijinaiti , Zhen Qianwei , Yang Jiaqi , Zhang Jingjing , Li Yi , Liu Hongli , Chen Qian , Cui Baoxia , Wu Shuxia , Zhang Youzhong
Published: September 2023

Objective

Lymph node metastasis (LNM) and lymphatic vasculature space infiltration (LVSI) in cervical cancer patients indicate a poor prognosis, but satisfactory methods for diagnosing these phenotypes are lacking. This study aimed to find new effective plasma biomarkers of LNM and LVSI as well as possible mechanisms underlying LNM and LVSI through data-independent acquisition (DIA) proteome sequencing.

Methods

A total of 20 cervical cancer plasma samples, including 7 LNM-/LVSI-(NC), 4 LNM-/LVSI + (LVSI) and 9 LNM + /LVSI + (LNM) samples from a cohort, were subjected to DIA to identify differentially expressed proteins (DEPs) for LVSI and LNM. Subsequently, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were performed for DEP functional annotation. Protein–protein interaction (PPI) and weighted gene coexpression network analysis (WGCNA) were used to detect new effective plasma biomarkers and possible mechanisms.

Results

A total of 79 DEPs were identified in the cohort. GO and KEGG analyses showed that DEPs were mainly enriched in the complement and coagulation pathway, lipid and atherosclerosis pathway, HIF-1 signal transduction pathway and phagosome and autophagy. WGCNA showed that the enrichment of the green module differed greatly between groups. Six interesting core DEPs (SPARC, HPX, VCAM1, TFRC, ERN1 and APMAP) were confirmed to be potential plasma diagnostic markers for LVSI and LNM in cervical cancer patients.

Conclusion

Proteomic signatures developed in this study reflected the potential plasma diagnostic markers and new possible pathogenesis mechanisms in the LVSI and LNM of cervical cancer.
CRISPR-Cas System, a Possible “Savior” of Rice Threatened by Climate Change: An Updated Review
Authors: Shaheen Nabeel , Ahmad Shakeel , Alghamdi Salem S , Rehman Hafiz Mamoon , Javed Muhammad Arshad , Tabassum Javaria , Shao Gaoneng
Published: September 2023

Climate change has significantly affected agriculture production, particularly the rice crop that is consumed by almost half of the world’s population and contributes significantly to global food security. Rice is vulnerable to several abiotic and biotic stresses such as drought, heat, salinity, heavy metals, rice blast, and bacterial blight that cause huge yield losses in rice, thus threatening food security worldwide. In this regard, several plant breeding and biotechnological techniques have been used to raise such rice varieties that could tackle climate changes. Nowadays, gene editing (GE) technology has revolutionized crop improvement. Among GE technology, CRISPR/Cas (Clustered Regularly Interspaced Short Palindromic Repeats/CRISPR-associated protein) system has emerged as one of the most convenient, robust, cost-effective, and less labor-intensive system due to which it has got more popularity among plant researchers, especially rice breeders and geneticists. Since 2013 (the year of first application of CRISPR/Cas-based GE system in rice), several trait-specific climate-resilient rice lines have been developed using CRISPR/Cas-based GE tools. Earlier, several reports have been published confirming the successful application of GE tools for rice improvement. However, this review particularly aims to provide an updated and well-synthesized brief discussion based on the recent studies (from 2020 to present) on the applications of GE tools, particularly CRISPR-based systems for developing CRISPR rice to tackle the current alarming situation of climate change, worldwide. Moreover, potential limitations and technical bottlenecks in the development of CRISPR rice, and prospects are also discussed.
The dimethadione-exposed rat fetus: an animal model for the prenatal ultrasound characterization of ventricular septal defect
Authors: Yang Yiru , Lyu GuoRong , He Shaozheng , Yang Hainan , Li Shangqing
Published: September 2023

Background

Ventricular septal defect (VSD) is the most prevalent congenital heart disease (CHD) and is easily misdiagnosed or missed. An appropriate VSD animal model could be used to analyze the ultrasound characteristics and their related pathological bases, and provides the opportunity to further explore the pathogenesis of VSD. Currently, little is known about whether ultrahigh-frequency ultrasound biomicroscopy (UBM) is suitable to diagnose VSD of fetal rats. There is no research on whether a dimethadione (DMO)-induced fetal VSD model is suitable for the observation and analysis of imaging characteristics and the associated pathological basis.

Methods

We used DMO to induce VSD. UBM was used to perform the prenatal ultrasound characterization. With the pathological results used as the gold standard, the ultrasound characteristics and their related pathological bases were analyzed.

Results

The incidence of VSD in the DMO group was 42.05% and 39.71% (diagnosed by UBM and pathology, respectively,P > 0.05). The prenatal ultrasound findings and pathological basis of various diseases, including isolated VSD, complex CHD containing VSD, and extracardiac lesions, were detected and discussed. It was discovered that some fetuses showed features of noncompacted ventricular myocardium, and for the first time, clusters of red blood cell traversing the cardiomyocytes.

Conclusions

The DMO-induced VSD model is a low-cost model with a high success rate and is suitable for the observation and analysis of VSD. UBM is suitable for evaluating VSD.
Systematic examination of methodological inconsistency in operationalizing cognitive reserve and its impact on identifying predictors of late-life cognition
Authors: Howard Kerry A. , Massimo Lauren , Griffin Sarah F. , Gagnon Ryan J. , Zhang Lu , Rennert Lior
Published: September 2023

Background

Cognitive reserve (CR) is the ability to maintain cognitive performance despite brain pathology. CR is built through lifecourse experiences (e.g., education) and is a key construct in promoting healthy aging. However, the operationalization of CR and its estimated association with late-life cognition varies. The purpose of this study was to systematically examine the operationalization of CR and the relationship between its operationalization and late-life cognition.

Methods

We performed a comprehensive review of experiences (proxies) used to operationalize CR. The review informed quantitative analyses using data from 1366 participants of the Memory and Aging Project to examine 1) relationships between proxies and 2) the relationship between operationalization and late-life cognition. We also conducted a factor analysis with all identified CR experiences to create a composite lifecourse CR score. Generalized linear mixed models examined the relationship between operationalizations and global cognition, with secondary outcomes of five domains of cognition to examine consistency.

Results

Based on a review of 753 articles, we found the majority (92.3%) of the 28 commonly used proxies have weak to no correlation between one another. There was substantial variability in the association between operationalizations and late-life global cognition (median effect size: 0.99, IQR: 0.34 to 1.39). There was not strong consistency in the association between CR operationalizations and the five cognitive domains (mean consistency: 56.1%). The average estimate for the 28 operationalizations was 0.91 (SE = 0.48), compared to 2.48 (SE = 0.40) for the lifecourse score and it was associated with all five domains of cognition.

Conclusions

Inconsistent methodology is theorized as a major limitation of CR research and barrier to identification of impactful experiences for healthy cognitive aging. Based on the weak associations, it is not surprising that the relationship between CR and late-life cognition is dependent on the experience used to operationalize CR. Scores using multiple experiences across the lifecourse may help overcome such limitations. Adherence to a lifecourse approach and collaborative movement towards a consensus operationalization of CR are imperative shifts in the study of CR that can better inform research on risk factors related to cognitive decline and ultimately aid in the promotion of healthy aging.
Cross-cultural adaptation and psychometric properties of the Chinese version of the Person-Centered Maternity Care Scale
Authors: Zhong Xiaoying , Hu Rong , Afulani Patience A. , Li Xixi , Guo Xiujing , He Tingting , Li Dehua , Li Zuowei
Published: September 2023

Background

Increasing evidence show that women across the world face unacceptable mistreatment during childbirth. Person-centered maternity care is fundamental and essential to quality of healthcare services. The aim of this study was to translate and determine the psychometric properties of the Person-Centered Maternity Care (PCMC) Scale among Chinese postpartum women.

Methods

A cross-sectional study was conducted among 1235 post-partum women in China. The cross-cultural adaptation process followed the Beaton intercultural debugging guidelines. A total of 1235 women were included to establish the psychometric properties of the PCMC. A demographic characteristics form and the PCMC were used for data collection. The psychometric properties of the PCMC were evaluated by examining item analysis, exploratory factor analysis, known-groups discriminant validity, and internal consistency.

Results

The number of extracted common factors was limited to three (dignity & respect, communication & autonomy, supportive care), explaining a total variance of 40.8%. Regarding internal consistency, the Cronbach’s alpha coefficient and split-half reliability of the full PCMC score were 0.989 and 0.852, respectively.

Conclusions

The Chinese version of the PCMC is a reliable and valid tool to assess person-centered care during childbirth in China.
Breastfeeding in primiparous women – expectations and reality: a prospective questionnaire survey
Authors: Oberfichtner Katrin , Oppelt Peter , Fritz Daniela , Hrauda Katharina , Fritz Christian , Schildberger Barbara , Lastinger Julia , Stelzl Patrick , Enengl Sabine
Published: September 2023

Background

Breastfeeding provides the optimal nutrition for infants and offers numerous benefits for both mother and child. The World Health Organisation recommends exclusive breastfeeding during the first 6 months of life and the introduction of complementary feeding between the fifth and seventh months of life. There is a discrepancy between breastfeeding recommendations and the actual duration of breastfeeding. The aim of this study was to analyse breastfeeding behaviour in primiparous women in order to be able to provide support for mothers.

Methods

In this prospective, questionnaire-based study conducted between 2020 and 2022, primiparous women were asked to complete three questionnaires at three defined survey time points (routine prepartum presentation, postpartum hospitalization, completed sixth month of life).

Results

A total of 140 women were included and returned all three questionnaires. Fifty-eight percent performed breastfeeding exclusively at least until their baby had reached the age of 6 months, whereas 20% already stopped within the first 6 months. The main reasons given for early cessation were insufficient milk supply and inadequate infant weight gain. A comprehensive level of prepartum knowledge had a significant positive effect on participants’ sense of confidence with breastfeeding. Sociodemographic factors such as age and educational level were also associated with breastfeeding behaviour, but significant corresponding differences in the duration of breastfeeding were not observed. Women with postpartum midwifery care breastfed significantly longer (p < 0.05).

Conclusions

Breastfeeding behaviour and duration are influenced by multiple factors. Although certain sociodemographic factors are unalterable, comprehensive prepartum knowledge transfer and postpartum midwifery care have a positive impact on breastfeeding behaviour.

Trial registration

The study was retrospectively registered at the German Clinical Trials Register (Deutsches Register Klinischer Studien, DRKS) on 6 December 2022 (DRKS00030763).
Effects of cardiorespiratory fitness and body mass index on cardiometabolic risk factors in schoolchildren
Authors: Bagatini Natália Carvalho , Feil Pinho Carolina Dertzbocher , Leites Gabriela Tomedi , da Cunha Voser Rogério , Gaya Anelise Reis , Santos Cunha Giovani dos
Published: September 2023

Introduction

High levels of physical fitness established during childhood and adolescence have been associated with positive effects on cardiometabolic risk factors (CMRF), which persist into adulthood. Conversely, a sedentary lifestyle, overweight, and obesity during this period are considered public health problems. These conditions tend to worsen in adulthood, increasing the incidence of chronic diseases, deteriorating CMRF, and consequently leading to higher comorbidity and mortality rates.

Objective

To investigate the effect of cardiorespiratory fitness (CRF) and body mass index (BMI) on CMRF in children and adolescents.

Methods

The sample consisted of 49 schoolchildren of both sexes aged 10–17 years. Anthropometric assessments, CRF test, muscle strength test, and blood pressure (BP) measurement were conducted. Participants were allocated into groups based on BMI (eutrophic, overweight, obese), and CRF levels (low-fit, normal-fit, and high-fit).

Results

Obese individuals had lower CRF values compared to the eutrophic and overweight groups. The cardiometabolic risk profile (CMRP) was significantly higher in the obese group compared to the eutrophic group but showed no significant difference compared to the overweight group. The hight-fit group had lower CMRP values compared to the low-fit group.

Conclusions

Higher BMI and CRF values had negative and positive effects on CMRF and CMRP in schoolchildren, respectively. Overweight or obese schoolchildren with low levels of CRF constitute an unfavourable cardiometabolic risk profile.
Extraction of a metallic susceptor after accidental ingestion of the heated tobaccostick TEREA™: a case report
Authors: Higashi Koki , Koike Yuhki , Sato Yuki , Yamashita Shinji , Nagano Yuka , Shimura Tadanobu , Kitajima Takahito , Matsushita Kohei , Yokota Kazuki , Amano Keishiro , Okugawa Yoshinaga , Toiyama Yuji
Published: September 2023

Background

Tobacco ingestion is widely known to cause nicotine toxicity, which may result in severe symptoms. Two heated tobacco sticks, called TEREA™ and SENTIA™, were launched in 2021 by Philip Morris International (New York, NY, USA), and their ingestion is associated with a risk of bowel injury because they contain a partially pointed metallic susceptor. However, this risk is not well known to the general public or healthcare providers. To increase awareness of this risk, we herein report a case involving extraction of a metallic susceptor after ingestion of the heated tobacco stick TEREA™.

Case presentation

A 7-month-old girl presented to the emergency department of a nearby hospital because she was suspected to have accidentally swallowed heated tobacco. Although she presented with no symptoms related to nicotine poisoning, abdominal X-ray examination revealed a metal object in her stomach. According to a statement released by the Japan Poison Information Center, the TEREA™ heated tobacco stick contains a metallic susceptor with a rectangular shape and sharp corners. The patient was transferred to our department because of the risk of bowel injury, and upper gastrointestinal endoscopy was performed. No cigarettes were found by endoscopic observation; however, a metallic susceptor was located in the second part of the duodenum. We grasped it with biopsy forceps and carefully removed it using an endoscope with a cap attached to the tip. The post-endoscopic course was uneventful.

Conclusions

Some patients who ingest heated tobacco sticks might be exposed not only to the effects of nicotine but also to physical damage caused by a metallic susceptor. Infants and toddlers especially could swallow these sticks, therefore tobacco companies need to make the problem more public. Clinicians also should alert the problem, and pay attention to this risk in the clinical setting.
Enhancing linkage to HIV care in the “Universal Test and Treat” era: Barriers and enablers to HIV care among adults in a high HIV burdened district in KwaZulu-Natal, South Africa
Authors: Nicol Edward , Jama Ngcwalisa Amanda , Mehlomakulu Vuyelwa , Hlongwa Mbuzeleni , Pass Desiree , Basera Wisdom , Bradshaw Debbie
Published: September 2023

Ending AIDS by 2030 would depend on how successful health systems are in linking people living with HIV (PLHIV) into care. The World Health Organization recommended the ‘Universal Test and Treat’ (UTT) strategy – initiating all individuals testing positive on antiretroviral therapy (ART) irrespective of their CD4 count and clinical staging. This study aimed to explore the enablers and barriers to linkage to HIV care among adults with a new HIV diagnosis in a high-HIV prevalent rural district in South Africa. A qualitative study was undertaken to explore patients’ perceptions of enablers and barriers of linkage-to-care, using a life-story narration and dialogue approach. In-depth interviews were conducted with 38 HIV-positive participants sampled from a cohort of 1194 HIV-positive patients recruited from December 2017 to June 2018. Participants were selected based on whether they had been linked to care or not within 3 months of positive HIV diagnosis. Interviews were thematically analysed using a general inductive approach. Of the 38 participants, 22 (58%) linked to care within three months of HIV-positive diagnosis. Factors that facilitated or inhibited linkage-to-care were found at individual, family, community, as well as health systems levels. Enablers included a positive HIV testing experience, and assistance from the fieldwork team. Support from family, and friends, as well as prior community-based education about HIV and ART were also noted. Individual factors such as acceptance of HIV status, previous exposure to PLHIV, and fear of HIV progressing, were identified. Barriers to linkage included, denial of HIV status, dislike of taking pills, and preference for alternative medicine. Negative experiences with counselling and health systems inefficiency were also noted as barriers. Perceived stigma and socio-economic factors, such as lack of food or money to visit the clinic were other barriers. Community-based and health system-level interventions would need to focus on clinic readiness in providing patients with necessary and effective health services such as proper and adequate counselling. This could increase the number of patients who link to care. Finally, interventions to improve linkage-to-care should consider a holistic approach, including training healthcare providers, community outreach and the provision of psychological, social, and financial support.
Why elderly in rural China didn’t wear masks during the COVID-19 pandemic? A qualitative narrative interview study
Authors: Liu Yunlai , Huang Chunyan
Published: September 2023

Background

During the COVID-19 pandemic, ageism and stigmatization towards the elderly have been prominent issues. In addition, there have been debates on Chinese social media as to why elderly people in rural areas are not wearing masks. While some factors that affect the mask-wearing behaviour of the elderly have been analyzed, little attention has been given to the lived experiences and behavioral intentions of rural elderly people who choose not to wear masks, despite government mandates to do so.

Method

In this research, 50 semi-structured interviews with 30 elderly individuals in three Chinese villages were carried out using the qualitative method of semi-structured interviews. Following verbatim recording and transcription of the conversations, the subject was analyzed using the Theory of Reasoned Action.

Results

We identified four factors that influence the non-masking behaviour of rural elderly, including past experiences, cultural concepts, cognitive attitudes, and health and safety anxiety, and identified nine sub-themes based on the four overarching themes. Past knowledge, experience, and history have led rural elderly people to distrust the government's mandatory “mask mandate,” believing that they do not need to wear masks. Rural cultural concepts and habits make the elderly feel that masks not only fail to provide protection but also become obstacles, resulting in poor daily experiences. Cognitive attitudes and emotions determine the elderly's evaluation of masks, which in turn affects their use of masks. Finally, elderly individuals’chronic diseases directly affect the physical pain and life safety caused by their use of masks, which is a major objective factor for their non-masking.

Conclusions

Although numerous studies have concluded that Chinese people wore masks out of collectivism and conformity during the pandemic, marginalized groups' opposition to wearing masks also contains distinctive, individualized elements and underlying causes. By exposing these elements and reasons, we can better comprehend the peculiar behavior of particular groups while fighting the pandemic. The needs of marginalized populations should be prioritized by public health policy makers to provide more equitable services.
Circulating choline levels are associated with prognoses in patients with pulmonary hypertension: a cohort study
Authors: Yang Yicheng , Yang Beilan , Liu Bingyang , Liang Yanru , Luo Qin , Zhao Zhihui , Liu Zhihong , Zeng Qixian , Xiong Changming
Published: September 2023

Backgrounds

Mounting evidences have highlighted the association between metabolites and cardiovascular diseases. Our previous works have demonstrated that circulating metabolite, trimethylamine oxide, was associated with prognosis of patients with pulmonary hypertension (PH). Choline is a precursor of trimethylamine oxide and its role in PH remains unknown. Here, we aimed to validate the hypothesis that circulating choline levels were associated with prognoses in patients with PH.

Methods

Inpatients diagnosed with PH—defined as mean pulmonary arterial pressure ≥ 25 mmHg by right heart catheterisation—from Fuwai Hospital were enrolled after excluding relative comorbidities. Fasting blood samples were obtained to assess choline levels and other clinical variables. The primary endpoints were defined as death, escalation of targeted medication, rehospitalization due to heart failure, PH deterioration. The follow-up duration was defined as the time from the choline examination to the occurrence of outcomes or the end of the study. The associations between circulating choline levels and disease severity and prognoses were explored.

Results

Totally, 272 inpatients with PH were enrolled in this study. Patients were divided into high and low choline groups according to the 50thquartile of circulating choline levels, defined as 12.6 µM. After confounders adjustment, the high circulating choline levels were still associated with poor World Health Organization functional class, elevated N-terminal pro-B-type natriuretic peptide, and decreased cardiac output index indicating the severe disease condition. Moreover, elevated choline levels were associated with poor prognoses in PH patients even after adjusting for confounders (hazard ratio = 1.934; 95% CI, 1.034–3.619;P = 0.039). Subgroup analyses showed that choline levels predicted the prognosis of patients with pulmonary arterial hypertension but not chronic thromboembolic pulmonary hypertension.

Conclusions

Choline levels were associated with disease severity and poor prognoses of patients with PH, especially in pulmonary arterial hypertension suggesting its potential biomarker role.
Clinical application of endobronchial ultrasonography-guided transbronchial needle aspiration biopsy—a single center, large sample, real-world study
Authors: Tang Chun-li , Zhu Zheng , Zhong Chang-hao , Zhou Zi-qing , Zhou Hui-qi , Geng Rong-mei , Chen Xiao-bo , Chen Yu , Li Shi-yue
Published: September 2023

Background

Endobronchial ultrasonography-guided transbronchial needle aspiration biopsy (EBUS-TBNA) has been used for more than 10 years in China. Its clinical application and diagnostic value in different diseases with large sample was lack of report.

Methods

A retrospective analysis was performed about the application and diagnostic value of EBUS-TBNA in different disease of patients in Respiratory Intervention Center of Guangzhou Institute of Respiratory Health from January 2012 to July 2020.

Results

A total 5758 patients were included with 182 patients excluded for lack of information. Finally, data of 5576 patients (3798 males and 1778 females) were analyzed. For anesthetize, most patients were undergoing general anesthesia of intravenous with spontaneous breathing (69.4%), followed by general anesthesia of intravenous and inhalation with tracheal intubation and mechanical ventilation (17.9%) and conscious sedation and analgesia (12.8%). Lymph nodes were the main sites of biopsy obtained (76.4%). Tumors accounted for the highest proportion of disease (66.4%), followed by infection diseases (9.9%), sarcoidosis (3.9%), lymphoma (1.1%), and others (18.7%). The sensitivity of EBUS-TBNA for diagnosis of tumor was 89.7%, and 40.8% for infection diseases. There were significant differences in the puncture site and proportions of diseases between male and females (both p < 0.05). Higher diagnostic value was found in male patients (p < 0.05).

Conclusion

EBUS-TBNA has good diagnostic value for different mediastinal and central pulmonary space-occupying lesions diseases, with highest sensitivity for tumors. Higher diagnostic value was found in male patients.
The role of prevertebral soft tissue swelling in dysphagia after anterior cervical corpectomy fusion: change trends and risk factors
Authors: Ma Yanyan , Sang Peiming , Chen Binhui , Li Jie , Bei Dikai
Published: September 2023

Objectives

This study aimed to analyze the change trends of prevertebral soft tissue swelling (PSTS) for anterior cervical corpectomy fusion(ACCF) and to evaluate the risk factors of PSTS for postoperative dysphagia.

Methods

There were 309 patients with degenerative cervical diseases who were treated with ACCF from November 2015 and September 2019 in our hospital. According to the symptom of swallowing function after ACCF, those were divided into the dysphagia group and the normal-swallowing function group. Cervical computed tomography(CT) was analyzed, and radiological evaluation of the prevertebral soft tissue was measured between the antero-inferior corner of each vertebral body and the air shadow of the airway through CT mid-sagittal slice images before operation and after operation(one week, one month, eight months and twelve months).

Results

The incidence of dysphagia after ACCF was 41.1%. 120 of 127(94.5%) patients had dysphagia disappeared at the 8 months after ACCF, and all disappeared at the 12 months. In both groups, PSTS would be biggest at 1 week postoperatively comparing to the preoperative, and then get smaller from 1 week to 12 months postoperatively (p < 0.05). After 12 months of operation, the PSTS of all cervical spinal levels would get equal to the preoperative size in the normal-swallowing function group, while the PSTS in dysphagia group would get equal only in C5-7 levels. The PSTS of preoperative C6 level and postoperative C2 level were more closely related to the present of postoperative dysphagia (OR: 9.403, 95%CI: 2.344–37.719, OR: 3.187, 95%CI: 1.78-5.705). It was more important to predict postoperative dysphagia using the value of PSTS at preoperative C6 level and postoperative C2 level, with the cutoff threshold for the PSTS of preoperative C6 level ≦1.51 cm and postoperative C2 level ≦1.3915 cm, which could get sensitivity & specificity 66.929% and 61.54%, 77.17% and 64.29%, respectively.

Conclusion

Our study showed that the increasing of the PSTS after ACCF should be considered as a risk factor of dysphagia after surgery. With the recovery of PSTS over time, the incidence of postoperative dysphagia decreases. The PSTS of preoperative C6 level and and postoperative C2 level should play an important part in predicting the risk of postoperative dysphagia.
Ex vivo detection of mandibular incisors’ root canal morphology using cone-beam computed tomography with 4 different voxel sizes and micro-computed tomography
Authors: Bai Bingbing , Tang Ying , Wu Yihan , Pei Fan , Zhu Qi , Zhu Peng , Gu Yongchun
Published: September 2023

Background

In recent years, cone-beam computed tomography (CBCT) has been widely used to evaluate patients’ root canal anatomy due to its high resolution and noninvasive nature. As voxel size is one of the most important parameters affecting CBCT image quality, the current study evaluated the diagnostic potential of CBCT with 4 different voxel sizes in the detection of double root canal systems and accessory canals (ACs) in permanent mandibular incisors.

Methods

A total of 106 extracted mandibular permanent incisors were collected from the dental clinics, and then were scanned by using micro-CT with a voxel size of 9 μm. The teeth were then fixed in the tooth sockets of human dry mandibles and scanned by using a CBCT device with 4 different voxel sizes (300, 200, 250, and 125 μm). Four observers detected in blind the root canal morphology of the teeth according to the CBCT images, and the presence or absence of a double root canal system, and the presence or absence of ACs, were scored according to a 5-point scale, respectively. Receiver operating characteristic (ROC) analysis was performed, and DeLong test was used to compare the area under the curve (AUC) values and the micro-CT data was taken as a gold standard.

Results

Among 106 sample teeth, 25 specimens with a double root canal system were identified by the micro-CT. ROC curve analysis of the data obtained by the four observers showed that in the detection of double root canal systems, the AUC values ranged from 0.765 to 0.889 for 300 μm voxel size, from 0.877 to 0.926 for 250 μm voxel size, from 0.893 to 0.967 for 200 μm voxel size, and from 0.914 to 0.967 for 125 μm voxel size (all p < 0.01). In general, we observed a trend that the AUC values, sensitivity, and specialty increased with the decrease in the voxel size, and significantly higher AUC values were detected in 125 μm voxel size images. In the detection of ACs, ROC curve analysis showed that among the four observers, the AUC values ranged from 0.554 to 0.639 for 300 μm voxel size, from 0.532 to 0.654 for 250 μm voxel size, from 0.567 to 0.626 for 200 μm voxel size, and from 0.638 to 0.678 for 125 μm voxel size. CBCT images at a voxel size of 125 μm had a weak diagnostic potential (AUC: 0.5–0.7, all p < 0.05) in the detection of AC, with a lower sensitivity ranging from 36.8 to 57.9% and a higher specialty ranging from 73.6 to 98.8%.

Conclusions

CBCT with 300 μm voxel size could only provide moderate diagnostic accuracy in the detection of a double canal system in mandibular incisors. CBCT with a voxel size of 125 μm exhibited high diagnostic value in the detection of double canal systems, while showing low but statistically significant value in the detection of ACs.
Penthorum chinense Pursh improves type 2 diabetes mellitus via modulating gut microbiota in db/db mice
Authors: Hu Jilei , Xie Huibo , Lin Ning , Yang Yan
Published: September 2023

Penthorum chinense Pursh (P. chinense) has been traditionally used as hepatoprotective food and medicine for hundreds of years due to its significant antioxidant and anti-inflammatory activities. However, the efficacy and mechanisms of action of P. chinense in type 2 diabetes mellitus were not fully understood. In this study, we found that P. chinense extract (PCP) supplementation resulted in reduced body weight and hyperglycemia, improved pancreatic tissue injury and insulin sensitivity, and decreased inflammatory cytokines expression in spontaneously diabetic db/db mice. 16S rRNA gene sequencing of fecal samples showed that PCP administration decreased the abundance of Firmicutes and increased the proportion of Bacteroidetes at the phylum level. Moreover, Muribaculum, Barnesiella, Prevotella, and Mucinivorans were enriched, with Desulfovibrio and Lactobacillus lowered at the genus level in db/db mice with PCP supplementation. These results suggested that PCP may ameliorate hyperglycemia, insulin resistance, and inflammation by remodeling the gut microbiota in db/db mice.
A prognostic model for systemic lupus erythematosus-associated pulmonary arterial hypertension: CSTAR-PAH cohort study
Authors: Qu Jingge , Li Mengtao , Zhang Xiao , Zhang Miaojia , Zuo Xiaoxia , Zhu Ping , Ye Shuang , Zhang Wei , Zheng Yi , Qi Wufang , Li Yang , Zhang Zhuoli , Ding Feng , Gu Jieruo , Liu Yi , Qian Junyan , Huang Can , Zhao Jiuliang , Wang Qian , Liu Yongtai , Tian Zhuang , Wang Yanhong , Wei Wei , Zeng Xiaofeng
Published: September 2023

Background

Pulmonary arterial hypertension is a major cause of death in systemic lupus erythematosus, but there are no tools specialized for predicting survival in systemic lupus erythematosus-associated pulmonary arterial hypertension.

Research question

To develop a practical model for predicting long-term prognosis in patients with systemic lupus erythematosus-associated pulmonary arterial hypertension.

Methods

A prognostic model was developed from a multicenter, longitudinal national cohort of consecutively evaluated patients with systemic lupus erythematosus-associated pulmonary arterial hypertension. The study was conducted between November 2006 and February 2020. All-cause death was defined as the endpoint. Cox regression and least absolute shrinkage and selection operators were used to fit the model. Internal validation of the model was assessed by discrimination and calibration using bootstrapping.

Results

Of 310 patients included in the study, 81 (26.1%) died within a median follow-up of 5.94 years (interquartile range 4.67–7.46). The final prognostic model included eight variables: modified World Health Organization functional class, 6-min walking distance, pulmonary vascular resistance, estimated glomerular filtration rate, thrombocytopenia, mild interstitial lung disease, N-terminal pro-brain natriuretic peptide/brain natriuretic peptide level, and direct bilirubin level. A 5-year death probability predictive algorithm was established and validated using the C-index (0.77) and a satisfactory calibration curve. Risk stratification was performed based on the predicted probability to improve clinical decision-making.

Conclusions

This new risk stratification model for systemic lupus erythematosus-associated pulmonary arterial hypertension may provide individualized prognostic probability using readily obtained clinical risk factors. External validation is required to demonstrate the accuracy of this model's predictions in diverse patient populations.