bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictive Value of the KOJI AWARENESS Self-Evaluation System for Running Injuries in Elite Male Long-Distance Runners: A Prospective Cohort Study
Authors: Murofushi Koji , Mitomo Sho , Hirohata Kenji , Furuya Hidetaka , Katagiri Hiroki , Kaneoka Koji , Hara Susumu , Yagishita Kazuyoshi
Published: August 2024

Background:

The KOJI AWARENESS (KA) test is a practical self-evaluation tool that assesses body movements and may help develop individual conditioning plans to improve movement function. However, the association between preseason KA scores and in-season injury occurrence remains unexplored.

Purpose:

To investigate whether the KA self-screening test score can predict running-related injuries in elite long-distance runners.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

A total of 47 elite college male long-distance runners (age, 18-22 years) were enrolled in this study in June 2022. The participants underwent the KA self-screening test to assess preseason upper limb, core, and lower limb function. Running-related injuries with a training time loss of >3 weeks were tracked for 6 months during the season. The participants were divided into injury and noninjury groups, and between-group comparisons and receiver operating characteristic (ROC) curve analysis were used to determine the association between the KA scores and the injury incidence. Chi-square tests and risk ratios were calculated based on the cutoff value- and injury-based grouping.

Results:

Among the runners, 10 (21.3%) sustained an injury. There were no significant differences in the demographic characteristics between the injury and noninjury groups. The injury group had significantly lower KA scores than the noninjury group (median, 44.5 [interquartile range, 43-46.8] vs median, 48 [interquartile range, 46-50], respectively; P = .009). The ROC curve analysis determined a cutoff value of 46.5 points (sensitivity, 73%; specificity, 63.6%), indicating that the KA scores exhibited a relatively high predictive value for running-related injuries (area under the ROC curve, 0.764 [95% CI, 0.600-0.930]). The risk ratio for group division based on the cutoff value was 2.590 (95% CI, 1.329-5.047).

Conclusion:

These findings demonstrated that the KA test is an effective self-screening tool for predicting the risk of running-related injuries in elite male long-distance runners.
Forging Reconciliation Despite Antagonism: Examining the Normalisation of Ties Between Saudi Arabia and Iran in 2023
Authors: Hwang Won-June
Published: August 2024

In April 2023, Saudi Arabia and Iran announced the normalisation of diplomatic ties with China’s mediation. Notably, Saudi Arabia sought China’s mediation during Xi Jinping’s visit in December 2022. Why did Saudi Arabia seek reconciliation while maintaining hostility with Iran? This study aims to uncover this puzzle using a case study approach. It examines the case through two mechanisms: reconciliation with one’s enemy and reconciliation with a friend’s enemy. According to the first approach, Saudi Arabia had to manage external threats to achieve the objectives of Vision 2030, an economic and social reform initiative implemented in response to political and economic shocks in the region. The second approach highlights Saudi Arabia’s complex relationship with the United States. Through reconciliation, Saudi Arabia could attain considerable leverage in this relationship. Its approach to Iran serves as an effective example of foreign policy amid escalating tensions between the United States and China.
Young Adult and Parent Willingness to Pay for Meningococcal Serogroup B Vaccination
Authors: Huang Liping , Srivastava Amit , Fairchild Angelyn , Whittington Dale , Johnson Reed
Published: August 2024

Introduction. Serogroup B (MenB) is the leading cause of invasive meningococcal disease among adolescents and young adults in the United States. The US Advisory Committee on Immunization Practices (ACIP) recommends MenB vaccination based on shared clinical decision making between patients and providers. However, suboptimal understanding of these recommendations could contribute to low vaccination awareness and coverage. Understanding young adult and parent expectations of their health care providers (HCPs) and the value they place on vaccine information could help inform a consistent approach to HCP MenB vaccination discussions and recommendations. Methods. Data collected via a discrete-choice experiment online survey were used to evaluate preferences and willingness to pay regarding MenB vaccination among US parents and young adults in 2019. Results. Of 2,388 respondents with valid data, 1,185 were parents of children aged 12 to 25 y, and 1,203 were young adults aged 18 to 25 y. Approximately 70% of parents and young adults indicated that they would react negatively if their HCP chose not to initiate a discussion with them about MenB vaccines. Neither parents nor young adults were willing to pay for additional time for MenB vaccine discussions with their HCP but were willing to pay an average of $416 and $282, respectively, for the vaccine. For parents and young adults, greater willingness to pay was associated with a provaccination attitude and the opinion that the HCP has a moral obligation to discuss the MenB vaccine with them. Conclusion. Both parents and young adults felt their HCP is responsible for initiating a discussion about MenB vaccination and disease risk and were willing to pay for the vaccine. These findings should help inform ACIP recommendations for meningococcal vaccination.

Highlights

ACIP recommends shared clinical decision making for MenB vaccination. Data were collected from young adults and parents of adolescents by online survey. We measured values and consultation preferences on MenB disease and vaccination. Young adults/parents strongly preferred doctor-initiated MenB vaccine discussion. Respondents were willing to pay for a MenB vaccine.
Choriocapillaris Loss in a Pediatric Patient With Congenital Cytomegalovirus Seen on Optical Coherence Tomography Angiography
Authors: Kozek Lindsay K. , Morcos David , Hoyek Sandra , Patel Nimesh A.
Published: August 2024

Purpose: To describe choriocapillaris loss on optical coherence tomography angiography (OCTA) imaging in a pediatric patient with congenital cytomegalovirus (CMV). Methods: A case was evaluated. Results: A 7-year-old female patient was referred for retinal evaluation of maculopathy in the right eye. She was diagnosed with congenital CMV at 14 months of age, at which time treatment was not deemed necessary. At 7 years of age, the patient was asymptomatic with 20/20 Snellen visual acuity. Funduscopy and colored fundus photographs showed macular scarring. Ancillary testing was performed, with retinal pigment epithelium alterations and disruption of the outer retinal layers seen on OCT and choriocapillaris loss in the area of the macular scar seen on OCTA. Conclusions: For patients with congenital CMV, OCTA imaging can show significant changes in choriocapillaris function. These changes do not necessarily correlate with visual function parameters. OCTA may be useful as an additional screening or surveillance modality for patients with congenital CMV or CMV retinitis.
India’s Trade Integration with the Republic of Korea: A Services Trade Analysis of India–Korea CEPA
Authors: Gupta Pralok
Published: August 2024

India and the Republic of Korea signed the India–Korea Comprehensive Economic Partnership Agreement (CEPA) in 2009 and have been actively engaged in upgrading this agreement since 2015. This article analyses the India–Korea CEPA from a services trade perspective. It compares the services commitments undertaken by the two countries under the India–Korea CEPA and the WTO. It further assesses the gains for India from the CEPA by comparing services exports and imports before and after the CEPA came into operation. The study finds that India’s services exports to Korea have increased more than its imports from Korea, resulting in an increase in India’s services trade surplus with Korea after the CEPA. The study recommends exploring bilateral labour agreements with Korea to facilitate the movement of natural persons in specific sectors and further liberalisation commitments from Korea in services of India’s interests during the CEPA upgradation.

JEL Classification: F13, F14, F15
Intertemporal Decision-Making, Diabetes Self-Management, and Health Outcomes in Patients With Type 2 Diabetes
Authors: Jin Pina , Wang Xiaojing , Li Aihua , Dong Huan , Wu Kailu , Wen Aichun , Ji Meihua
Published: August 2024

Purpose

The purpose of this study was to identify the independent factors associated with intertemporal decision-making and to examine its relationship with diabetes self-management behaviors, glucose variability, and diabetes complications in patients with diabetes.

Methods

A cross-sectional study using convenience sampling (n = 368) was conducted in patients with type 2 diabetes (T2DM) between November 2021 and April 2023. Data were collected using self-reported questionnaires and retrieval of clinical information from medical records. Intertemporal decision-making was operationalized using delay discounting. The outcome variables included diabetes self-management behaviors, A1C, diabetic retinopathy, and carotid artery disease. Hierarchical regression and binary logistic regression models were used to explore the relationships among intertemporal decision-making, self-management, A1C, and carotid artery disease.

Results

The analyses showed that intertemporal decision-making was negatively associated with physical activity and carotid artery disease, in which individuals with lower delay discounting tended to have healthier physical activity; when the delay discounting rate increased 1 unit, the risk of the carotid artery disease increased by 39.8%.

Conclusions

The study reveals that a lower delay discounting can promote healthier physical activity and decrease the incidence of carotid artery disease. These results offer new knowledge for researchers and clinicians to consider intertemporal decision-making in developing interventional programs to improve physical activity and reduce carotid artery complication in patients with T2DM when providing care.
The Impact of the Sonographic Findings Within the Epididymis on the Differential Diagnosis of Acute Scrotum
Authors: Shabani Elham , Tanha Hosein , Moradi Ali , Khoroushi Farzaneh , Alamdaran Seyed Ali
Published: August 2024

Objective:

The aim of this study was to assess the sonographic changes within the testis, epididymis, and the corresponding appendages, in contributing to the pediatric differential diagnosis, of an acute scrotum.

Materials and Methods:

A retrospective extraction of pediatric patients’ (age <13 years) data was completed for those initially seen with an acute scrotum. The data procured from the medical records included demographic characteristics, clinical and sonographic findings, and the final diagnosis.

Results:

The final diagnoses among a cohort of 86 pediatric males (average age 6 ± 3.9 years) with acute scrotum were as follows: epididymal and testicular appendix torsion (44.7% and 17.6%, respectively), testicular torsion (15.3%), trauma and hematoma (5.9%), incarcerated hernia (4.7%), idiopathic scrotal edema (4.7%), epididymitis (4.7%), and Henoch-Schonlein purpura (3.5%). The heterogeneous testicular appearance in patients with testicular torsion was significantly compared with the appendix torsion. The increased testicle size noted on the sonogram favored the diagnosis of testicular torsion. In cases of testicular torsion, the vascular flow was reduced or absent, although it was normal or increased in appendix torsion. Increased epididymal vascular flow was more common in cases of appendix torsion.

Conclusion:

Based on the diagnostic findings in this cohort, the following were the most common and accurate sonographic findings in distinguishing the causes of a pediatric acute scrotum: an epididymis enlargement coexisting with a small adjacent avascular mass, due to the torsion of intra-scrotal appendages and a mass shape of the epididymis.
Genetic risk classification for adults with AML receiving less-intensive therapies: the 2024 ELN recommendations
Authors: Döhner Hartmut , DiNardo Courtney D. , Appelbaum Frederick R. , Craddock Charles , Dombret Hervé , Ebert Benjamin L. , Fenaux Pierre , Godley Lucy A. , Hasserjian Robert P. , Larson Richard A. , Levine Ross L. , Miyazaki Yasushi , Niederwieser Dietger , Ossenkoppele Gert , Röllig Christoph , Sierra Jorge , Stein Eytan M. , Tallman Martin S. , Tien Hwei-Fang , Wang Jianxiang , Wierzbowska Agnieszka , Wei Andrew H. , Löwenberg Bob
Published: August 2024

The European LeukemiaNet (ELN) genetic risk classifications were developed based on data from younger adults receiving intensive chemotherapy. Emerging analyses from patients receiving less-intensive therapies prompted a proposal for an ELN genetic risk classification specifically for this patient population.
Unbalanced MYC break-apart FISH patterns indicate the presence of a MYC rearrangement in HGBCL-DH-BCL2
Authors: Collinge Brett , Ben-Neriah Susana , Hilton Laura K. , Alduaij Waleed , Tucker Tracy , Slack Graham W. , Farinha Pedro , Craig Jeffrey W. , Boyle Merrill , Meissner Barbara , Villa Diego , Gerrie Alina S. , Sehn Laurie H. , Savage Kerry J. , Morin Ryan D. , Mungall Andrew J. , Steidl Christian , Scott David W.
Published: August 2024

Fluorescence in situ hybridization (FISH) using break-apart probes is recommended for identifying high-grade B-cell lymphoma with MYC and BCL2 rearrangements (HGBCL-DH-BCL2). Unbalanced MYC break-apart patterns, in which the red or green signal is lost, are commonly reported as an equivocal result by clinical laboratories. In a cohort of 297 HGBCL-DH-BCL2, 13% of tumors had unbalanced MYC break-apart patterns with loss of red (LR; 2%) or loss of green (LG; 11%) signal. To determine the significance of these patterns, MYC rearrangements were characterized by sequencing in 130 HGBCL-DH-BCL2, including 3 LR and 14 LG tumors. A MYC rearrangement was identified for 71% of tumors with LR or LG patterns, with the majority involving immunoglobulin loci or other recurrent MYC rearrangement partners. The architecture of these rearrangements consistently preserved the rearranged MYC allele, with the MYC gene predicted to be on the derivative chromosome containing the signal that is still present in nearly all cases. MYC protein expression, MYC messenger RNA expression, and the proportion of tumors expressing the dark-zone signature was not significantly different between balanced and unbalanced groups. These results support a recommendation that unbalanced MYC break-apart FISH patterns be reported as positive for MYC rearrangement in the context of diagnosing HGBCL-DH-BCL2.
Unusual testicular metastatic localization of Ewing’s sarcoma: case report
Authors: Aboulaich Youness , Kharbach Youssef , Khallouk Abdelhak
Published: August 2024

Background

Ewing’s sarcoma is a rare form of bone cancer that can also affect soft tissues. In some cases, it can spread to other parts of the body, including the testicles, causing testicular metastases. To our knowledge, no testicular metastasis of Ewing’s sarcoma has been reported in the literature.

We report an original case of an 18-year-old patient who presented with bilateral testicular masses revealing an exceptional metastasis of metastatic bone Ewing sarcoma under chemotherapy for one year. It was difficult to diagnose synchronous bilateral testicular metastases of Ewing’s sarcoma due to the low frequency of these metastases. However, given the history of metastatic cancer, the data from the clinical examination, and the results of ultrasound, it should be considered and included in the differential diagnosis.

Conclusion

Despite the uncommon occurrence of secondary testicular metastasis, it should be considered in the differential diagnosis when encountering such a clinical presentation.
How is diagnostic uncertainty communicated and managed in real world primary care settings?
Authors: Russell Jessica , Boswell Laura , Ip Athena , Harris Jenny , Singh Hardeep , Meyer Ashley N. D. , Giardina Traber D. , Bhuiya Afsana , Whitaker Katriina L. , Black Georgia B.
Published: August 2024

Background

Managing diagnostic uncertainty is a major challenge in primary care due to factors such as the absence of definitive tests, variable symptom presentations and disease evolution. Maintaining patient trust during a period of investigative uncertainty, whilst minimising scope for diagnostic error is a challenge. Mismanagement can lead to diagnostic errors, treatment delays, and suboptimal patient outcomes.

Objective

Our aim was to explore how UK primary care physicians (GPs) address and communicate diagnostic uncertainty in practice.

Design

This qualitative study used video and audio-recordings. Verbatim transcripts were coded with a modified, validated tool to capture GPs’ actions and communication in primary care consultations that included diagnostic uncertainty. The tool includes items relating to advice regarding new symptoms or symptom deterioration (sometimes called ‘safety netting’). Video data was analysed to identify GP and patient body postures during and after the delivery of the management plan.

Participants

All patient participants had a consultation with a GP, were over the age of 50 and had (1) at least one new presenting problem or (2) one persistent problem that was undiagnosed.

Approach

Data collection occurred in GP-patient consultations during 2017–2018 across 7 practices in UK during 2017–2018.

Key results

GPs used various management strategies to address diagnostic uncertainty, including (1) symptom monitoring without treatment, (2) prescribed treatment with symptom monitoring, and (3) addressing risks that could arise from administrative tasks. GPs did not make management plans for potential treatment side effects. Specificity of uncertainty management plans varied among GPs, with only some offering detailed actions and timescales. The transfer of responsibility for the management plan to patients was usually delivered rather than negotiated, with most patients confirming acceptance before concluding the discussion.

Conclusions

We offer guidance to healthcare professionals, improving awareness of using and communicating management plans for diagnostic uncertainty.
Micropapillary breast carcinoma in comparison with invasive duct carcinoma. Does it have an aggressive clinical presentation and an unfavorable prognosis?
Authors: Elzohery Yasmine Hany Abdel Moamen , Radwan Amira H. , Gareer Sherihan W. Y. , Mamdouh Mona M. , Moaz Inas , Khalifa Abdelrahman Mohammad , Mohen Osama Abdel , Elithy Mohamed Fathy Abdelfattah Abdelrahm , Hassaan Mahmoud
Published: August 2024

Background

Invasive micropapillary carcinoma (IMPC) was first proposed as an entity by Fisher et al. In the 2003 World Health Organization (WHO) guidelines for histologic classification of the breast tumors. IMPC was recognized as a distinct, rare histological subtype of breast cancer.

IMPC is emerging as a surgical and oncological challenge due to its tendency to manifest as a palpable mass, larger in size and higher in grade than IDC with more rate of lymphovascular invasion (LVI) and lymph node (LN) involvement, which changes the surgical and adjuvant management plans to more aggressive, with comparative prognosis still being a point of ongoing debate.

Aim of the study

In this study, we compared the clinicopathological characteristics, survival and surgical management of breast cancer patients having invasive micropapillary carcinoma pathological subtype in comparison to those having invasive duct carcinoma.

Method

This is a comparative study on female patients presented to Baheya center for early detection and treatment of breast cancer, in the period from 2015 to 2022 diagnosed with breast cancer of IMPC subtype in one group compared with another group of invasive duct carcinoma. we analyzed 138 cases of IMPC and 500 cases of IDC.

Results

The incidence of LVI in the IMPC group was 88.3% in comparison to 47.0% in the IDC group (p < 0.001). IMPC had a higher incidence of lymph node involvement than the IDC group (68.8% and 56% respectively). IMPC had a lower rate of breast conserving surgery (26% vs.37.8%) compared with IDC.

The survival analysis indicated that IMPC patients had no significant difference in overall survival compared with IDC patients and no differences were noted in locoregional recurrence rate and distant metastasis rate comparing IMPCs with IDCs.

Conclusion

The results from our PSM analysis suggested that there was no statistically significant difference in prognosis between IMPC and IDC patients after matching them with similar clinical characteristics. However, IMPC was found to be more aggressive, had larger tumor size, greater lymph node metastasis rate and an advanced tumor stage.
The predictive role of the total potassium intake and odds of breast cancer: a case-control study
Authors: Ahmadirad Hamid , Norouzzadeh Mostafa , Teymoori Farshad , Jahromi Mitra Kazemi , Farhadnejad Hossein , Babrpanjeh Mitra , Mokhtari Ebrahim , Heidari Zeinab , Mirmiran Parvin , Rashidkhani Bahram
Published: August 2024

Backgrounds

Dietary potassium can play an important role in decreasing inflammatory factors as a protective factor for cancers. In this case-control study, we aimed to assess the possible association between dietary potassium intake and the risk of breast cancer (BC) among Iranian adult women.

Methods

The present case-control study was conducted at Shohada and Imam Hossain hospitals, in Tehran. The study included 134 newly diagnosed cases of BC and 267 controls. A validated semi-quantitative 168-item food frequency questionnaire was used to compute the potassium intake. Logistic regression, adjusted for potential confounders, was used to estimate odds ratios(ORs) and 95% confidence intervals(CI) of BC according to tertiles of potassium intake.

Results

The mean(M) ± standard deviation(SD) of age and body mass index (BMI) were 47.9 ± 10.3 years and 29.4 ± 5.5 kg/m2, respectively. Also, the M ± SD of potassium intake for the control and case groups was 1616 ± 293 and 1542 ± 338 (mg/1000 Kcal), respectively. In the multivariable-adjusted model for potential confounders, the higher total potassium intake was associated with decreased odds of BC (OR: 0.35, 95%CI: 0.19–0.62, P for trend < 0.001). Moreover, an inverse relationship was observed between potassium from plant sources (OR: 0.39, 95%CI: 0.22–0.69, P for trend = 0.001) and fruit and vegetable sources (OR: 0.49, 95%CI: 0.28–0.87, P for trend = 0.016) and odds of BC.

Conclusions

Our findings suggested that diet rich in potassium may have a predictive role to reduce the odds of BC.
Awareness, support, and opinions of healthy food and drink policies: a survey of staff and visitors in New Zealand healthcare organisations
Authors: Gerritsen Sarah , Rosin Magda , Te Morenga Lisa , Jiang Yannan , Kidd Bruce , Shen Stephanie , Umali Elaine , Mackay Sally , Ni Mhurchu Cliona
Published: August 2024

Background

In 2016, a voluntary National Healthy Food and Drink Policy (hereafter, “the Policy”) was released to encourage public hospitals in New Zealand to provide food and drink options in line with national dietary guidelines. Five years later, eight (of 20) organisations had adopted it, with several preferring to retain or update their own institutional-level version. This study assessed staff and visitors’ awareness and support for and against the Policy, and collected feedback on perceived food environment changes since implementation of the Policy.

Methods

Cross-sectional electronic and paper-based survey conducted from June 2021 to August 2022. Descriptive statistics were used to present quantitative findings. Free-text responses were analysed following a general inductive approach. Qualitative and quantitative findings were compared by level of implementation of the Policy, and by ethnicity and financial security of participants.

Results

Data were collected from 2,526 staff and 261 visitors in 19 healthcare organisations. 80% of staff and 56% of visitors were aware of the Policy. Both staff and visitors generally supported the Policy, irrespective of whether they were aware of it or not, with most agreeing that “Hospitals should be good role models.” Among staff who opposed the Policy, the most common reason for doing so was freedom of choice. The Policy had a greater impact, positive and negative, on Māori and Pacific staff, due to more frequent purchasing onsite. Most staff noticed differences in the food and drinks available since Policy implementation. There was positive feedback about the variety of options available in some hospitals, but overall 40% of free text comments mentioned limited choice. 74% of staff reported that food and drinks were more expensive. Low-income staff/visitors and shift workers were particularly impacted by reduced choice and higher prices for healthy options.

Conclusions

The Policy led to notable changes in the healthiness of foods and drinks available in NZ hospitals but this was accompanied by a perception of reduced value and choice. While generally well supported, the findings indicate opportunities to improve implementation of food and drink policies (e.g. providing more healthy food choices, better engagement with staff, and keeping prices of healthy options low) and confirm that the Policy could be expanded to other public workplaces.
Antimicrobial and cytotoxic activities of flavonoid and phenolics extracted from Sepia pharaonis ink (Mollusca: Cephalopoda)
Authors: Abdel-Malek Asmaa R. , Moustafa Alaa Y. , Salem Shimaa H.
Published: August 2024

Background

Several studies have been reported previously on the bioactivities of different extracts of marine molluscs. Therefore, we decided to evaluate the cytotoxic and antimicrobial activities of S. pharaonis ink as a highly populated species in the Red Sea. We extracted the flavonoids from the ink and analyzed their composition. Then we evaluated systematically the cytotoxic and antimicrobial properties of this extract. A pharmacokinetic study was also conducted using SwissADME to assess the potential of the identified flavonoids and phenolic compounds from the ink extract to be orally active drug candidates.

Results

Cytotoxic activity was evaluated against 5 cell lines (MCF7, Hep G2, A549, and Caco2) at different concentrations (0.4 µg/mL, 1.6 µg/mL, 6.3 µg/mL, 25 µg/mL, 100 µg/mL). The viability of examined cells was reduced by the extract in a concentration-dependent manner. The highest cytotoxic effect of the extract was recorded against A549 and Hep G2 cancer cell lines cells with IC50 = 2.873 and 7.1 µg/mL respectively. The mechanistic analysis by flow cytometry of this extract on cell cycle progression and apoptosis induction indicated that the extract arrests the cell cycle at the S phase in Hep G2 and MCF7, while in A549 cell arrest was recorded at G1 phase. However, it causes G1 and S phase arrest in Caco2 cancer cell line. Our data showed that the extract has significant antimicrobial activity against all tested human microbial pathogens. However, the best inhibitory effect was observed against Candida albicans ATCC 10,221 with a minimum inhibitory concentration (MIC) of 1.95 µg/mL. Pharmacokinetic analysis using SwissADME showed that most flavonoids and phenolics compounds have high drug similarity as they satisfy Lipinski’s criteria and have WLOGP values below 5.88 and TPSA below 131.6 Å2.

Conclusion

S. pharaonis ink ethanolic extract showed a promising cytotoxic potency against various cell lines and a remarkable antimicrobial action against different pathogenic microbial strains. S. pharaonis ink is a novel source of important flavonoids that could be used in the future in different applications as a naturally safe and feasible alternative of synthetic drugs.
Examining emotional and behavioural trajectories in siblings of children with life-limiting conditions
Authors: Tay Joanne , Widger Kimberley , Steele Rose , Stremler Robyn , Pole Jason D.
Published: August 2024

Background

Healthy siblings of children with life-limiting conditions often experience emotional and behavioural struggles over the course of the ill child’s condition(s). Resources to support these siblings are limited due to a lack of understanding about their needs. Therefore, this study was designed to characterize the emotional and behavioural trajectories among siblings of children with progressive, life-limiting genetic, metabolic, or neurological conditions over a 12-month observation period.

Methods

Seventy siblings were recruited from a large-survey based study (Charting the Territory) that examined the bio-psychosocial health outcomes of parents and siblings. Linear mixed effect models were used to assess the association between siblings’ emotions and behaviour trajectories and selected demographic variables. Siblings’ emotions and behaviour were measured with Child Behaviour Checklist (CBCL).

Results

Siblings’ mean age was 11.2 years at baseline and Internalizing, Externalizing, and Total Behaviour Problems mean scores were within normal ranges across time. However, 7–25% of siblings had scores within the clinical range. Brothers had higher levels of Internalizing Problems than sisters, whereas sisters had higher levels of Externalizing Problems than brothers. When treatment was first sought for the ill child less than a year prior to study participation, siblings had higher levels of Internalizing and Externalizing Problems compared with siblings who participated more than one year after treatment was sought.

Conclusion

Healthy siblings experience emotional and behavioural problems early in the child’s disease trajectory. Although these problems improve with time, our findings show that brothers and sisters experience different types of challenges. Therefore, timely support for siblings is important as they navigate through the uncertainties and challenges.
Impact of simulated patient-based communication training vs. real patient-based communication training on empathetic behaviour in undergraduate students – a prospective evaluation study
Authors: Britz Vanessa , Sterz Jasmina , Koch Yannik , Schreckenbach Teresa , Stefanescu Maria-Christina , Zinßer Uwe , Verboket Rene Danilo , Sommer Katharina , Ruesseler Miriam
Published: August 2024

Background

Empathy is a key competency and is essential for doctor-patient relationships. Studies have proven a continuous reduction of empathy in medical students during their study period. The use of SPs is positively evaluated for competency acquisition and real patient communication training has positive effects on empathy empowerment. Therefore, the present study focusses on the impact of simulated patient (SP) vs real patient (RP) communication training on empathetic behaviour in undergraduate medical students.

Methods

The prospective evaluation took place during a 210-minute skills lab unit on medical communication for 3rd year medical students. Study participants were allocated in advance to one of three groups: one group trained with an SP (SP-group) and was informed about the fact that it was an SP; another group trained with an SP but assumed to encounter an RP (incognito patient group (IP-group)); the last group trained with an RP and was correctly informed about it (real patient group (RP-group). Self-assessed empathy was measured by using Jefferson Scale of Physician Empathy (JSPE) and Interpersonal Reactivity Index (IRI), as these are the most commonly used instruments for assessing empathy. Study participants were evaluated on empathetic behaviour by their group-associated patient using the Consultation and Relational Empathy (CARE) scale.

Results

146 students participated. There was no significant difference in self-assessed empathy between groups for JSPE and IRI. External assessment via CARE showed a statistically significant difference between SP-group and IP-group , as well as between SP-group and RP-group. There was no significant difference between IP-group and RP-group. This means that students training with real patients (or who believed them to be real) did receive significantly lower performance ratings on their empathy.

Conclusion

The results demonstrate a significant lower external empathy rating for students who had trained with a real patient or if they were in the belief of having encountered a real patient; this may be due to inhibitions and a lack of routine. Therefore, we recommend implementing SPs in the early study period with the gradual integration of RPs in the student’s further course of study.
Congenital myasthenic syndrome secondary to pathogenic variants in the SLC5A7 gene: report of two cases
Authors: Muntadas Javier A , Hyland Martin R , Martínez Maria Del Rosario Ortolá , Young Jaime N , Chong Jessica X , Bamshad Michael J , Maselli Ricardo A.
Published: August 2024

Background

Congenital Myasthenic Syndromes (CMS) are rare genetic diseases, which share as a common denominator muscle fatigability due to failure of neuromuscular transmission. A distinctive clinical feature of presynaptic CMS variants caused by defects of the synthesis of acetylcholine is the association with life-threatening episodes of apnea. One of these variants is caused by mutations in the SLC5A7 gene, which encodes the sodium-dependent HC-3 high-affinity choline transporter 1 (CHT1). To our knowledge there are no published cases of this CMS type in Latin America.

Case presentation

We present two cases of CHT1-CMS. Both patients were males presenting with repeated episodes of apnea, hypotonia, weakness, ptosis, mild ophthalmoparesis, and bulbar deficit. The first case also presented one isolated seizure, while the second case showed global developmental delay. Both cases, exhibited incomplete improvement with treatment with pyridostigmine.

Conclusions

This report emphasizes the broad incidence of CMS with episodic apnea caused by mutations in the SLC5A7 gene and the frequent association of this condition with serious manifestations of central nervous system involvement.
Metabolic reprogramming of poly(morpho)nuclear giant cells determines glioblastoma recovery from doxorubicin-induced stress
Authors: Pudełek Maciej , Ryszawy Damian , Piwowarczyk Katarzyna , Lasota Sławomir , Madeja Zbigniew , Kędracka-Krok Sylwia , Czyż Jarosław
Published: August 2024

Background

Multi-drug resistance of poly(morpho)nuclear giant cells (PGCs) determines their cytoprotective and generative potential in cancer ecosystems. However, mechanisms underlying the involvement of PGCs in glioblastoma multiforme (GBM) adaptation to chemotherapeutic regimes remain largely obscure. In particular, metabolic reprogramming of PGCs has not yet been considered in terms of GBM recovery from doxorubicin (DOX)-induced stress.

Methods

Long-term proteomic and metabolic cell profiling was applied to trace the phenotypic dynamics of GBM populations subjected to pulse DOX treatment in vitro, with a particular focus on PGC formation and its metabolic background. The links between metabolic reprogramming, drug resistance and drug retention capacity of PGCs were assessed, along with their significance for GBM recovery from DOX-induced stress.

Results

Pulse DOX treatment triggered the transient formation of PGCs, followed by the appearance of small expanding cell (SEC) clusters. Development of PGCs was accompanied by the mobilization of their metabolic proteome, transient induction of oxidative phosphorylation (OXPHOS), and differential intracellular accumulation of NADH, NADPH, and ATP. The metabolic background of PGC formation was confirmed by the attenuation of GBM recovery from DOX-induced stress following the chemical inhibition of GSK-3β, OXPHOS, and the pentose phosphate pathway. Concurrently, the mobilization of reactive oxygen species (ROS) scavenging systems and fine-tuning of NADPH-dependent ROS production systems in PGCs was observed. These processes were accompanied by perinuclear mobilization of ABCB1 and ABCG2 transporters and DOX retention in the perinuclear PGC compartments.

Conclusions

These data demonstrate the cooperative pattern of GBM recovery from DOX-induced stress and the crucial role of metabolic reprogramming of PGCs in this process. Metabolic reprogramming enhances the efficiency of self-defense systems and increases the DOX retention capacity of PGCs, potentially reducing DOX bioavailability in the proximity of SECs. Consequently, the modulation of PGC metabolism is highlighted as a potential target for intervention in glioblastoma treatment.
Effect of kinesiophobia on postoperative rehabilitation outcomes in patients with cervical spondylotic myelopathy: a cross-sectional study
Authors: Chen Yaqiong , Zhong Guiqin , Zhong Shichai , Lin Jingjing , Lin Yanjuan
Published: August 2024

Objective

This study aims to investigate the occurrence of postoperative kinesiophobia in patients with CSM and compare the postoperative recovery of patients with and without kinesiophobia to understand its influence on clinical outcomes in CSM.

Methods

Between November 2020 and November 2022, surgical treatment was performed in the neurosurgical wards of 2 Grade III Class A general public hospitals in the Fujian Province. The demographic and disease data of the patients were collected, and patients were divided into a kinesiophobia group and non-kinesiophobia group according to the Tampa kinesiophobia Scale (TSK). The cervical dysfunction index, cervical Japanese Orthopaedic Association (JOA) rating, self-anxiety rating, and activity of daily living rating scales were collected three months postoperatively. The influence of postoperative kinesiophobia on early rehabilitation was also analysed.

Results

A total of 122 patients were an average age of (55.2 ± 10.3) years included in this study. The average score of kinesophobia after surgery was 41.2 ± 4.5, with an incidence of 75.4%. Multivariate logistic regression analysis showed that age (OR = 1.105, 95% CI = 1.014–1.204), neck disability index (NDI) (OR = 1.268, 95% CI = 1.108–1.451), diabetes mellitus (OR = 0.026, 95% CI = 0.001–0.477), and Japanese Orthopaedic Association (JOA) score (OR = 0.698, 95% CI = 0.526–0.927) were associated with the occurren.

Conclusion

Doctors should be aware of kinesiophobia in patients with CSM. Education regarding kinesiophobia, strategies to avoid it, and treatment strategies using a multidisciplinary approach can improve recovery outcomes.
Galectin-3 induces pathogenic immunosuppressive macrophages through interaction with TREM2 in lung cancer
Authors: Wang Qiaohua , Wu Yongjian , Jiang Guanmin , Huang Xi
Published: August 2024

Background

High infiltration of tumor-associated macrophages (TAMs) is associated with tumor promotion and immunosuppression. The triggering receptor expressed on myeloid cells 2 (TREM2) is emerged as a key immunosuppressive regulator for TAMs, however, how TREM2-expressing TAMs are recruited and what ligands TREM2 interacts with to mediate immunosuppression is unknown.

Methods

Flow cytometry and single-cell RNA sequencing were used to analyze TREM2 expression. Mechanistically, mass spectrometry and immunoprecipitation were employed to identify proteins binding to TREM2. Phagocytosis and co-culture experiments were used to explore the in vitro functions of galectin3-TREM2 pair. Establishment of TREM2f/f-Lyz2-cre mice to validate the role of TREM2 signaling pathway in lung carcinogenesis. GB1107 were further supplemented to validate the therapeutic effect of Galectin3 based on TREM2 signaling regulation.

Results

This study identified that abundant TREM2+ macrophages were recruited at the intra-tumor site through the CCL2-CCR2 chemotactic axis. Galectin-3 impaired TREM2-mediated phagocytosis and promoted the conversion of TREM2+ macrophages to immunosuppressive TAMs with attenuated antigen presentation and co-stimulatory functions both in vitro both in vivo, and galectin-3 is a potential ligand for TREM2. Genetic and pharmacological blockade of TREM2 and galectin-3 significantly inhibited lung cancer progression in subcutaneous and orthotopic cancer models by remodeling the tumor immune microenvironment.

Conclusion

Our findings revealed a previously unknown association between galectin-3 and TREM2 in TAMs of lung cancer, and suggested simultaneous inhibition of galectin3 and TREM2 as potent therapeutic approach for lung cancer therapy.

Graphical Abstract
Transient efficacy of buparvaquone against Theileria haneyi in chronically infected horses
Authors: Onzere Cynthia K. , Hassan Amany , Sears Kelly , Kappmeyer Lowell S. , Villarino Nicolas F. , Fry Lindsay M. , Bastos Reginaldo G.
Published: August 2024

﻿Abstract

Background

Theileria haneyi is one of the three known causative agents of equine piroplasmosis. While imidocarb is generally effective in the clearance of the highly pathogenic Theileria equi, it is ineffective in the treatment of T. haneyi. Moreover, co-infection with T. haneyi has been shown to impede the successful treatment of T. equi. Furthermore, tulathromycin and diclazuril have demonstrated inefficacy in eradicating T. haneyi. The absence of an effective therapeutic agent against this parasite represents a significant obstacle in managing equine piroplasmosis.

Methods

To address this issue, we evaluated the efficacy of buparvaquone in the treatment of T. haneyi in chronically infected horses.

Results

Our findings showed that treatment of horses with the recommended dose of 2.5 mg/kg of buparvaquone led to a rapid abatement of T. haneyi levels, to a level where the parasites were not detectable by nested PCR. Following treatment, the horses remained PCR negative for a minimum of seven weeks until recrudescence occurred. Subsequent re-administration of buparvaquone at an increased dosage of 6 mg/kg upon recrudescence failed to exert a theilericidal effect on T. haneyi. Throughout the treatment regimen, the hematological parameters of the horses and most components of the chemistry panel remained within the normal range, except for blood urea nitrogen levels, which fell below the normal range in certain instances.

conclusions

BPQ at 2.5 mg/kg and 6 mg/kg had a robust theilericidal effect but was ineffective in the clearance of the T. haneyi infection in persistently infected animals.

Graphical Abstract
Food insecurity amongst asylum seekers and people without status in Israel
Authors: Blaychfeld-Magnazi Moran , Mor Zohar , Sartena Gaya , Goldsmith Rebecca Anne , Ophir Einat , Endevelt Ronit
Published: August 2024

Background

The COVID-19 pandemic caused massive disruptions globally, with food insecurity a primary concern amongst vulnerable communities. As one of the most marginalized and vulnerable groups in Israeli society asylum seekers and undocumented populations were amongst the first to be affected by the pandemic and the economic crisis that followed. The objective of the study was to evaluate the severity and causes of food insecurity among asylum seekers and other undocumented communities because of COVID-19.

Methods

A multi method approach was used. The quantitative component included an online questionnaire regarding access to food, aid and choices, and the 6 item Household Food Security Survey Module (HFSSM) The qualitative component included 4 focus groups and thematic analysis. The study was conducted in November 2020, by the Ministry of Health's Nutrition Division and the Tel Aviv Municipality's foreign community assistance and information center (Mesila). The convenience sample was drawn from the low-income neighborhood population of South Tel Aviv. Logistic regression, multivariate analysis and content analysis, were performed.

Results

Four hundred eighty-five people completed the quantitative survey, with average age 33.2 ± 5.4 years and 349 (72.0%) experienced food insecurity. In the multivariate analysis, being older (p = 0.04, Odds Ratio OR 1.1, Confidence Interval CI 1.05–1.15) and being single (unmarried) (p = 0.03, OR 2.1, CI 1.2, 3.5) predicted food insecurity. Qualitative findings identified three main themes: children preferring Israeli/ Western foods to traditional foods; financial stresses were compounded; a preference for receiving assistance with purchasing food (vouchers), rather than food handouts.

Conclusion

In conclusion, vulnerable populations (asylum seekers and other undocumented communities) were severely affected and are in danger of food insecurity. Culturally relevant and contextualized solutions are needed to address the acute hunger within the community. These include establishment of a cross-ministerial forum, a social grocery store, increased liaison with food rescue bodies, complete nutritional support for children in educational settings and increased guidance regarding food choices and budgeting.
On properties and operations of complex neutrosophic soft groups
Authors: Rahoumah Fatimah , Yow Kai Siong , Nik Long Nik Mohd Asri , Gasim Menshawi
Published: August 2024

Complex neutrosophic soft groups represent a significant advancement in handling uncertainty by integrating the concepts of fuzzy logic, soft sets, and neutrosophic logic. These groups generalize complex fuzzy soft groups and introduce an additional dimension through neutrosophic membership functions, namely truth, indeterminacy, and falsity. This creates a richer framework for dealing with uncertainty and ambiguity, making it well-suited for managing complex data structures in real-world applications. We explore some important definitions and theoretical frameworks surrounding complex neutrosophic soft groups, highlighting the unique aspect of neutrosophic membership functions. Additionally, we present an overview of neutrosophic soft groups, exploring some of their key operations and fundamental properties. We then examine the basics of homogeneous complex neutrosophic soft sets and their roles in establishing complex neutrosophic soft groups.
Genomic profiles and clinical presentation of chordoma
Authors: Koka Hela , Zhou Weiyin , McMaster Mary L. , Bai Jiwei , Luo Wen , Klein Alyssa , Zhang Tongwu , Hua Xing , Li Xin , Wang Difei , Xiong Yujia , Jones Kristine , Vogt Aurelie , Hicks Belynda , Parry Dilys , Goldstein Alisa M. , Yang Xiaohong R.
Published: August 2024

Chordoma is a rare bone cancer with variable clinical outcomes. Here, we recruited 184 sporadic chordoma patients from the US and Canada and collected their clinical and treatment data. The average age at diagnosis was 45.5 years (Range 5–78) and the chordoma site distribution was 49.2% clivus, 26.2% spinal, and 24.0% sacral. Most patients (97.5%) received surgery as the primary treatment, among whom 85.3% also received additional treatment. Except for the most prevalent cancers like prostate, lung, breast, and skin cancer, there was no discernible enrichment for any specific cancer type among patients or their family members. Among a subset of patients (N = 70) with tumor materials, we conducted omics analyses and obtained targeted panel sequencing and SNP array genotyping data for 51 and 49 patients, respectively. The most recurrent somatic driver mutations included PIK3CA (12%), followed by chromatin remodeling genes PBRM1 and SETD2. Amplification of the 6q27 region, containing the chordoma susceptibility gene TBXT, was detected in eight patients (16.3%). Clival patients appeared to be less likely to carry driver gene mutations, chromosome arm level deletion events (e.g., 5p, 5p, and 9p), or 6q27 amplification compared to sacral patients. After adjusting for age, sex, tumor site, and additional treatment, patients with somatic deletions of 14q (OR = 13.73, 95% CI 1.96–96.02, P = 0.008) and 18p (OR = 13.68, 95% CI 1.77–105.89, P = 0.012) were more likely to have persistent chordoma. The study highlights genomic heterogeneity in chordoma, potentially linked to location and clinical progression.