bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ligation versus stapling in video-assisted thoracoscopic (VATS) bullectomy; early outcome of a low cost technqiue
Authors: Hassan Mohamed Osman Omar , Zhang Linyou , El-Haish Mahmoud Khairy , Ahmed Mohsen Saber Mohamed , Elkhayat Hussein 
Published: March 2023

Abstract
Background
Spontaneous pneumothorax is thoracic condition, with annual incidence of 7 to 9 cases per 100,000 people. Most of thoracic surgeons prefer minimally invasive method that uses staplers to resect bullous parenchyma, but this technique is costly. Now, the problem of rising health care costs is faced by all countries all over the world. As result, preventing use of disposable consumables in video-assisted thoracic surgery (VATS) will aid in cost control.
In our study, we described a new cheap technique which was VATS ligation of bullae by silk ligature and we compared it to standard technique of using staplers in VATS bullectomy.

Aim of Work
We aimed to investigate the results of VATS ligation of bullae by silk ligature in comparison to using staplers in VATS bullectomy.

Patient & techniques
This was retrospective research done on 120 studied cases at cardiothoracic surgery, 2nd Affiliated Hospital, Harbin Medical University, China and Assiut University Hospital, Egypt from March 2020 to December 2021.

Results
We retrospectively investigate data of 120 patients and there was no variation in patient characteristics among VATS bullectomy using staplers and VATS bullae ligation. Air leak duration and post-operative drainage were statistically significant higher in VATS bullectomy using staplers than bullae ligation.
Hospital stay duration (mean = 3.800 ± 1.070 vs 4.917 ± 2.794) and complications were statistically significant higher in VATS bullectomy using staplers than thoracoscopic bullae ligation.

Conclusion
Treatment of spontaneous pneumothorax by thoracoscopic ligation of bullae by silk ligature is comparable to VATS bullectomy using staplers in short-term results and offers less complications and better economic results.
Drivers of mobile commerce adoption intention by Saudi SMEs during the COVID-19 pandemic
Authors: Alaskar Thamir Hamad , Alsadi Amin K. 
Published: March 2023

AbstractGrounded in the technology-organization-environment framework, this paper investigates critical drivers of mobile commerce (m-commerce) adoption intention by SMEs in Saudi Arabia, a developing country in transition, during the COVID-19 pandemic. A quantitative approach was adopted in this study for data collection and analysis. A proposed research model was tested and validated using PLS-SEM on data collected using a structured questionnaire from a sample of 171 Saudi SMEs located in the capital city of Riyadh. The findings reveal that top management support, environmental uncertainty and perceived benefits are the critical drivers of m-commerce adoption intention. However, perceived costs do not influence firms’ intentions to adopt m-commerce. This study contributes to a better understanding of m-commerce adoption intention in developing countries, particularly in Saudi Arabia. Both theoretical and practical implications of interest can be derived from this study.
SP1 transcriptionally regulates UBE2N expression to promote lung adenocarcinoma progression
Authors: Li Jianjun , Qi Chunchun , Shao Shanshan , Chen Yanru , Peng Zimei , Shen Qinglin , Zhang Zhen 
Published: March 2023

AbstractLung adenocarcinoma (LUAD) is the main cause of cancer-related death worldwide. Understanding the mechanisms of LUAD progression may provide insights into targeted therapy approaches for this malignancy. Ubiquitin-conjugating enzyme 2 N (UBE2N) has been demonstrated to play key roles in the progression of various cancers. However, the functions and mechanisms underlying UBE2N expression in LUAD are still unclear. In this study, we found that UBE2N is highly expressed in LUAD and patients with high UBE2N expression in their tumors have poor clinical outcomes. Moreover, we showed that UBE2N interference significantly inhibited LUAD progression in vitro and in vivo. At the molecular level, we demonstrated that the UBE2N is a bona fide target of transcription factor SP1. SP1 directly bound to the promoter of UBE2N and upregulated its expression in LUAD cells, which in turn contributed to the progression of LUAD. Furthermore, we found that there is a strong positive correlation between the expression of SP1 and UBE2N in LUAD samples. Importantly, LUAD patients with concomitantly high expression of SP1 and UBE2N were significantly associated with poor clinical outcomes. In conclusion, our study demonstrated that the SP1-UBE2N signaling axis might play a key role in the malignant progression of LUAD, which provides new targets and strategies for the treatment of LUAD.
Natural History and Predictive Factors of Outcome in Medullary Thyroid Microcarcinoma
Authors: Kesby Nicholas , Mechera Robert , Fuchs Talia , Papachristos Alexander , Gild Matti , Tsang Venessa , Clifton-Bligh Roderick , Robinson Bruce , Sywak Mark , Sidhu Stan , Chou Angela , Gill Anthony J , Glover Anthony 
Published: March 2023

Abstract

Context
Management of sporadic medullary thyroid microcarcinoma smaller than 1 cm (micro-MTC) is controversial because of conflicting reports of prognosis. As these cancers are often diagnosed incidentally, they pose a management challenge when deciding on further treatment and follow-up.

Objective
We report the outcomes of surgically managed sporadic micro-MTC in a specialist endocrine surgery and endocrinology unit and identify associations for recurrence and disease-specific survival in this population.

Methods
Micro-MTCs were identified from a prospectively maintained surgery database, and slides were reviewed to determine pathological grade. The primary end points were recurrence, time to recurrence and disease-specific survival. Prognostic factors assessed included size, grade, lymph node metastasis (LNM), and postoperative calcitonin.

Results
From 1995 to 2022, 64 patients were diagnosed with micro-MTC with 22 excluded because of hereditary disease. The included patients had a median age of 60 years, tumor size of 4 mm, and 28 (67%) were female. The diagnosis was incidental in 36 (86%) with 4 (10%) being high grade, 5 (12%) having LNM and 9 (21%) having elevated postoperative calcitonin. Over a 6.6-year median follow-up, 5 (12%) developed recurrence and 3 (7%) died of MTC. High grade and LNM were associated with 10-year survival estimates of 75% vs 100% for low grade and no LNM (hazard ratio = 831; P &lt; .01). High grade, LNM, and increased calcitonin were associated with recurrence (P &lt; .01). Tumor size and type of surgery were not statistically significantly associated with recurrence or survival. No patients with low grade micro-MTC and normal postoperative calcitonin developed recurrence.

Conclusion
Most sporadic micro-MTCs are detected incidentally and are generally associated with good outcomes. Size is not significantly associated with outcomes. Using grade, LNM, and postoperative calcitonin allows for the identification of patients at risk of recurrence to personalize management.
New Horizons: Testosterone or Exercise for Cardiometabolic Health in Older Men
Authors: Green Daniel J , Chasland Lauren C , Naylor Louise H , Yeap Bu B 
Published: March 2023

AbstractMiddle-aged and older men have typically accumulated comorbidities, are increasingly sedentary, and have lower testosterone concentrations (T) compared to younger men. Reduced physical activity (PA) and lower T both are associated with, and may predispose to, metabolically adverse changes in body composition, which contribute to higher risks of cardiometabolic disease. Exercise improves cardiometabolic health, but sustained participation is problematic. By contrast, rates of T prescription have increased, particularly in middle-aged and older men without organic diseases of the hypothalamus, pituitary, or testes, reflecting the unproven concept of a restorative hormone that preserves health. Two recent large randomized trials of T, and meta-analyses of randomized trials, did not show a signal for adverse cardiovascular (CV) events, and T treatment on a background of lifestyle intervention reduced type 2 diabetes by 40% in men at high risk. Men with both higher endogenous T and higher PA levels have lower CV risk, but causality remains unproven. Exercise training interventions improve blood pressure and endothelial function in middle-aged and older men, without comparable benefits or additive effects of T treatment. Therefore, exercise training improves cardiometabolic health in middle-aged and older men when effectively applied as a supervised regimen incorporating aerobic and resistance modalities. Treatment with T may have indirect cardiometabolic benefits, mediated via favorable changes in body composition. Further evaluation of T as a pharmacological intervention to improve cardiometabolic health in aging men could consider longer treatment durations and combination with targeted exercise programs.
Hepatic but not Intestinal FBP1 Is Required for Fructose Metabolism and Tolerance
Authors: Bai Qiufang , Liu Yajin , Wang Chen-Ma , Wang Jue-Rui , Feng Yingying , Ma Xianhua , Yang Xiaohang , Shi Ya-Nan , Zhang Weiping J 
Published: March 2023

Abstract
Fructose intolerance in mammals is caused by defects in fructose absorption and metabolism. Fructose-1,6-bisphosphatase 1 (FBP1) is a key enzyme in gluconeogenesis, and its deficiency results in hypoglycemia as well as intolerance to fructose. However, the mechanism about fructose intolerance caused by FBP1 deficiency has not been fully elucidated. Here, we demonstrate that hepatic but not intestinal FBP1 is required for fructose metabolism and tolerance. We generated inducible knockout mouse models specifically lacking FBP1 in adult intestine or liver. Intestine-specific deletion of Fbp1 in adult mice does not compromise fructose tolerance, as evidenced by no significant body weight loss, food intake reduction, or morphological changes of the small intestine during 4 weeks of exposure to a high-fructose diet. By contrast, liver-specific deletion of Fbp1 in adult mice leads to fructose intolerance, as manifested by substantial weight loss, hepatomegaly, and liver injury after exposure to a high-fructose diet. Notably, the fructose metabolite fructose-1-phosphate is accumulated in FBP1-deficient liver after fructose challenge, which indicates a defect of fructolysis, probably due to competitive inhibition by fructose-1,6-bisphosphate and may account for the fructose intolerance. In conclusion, these data have clarified the essential role of hepatic but not intestinal FBP1 in fructose metabolism and tolerance.
Acute Inhibition of Intestinal Neprilysin Enhances Insulin Secretion via GLP-1 Receptor Signaling in Male Mice
Authors: Esser Nathalie , Mundinger Thomas O , Barrow Breanne M , Zraika Sakeneh 
Published: March 2023

Abstract
The peptidase neprilysin modulates glucose homeostasis by cleaving and inactivating insulinotropic peptides, including some produced in the intestine such as glucagon-like peptide-1 (GLP-1). Under diabetic conditions, systemic or islet-selective inhibition of neprilysin enhances beta-cell function through GLP-1 receptor (GLP-1R) signaling. While neprilysin is expressed in intestine, its local contribution to modulation of beta-cell function remains unknown. We sought to determine whether acute selective pharmacological inhibition of intestinal neprilysin enhanced glucose-stimulated insulin secretion under physiological conditions, and whether this effect was mediated through GLP-1R. Lean chow-fed Glp1r+/+ and Glp1r−/− mice received a single oral low dose of the neprilysin inhibitor thiorphan or vehicle. To confirm selective intestinal neprilysin inhibition, neprilysin activity in plasma and intestine (ileum and colon) was assessed 40 minutes after thiorphan or vehicle administration. In a separate cohort of mice, an oral glucose tolerance test was performed 30 minutes after thiorphan or vehicle administration to assess glucose-stimulated insulin secretion. Systemic active GLP-1 levels were measured in plasma collected 10 minutes after glucose administration. In both Glp1r+/+ and Glp1r−/− mice, thiorphan inhibited neprilysin activity in ileum and colon without altering plasma neprilysin activity or active GLP-1 levels. Further, thiorphan significantly increased insulin secretion in Glp1r+/+ mice, whereas it did not change insulin secretion in Glp1r−/− mice. In conclusion, under physiological conditions, acute pharmacological inhibition of intestinal neprilysin increases glucose-stimulated insulin secretion in a GLP-1R–dependent manner. Since intestinal neprilysin modulates beta-cell function, strategies to inhibit its activity specifically in the intestine may improve beta-cell dysfunction in type 2 diabetes.
Changes of Serum Bone Metabolism Indexes and Ultrasonic Bone Mineral Density in Patients with Diabetic Nephropathy at Different Stages and their effects on Diabetic Renal Microvascular Complications
Authors: Han Lulu , Wang Shenghai , Ma Jingjing , Song Ningning , Wang Zhao , Yao Mingyan 
Published: March 2023

Objective: To determine the changes in serum bone metabolism indexes and ultrasonic bone mineral density (BMD) in patients with diabetic nephropathy at different stages, and their effects on diabetic renal microvascular complications.
Methods: This is a clinical comparative study. One hundred twenty two diabetic patients admitted to the Baoding No.1 Central Hospital from January 2020 to March 2022 were selected as subjects and divided into three groups according to their actual condition: the simple diabetes (Group-A, 40 cases), diabetic nephropathy with micro urinary protein (Group-B, 40 cases) and diabetic nephropathy with massive proteinuria (Group-C, 42 cases). Another 36 healthy subjects were selected as the control group. Differences in serum bone metabolism indexes and ultrasound BMD levels were compared.
Results: Twenty five hydroxy-vitamin D, BGP, T-PINP and ultrasound BMD levels in the control group were > Group-A > Group-B > Group-C, PTH and β-CTX in the control group were < Group-A < Group-B < Group-C, statistically significant differences (p<0.05). The urinary albumin to urinary creatinine ratio (ACR) value in Group-B was significantly lower than Group-C (p<0.05). Logistic regression analysis showed that 25-hydroxy-vitamin D, PTH, BGP, β-CTX, T-PINP and ultrasound BMD were the influencing factors of diabetic renal microvascular complications (p<0.05).
Conclusion: Bone metabolism indexes and ultrasound bone mineral density are abnormally expressed in patients with diabetic nephropathy at different stages, which are closely related to the urine protein of patients. They have important clinical value in the diagnosis of early diabetic nephropathy.
doi: https://doi.org/10.12669/pjms.39.3.6650
How to cite this: Han L, Wang S, Ma J, Song N, Wang Z, Yao M. Changes of Serum Bone Metabolism Indexes and Ultrasonic Bone Mineral Density in Patients with Diabetic Nephropathy at Different Stages and their effects on Diabetic Renal Microvascular Complications. Pak J Med Sci. 2023;39(3):656-661. doi: https://doi.org/10.12669/pjms.39.3.6650
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Sociodemographic and clinical characteristics of early COVID-19 deaths in Almadinah Almonawarah, Saudi Arabia: An analytical cross-sectional study
Authors: Surrati Amal M. Qasem , Sobh Eman , Mansuri Farah Asad , Bokhari Abdulraouf A. , Haroon Samira Mousa , Alewi Nouf Moalla 
Published: March 2023

Background and Objective: Identification of clinical characteristics and risk factors for mortality in COVID-19 is important for early detection and precise case management. The study aimed to describe the sociodemographic, clinical, and laboratory characteristics of in-hospital COVID-19 deaths in Almadinah Almonawarah city, Saudi Arabia, and to identify risk factors for early mortality among them.
Methods: This is an analytical cross-sectional study. The main outcomes were demographic and clinical characteristics of COVID 19 patients who died from March till December 2020, during the hospital stay. We collected 193 records of COVID-19 patients, from two major hospitals in Al Madinah region, Saudi Arabia. Descriptive and inferential analysis were performed to identify and relate the factors of early death.
Results: Out of the total deaths, 110 died during the first 14 days of admission (Early death group) and 83 died after 14 days of admission (Late death group). Early death group had a significantly higher percentages of old age patients (p=0.027) and males (72.7%). Comorbidities were found in 166 (86%) of cases. Multimorbidity were significantly higher in early deaths than in late deaths 74.5% (p=<0.001). Women had significantly higher mean values of CHA2SD2 comorbidity scores (3.28 versus 1.89 for men; p <0.001). Moreover, predictors of high comorbidity scores were older age (p=0.005), higher respiratory rate (p=0.035), and raised alanine transaminase (p=0.047).
Conclusion: Old age, comorbid illness, and severe respiratory involvement were prevalent among COVID-19 deaths. Comorbidity scores were significantly higher in women. Comorbidity was found to be significantly more associated with early deaths.
doi: https://doi.org/10.12669/pjms.39.3.6736
How to cite this: Surrati AMQ, Sobh E, Mansuri FA, Bokhari AA, Haroon SM, Alewi NM. Sociodemographic and clinical characteristics of early COVID-19 deaths in Almadinah Almonawarah, Saudi Arabia: An analytical cross-sectional study. Pak J Med Sci. 2023;39(3):704-709. doi: https://doi.org/10.12669/pjms.39.3.6736
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Effect of Ramadan Fasting on Body Weight and Body Mass Index (BMI) in Public Sector Undergraduate Medical Students of Peshawar
Authors: Abdul Majid  , Muhammad Osama  , Muhammad Noman  , Ulfat Nisa  , Iqbal Haider  
Published: March 2023

Objective: To determine the effects of fasting on weight and eventually on Body Mass Index (BMI) in medical students of a Public Sector Medical College.
Methods: It was a prospective analytical study conducted in a Public Sector Medical College in Peshawar City from 28th March to 20th May 2022 (1443 Hijri). Convenience Sampling was used and 115 students (58 male and 57 female) of 1st Year MBBS to Final Year MBBS were enrolled. Four readings of weight were taken, one before, two during, and one after Ramadan. A well-structured self-administered questionnaire was used to inquire about basic demographic characteristics, sleep patterns during Ramadan and normal routine, and family history of obesity. The collected data were analyzed through SPSS software and a repeated measures ANOVA test was used for drawing statistical conclusions.
Results: A slight increase in the mean weight was observed during the second week of Ramadan while a loss of 0.4 kg occurred during the fourth week of Ramadan, F (1, 81) = 1777.55; p < 0.0001. The same pattern was observed for BMI, F (1, 81) = 2705.18; p < 0.0001. However, the weight and the BMI were regained in two to three weeks following Ramadan.
Conclusion: Ramadan offers a non-hazardous way of weight loss. Further studies across different geographical locations with larger sample sizes should be conducted to identify and quantify the association between weight and fasting and also to identify potential confounders.
doi: https://doi.org/10.12669/pjms.39.3.7017
How to cite this: Majid A, Osama M, Noman M, Nisa U, Haider I. Effect of Ramadan Fasting on Body Weight and Body Mass Index (BMI) in Public Sector Undergraduate Medical Students of Peshawar. Pak J Med Sci. 2023;39(3):662-666. doi: https://doi.org/10.12669/pjms.39.3.7017
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Smartphone-based fundus imaging for evaluation of Retinopathy of Prematurity in a low-income country: A pilot study
Authors: Choudhary Roha Ahmad , Hashmi Shiraz , Tayyab Haroon 
Published: March 2023

Objectives: To evaluate the feasibility of a novel and simple smart phone-based Retinopathy of Prematurity (ROP) screening approach in a resource-constrained setting.
Methods: This cross-sectional validation study was conducted at the Department of Ophthalmology and Neonatal Intensive Care Unit (NICU) of The Aga Khan University Hospital, Pakistan, from January 2022 to April 2022. A total of 63 images of eyes with active ROP (stage-1, 2, 3, 4 and/or plus or pre-plus disease) were included in this study. The stage of ROP was documented by the principal investigator using an indirect ophthalmoscope and retinal images were obtained using this novel technique. These images were shared with two masked ROP experts who rated the image quality and determined the stage of ROP and presence of plus disease. Their reports were compared with the initial findings reported by principal investigator using indirect ophthalmoscope.
Results: We reviewed 63 images for image quality, stage of ROP and presence of plus disease. There was significant agreement between the gold standard and the Rater-1 and 2 for the presence of plus disease (Cohen’s kappa was 0.84 and 1.0) and the stage of the disease (Cohen’s kappa 0.65 and 1.0). There was significant agreement between the Rater for presence of plus disease and any stage of ROP (Cohen’s κ: 0.84 and 0.65 for plus disease and any stage of the ROP, respectively). Rater-1 and 2 rated 96.83% and 98.41% images as excellent / acceptable respectively.
Conclusions: High quality retinal images can be captured with a smartphone and 28D lens without using any additional adapter equipment. This approach of ROP screening can form basis of telemedicine for ROP in resource constrained areas.
doi: https://doi.org/10.12669/pjms.39.3.7053
How to cite this: Choudhary RA, Hashmi S, Tayyab H. Smartphone-based fundus imaging for evaluation of Retinopathy of Prematurity in a low-income country: A pilot study. Pak J Med Sci. 2023;39(3):638-643. doi: https://doi.org/10.12669/pjms.39.3.7053
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.