RESEARCH DESIGN AND METHODS: The CDOM was developed using the prospective Hong Kong Diabetes Register (HKDR) cohort (n = 21,453; median follow-up duration, 7.9 years; 166,433 patient-years). It was externally validated with a retrospective territory-wide cohort of Chinese patients with T2D attending Hong Kong publicly funded diabetes centers and community clinics (n = 176,120; follow-up duration, 7.2 years; 953,523 patient-years).
RESULTS: The CDOM predicted first and recurrent events with satisfactory performance during internal (C-statistic = 0.740-0.941) and external (C-statistic = 0.758-0.932) validation after calibration. The respective C-statistic values for cancer were 0.664 and 0.661. Subgroup analysis showed consistent performance during internal (C-statistic = 0.632-0.953) and external (C-statistic = 0.598-0.953) validation after calibration.
CONCLUSIONS: The CDOM, developed using comprehensive register data with long-term follow-up, is a robust tool for predicting long-term outcomes in Chinese patients with T2D. The model enables the identification of patient subgroups to augment study design and develop tailored novel treatment strategies, inform policy, and guide practice to improve cost-effectiveness of diabetes care.
METHOD: Cross-sectional study of Malaysian stroke children who were followed-up for at least 2 years. Paediatric Stroke Outcome Measure (PSOM) and modified Rankin scale (mRS) were utilised to assess neurological and functional outcomes. HRQL was assessed using PedsQL (Paediatric Quality of Life inventory) 4.0. Multiple regression analysis was used to determine factors associated with poor PSOM, poor mRS, and lower HRQL.
RESULTS: Seventy-six children were recruited. Majority have good mRS (72.4 %) and good PSOM (75 %). PedsQL total, physical health summary and psychosocial health summary mean scores were 74.2(SD 21.57), 74.2(SD 28.16) and 76.13(SD 18.66) respectively, which were significantly lower compared with healthy Malaysian children (p ≤ 0.001). Learning disability post-stroke was associated with poor PSOM and poor mRS; while cardiac surgery was associated with poor mRS. Learning disability post-stroke was associated with lower total, physical health summary and psychosocial health summary PedsQL scores. Poor mRS was associated with lower total PedsQL scores while poor PSOM was associated with lower total and physical health summary PedsQL.
CONCLUSION: Although majority of Malaysian children with stroke had good long-term neurological and functional outcomes, they had lower HRQL compared to healthy Malaysian children. Optimizing care for cardiac surgery to reduce the risk of perioperative stroke may lead to improved neurological outcome. There is a need to address the issues of learning disability post-stroke and poor neurological outcome to reduce their impact on HRQL.
METHODS AND ANALYSIS: A two-arm, parallel, open-label, multicentre, cluster randomised, two-stage adaptive design trial is proposed to first evaluate the superiority of mTB-Tobacco, compared with usual care and then the non-inferiority of mTB-tobacco compared with face-to-face behaviour support. Study settings include TB treatment centres in Bangladesh and Pakistan. The study population includes adult patients, newly diagnosed (within 4 weeks) with pulmonary TB disease, daily smokers, willing to quit and have access to mobile phones. The primary outcome includes biochemically verified continuous smoking abstinence assessed at 6 months per Russell Standard. A generalised linear mixed-effects model will be used to assess the impact of mTB-Tobacco intervention on continuous outcomes, incorporating fixed effects for the intervention, random effects for clusters and relevant covariates. Cost-effectiveness analysis will be done to estimate the cost per quitter and cost per quality-adjusted life year gained, calculate the incremental cost-effectiveness ratios to establish the value for money for mTB-Tobacco.
ETHICS AND DISSEMINATION: This trial will be conducted in compliance with International Council on Harmonisation - Good Clinical Practice guidelines and the Declaration of Helsinki. The study has been approved by the ethics committees of the University of Edinburgh Medical School Research Ethics Committee (EMREC) of UK, the Bangladesh Medical Research Council (BMRC) and the National Bioethics Committee (PMRC) of Pakistan. The results of this trial will be disseminated in peer-reviewed journals and presented in academic conferences.
TRIAL REGISTRATION NUMBER: ISRCTN86971818 (https://doi.org/10.1186/ISRCTN86971818); pre-enrolment, submission date: 29 August 2023; registration date: 11 September 2023.
METHODS: An exploratory qualitative study was conducted between May 2016 and November 2017, using semi-structured in-depth interviews (IDIs) and focus group discussions (FGDs) with male and female senior surgeons, medical officers, and surgical trainees. A coding tree was constructed and refined after initial rounds of data analysis. Thematic content analysis was performed using the NVivo 11 Pro (Windows) qualitative data analysis software.
RESULTS: Ten IDIs and five FGDs (N = 34 participants) revealed three key themes: (A) influences on trainees' career choices, (B) challenges encountered during surgical training, and (C) trainee empowerment. Participants highlighted the demanding nature of surgical training, the lack of flexibility in work schedules, and the male-dominated work environment as significant barriers for women. Despite these challenges, supportive family structures and strong mentorship were found to be critical for the retention of women in surgery.
CONCLUSION: Institutional support, mentorship opportunities, and culture change are essential for improving the representation and retention of female surgeons in Malaysia. Tailored policies that acknowledge the unique challenges faced by women in surgery could foster a more inclusive and supportive environment.
METHODS: This cross-sectional study involved 1,719 students. Mplus 8.0 software was used to conduct latent profile analysis to explore the potential categories of depression and anxiety comorbidities. R4.3.2 software was used to explore the network of core depression and anxiety symptoms, bridge these disorders, and evaluate the effects of risk and protective factors.
RESULTS: Three categories were established: "healthy" (57.8%), "mild depression-mild anxiety" (36.6%), and "moderately severe depression-moderate anxiety" (5.6%). "Depressed mood", "nervousness", and "difficulty relaxing" were core symptoms in both the depression-anxiety comorbidity network and the network of risk and protective factors. Stress perception and neuroticism serve as bridging nodes connecting some symptoms of depression and anxiety and are thus considered the most prominent risk factors.
CONCLUSIONS: According to the core and bridging symptoms identified in this study, targeted intervention and treatment can be provided to groups with comorbid depression and anxiety, thereby reducing the risk of these comorbidities in adolescents.
METHODS: We propose a type III hybrid implementation/effectiveness interventional cohort trial in 35 ICUs in up to 11 low- and middle- income countries. The study intervention is a structured review of antimicrobial prescriptions as recommended by the World Health Organisation. Strategies to support stakeholder-led implementation include development of local protocols, registry-enabled audit and feedback, and education. Evaluation of implementation, and the determinants of its success, is informed by the RE-AIM framework and the Consolidated Framework for Implementation Research respectively. The primary outcome is a composite measure of fidelity, reach and adoption. Secondary outcomes describe the effectiveness of the intervention on improving antimicrobial prescribing. Qualitative interviews will assess relevant implementation acceptability, adaptations and maintenance. A baseline survey will investigate ICU-level antimicrobial stewardship structures and processes.
DISCUSSION: This study addresses global policy priorities by supporting implementation research of antimicrobial stewardship, and strengthening associated healthcare professional competencies. It does this in a setting where improvement is sorely needed: low- and middle- income country ICUs. The study will also describe the influence of pre-existing antimicrobial stewardship structures and processes on implementation and improve understanding about the efficacy of strategies to overcome barriers to implementation in these settings.
TRIAL REGISTRATION: This study protocol has been registered with ClinicalTrials.gov (ref NCT06666738) on 31 Oct 2004. https://clinicaltrials.gov/study/NCT06666738?term=NCT06666738&rank=1 .
OBJECTIVES: The goal of this study is to identify prospective therapeutic candidates from the extract of Euphorbia tirucalli (pencil cactus) leaves, which have the ability to inhibit Epstein-Barr virus (EBV)-positive Head- Neck cancer cells.
MATERIALS AND METHODS: The thirteen most important chemical components found in Euphorbia tirucalli (pencil cactus) leaves were analyzed by means of molecular modeling techniques such as Absorption, Distribution, Metabolism, Excretion, and Toxicity (ADMET), Quantum Mechanics (QM) calculation, molecular docking, and molecular dynamics (MD) simulations. Using the Prediction of Activity Spectra for Substances (PASS) model, we assess the potency of these compounds. Important molecular properties such as chemical potential, electronegativity, hardness, and softness can be determined with the use of quantum chemical calculations employing HOMO-LUMO analysis. These drugs' safety and toxicological characteristics are better understood to assessments of their pharmacokinetics and ADMET. Finally, molecular dynamics simulations are employed to verify binding interactions and assess the stability of docked complexes.
RESULTS: The molecular docking analysis identifies ligands (01), (02), and (10) as strong competitors, with strong binding affinity for the Epstein-Barr virus (EBV)-positive Head-Neck cancer cell line. Not only do the ligands (01), (02), and (10) match the criteria for a potential new inhibitor of head-neck cancer, but they also outperform the present FDA-approved treatment.
CONCLUSION: Taraxerol, euphol, and ephorginol, three phytochemicals isolated from the leaves of the Euphorbia tirucalli (pencil cactus), have been identified as effective anti-cancer agents with the potential to serve as a foundation for novel head-neck cancer therapies, particularly those targeting the Epstein-Barr virus (EBV)-overexpressing subtype of this disease. An effective, individualized treatment plan for head-neck cancer is a long way off, but this study is a major step forward that could change the lives of patients and reduce the global burden of this disease.
MATERIALS AND METHODS: This retrospective study included data from 98 Japanese patients legs and 324 Chinese patients legs. PTS was measured on long-leg and short-leg radiographs and CT. Two independent surgeons assessed the measurements, and the inter- and intra-observer reliability were evaluated. The primary outcome was the comparison of medial and lateral PTS measurements, while the secondary aim was to assess the impact of tibial length on measurement accuracy.
DISCUSSION: The study revealed that lateral PTS was consistently smaller than medial PTS, with an average difference of 1.2°-1.9°. Shorter leg radiographs tend to underestimate PTS compared to full-length tibial measurements. The correlation between measurements from short and long leg radiographs showed that PTS measurements were more prone to errors, which may be due to anatomical factors such as tibial bowing. Inter- and intra-observer reliability were good for medial PTS but poor to moderate for lateral PTS, especially when using radiographs.
CONCLUSION: For accurate measurement of both medial and lateral PTS, surgeons should consider using additional examination methods such as CT and MRI. If PTS is to be measured on radiographs, the focus should be on the medial PTS, as it tends to provide more reliable results.