bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring Natural Immune Responses to Shigella Exposure Using Multiplex Bead Assays on Dried Blood Spots in High-Burden Countries: Protocol From a Multisite Diarrhea Surveillance Study
Authors: Benedicto-Matambo Prisca , Avolio Lindsay N , Badji Henry , Batool Rabab , Khanam Farhana , Munga Stephen , Tapia Milagritos D , Peñataro Yori Pablo , Awuor Alex O , Ceesay Bubacarr E , Cornick Jennifer , Cunliffe Nigel A , Garcia Bardales Paul F , Heaney Christopher D , Hotwani Aneeta , Ireen Mahzabeen , Taufiqul Islam Md , Jallow Ousman , Kaminski Robert W , Shapiama Lopez Wagner V , Maiden Victor , Ikumapayi Usman Nurudeen , Nyirenda Ruth , Ochieng John Benjamin , Omore Richard , Paredes Olortegui Maribel , Pavlinac Patricia B , Pisanic Nora , Qadri Firdausi , Qureshi Sonia , Rahman Nazia , Rogawski McQuade Elizabeth T , Schiaffino Francesca , Secka Ousman , Sonye Catherine , Sultana Shazia , Timite Drissa , Traore Awa , Yousafzai Mohammad Tahir , Taufiqur Rahman Bhuiyan Md , Jahangir Hossain M , Jere Khuzwayo C , Kosek Margaret N , Kotloff Karen L , Qamar Farah Naz , Sow Samba O , Platts-Mills James A
Published: March 2024

Background

Molecular diagnostics on human fecal samples have identified a larger burden of shigellosis than previously appreciated by culture. Evidence of fold changes in immunoglobulin G (IgG) to conserved and type-specific Shigella antigens could be used to validate the molecular assignment of type-specific Shigella as the etiology of acute diarrhea and support polymerase chain reaction (PCR)–based microbiologic end points for vaccine trials.

Methods

We will test dried blood spots collected at enrollment and 4 weeks later using bead-based immunoassays for IgG to invasion plasmid antigen B and type-specific lipopolysaccharide O-antigen for Shigella flexneri 1b, 2a, 3a, and 6 and Shigella sonnei in Shigella-positive cases and age-, site-, and season-matched test-negative controls from all sites in the Enterics for Global Health (EFGH) Shigella surveillance study. Fold antibody responses will be compared between culture-positive, culture-negative but PCR-attributable, and PCR-positive but not attributable cases and test-negative controls. Age- and site-specific seroprevalence distributions will be identified, and the association between baseline antibodies and Shigella attribution will be estimated.

Conclusions

The integration of these assays into the EFGH study will help support PCR-based attribution of acute diarrhea to type-specific Shigella, describe the baseline seroprevalence of conserved and type-specific Shigella antibodies, and support correlates of protection for immunity to Shigella diarrhea. These insights can help support the development and evaluation of Shigella vaccine candidates.
The Enterics for Global Health (EFGH) Shigella Surveillance Study in Kenya
Authors: Omore Richard , Awuor Alex O , Ogwel Billy , Okonji Caleb , Sonye Catherine , Oreso Caren , Akelo Victor , Amollo Manase , Ogudi Isaiah , Anyango Raphael O , Audi Marjorie , Apondi Evans , Riziki Laura , Ambila Lilian , Dilruba Nasrin , Muok Erick , Munga Stephen , Ochieng John B , Kotloff Karen L
Published: March 2024

Background

Although Shigella is an important cause of diarrhea in Kenyan children, robust research platforms capable of conducting incidence-based Shigella estimates and eventual Shigella-targeted clinical trials are needed to improve Shigella-related outcomes in children. Here, we describe characteristics of a disease surveillance platform whose goal is to support incidence and consequences of Shigella diarrhea as part of multicounty surveillance aimed at preparing sites and assembling expertise for future Shigella vaccine trials.

Methods

We mobilized our preexisting expertise in shigellosis, vaccinology, and diarrheal disease epidemiology, which we combined with our experience conducting population-based sampling, clinical trials with high (97%–98%) retention rates, and healthcare utilization surveys. We leveraged our established demographic surveillance system (DSS), our network of healthcare centers serving the DSS, and our laboratory facilities with staff experienced in performing microbiologic and molecular diagnostics to identify enteric infections. We joined these resources with an international network of sites with similar capabilities and infrastructure to form a cohesive scientific network, designated Enterics for Global Health (EFGH), with the aim of expanding and updating our knowledge of the epidemiology and adverse consequences of shigellosis and enriching local research and career development priorities.

Conclusions

Shigella surveillance data from this platform could help inform Shigella vaccine trials.
Genesis of Fe–Ti Oxide-Bearing Ultramafic Intrusions in the Duluth Complex, Minnesota, USA
Authors: Kleinsasser Jackie M , Simon Adam C , Peterson Dean , Kattemalavadi Amartya , Goan Ian R , Keller Tobias , Hudak George J , Koshurba Kaitlin
Published: March 2024

The Duluth Complex is a large mafic intrusive system located in northeastern Minnesota emplaced as part of the 1.1-Ga Midcontinent Rift. Several Fe–Ti oxide-bearing ultramafic intrusions are hosted along the Western Margin of the Duluth Complex, and are discordant bodies present in a variety of geometries, hosted in multiple rock types, and dominated by peridotite, pyroxenite, and semi-massive to massive Fe–Ti oxide rock types. Their origin has been debated, and here we present geochemical evidence and modeling that supports a purely magmatic origin for the Titac and Longnose Fe–Ti oxide-bearing ultramafic intrusions. Ilmenite and titanomagnetite textures indicate a protracted cooling process, and δ34S values of sulfides reveal little assimilation of the footwall Virginia Formation, a fine-grained pelitic unit that contains sulfide-rich bands. We model the crystallization of a hypothetical parental magma composition to the host intrusion of Longnose using Rhyolite-MELTS and demonstrate that the accumulation of Fe–Ti oxides in the discordant intrusions cannot be explained by density-driven segregation of crystallized Fe–Ti oxides. Instead, we show that the development of silicate liquid immiscibility, occurring by the unmixing of the silicate melt into conjugate Si- and Fe-rich melts, can result in the effective segregation and transportation of the Fe-rich melt. The Fe-rich melt is ~2 orders of magnitude less viscous than the Si-rich melt, allowing the Fe-rich melt to be more effectively segregated and transported in the mush regime (crystallinities >50%). This suggests that viscosity, in addition to density, plays a significant role in forming the discordant Fe–Ti oxide-bearing ultramafic intrusions. We propose a genetic model that could also be responsible for the Fe–Ti oxide-rich layers or bands that are hosted within the igneous stratigraphy of mafic intrusions of the Duluth Complex.
Transcriptomic and neuroimaging data integration enhances machine learning classification of schizophrenia
Authors: Wang Mengya , Zhao Shu-Wan , Wu Di , Zhang Ya-Hong , Han Yan-Kun , Zhao Kun , Qi Ting , Liu Yong , Cui Long-Biao , Wei Yongbin
Published: March 2024

Background

Schizophrenia is a polygenic disorder associated with changes in brain structure and function. Integrating macroscale brain features with microscale genetic data may provide a more complete overview of the disease etiology and may serve as potential diagnostic markers for schizophrenia.

Objective

We aim to systematically evaluate the impact of multi-scale neuroimaging and transcriptomic data fusion in schizophrenia classification models.

Methods

We collected brain imaging data and blood RNA sequencing data from 43 patients with schizophrenia and 60 age- and gender-matched healthy controls, and we extracted multi-omics features of macroscale brain morphology, brain structural and functional connectivity, and gene transcription of schizophrenia risk genes. Multi-scale data fusion was performed using a machine learning integration framework, together with several conventional machine learning methods and neural networks for patient classification.

Results

We found that multi-omics data fusion in conventional machine learning models achieved the highest accuracy (AUC ~0.76–0.92) in contrast to the single-modality models, with AUC improvements of 8.88 to 22.64%. Similar findings were observed for the neural network, showing an increase of 16.57% for the multimodal classification model (accuracy 71.43%) compared to the single-modal average. In addition, we identified several brain regions in the left posterior cingulate and right frontal pole that made a major contribution to disease classification.

Conclusion

We provide empirical evidence for the increased accuracy achieved by imaging genetic data integration in schizophrenia classification. Multi-scale data fusion holds promise for enhancing diagnostic precision, facilitating early detection and personalizing treatment regimens in schizophrenia.
Governing with public engagement: an anticipatory approach to human genome editing
Authors: Barlevy Dorit , Juengst Eric , Kahn Jeffrey , Moreno Jonathan , Lambert Lauren , Charo Alta , Chneiweiss Hervé , Farooque Mahmud , Guston David H , Hyun Insoo , Knoepfler Paul S , Selin Cynthia , Wilbanks Rebecca , Zaghlula Manar , Scott Christopher Thomas
Published: March 2024

In response to calls for public engagement on human genome editing (HGE), which intensified after the 2018 He Jiankui scandal that resulted in the implantation of genetically modified embryos, we detail an anticipatory approach to the governance of HGE. By soliciting multidisciplinary experts’ input on the drivers and uncertainties of HGE development, we developed a set of plausible future scenarios to ascertain publics values—specifically, their hopes and concerns regarding the novel technology and its applications. In turn, we gathered a subset of multidisciplinary experts to propose governance recommendations for HGE that incorporate identified publics’ values. These recommendations include: (1) continued participatory public engagement; (2) international harmonization and transparency of multiple governance levers such as professional and scientific societies, funders, and regulators; and (3) development of a formal whistleblower framework.
Inequities in Indirect Cost Rates Between Historically Black Colleges and Universities and Other Institutions
Authors: Hauschildt Katrina E. , Messersmith Julie , Iwashyna Theodore J.
Published: March 2024

Purpose

Federal research grants provide support for the indirect costs (IDCs) of research infrastructure that are not specific to particular research projects but are nonetheless essential to enable research. Institutions independently negotiate IDC rates. The authors sought to identify whether inequities exist in negotiated IDC rates between historically Black colleges and universities (HBCUs) and other universities (non-HBCUs).

Method

In 2023, the authors analyzed mean negotiated IDC rates between the top 20 HBCUs (in fiscal year [FY] 2021 research expenditures) and 3 non-HBCU comparison groups: the top 40 non-HBCUs in FY 2021 research expenditures, metropolitan statistical area (MSA)–matched non-HBCUs (among the top 200 institutions by FY 2021 research expenditures), and FY 2021 research expenditure–matched non-HBCUs.

Results

The authors found that the top 20 HBCUs’ mean IDC rates (50.0%) were, after adjustment, 8.5 percentage points (95% confidence interval [CI], 5.7–11.2) lower than those of the top 40 non-HBCUs (58.5%). The mean IDC rates of top HBCUs (n = 14, 48.4%) were, after adjustment, 6.3 percentage points (95% CI, 3.1–9.4) lower than those of MSA-matched non-HBCUs (n = 23, 55.3%). There was no statistically significant difference in the mean IDC rates between the top 20 HBCUs (50.0%) and expenditure-matched non-HBCUs (n = 31; 48.2%).

Conclusions

Inequities in negotiated IDC rates between top HBCUs and non-HBCUs likely both reflect and may contribute to the persistence of institution-level inequities in federally funded research. Proactive investments in HBCUs’ research infrastructures are likely needed to ameliorate these funding inequities and support the role of HBCUs in providing opportunity for underrepresented groups in biomedical sciences.
Dorsal Hook Plating of Patella Fractures with Immediate Range of Motion Results in Reliable Fixation, Low Implant Removal Rates, and Satisfactory Clinical Outcomes
Authors: Barth Kathryn A. , Bilodeau Robert E. , Klinger Craig E. , Brusalis Christopher M. , Ricci William M. , Phen Huai Ming
Published: March 2024

Objectives:

To evaluate radiographic and clinical patient reported clinical outcomes following dorsal hook plating of displaced patella fractures with permittance of immediate post-operative active closed chain range of motion.

Design:

Retrospective review of prospectively collected data.

Setting:

Urban Academic Level 1 Trauma Center.

Patient Selection Criteria:

Adult patients with displaced patella fractures (OTA/AO 34C1-3) who underwent dorsal plating with immediate range of motion between 2018-2023.

Outcome Measures and Comparisons:

Numerical Rating Scale for Pain, Knee Outcome Score (KOS-ADL), Tegner-Lysholm Score, radiographic union, and wound complications were collected.

Results:

61 patients were included (47 female) with an average age of 63 years (SD 14.7, range 22-86 years). The mean BMI was 24.2 (SD 3.6, range 16.6-33.3). There were thirteen 34-C2 and forty-eight 34-C3 fractures. All but 2 patients (96.7%) achieved bony union after the index procedure. 89% (n=54) of patients completed outcome surveys with at least 6 months follow-up. Six patients (9.8%) underwent removal of plate implant at a mean of 15.1 months post-operatively. The mean KOS-ADL score was 91.4, the mean Tegner-Lysholm score was 78.1, and the mean NRS was 2.7.

Conclusion:

Dorsal hook plating offers secure fixation to allow early range of motion, reliable fixation with low non-union and implant failure rates, low implant removal rates, and satisfactory patient reported outcomes.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Network meta-analysis of first-line systemic regimens for older patients with advanced NSCLC
Authors: Luciani Andrea , Dottorini Lorenzo , Battaiotto Elena , Petrelli Fausto
Published: March 2024

Various immunotherapy treatments have received approval for the treatment of advanced non-small cell lung cancer (NSCLC), either as standalone or in conjunction with chemotherapy, contingent upon the extent of PD-L1 expression. These treatments are commonly utilized in clinical practice. However, a specific gap exists in direct comparisons of these regimens in elderly patients. The aim of this network meta-analysis (NMA) was to examine the effectiveness of PD-1/PD-L1 inhibitors, either alone or in conjunction with chemotherapy, as the initial treatment for elderly patients diagnosed with advanced NSCLC. We extensively searched PubMed, EMBASE and the Cochrane Library to gather randomized clinical trials that utilized PD-1/PD-L1 inhibitors as the first-line therapy for advanced NSCLC. By means of Bayesian NMA, we conducted an analysis on hazard ratios (HRs) related to overall survival (OS). A total of 5240 patients were included in the 21 trials. Across all studies, cemiplimab exhibited a noteworthy superiority to chemotherapy in terms of OS [HR = 0.48, 95% confidence interval (CI): 0.3–0.77]. In the subgroup analysis, it was observed that patients with PD-L1 expression of 50% or higher experienced the greatest OS benefit from cemiplimab (HR = 0.48, 95% CI: 0.3–0.77). Conversely, the cohort with unselected PD-L1 scores (>1 or any score) exhibited the greatest OS benefit when treated with pembrolizumab combined with chemotherapy, as indicated by a HR of 0.69 (95% CI: 0.52–0.9). Chemotherapy combined with pembrolizumab and cemiplimab monotherapy may represent the reference regimens for older patients with NSCLC with unselected and >50% PD-L1 expression, respectively.
Tislelizumab plus chemotherapy is an optimal option for second-line treatment for advanced gastroesophageal junction adenocarcinoma
Authors: Yang Ping , Pan Tao , Wang Ming-Kun , Xiao Meng-Sheng , Zhang Shuang , Liu Sha
Published: March 2024

The development of programmed cell death receptor-1 and its ligand (PD-L1) have offered new treatment options for several cancers, but the clinical benefit of tislelizumab in the gastroesophageal junction (GEJ) adenocarcinoma is still murky. Thus, we aim to investigate the efficacy and safety of tislelizumab combined with chemotherapy in patients with GEJ cancer. In this study, 90 GEJ patients were retrospectively enrolled including 45 patients who received chemotherapy plus tislelizumab while 45 underwent chemotherapy only. Overall response rate (ORR), overall survival (OS), and progression-free survival (PFS) were estimated and safety was assessed by treatment-related adverse events between two arms. The ORR was significantly higher in the tislelizumab group than in patients with chemotherapy alone (71.1 vs. 44.4%). The PFS [54.7% (47.2–62.2) vs. 33.3% (26.3–40.3), P = 0.047] and OS [62.1% (54.5–69.7) vs. 40.0% (32.5–47.5), P = 0.031] were also significantly improved in patients with concomitant use of tislelizumab. When stratified by PD-L1 combined positive score (CPS), patients with PD-L1 CPS ≥ 1 also with significantly higher PFS and OS when taking tislelizumab (P = 0.015 and P = 0.038). The incidence of hematologic toxicity was similar in the combination arm compared to the chemotherapy alone arm and the number of adverse events was not significantly increased by adding tislelizumab (all P > 0.05). Concomitant use of tislelizumab and chemotherapy in GEJ patients may be with optimal therapeutic effect and similar incidence of adverse events than chemotherapy alone. Further studies with larger number of patients are warranted to confirm it.
A Unique Presentation Site of Pleomorphic Adenoma in a Young Woman: A Case Report
Authors: Rasheed Faryal S. , Alelyani Rakan H. , Alazzmi Hana A. , Alfadhel Emad A. , Alaqil Sultan N. , Alobaidi Hussain A. , Moazin Othillah M. , Alshammari Haifa M. , Bhaat Tanveer A. , Nawwab Eyad A.
Published: March 2024

The expression “pleomorphic adenoma” has been used synonymously with mixed cutaneous tumors and chondroid syringomas. It originates from eccrine or apocrine skin, salivary glands, and lacrimal glands. Histologically, it comprises an epithelial-lined glandular component embedded in the cartilaginous, myxomatous, or fibrous stroma. These lesions are usually misdiagnosed because they are extremely rare. It commonly affects middle-aged men and has a slow-growing nature. The usual manifestation is a firm nodular lesion in the periorbital region, particularly at eyelid margins. A unique presentation of this tumor was described in a young woman. The tumor presented as a small, static, nontender lump located at the junction of the superior margin of the left eyebrow and forehead. After a thorough clinical assessment, she underwent a complete surgical excision of the lesion. The most probable preoperative clinical impression at that time was that of a sebaceous cyst. However, histopathological examination revealed it to be a pleomorphic adenoma, which, to our knowledge, has never been reported in the literature at this specific anatomical site. Two years after the procedure, the patient’s follow-up was uneventful, and revealed no recurrence of the lesion. Although its incidence is exceptionally low, it should always be considered in the differential diagnosis of cutaneous lesions in the head, neck, and trunk. Complete surgical excision for histopathological assessment is recommended to rule out malignancy and avoid the frequent issue of local recurrence in cases of benign tumors.
Independent Plastic Surgery Match Regional Trends Comparing In-person and Virtual Interview Cycles
Authors: Mullen Sarah A. , Akhter Haris M. , Weis Lauren E. , Samson Kaeli K. , Hon Heidi H.
Published: March 2024

Background:

There is a trend toward matching in a different region than previous training for the independent plastic surgery match cycles from 2019 to 2021, which differs from the trend to match within the same region for integrated plastic surgery programs. Notably, residency interviews transitioned from in-person to virtual in 2020 due to the coronavirus pandemic. Therefore, we compared in-person versus virtual interview match trends from 2019 to 2023.

Methods:

Zip codes and regions of each successfully matched plastic surgery applicant’s medical school, residency, and plastic surgery program were gathered from publicly available data for the 2019 and 2020 in-person interview cycles and 2021, 2022, and 2023 virtual interview cycles.

Results:

Although regions did not differ significantly in the proportions of positions each year (P = 0.85), there was a trend toward fewer positions in each region from 2019 to 2022. Overall, applicants were more likely to match in a different region as their medical school or residency during virtual compared with in-person interviews (P = 0.002 and P = 0.04). Applicants matched to programs further from their medical school zip code in virtual interview years (P = 0.02). There was no significant difference in distance between surgical residencies and plastic surgery residencies between the two time periods (P = 0.51).

Conclusions:

Trends toward matching into a different region than prior training after the switch to virtual interviews could be attributed to applicant accessibility to interview broadly. However, this could also be due to the decreased number of independent residency positions over the years, requiring applicants to move regions and travel further from where they began their training.
Hyperbaric Oxygen Therapy for Diabetic Foot Ulcers Based on Wagner Grading: A Systematic Review and Meta-analysis
Authors: Oley Mendy Hatibie , Oley Maximillian Christian , Kepel Billy Johnson , Faruk Muhammad , Wagiu Angelica Maurene Joicetine , Sukarno Irawan , Tulong Marcella Tirsa , Sukarno Vania
Published: March 2024

Background:

Diabetic foot ulcers (DFUs) are common complications of uncontrolled diabetes mellitus that can result in infection and amputation of the lower extremities. This study compared the benefits and risks of hyperbaric oxygen therapy with those of other DFU treatments, based on the Wagner grading system.

Methods:

Systematic searches for randomly controlled trials using hyperbaric oxygen therapy for DFUs were performed using PubMed, the Cochrane Library, and Embase. Data regarding demographics, wound healing, minor and major amputations, operative debridement, nonhealing wounds, and adverse effects were analyzed based on Wagner grades, using RevMan 5.4.1 and Microsoft Excel.

Results:

Hyperbaric oxygen therapy was significantly superior to other treatments for wound healing rates 8 or more weeks after the final treatment (RR = 2.39; 1.87–3.05; P < 0.00001) minor/distal amputations (RR = 0.58; 0.43–0.80; P < 0.007), and major/proximal amputations (RR = 0.31; 0.18–0.52; P < 0.00001) for the 14 studies analyzed. In addition, this therapy increased the rate of complete wound healing for Wagner grades II (RR = 21.11; 3.05–146.03; P = 0.002), III (RR = 19.58; 2.82–135.94, P = 0.003), and IV (RR = 17.53; 2.45–125.44; P = 0.004); decreased the minor/distal amputation rate for grade III (RR = 0.06; 0.01–0.29; P = 0.0004) and the major/proximal amputation rate on for grade IV (RR = 0.08; 0.03–0.25; P < 0.0001); and decreased the operative debridement rate for Wagner grade II (RR = 0.09; 0.01–0.60; P = 0.01).

Conclusions:

Moderate-quality evidence revealed that adjunctive hyperbaric oxygen therapy improved DFU wound healing for Wagner grades II, III, and IV; prevented minor and major amputations for grades III and IV, respectively; and prevented operative debridement in grade II wounds.
Efficacy of Orthoplastic Management in the Treatment of Traumatic Popliteal Artery Injury
Authors: Izawa Yuta , Futamura Kentaro , Murakami Hiroko , Sato Kazuo , Tsuchida Yoshihiko
Published: March 2024

Background:

Popliteal artery injury (PAI) is a challenging condition. Even with appropriate initial treatment and reconstruction of the associated injuries, extensive soft-tissue necrosis may occur, requiring lower leg amputation. There are no reports on the effectiveness of orthoplastic surgery in treating traumatic PAI. However, orthoplastic surgery is also considered very effective in PAI treatment, which requires delicate handling of soft-tissue and blood vessels. This study aimed to examine the treatment outcomes of traumatic PAI at a trauma center with the capacity for orthoplastic management.

Methods:

Patients with PAI who were treated at our institution between August 2013 and December 2021 were included in this study. The surgeons included multiple orthoplastic surgeons with capabilities in vascular repair, bone and ligament reconstruction, and soft-tissue reconstruction. Patient demographics, injury characteristics, degree of ischemia, and treatment were investigated. We also investigated whether soft-tissue reconstruction and lower limb amputation were necessary as outcomes of treatment.

Results:

Fifteen limbs of 14 patients with PAI met the inclusion criteria. Extensive soft-tissue necrosis was observed in three limbs. Two of these limbs were covered with a free latissimus dorsi flap and could be salvaged. In the remaining limb, lower limb amputation was unavoidable because of unexplained cardiac arrest during the initial surgery, but a fillet flap was used to successfully preserve the knee joint.

Conclusion:

Orthoplastic management has the potential to improve limb salvage rates and provide good outcomes for the treatment of traumatic PAI.
Effect of adrenocorticotropic hormone stimulation during adrenal vein sampling for the subtyping of primary aldosteronism: a prospective study
Authors: Yang Fan , Wang Yijie , Zhang Ziwei , Zeng Yangjie , Liu Mengsi , Tian Zhaoyang , Li Ping
Published: March 2024

Objective:

Adrenal venous sampling (AVS) is key for primary aldosteronism subtype identification. However, the value of adrenocorticotropic hormone (ACTH) stimulation in AVS is still controversial.

Methods:

In this prospective study, we investigated the role of continuous ACTH infusion on the performance and interpretation of bilateral simultaneous AVS using a standard protocol in 59 primary aldosteronism patients. We analyzed the selectivity index and lateralization index in AVS pre and post-ACTH and estimated the prognosis of patients who underwent adrenalectomy with different cutoff points of lateralization index post-ACTH.

Results:

The confirmed success rate of bilateral adrenal vein catheterization increased from 84% pre-ACTH to 95% post-ACTH. Fifty percent of the patients had a decline in lateralization index post-ACTH, 30% of patients showed unilateral primary aldosteronism pre-ACTH but bilateral primary aldosteronism post-ACTH according to lateralization index at least 2 pre-ACTH and lateralization index at least 4 post-ACTH. The outcomes of the patients with primary aldosteronism after adrenalectomy indicated that all patients achieved clinical and biochemical success regardless of lateralization index at least 4 or less than 4 post-ACTH. Receiver operating characteristic curves showed that lateralization index cutoff 2.58 post-ACTH stimulation yielded the best threshold in lateralization with a sensitivity of 73.1% and a specificity of 92.9%.

Conclusion:

ACTH stimulation increased the AVS success rates in patients with primary aldosteronism, reduced lateralization index in some cases and decreased the proportion of identified unilateral primary aldosteronism, resulting in some patients losing the opportunity for disease cure. Compared with lateralization index at least 4, a lower cutoff point of lateralization index at least 2.58 after ACTH stimulation has better accuracy of lateralization diagnosis.
3D Printed Lung Phantom for Individual Monitoring
Authors: Capello Kevin , Tremblay Marilyn , Schiebelbein Aryanna , Janzen Noah
Published: March 2024

The Human Monitoring Laboratory, Health Canada (HML), has used a 3D printer to re-engineer its Lawrence Livermore National Laboratory (LLNL) foam lung sets (manufactured by Radiology Support Devices, Inc., Long Beach, CA). The foam sets are currently the HML standard for calibrating and performance testing lung-counting systems in Canada. This paper describes the process of creating and validating new 3D-printed lung sets modeled from one of the HML’s existing RSD foam sets. The existing sets were custom made, making them costly and difficult to obtain or replace. Also, after many years of use, the HML has found that they are prone to wear and tear. When used with planar inserts containing various isotopes, the blank sets can become contaminated and are difficult to clean. Using 3D printing, the HML has created new blank lung sets that are nearly identical copies of the originals and are inexpensive and easily manufactured. Measurements using natural uranium (Nat U), 241Am, and 152Eu planar lung inserts were performed to compare obtained efficiencies at a wide range of energies using the original RSD foam sets and the 3D-printed ones. Both the foam and the 3D-printed lung sets were counted using the LLNL chest phantom positioned in the same counting geometry in the lung counting system. Biases, all below 15%, were obtained between the foam and the 3D-printed sets for energies above 40 KeV. Based on these results, as well as cost benefits and ease of use, the HML has decided to replace its original RSD foam lung set with the 3D-printed version for its lung performance testing program.
High-rate Gamma Spectrometry Using a LaBr3(Ce) Scintillator with a Fast Pulse Shaping
Authors: Ren Tianyi , Byun Soo Hyun
Published: March 2024

The performance of a LaBr3(Ce) gamma spectrometer at high count rates was investigated up to an input count rate of 1.3 Mcps. In order to make its pulse processing faster, a preamplifier provided by the detector manufacturer was eliminated, and the signal from the photomultiplier tube was fed directly to a digital pulse processing system. To accomplish both fast pulse processing and good energy resolution, the pulse-shaping parameters were optimized at a low count rate of 1.5 kcps, and then measurements were carried out at various count rates. Input count rates ranging from 1.5 kcps to 21 kcps were produced using a set of 137Cs resin sources, while higher rates between 45 kcps and 1.3 Mcps were produced using a 1.2-GBq 137Cs source. The spectrometer showed an excellent performance for the input rate up to 150 kcps, while the dead time increased rapidly for the input rates above 150 kcps. The system dead time has been improved greatly by eliminating the preamplifier.
A Perspective from Ontario Tech University Industrial Research Chairs on 20 Years of Capacity Building in Health Physics and Radiation Science
Authors: Waller Edward , Atkinson Kirk , Waker Anthony
Published: March 2024

Ontario Tech University (University of Ontario Institute of Technology) is one of Canada’s newest universities, having been incorporated in 2002. In 20 y, the University has increased enrollment from a few hundred students to over 10,000. The University was designed to be “market driven” and as such offered courses that had high market demand. The Faculty of Energy Systems and Nuclear Science was one of the first faculties to be established at the University, with the intent to fill a gap between personnel that were retiring out of the nuclear industry and the dearth of nuclear engineers and health physicists being educated in Canada. As such, the University established unique programs in both nuclear engineering and health physics/radiation science with strong input from industry stakeholders. This paper will discuss the evolution of the Health Physics and Radiation Science program at Ontario Tech from the teaching and capacity building perspective, and it provides insight regarding health physics and radiation science research at Ontario Tech under the industrial research chair program.
Effectiveness of Using a Self-Directed Learning Program to Teach Physical Examination and Health Assessment Skills: A Quasi-Experimental Study
Authors: CHEN Shiah-Lian , LIAO I-Chen
Published: March 2024

Background

Conducting health assessments and physical examinations are essential skills for independent practice. Exploring how to teach these skills effectively is essential.

Purpose

This study was designed to validate the effectiveness of a self-directed learning program in improving nursing student outcomes in terms of their learning health assessment and physical examination skills.

Method

A quasi-experimental design was used, and second-year nursing students enrolled in a health assessment and physical examination course at a university of science and technology in central Taiwan were recruited using purposive sampling. Both the control and experimental groups were taught using a traditional teaching method. The experimental group additionally participated in a self-directed learning program. Structured questionnaires, including the Chinese version of the Self-Directed Learning Readiness Scale, Scales of Motivation and Learning Strategies, Interpersonal Skills Assessment Tool, the Course Satisfaction Evaluation Scale, and the Perception of Health Assessment and Physical Examination Competence Scale, were used to collect data at three time points.

Results

After controlling for the effects of pretest scores, after the intervention, the experimental group achieved significantly higher scores than the control group for self-directed learning (creative learning and love of learning), learning motivation (goal orientation, work value, expected success, and test anxiety), and cognitive strategies (total score, elaboration strategy, recitation strategy, and monitoring strategy). In addition, the health assessment exercise improved interpersonal and communication skills, and learning satisfaction was significantly higher in the experimental group than the control group.

Conclusions/Implications for Practice

A physical examination and health assessment course designed using the self-directed learning framework can effectively improve student competence in related skills to enhance their ability to assess patient health problems in clinical settings. This study presents an alternative approach to teaching health assessment and physical examination courses and validates the positive effect of this approach on student learning outcomes.
Pharmacologic prevention and therapy of postoperative paralytic ileus after gastrointestinal cancer surgery: systematic review and meta-analysis
Authors: Reichert Martin , Willis Franziska , Post Stefan , Schneider Martin , Vilz Tim , Willis Maria , Hecker Andreas
Published: March 2024

Background:

Postoperative paralytic ileus (POI) is a significant concern following gastrointestinal tumor surgery. Effective preventive and therapeutic strategies are crucial but remain elusive. Current evidence from randomized-controlled trials on pharmacological interventions for prevention or treatment of POI are systematically reviewed to guide clinical practice and future research.

Materials and methods:

Literature was systematically searched for prospective randomized-controlled trials testing pharmacological interventions for prevention or treatment of POI after gastrointestinal tumor surgery. Meta-analysis was performed using a random effects model to determine risk ratios and mean differences with 95% CI. Risk of bias and evidence quality were assessed.

Results:

Results from 55 studies, involving 5078 patients who received experimental interventions, indicate that approaches of opioid-sparing analgesia, peripheral opioid antagonism, reduction of sympathetic hyperreactivity, and early use of laxatives effectively prevent POI. Perioperative oral Alvimopan or intravenous administration of Lidocaine or Dexmedetomidine, while safe regarding cardio-pulmonary complications, demonstrated effectiveness concerning various aspects of postoperative bowel recovery [Lidocaine: −5.97 (−7.20 to −4.74)h, P<0.0001; Dexmedetomidine: −13.00 (−24.87 to −1.14)h, P=0.03 for time to first defecation; Alvimopan: −15.33 (−21.22 to −9.44)h, P<0.0001 for time to GI-2] and length of hospitalization [Lidocaine: −0.67 (−1.24 to −0.09)d, P=0.02; Dexmedetomidine: −1.28 (−1.96 to −0.60)d, P=0.0002; Alvimopan: −0.58 (−0.84 to −0.32)d, P<0.0001] across wide ranges of evidence quality. Perioperative nonopioid analgesic use showed efficacy concerning bowel recovery as well as length of hospitalization [−1.29 (−1.95 to −0.62)d, P=0.0001]. Laxatives showed efficacy regarding bowel movements, but not food tolerance and hospitalization. Evidence supporting pharmacological treatment for clinically evident POI is limited. Results from one single study suggest that Neostigmine reduces time to flatus and accelerates bowel movements [−37.06 (−40.26 to −33.87)h, P<0.0001 and −42.97 (−47.60 to −38.35)h, P<0.0001, respectively] with low evidence quality.

Conclusion:

Current evidence concerning pharmacological prevention and treatment of POI following gastrointestinal tumor surgery is limited. Opioid-sparing concepts, reduction of sympathetic hyperreactivity, and laxatives should be implemented into multimodal perioperative approaches.
Comparing the efficacy of vedolizumab between males and females: a post-hoc analysis of GEMINI-1 and VARSITY
Authors: Chhibba Tarun , Wong Emily C.L. , Reinisch Walter , Targownik Laura , Narula Neeraj
Published: March 2024

Vedolizumab is a first-line treatment option for ulcerative colitis. There are differences in incidence of ulcerative colitis between males and females, but whether sex affects treatment outcomes is less clear. We examined sex-based differences in patients with ulcerative colitis initiated on vedolizumab from two major randomized controlled trials (RCTs). We conducted a post-hoc analysis on participants with ulcerative colitis from the VARSITY and GEMINI-1 RCTs who received vedolizumab. Outcomes of interest were rates of clinical improvement, clinical remission, and endoscopic improvement at weeks 6, 14, and 52 in male and female participants, as were differences in concentrations of trough vedolizumab and C-reactive protein; 1009 persons in GEMINI-1 and VARSITY trials were included. Male and female patients had similar disease characteristics aside from males being more likely to have Mayo 3 grade endoscopic severity at baseline (62.8 vs. 48.9%, P < 0.001). At week 6, females were more likely to have endoscopic improvement (47.4 vs. 35.2%, P = 0.001) and increased vedolizumab trough levels [34.0 (23.0–44.5) vs. 28.9 (19.0–34.6), P < 0.001]. The probability of achieving clinical remission (28.9 vs. 34.5%, P = 0.057) or endoscopic improvement (35.5 vs. 39.3%, P = 0.212) at week 52 was not different between males and females. Females with ulcerative colitis treated with vedolizumab appear more likely to achieve early endoscopic improvement than males, though longer-term outcomes demonstrated no difference. Further studies are required to better understand mechanisms through which sex or sex-associated factors could influence response to therapy in ulcerative colitis.
Effectiveness of 1-year pemafibrate treatment on steatotic liver disease: the influence of alcohol consumption
Authors: Iwasa Motoh , Sugimoto Ryosuke , Eguchi Akiko , Tamai Yasuyuki , Shigefuku Ryuta , Fujiwara Naoto , Tanaka Hideaki , Kobayashi Yoshinao , Ikoma Jiro , Kaito Masahiko , Nakagawa Hayato
Published: March 2024

Background/aims

Pemafibrate is a selective peroxisome proliferator-activated receptor α modulator that improves serum alanine aminotransferase (ALT) in dyslipidemia patients. We previously reported that pemafibrate significantly improves liver function, serum triglyceride (TG) levels and liver stiffness in non-alcoholic fatty liver disease patients, however the influence of alcohol consumption was not considered. Therefore, we explored pemafibrate efficacy in patients with steatotic liver disease (SLD) and alcohol-associated liver disease (ALD).

Methods

We retrospectively evaluated pemafibrate efficacy on liver enzymes and lipids in metabolic dysfunction-associated SLD (MASLD) (n = 93), MASLD plus increased alcohol intake (MetALD; n = 23) and ALD (n = 22) patients who had taken pemafibrate for at least 48 weeks. Liver shear wave velocity (SWV, n = 75) was also evaluated.

Results

In MASLD group, ALT, aspartate aminotransferase (AST), γ-glutamyl transpeptidase (γ-GTP) and TG values were significantly decreased from baseline to week 24 and week 48 (P < 0.0001). ALT and TG values in MetALD group and ALT and AST values in ALD group were also significantly decreased from baseline to week 24 and week 48. Study participant SWV values decreased from baseline to week 48. We observed no significant difference in changes to ALT, AST, γ-GTP and TG (value at week 24 or week 48 minus value at baseline) among the three groups.

Conclusion

Pemafibrate improves liver function and liver stiffness thus making it a promising therapeutic agent for SLD, even in patients with excess alcohol consumption (MetALD and ALD groups).
The Construction of Peer Support Among Recently Diagnosed Breast Cancer Patients
Authors: Toija Anu , Kettunen Tarja , Kasila Kirsti
Published: March 2024

Background

Breast cancer (BC) and its treatments decrease patients’ psychological well-being. Peer support is one form of social support, but little is known about what gives rise to peer support.

Objective

The purpose of this study was to examine how peer support is constructed among recently diagnosed BC patients.

Methods

Eighteen women were randomly picked from 130 women who had received phone calls from a trained peer supporter and were invited to group interviews. In the interviews, patients discussed their cancer, peer support experiences, and social support. The transcribed data were analyzed using Braun and Clarke’s thematic analysis approach.

Results

The construction of peer support among newly diagnosed BC patients was complex. It depended on the needs of the patient and the success of interactions. Once they had received a diagnosis, the lives of the patients changed suddenly, and patients dove into the I-we-others consideration and had a need to talk. Interaction with peer supporters gave them a chance to share their stories. At their best, interactions led to belonging, caring, and a sense of security.

Conclusions

The need to be heard and seen is strong in a patient’s changing health situation. Peer support plays an important role in high-standard care and in strengthening patients’ self-determination.

Implications for Practice

Hospitals should create chances for supportive communication, and the supportive communication should be easily accessible and successful. The training of peer supporters should ensure that they have reflected on their own BC process and know how to consider the needs of newly diagnosed patients.
Contemporary Diagnostic Reporting for Prostatic Adenocarcinoma: Morphologic Aspects, Molecular Correlates, and Management Perspectives
Authors: Muthusamy Selvaraj , Smith Steven Christopher
Published: March 2024

The diagnosis and reporting of prostatic adenocarcinoma have evolved from the classic framework promulgated by Dr Donald Gleason in the 1960s into a complex and nuanced system of grading and reporting that nonetheless retains the essence of his remarkable observations. The criteria for the “Gleason patterns” originally proposed have been continually refined by consensuses in the field, and Gleason scores have been stratified into a patient-friendly set of prognostically validated and widely adopted Grade Groups. One product of this successful grading approach has been the opportunity for pathologists to report diagnoses that signal carefully personalized management, placing the surgical pathologist’s interpretation at the center of patient care. At one end of the continuum of disease aggressiveness, personalized diagnostic care means to sub-stratify patients with more indolent disease for active surveillance, while at the other end of the continuum, reporting histologic markers signaling aggression allows sub-stratification of clinically significant disease. Whether contemporary reporting parameters represent deeper nuances of more established ones (eg, new criteria and/or quantitation of Gleason patterns 4 and 5) or represent additional features reported alongside grade (intraductal carcinoma, cribriform patterns of carcinoma), assessment and grading have become more complex and demanding. Herein, we explore these newer reporting parameters, highlighting the state of knowledge regarding morphologic, molecular, and management aspects. Emphasis is made on the increasing value and stakes of histopathologists’ interpretations and reporting into current clinical risk stratification and treatment guidelines.
BRAF Mutated and Morphologically Spitzoid Tumors, a Subgroup of Melanocytic Neoplasms Difficult to Distinguish From True Spitz Neoplasms
Authors: Gerami Pedram , Chen Alice , Sharma Natasha , Patel Pragi , Hagstrom Michael , Kancherla Pranav , Geraminejad Tara , Olivares Shantel , Biswas Asok , Bosenberg Marcus , Busam Klaus J. , de La Fouchardière Arnaud , Duncan Lyn M. , Elder David E. , Ko Jennifer , Landman Gilles , Lazar Alexander J. , Lowe Lori , Massi Daniela , Mihic-Probst Daniela , Parker Douglas C. , Scolyer Richard A. , Shea Christopher R. , Zembowicz Artur , Yun Sook Jung , Blokx Willeke A.M. , Barnhill Raymond L.
Published: March 2024

Drivers of Spitz neoplasms include activating point mutations in HRAS and Spitz-associated genomic fusions. It has become evident that some BRAF-mutated melanocytic neoplasms can morphologically mimic Spitz tumors (STs). These have been termed BRAF mutated and morphologically spitzoid (BAMS). In this study, 17 experts from the International Melanoma Pathology Study Group assessed 54 cases which included 40 BAMS and 14 true STs. The participants reviewed the cases blinded to the genomic data and selected among several diagnostic options, including BAMS, ST, melanoma, and other. A total of 38% of all diagnostic selections in the BAMS cases were for BAMS, whereas 32% were for ST. In 22 of the BAMS cases, the favored diagnosis was BAMS, whereas in 17 of the BAMS cases, the favored diagnosis was ST. Among the 20 cases in the total group of 54 with the highest number of votes for ST, half were BAMS. Of BAMS, 75% had a number of votes for ST that was within the SD of votes for ST seen among true ST cases. There was poor interobserver agreement for the precise diagnosis of the BAMS (kappa = 0.16) but good agreement that these cases were not melanoma (kappa = 0.7). BAMS nevi/tumors can closely mimic Spitz neoplasms. Expert melanoma pathologists in this study favored a diagnosis of ST in nearly half of the BAMS cases. There are BAMS cases that even experts cannot morphologically distinguish from true Spitz neoplasms.