bluuebunny/crossref_metadata_2025 huggingface dataset:
Awareness of forensic dentistry among dental professionals in western Saudi Arabia: A knowledge, attitude, and practice-based cross-sectional study
Authors: Alamoudi Ruaa A. , Alghamdi Nuha S.
Published: April 2024

The aim of the study is to assess the knowledge, attitude, practice, and self-reported record for a list of items that are useful to forensic dentistry (FD) among dental professionals from the western region of Saudi Arabia. This cross-sectional survey was conducted among 406 dental health professionals. A pre-validated questionnaire written in Google Forms was used as a study tool. The questionnaire contained 4 parts: 1 - demographics; 2 - knowledge about FD; 3 - the attitudes; 4 - assessing dental record maintenance. Statistical data were analyzed using Pearson chi-square (χ2). The degree distribution amongst 406 respondents was: 64 bachelors; 162 masters; 180 Doctor of Philosophy (PhDs). 52% of respondents agreed that dentists should have enough knowledge about FD. Yet, 90.4% did not receive any training. All qualifications were aware of FD with no significant difference between groups (P = .06). According to degree, a significant difference between the 3 groups (P = .004), where a bachelor degree showed the least desire in testimony in court for FD evidence (50%) compared to master and PhD degrees (80%, 75%, respectively). Almost 56% of consultants reported that it is not primarily for the dentist to have a good knowledge of FD, while all other qualifications agreed to the opposite (66%). 55.4% of general dentists, 73% of residents, and 94% of consultants believed that FD is an accurate, sensitive, and reliable method in the identification of unknown victims or criminals. Our study revealed that there is a lack of knowledge, attitude, and practice among undergraduates and general dental practitioners. However, this scenario can be upgraded by the inclusion of FD in the dental curriculum in Saudi Arabia.
Prognostic significance of the chemerin level in coronavirus disease 2019 patients
Authors: Gokdemir Gül Şahika , Gokdemir Mehmet Tahir , Araç Songül , Yokuş Beran
Published: April 2024

Increased serum chemerin levels have been reported in several inflammatory diseases. Few studies have investigated the relationship between chemerin and clinical features of COVID-19. Thus, chemerin may modulate the development and progression of COVID-19. We compared the serum chemerin concentration between patients with and without SARS-CoV-2 infection and its association with the severity and prognosis of COVID-19 pneumonia. This is a prospective, single-center, cross-sectional study. We enrolled COVID-19 patients who presented to our tertiary hospital and healthy controls. The COVID-19 patients were conducted and the dates of symptom onset were recorded. After admission to the hospital and stabilization, blood samples were obtained for routine hemogram, biochemistry, and chemerin. The chemerin level was 37.93 ± 17.3 ng/mL in patients followed in the ICU, 29.41 ± 12.79 ng/mL in inpatients, 30.48 ± 10.86 ng/mL in outpatients, and 25.12 ± 9.82 ng/mL in healthy controls. The difference between patients treated in the ICU and healthy controls was significant (P < .001). The high-sensitivity C-reactive protein (hs-CRP), ferritin, procalcitonin (PCT), and D-dimer levels were significantly higher in the intensive care unit (ICU) group (P < .001). Moreover, the chemerin level of patients who died was significantly higher than that of those who survived (P < .001). The chemerin level was increased in COVID-19 patients and also increased with increasing disease severity. The chemerin level was higher in the COVID-19 patients than healthy controls and was significantly higher in patients who died compared to those who did not.
The significance of detecting HBV pgRNA and HBcrAg in HBV patients treated with NAs
Authors: Lin Jie , Jiang Shiyao , Chen Xiangyu , Zhu Min , Zhang Haifeng
Published: April 2024

The value of detecting hepatitis B virus (HBV), pregenomic RNA (pgRNA), and hepatitis B core-related antigen (HBcrAg), both separately and jointly, in the management of HBV patients undergoing treatment with Nucleotide Analog was investigated. A total of 149 HBV patients who were being treated with Nucleotide Analog were enrolled in this study. The quantitative levels of HBV pgRNA and HBcrAg in the sera of these patients were determined, aiming to comprehend their replication levels and expression during the course of antiviral therapy. The patients were separated into 3 groups based on treatment duration: treatment time ≤ 12 months, treatment time ranging from 12 months to <60 months, and treatment time ≥ 60 months. Significantly different levels of HBcrAg and HBV pgRNA were observed among 3 groups (P < .05). In the group of patients with positive hepatitis B e antigen, both HBcrAg and pgRNA levels were higher compared to the group with negative hepatitis B e antigen, and this difference between the 2 groups was found to be statistically significant. Stratified analysis based on levels of hepatitis B surface antigen (HBsAg) revealed that the group with HBsAg levels < 100 IU/mL had lower levels of both HBcrAg and pgRNA compared to the group with HBsAg levels ≥ 100 IU/mL (P < .001). Following antiviral therapy, various degrees of transcription of covalently closed circular DNA continue to exist within the liver of HBV patients. The levels of serum HBcrAg and HBV pgRNA vary among patients with different treatment durations, indicating their efficacy in evaluating disease conditions during antiviral therapy.
Clinicopathological correlation of patients with lupus nephritis: Data from a tertiary center in Saudi Arabia
Authors: Bawazir Yasser
Published: April 2024

Systemic lupus erythematosus mainly affects young women, and approximately half of systemic lupus erythematosus patients develop lupus nephritis (LN). However, data on the types and remission rates of LN in Saudi Arabia are limited. Therefore, we aimed to highlight the LN remission rates in our population. A retrospective record review was conducted between January 2007 and December 2020 in a tertiary center in the western region of Saudi Arabia to determine the remission rates among patients with biopsy-proven LN who met the EULAR\ACR 2019 classification criteria. We identified 59 patients with biopsy-proven LN, mostly in young women. The common histopathological pattern was Class IV LN in 26 patients (44%). Three induction protocols were identified, along with systemic steroids: the high-dose cyclophosphamide protocol in 21 patients (35.6%), low-dose protocol in 4 patients (6.8%), and mycophenolate mofetil (MMF) in 41 patients (69.5%). Partial response, defined as the reduction of the 24-hour proteinuria by 25% at 3 months and 50% at 6 months, was achieved in 18 patients (33.3%) at 3 months and decreased to 13 patients (24.1%) at 6 months. Complete clinical response, defined as 24-hour urinary protein between 500 and 700 mg at 12 months, was achieved in 44 patients (81.5%). Complete remission was higher among patients with Class IV LN (64.4%). The achievement of partial clinical response at 3 months was significantly lower among patients with hypertension (P = .041). This study presented the LN remission rates in a single center in Saudi Arabia. Similar to previous studies, Class IV LN were the most common histopathological finding in this study. Complete remission at 12 months was achieved in 44 (81%) patients. Delayed remission is associated with hypertension at the time of LN diagnosis.
Coronary artery calcification score as a prognostic indicator for COVID-19 mortality: evidence from a retrospective cohort study in Iran
Authors: Hedayati Goudarzi Mohammad Taghi , Abrotan Saeed , Ziaie Naghmeh , Amin Kamyar , Saravi Mehrdad , Jalali Seyed farzad , Pourkia Roghayeh , Jafaripour Iraj , Moradi Amir , kargar-soleimanabad Saeed , Saffar Homina
Published: April 2024

Background:

Coronary artery calcification (CAC) has been established as an independent risk factor for major adverse cardiovascular events. Nevertheless, the effect of CAC on in-hospital mortality and adverse clinical outcomes in patients with COVID-19 has yet to be determined.

Objective:

To investigate the association between CAC score and in-hospital mortality of COVID-19 patients

Method:

This retrospective cohort study was conducted across tertiary hospitals of University of Medical Sciences in Babol, a northern city in Iran, and enroled 551 confirmed COVID-19 patients with definitive clinical outcomes of death or discharge between March and October 2021. Demographic and clinical data, along with chest computed tomography (CT) findings and CAC score on admission, were systematically collected. The study utilized logistic regression analysis and Kaplan-Meier plots to explore the association between CAC score and in-hospital death and adverse clinical outcomes.

Results:

The mean age was 60.05±12.8. A significant difference regarding CAC score, age, history of hypertension, hyperlipidemia, cardiovascular diseases, and respiratory diseases among survivors and non-survivors was observed; however, gender was not found to be different. Furthermore, in multivariate analysis, CAC score greater than or equal to 400 [odds ratio (OR): 4.2, 95% CI: 1.70–10.33, P value: 0.002], hospitalization time (OR: 1.31, 95% CI: 1.13–1.53, P value < 0.001), length of ICU stay (OR: 2.02, 95% CI: 1.47–2.77, P value < 0.001), severe or critical COVID-19 severity in time of admission (95% CI: 1.79–18.29, P value: 0.003), and history of respiratory diseases (95% CI: 2.18–40, P value: 0.003) were found to be associated with higher odds of in-hospital mortality. Log-rank test also revealed a significant difference regarding the time of admission to death between patients with CAC score greater than or equal to 400 and those with CAC score less than 400 (P value < 0.001).

Conclusion:

Elevated CAC score is a crucial risk factor linked to in-hospital mortality and unfavourable clinical results in confirmed COVID-19 patients. This finding emphasizes the need for careful monitoring of individuals with high CAC scores.
Magnitude and associated factors of postoperative mortality among patients who underwent surgery in Ethiopia: systematic review and meta-analysis
Authors: Tsehay Yeshimebet Tamir , Bogale Alemwork Dessalegn , Mulatu Sileshi , Netsere Henok Biresaw , Adal Ousman , Messelu Mengistu Abebe , Mamo Sosina Tamre , Demile Tiruye Azene , Abebe Gebremeskel Kibret , Mekonnen Gebrehiwot Berie , Belay Alamirew Enyew , Wondie Wubet Tazeb , Belayneh Asnake Gashaw
Published: April 2024

Background:

Postoperative mortality is one of the six surgical indicators identified by the Lancet Commission on Global Surgery for monitoring access to high-quality surgical care. This study aimed to assess the magnitude and associated factors of postoperative mortality among patients who underwent surgery in Ethiopia.

Methods:

This systematic review and meta-analysis were conducted based on the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Ten studies were included in this Systematic review and meta-analysis. The risk of bias for each study was assessed using the Joanna Briggs Institute quality appraisal scale. Publication bias was checked using a funnel plot and Egger’s regression test. Heterogeneity across studies was assessed by I2 statistics. STATA version 17 software was used for analysis. A random effect model and the DerSimonian–Laird method of estimation was used to estimate the pooled magnitude of postoperative mortality. Odds ratios with 95% CIs were calculated to determine the associations of the identified factors with postoperative mortality.

Results:

The results revealed that the pooled magnitude of postoperative mortality among patients who underwent surgery in Ethiopia was 4.53% (95% CI :3.70–5.37). An American Society of Anesthesiologists score greater than or equal to III [adjusted odds ratio (AOR): 2.45, 95% CI: 2.02, 2.96], age older than or equal to 65 years (AOR: 3.03, 95% CI: 2.78, 3.31), and comorbidity (AOR: 3.28, 95% CI: 1.91, 5.63) were significantly associated with postoperative mortality.

Conclusion and recommendations:

The pooled magnitude of postoperative mortality among patients who underwent surgery in Ethiopia was high. The presence of comorbidities, age older than 65 years, and ASA physical status greater than III were significantly associated with postoperative mortality. Therefore, the Ministry of Health and other concerned bodies should consider quality improvement processes.
Fertility education on Instagram: advertisements vs. educational content analysis for posts in Bahasa (Indonesian language)
Authors: Harzif Achmad K , Kusuma Berli , Ummah Nafi’atul , Puspawardani Aisyah R , Nurbaeti Putri , Wiweko Budi
Published: April 2024

Background:

As one of Indonesia’s major social media platforms, Instagram provides abundant information, including fertility topics. However, fertility information in Bahasa (Indonesian language) had never been mapped before. This study aims to determine the prevalence, authorship, and types of fertility-related information in Bahasa shared on Instagram using hashtag and content analysis. Additional outcomes included a comparison of post content stratified by author type (healthcare providers vs. non-healthcare providers).

Materials and methods:

Five hashtags comprising fertility terms in Bahasa (Indonesian language) were derived. Content analysis was performed on the top 100 posts for each hashtag to determine the authorship and content type. The contents posted by healthcare providers were analyzed and compared to those published by non-healthcare providers.

Results:

Our search yielded 3 883 000 posts for the five most popular hashtags. The three most popular hashtags were ‘promil’, ‘program hamil’ and ‘bayitabung’. Authorship of the top posts for each hashtag was predominantly by for-profit healthcare institutions (27.6%), followed by commercial alternative/herbal medicine (20.2%), patients (20%), physicians (11.8%), allied health professionals (3.2%), professional societies (0.8%), and others (16.4%). Of these posts, 35.4% were advertisements, 28% were related to patient experience, and 18% were educational. Healthcare provider groups were more likely to author educational posts than advertisements, while non-healthcare providers were more likely to post content for commercial purposes (P < 0.001).

Conclusion:

Fertility-related posts were dominated by for-profit healthcare institutions and alternative/herbal medicines for commercial purposes. The physician group authored more of the educational content. There is plenty of room for optimal utilization of social platforms as educational media.
Infantile tremor syndrome with global developmental delay and microcephaly in a 16-month-old male: a case report
Authors: Shah Ujjwal Kumar , Chaudhary Shipra , Ghimire Aasha , Shah Neha , Muskan Vitasta
Published: April 2024

Introduction and importance:

Infantile tremor syndrome (ITS) affects children aged 6–18 months, and is characterized by tremors, pallor, developmental regression, skin pigmentation changes, and sparse hypopigmented hair. This case report highlights an ITS presentation in a 16-month-old exclusively breastfed male, emphasizing the significance of complementary feeding.

Case presentation:

The patient presented with abnormal body movements, loss of developmental milestones, hyperpigmented skin changes, hypopigmented scalp hairs, pallor, and microcephaly. Born to a vegetarian mother with inadequate prenatal care, the child’s exclusive breastfeeding till 16 months of age without complementary feeding led to severe developmental delay and moderate malnutrition. Diagnostic workup revealed vitamin B12 deficiency, anaemia, and neurologic abnormalities.

Clinical discussion:

ITS is associated with various manifestations, including pallor, hyperpigmentation, and tremors, commonly linked to vitamin B12 deficiency. In this case, developmental delays and malnutrition underscored the importance of early recognition. Despite neurological improvement with vitamin B12 supplementation, ITS’s long-term impact on cognitive functions necessitates vigilance and appropriate nutritional interventions.

Conclusion:

Early recognition of ITS is vital for the prevention of long-term neurodevelopmental sequelae. Injectable vitamin B12 supplementation and nutritional interventions have demonstrated significant developmental gains. Increased awareness among mothers about nutritional intake during pregnancy and lactation is crucial, especially among vegetarians.
Targeting Breast Cancer Using 177Lu-Labeled Trastuzumab and Trastuzumab Fragment
Authors: Rathore Yogesh , Lakhanpal Tamanna , Chakraborty Sudipta , Chakravarty Rubel , Mittal B.R. , Irrinki R.N. Santhosh , Laroiya Ishita , Kaur Komalpreet , Shukla Jaya
Published: April 2024

Purpose

A monoclonal antibody, trastuzumab, is used for immunotherapy for HER2-expressing breast cancers. Large-sized antibodies demonstrate hepatobiliary clearance and slower pharmacokinetics. A trastuzumab fragment (Fab; 45 kDa) has been generated for theranostic use.

Patients and Methods

Fab was generated by papain digestion. Trastuzumab and Fab have been radiolabelled with 177Lu after being conjugated with a bifunctional chelating. The affinity and target specificity were studied in vitro. The first-in-human study was performed.

Results

The bifunctional chelating agent conjugation of 1–2 molecules with trastuzumab and Fab was detected at the molar ratio 1:10 in bicarbonate buffer (0.5 M, pH 8) at 37°–40°C. However, 2–3 molecules of bifunctional chelating agent were conjugated when DMSO in PBS (0.1 M, pH 7) was used as a conjugation buffer at a molar ratio of 1:10. The radiolabelling yield of DOTA-conjugated Fab and trastuzumab at pH 5, 45°C to 50°C, with incubation time 2.5–3 hours was 80% and 41.67%, respectively. However, with DOTAGA-conjugated trastuzumab and Fab, the maximum radiolabelling yield at pH 5.5, 37°C, and at 2.5–3 hours was 80.83% and 83%, respectively. The calculated Kd of DOTAGA Fab and trastuzumab with HER2-positive SKBR3 cells was 6.85 ± 0.24 × 10−8 M and 1.71 ± 0.10 × 10−8 M, respectively. DOTAGA-Fab and trastuzumab showed better radiolabelling yield at mild reaction conditions.

177Lu-DOTAGA-Fab demonstrated higher lesion uptake and lower liver retention as compared with 177Lu-DOTAGA-trastuzumab. However, 177Lu-DOTAGA-Fab as compared with 177Lu-DOTAGA-trastuzumab showed a relatively early washout (5 days) from the lesion.

Conclusions

177Lu-DOTAGA-Fab and trastuzumab are suitable for targeting the HER2 receptors.
Prediction of Permanent Enophthalmos Using 3-Dimensional Integral Model in Blowout Fractures
Authors: Kim Jun Hyun , Choi Yean Su , Shin Ho Seong
Published: April 2024

Background:

The objective of this study is to validate the possibility of setting volumetric surgical indications by predicting permanent enophthalmos using a simplified formula.

Methods:

The volume difference of bilateral orbits in a CT scan was automatically measured, and permanent enophthalmos was predicted by substituting the volume difference into a formula made using the 3-dimensional (3D) integral model.

Results:

The predicted enophthalmos showed a strong positive correlation with the permanent enophthalmos of 52 blowout fracture patients. Analyzing CT of 768 pure blowout fracture patients, the mean predicted enophthalmos was 1.84 mm, and both the size of the fracture area and the degree of EOM herniation showed the absence of correlations.

Conclusions:

Through the digitized orbital volume analysis and formula using the 3D integral model, blowout fracture patients who require surgery in the early post-traumatic period can be identified with convenience and reproducibility.
The Prevalence of Difficult Airway and Associated Risk Factors in Pediatric Patients: A Cross-sessional Observational Study
Authors: Shen Chen , Shi Yun
Published: April 2024

Background:

Difficult airway remains a great challenge in pediatric anesthesia practice. Previously published data show the prevalence of difficult airways in pediatric population varies in a wide range. However, there is a lack of studies in the Asian region.

Methods:

This cross-sectional single-center study was conducted in a tertiary pediatric hospital in China from October 2022 to October 2023. The patients who underwent elective surgery under general anesthesia with tracheal intubation were recruited consecutively. Data on patient characteristics, airway assessment, and airway management information were collected. Multivariable logistic regression analysis was performed to detect the independent variables of difficult airway in pediatric patients.

Results:

A total of 18,491 pediatric patients were included in this study. The overall incidence of difficult airways was 0.22%, 39% of whom were unanticipated. Very few previous airway management information was available in the patients presented with a known difficult airway. Patients with younger age, higher American Society of Anesthesiologists (ASA) physical status classification grade, and presented for craniofacial and thoracic surgery were associated with higher incidence of difficult airway. Further multivariable logistic regression analysis revealed that age ≤28 days (OR=50.48), age between 28days and 1 year (OR=6.053), craniofacial surgery (OR=1.81), and thoracic surgery (OR=0.2465) were independent risk factors of increased incidence of difficult airway.

Conclusions:

Our study showed the prevalence of difficult airways in pediatric surgical patients. Patient characteristics, age, and type of surgery were identified as the independent factors associated with increased occurrence of difficult airways. Unanticipated difficult airway was not unusual in our study population, even for the patients with previous surgical history.
Liraglutide Protects Pancreatic Islet From Ischemic Injury by Reducing Oxidative Stress and Activating Akt Signaling During Cold Preservation to Improve Islet Transplantation Outcomes
Authors: Cai Xiangheng , Cao Jinglin , Wang Le , Zou Jiaqi , Li Rui , Sun Peng , Ding Xuejie , Zhang Boya , Liu Zewen , Pei Xirui , Yang Jiuxia , Zhan Yixiang , Liu Na , Liu Tengli , Liang Rui , Gao Jie , Wang Shusen
Published: April 2024

Background.

Islet transplantation is a promising therapy for patients with type 1 diabetes. However, ischemic injury to the donor islets during cold preservation leads to reduced islet quality and compromises transplant outcome. Several studies imply that liraglutide, a glucagon-like peptide-1 receptor agonist, has a positive effect on promoting islet survival, but its impact on islet cold-ischemic injury remains unexplored. Therefore, the aim of this study was to investigate whether liraglutide can improve islet transplantation efficacy by inhibiting cold-ischemic injury and to explore the underlying mechanisms.

Methods.

Liraglutide was applied in a mouse pancreas preservation model and a human islets cold-preservation model, and islet viability, function, oxidative stress levels were evaluated. Furthermore, islet transplantation was performed in a syngeneic mouse model and a human-to-nude mouse islet xenotransplantation model.

Results.

The supplementation of liraglutide in preservation solution improved islet viability, function, and reduced cell apoptosis. Liraglutide inhibited the oxidative stress of cold-preserved pancreas or islets through upregulating the antioxidant enzyme glutathione levels, inhibiting reactive oxygen species accumulation, and maintaining the mitochondrial membrane integrity, which is associated with the activation of Akt signaling. Furthermore, the addition of liraglutide during cold preservation of donor pancreas or donor islets significantly improved the subsequent transplant outcomes in both syngeneic mouse islet transplantation model and human-to-nude mouse islet xenotransplantation model.

Conclusions.

Liraglutide protects islets from cold ischemia-related oxidative stress during preservation and hence improved islet transplantation outcomes, and this protective effect of liraglutide in islets is associated with the activation of Akt signaling.
Cell-specific Extracellular Vesicles and Their miRNA Cargo Released Into the Organ Preservation Solution During Cold Ischemia Storage as Biomarkers for Liver Transplant Outcomes
Authors: Vidal-Correoso Daniel , Mateo Sandra V. , Muñoz-Morales Ana M. , Lucas-Ruiz Fernando , Jover-Aguilar Marta , Alconchel Felipe , Martínez-Alarcón Laura , Sánchez-Redondo Sara , Santos Vanesa , López-López Víctor , Ríos-Zambudio Antonio , Cascales Pedro , Pons José Antonio , Ramírez Pablo , Pelegrín Pablo , Peinado Héctor , Baroja-Mazo Alberto
Published: April 2024

Background.

Liver transplantation (LT) is crucial for end-stage liver disease patients, but organ shortages persist. Donation after circulatory death (DCD) aims to broaden the donor pool but presents challenges. Complications like acute rejection, hepatic artery thrombosis, and biliary issues still impact posttransplant prognosis. Biomarkers, including extracellular vesicles (EVs) and microRNAs (miRNAs), show promise in understanding and monitoring posttransplant events. This study explores the role of EVs and their miRNA cargo in LT, including their potential as diagnostic tools.

Methods.

EVs from intrahepatic end-ischemic organ preservation solution (eiOPS) in 79 donated livers were detected using different techniques (nanosight tracking analysis, transmission electron microscopy, and flow cytometry). EV-derived miRNAs were identified by quantitative real time-polymerase chain reaction. Bioinformatics analysis was performed using the R platform.

Results.

Different-sized and origin-specific EVs were found in eiOPS, with significantly higher concentrations in DCD compared with donation after brain death organs. Additionally, several EV-associated miRNAs, including let-7d-5p, miR-28-5p, miR-200a-3p, miR-200b-3p, miR-200c-3p, and miR-429, were overexpressed in DCD-derived eiOPS. These miRNAs also exhibited differential expression patterns in liver tissue biopsies. Pathway analysis revealed enrichment in signaling pathways involved in extracellular matrix organization and various cellular processes. Moreover, specific EVs and miRNAs correlated with clinical outcomes, including survival and early allograft dysfunction. A predictive model combining biomarkers and clinical variables showed promise in acute rejection detection after LT.

Conclusions.

These findings provide new insights into the use of EVs and miRNAs as biomarkers and their possible influence on posttransplantation outcomes, potentially contributing to improved diagnostic approaches and personalized treatment strategies in LT.
Highly Sensitized Candidates Remain at Risk for Microvascular Inflammation Even When Donor-specific Antibody Is Avoided: A Matched Cohort Study
Authors: Agrawal Amogh , Balakrishnan Suryanarayanan , Gandhi Manish J. , Alexander Mariam P. , Cornell Lynn , Bentall Andrew J. , Kukla Aleksandra , Stegall Mark , Schinstock Carrie A.
Published: April 2024

Background.

Microvascular inflammation (MVI) is a key feature of antibody-mediated rejection (AMR) among patients with HLA donor-specific antibody (DSA), but MVI at AMR thresholds (Banff glomerulitis [g] + peritubular capillaritis [ptc] score ≥ 2) without DSA has been increasingly recognized. We aimed to determine the incidence of MVI among highly sensitized kidney transplant recipients without DSA.

Methods.

We performed a single-center, retrospective, matched cohort study comparing outcomes of kidney transplant recipients with cPRA ≥90% with preexisting DSA (n = 49), cPRA ≥90% without preexisting DSA (n = 47), and matched controls with cPRA = 0 without preexisting DSA (n = 49). Controls were matched by age, donor type, and transplant date. Indication and surveillance biopsies combined with annual de novo DSA screening were obtained.

Results.

Kidney transplant recipients with a cPRA ≥90% and no evidence of preexisting or de novo DSA had a higher incidence of MVI (glomerulitis + peritubular capillaritis ≥ 2) than patients with cPRA = 0 [35% (17/49) versus 12% (6/49), P = 0.0003] over a median (interquartile range) follow-up of 5 (4–6) y posttransplant. Among this cPRA ≥90% group without DSA, MVI persisted in 54% of cases on follow-up biopsy (7/13), and 24% (4/13) of cases developed transplant glomerulopathy (Banff cg score > 0).

Conclusions.

Highly sensitized transplant recipients have a high incidence of persistent and progressive MVI, even without DSA. The mechanisms underlying these histologic features needs to be elucidated, but this information is important to consider when making decisions about transplantation among highly sensitized individuals.
Outcomes of Heart Transplantation From Donation After Circulatory Death: An Up-to-date Systematic Meta-analysis
Authors: Zong Junjie , Ye Weicong , Yu Jizhang , Zhang Xi , Cui Jikai , Chen Zhang , Li Yuan , Wang Song , Ran Shuan , Niu Yuqing , Luo Zilong , Li Xiaohan , Zhao Jiulu , Hao Yanglin , Xia Jiahong , Wu Jie
Published: April 2024

Background.

Donation after circulatory death (DCD) heart transplantation (HTx) significantly expands the donor pool and reduces waitlist mortality. However, high-level evidence-based data on its safety and effectiveness are lacking. This meta-analysis aimed to compare the outcomes between DCD and donation after brain death (DBD) HTxs.

Methods.

Databases, including MEDLINE, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials, were systematically searched for randomized controlled trials and observational studies reporting the outcomes of DCD and DBD HTxs published from 2014 onward. The data were pooled using random-effects models. Risk ratios (RRs) with 95% confidence intervals (CIs) were used as the summary measures for categorical outcomes and mean differences were used for continuous outcomes.

Results.

Twelve eligible studies were included in the meta-analysis. DCD HTx was associated with lower 1-y mortality rate (DCD 8.13% versus DBD 10.24%; RR = 0.75; 95% CI, 0.59-0.96; P = 0.02) and 5-y mortality rate (DCD 14.61% versus DBD 20.57%; RR = 0.72; 95% CI, 0.54-0.97; P = 0.03) compared with DBD HTx.

Conclusions.

Using the current DCD criteria, HTx emerges as a promising alternative to DBD transplantation. The safety and feasibility of DCD hearts deserve further exploration and investigation.
Presence of glyphosate in urine due to environmental exposure among populations of agro-industrial areas in Buenos Aires, Argentina
Authors: Figar Silvana , Ferloni Analia , Saravi Amparo , Dawidowski Adriana R. , Aliperti Valeria I. , Bressán Ignacio , De Florio Florencia , Vicens Jimena , Golde Nahuel Braguinsky , Garcia Natalia K. , Pazur Glenda , Hough Guillermo E. , Gadano Adrián C.
Published: April 2024

Introduction

An increasing number of rural communities express perception of health damage from glyphosate and other agrochemicals. We measure the presence of glyphosate in the human body, in order to create, together with the local community, a systemic model that highlights modifiable causal socio-environmental conditions.

Materials and methods

Participatory Action Research. Measurement of environmental factors and self-reported oncological disease were obtained in a three-stage probabilistic sampling (blocks, houses, family) of people living in French city - 9 de Julio-Buenos Aires. Glyphosate in urine was analyzed by liquid chromatography coupled to tandem mass spectrometry. The exposure pathway was obtained by interviewing positive cases. A conceptual systemic model was designed.

Results

of the total 46 blocks of French, 23 were included with systematic sampling and from the 76 houses selected (50%) one person was included in the study. Oncological disease was reported in 21.8% of the households. 13% of the population (95% CI 6.5-23) presented quantifiable glyphosate in urine in June 2023. Occupational exposure was ruled out in all cases. The main self-reported sources were: unloading agrochemicals in the nearby warehouse, the grain storage complex, pesticide drift and self-propelled sprayers that pass by on the street, variables belonging to economic and cultural conditions. A network of actors emerged who, gathered on a website, propose actions to the mayor’s office.

Discussion

This study has high external validity for public health decision makers regarding the determinants. It is necessary to notify the Argentine Integrated Health System, both suspected exposure and possibly related health events, and to design how to refer human samples to highly complex laboratories to measure pesticides.

Conclusion

the presence of glyphosate in urine was due to environmental exposure; It expresses a path of passive, involuntary and chronic absorption of environmental pollutants and is due to French’s agricultural activity with dominance of market forces in the system, poorly antagonized by care forces.
REAL TIME MONITORING OF RESPIRATORY VIRAL INFECTIONS IN COHORT STUDIES USING A SMARTPHONE APP
Authors: Hancock David G , Kicic-Starcevich Elizabeth , Sondag Thijs , Rivers Rael , McGee Kate , Karpievitch Yuliya V , D’Vaz Nina , Agudelo-Romero Patricia , Caparros-Martin Jose A , Iosifidis Thomas , Kicic Anthony , Stick Stephen M
Published: April 2024

Background and Objectives

Cohort studies investigating respiratory disease pathogenesis aim to pair mechanistic investigations with longitudinal virus detection but are limited by the burden of methods tracking illness over time. In this study, we explored the utility of a smartphone app to robustly identify symptomatic respiratory illnesses, while reducing burden and facilitating real-time data collection and adherence monitoring.

Methods

The AERIAL TempTracker smartphone app was assessed in the AERIAL and COCOON birth cohort studies. Participants recorded daily temperatures and associated symptoms/medications in TempTracker for 6-months, with daily use adherence measured over this period. Regular participant feedback was collected at quarterly study visits. Symptomatic respiratory illnesses meeting study criteria prompted an automated app alert and collection of a nose/throat swab for testing of eight respiratory viruses.

Results

In total, 32,764 daily TempTracker entries from 348 AERIAL participants and 30,542 entries from 361 COCOON participants were recorded. This corresponded to an adherence median of 67.0% (range 1.9-100%) and 55.4% (range 1.1-100%) of each participant’s study period, respectively. Feedback was positive, with 75.5% of responding families reporting no barriers to use. A total of 648 symptomatic respiratory illness events from 249/709 participants were identified with significant variability between individuals in the frequency (0-16 events per participant), duration (1-13 days), and virus detected (rhinovirus in 42.7%).

Conclusions

A smartphone app provides a reliable method to capture the longitudinal virus data in cohort studies which facilitates the understanding of early life infections in chronic respiratory disease development.

Summary at a Glance

A smartphone app can facilitate capturing symptomatic respiratory viral infections in longitudinal cohort studies, while supporting adherence and reducing participant burden. The app helped identify community variations in virus prevalence as well as the individual variability in viral responses necessary to understand the mechanism of chronic disease development.
Cost Comparison and Spending on Tobacco Products: Evidence from A Nationally Representative Sample of Adult E-Cigarette Users
Authors: Ma Shaoying , Yang Qian , Ahn Sooa , Park Hojin , He Yanyun , Bridges John F P , Shang Ce
Published: April 2024

Background

Over 20 states and local jurisdictions in the U.S. have imposed e-cigarette taxes. It is important to evaluate how adult vapers, including those who also smoke respond to e-cigarette taxation. The purpose of this study is to examine factors associated with adult vapers’ cost perception of e-cigarettes relative to cigarettes and budget allocations between two products.

Methods

We recruited a nationally representative sample of 801 adult e-cigarette users in the U.S., who participated in an online survey in April and May 2023. Nested-ordered logit models and ordinary least squares regressions were used in the analysis.

Results

On average, monthly e-cigarette spending was $82.22, and cigarette spending was $118.77 among dual users. Less frequent e-cigarette use and higher state-level e-cigarette taxes were associated with perceiving smoking as cheaper than vaping. Age and exclusive use of tank systems were associated with perceiving vaping as cheaper than smoking. Exclusive use of tank systems was also associated with lower e-cigarette spending. Adults who used e-cigarettes more frequently preferred to report weekly budget on e-cigarettes (p< 0.01), and among dual users, everyday smokers preferred to report weekly (versus monthly) budget on cigarettes compared to someday smokers (p< 0.001).

Conclusion

Among US adult vapers, frequencies of tobacco use and e-cigarette device type are closely related to cost measures; and e-cigarette taxes are associated with cost perception of e-cigarettes relative to cigarettes, suggesting potential financial disincentive for vaping. Policymaker may consider imposing differential taxes by e-cigarette product types due to their different costs to consumers.
Enhancing Early Detection of Cognitive Decline in the Elderly: A Comparative Study Utilizing Large Language Models in Clinical Notes
Authors: Du Xinsong , Novoa-Laurentiev John , Plasaek Joseph M. , Chuang Ya-Wen , Wang Liqin , Marshall Gad , Mueller Stephanie K. , Chang Frank , Datta Surabhi , Paek Hunki , Lin Bin , Wei Qiang , Wang Xiaoyan , Wang Jingqi , Ding Hao , Manion Frank J. , Du Jingcheng , Bates David W. , Zhou Li
Published: April 2024

Background

Large language models (LLMs) have shown promising performance in various healthcare domains, but their effectiveness in identifying specific clinical conditions in real medical records is less explored. This study evaluates LLMs for detecting signs of cognitive decline in real electronic health record (EHR) clinical notes, comparing their error profiles with traditional models. The insights gained will inform strategies for performance enhancement.

Methods

This study, conducted at Mass General Brigham in Boston, MA, analyzed clinical notes from the four years prior to a 2019 diagnosis of mild cognitive impairment in patients aged 50 and older. We used a randomly annotated sample of 4,949 note sections, filtered with keywords related to cognitive functions, for model development. For testing, a random annotated sample of 1,996 note sections without keyword filtering was utilized. We developed prompts for two LLMs, Llama 2 and GPT-4, on HIPAA-compliant cloud-computing platforms using multiple approaches (e.g., both hard and soft prompting and error analysis-based instructions) to select the optimal LLM-based method. Baseline models included a hierarchical attention-based neural network and XGBoost. Subsequently, we constructed an ensemble of the three models using a majority vote approach.

Results

GPT-4 demonstrated superior accuracy and efficiency compared to Llama 2, but did not outperform traditional models. The ensemble model outperformed the individual models, achieving a precision of 90.3%, a recall of 94.2%, and an F1-score of 92.2%. Notably, the ensemble model showed a significant improvement in precision, increasing from a range of 70%-79% to above 90%, compared to the best-performing single model. Error analysis revealed that 63 samples were incorrectly predicted by at least one model; however, only 2 cases (3.2%) were mutual errors across all models, indicating diverse error profiles among them.

Conclusions

LLMs and traditional machine learning models trained using local EHR data exhibited diverse error profiles. The ensemble of these models was found to be complementary, enhancing diagnostic performance. Future research should investigate integrating LLMs with smaller, localized models and incorporating medical data and domain knowledge to enhance performance on specific tasks.
A longitudinal analysis of incidence of hypertension and blood pressure measurements by age of migration among older Hispanic men and women
Authors: Walker Brandon S. , Waitzman Norman J , Goldstein Evan V. , Vanneman Megan E. , Kelley Alan Taylor , Wilson Fernando A.
Published: April 2024

Objective

To conduct a longitudinal analysis of incidence of self-reported hypertension and blood pressure measurements among foreign-born Hispanics by age of migration, compared to US-born populations.

Methods

The sample was drawn from 2002-2018 of the Health and Retirement Study and included 22,909 individuals. Subsets of this sample were used to conduct a longitudinal analysis of the incidence of hypertension and mean blood pressure measurements.

Results

Foreign-born Hispanic women migrating at age 40 and older had a greater incidence of hypertension and a greater increase in systolic blood pressure as they aged compared to US-born Whites.

Discussion

In contrast to the Hispanic Paradox that suggests better health among Hispanic immigrants despite lower socioeconomic status, this was not observed among older Hispanic immigrants for hypertension. Furthermore, older Hispanic women who migrated later in life had a greater incidence of hypertension and greater increases in systolic blood pressure as they aged compared to US-born White women.
Embryonic motor neuron programming factors reactivate immature gene expression and suppress ALS pathologies in postnatal motor neurons
Authors: Lowry Emily R. , Patel Tulsi , Costa Jonathon A. , Chang Elizabeth , Tariq Shahroz , Melikyan Hranush , Davis Ian M. , Aziz Siaresh , Dermentzaki Georgia , Lotti Francesco , Wichterle Hynek
Published: April 2024

Aging is a major risk factor in amyotrophic lateral sclerosis (ALS) and other adult-onset neurodegenerative disorders. Whereas young neurons are capable of buffering disease-causing stresses, mature neurons lose this ability and degenerate over time. We hypothesized that the resilience of young motor neurons could be restored by re-expression of the embryonic motor neuron selector transcription factors ISL1 and LHX3. We found that viral re-expression of ISL1 and LHX3 reactivates aspects of the youthful gene expression program in mature motor neurons and alleviates key disease-relevant phenotypes in the SOD1G93Amouse model of ALS. Our results suggest that redeployment of lineage-specific neuronal selector transcription factors can be an effective strategy to attenuate age-dependent phenotypes in neurodegenerative disease.
Association between sex and race and ethnicity and intravenous sedation use in patients receiving invasive ventilation
Authors: Walker Sarah L. , Angriman Federico , Burry Lisa , Celi Leo Anthony , Fiest Kirsten M. , Gichoya Judy , Johnson Alistair , Liu Kuan , Mehta Sangeeta , Roman-Sarita Georgiana , Seyyed-Kalantari Laleh , Vu Thanh-Giang T. , Whitlock Elizabeth L. , Tomlinson George , Yarnell Christopher J.
Published: April 2024

Rationale

Intravenous sedation is an important tool for managing invasively ventilated patients, yet excess sedation is harmful, and dosing could be influenced by implicit bias.

Objective

To measure the association between sex, race and ethnicity, and sedation practices.

Methods

We performed a retrospective cohort study of adults receiving invasive ventilation for 24 hours or more using the MIMIC-IV (2008-2019) database from Boston, USA. We used a repeated-measures design (4-hour time intervals) to study the association between patient sex (female, male) or race and ethnicity (Asian, Black, Hispanic, White) and sedation outcomes. Sedation outcomes included sedative use (propofol, benzodiazepine, dexmedetomidine) and minimum sedation score. We divided sedative use into five categories: no sedative given, then lowest, second, third, and highest quartiles of sedative dose. We used multilevel Bayesian proportional odds modeling to adjust for baseline and time-varying covariates and reported posterior odds ratios with 95% credible intervals [CrI].

Results

We studied 6,764 patients: 43% female; 3.5% Asian, 12% Black, 4.5% Hispanic and 80% white. We analyzed 116,519 4-hour intervals. Benzodiazepines were administered to 2,334 (36%) patients. Black patients received benzodiazepines less often and at lower doses than White patients (OR 0.66, CrI 0.49 to 0.92). Propofol was administered to 3,865 (57%) patients. Female patients received propofol less often and at lower doses than male patients (OR 0.72, CrI 0.61 to 0.86). Dexmedetomidine was administered to 1,439 (21%) patients, and use was largely similar across sex or race and ethnicity. As expressed by sedation scores, male patients were more sedated than female patients (OR 1.41, CrI 1.23 to 1.62), and White patients were less sedated than Black patients (OR 0.78, CrI 0.65 to 0.95).

Conclusion

Among patients invasively ventilated for at least 24 hours, intravenous sedation and attained sedation levels varied by sex and race and ethnicity. Adherence to sedation guidelines may improve equity in sedation management for critically ill patients.
Age- and sex-related changes in motor functions: A Comprehensive Assessment and Component Analysis
Authors: Wunderle Veronika , Kuzu Taylan D. , Tscherpel Caroline , Fink Gereon R. , Grefkes Christian , Weiss Peter H.
Published: April 2024

Age-related motor impairments often cause caregiver dependency or even hospitalization. However, comprehensive investigations of the different motor abilities and the changes thereof across the adult lifespan remain sparse.

We, therefore, extensively assessed essential basic and complex motor functions in 444 healthy adults covering a wide age range (range 21 to 88 years). Basic motor functions, here defined as simple isolated single or repetitive movements in one direction, were assessed by means of maximum grip strength (GS) and maximum finger-tapping frequency (FTF). Complex motor functions, comprising composite sequential movements involving both proximal and distal joints/muscle groups, were evaluated with the Action Research Arm Test (ARAT), the Jebsen-Taylor Hand Function Test (JTT), and the Purdue Pegboard Test.

Men achieved higher scores than women concerning GS and FTF, whereas women stacked more pins per time than men during the Purdue Pegboard Test. There was no significant sex effect regarding JTT. We observed a significant but task-specific reduction of basic and complex motor performance scores across the adult lifespan. Linear regression analyses significantly predicted the participants’ ages based on motor performance scores (R2= .502). Of note, the ratio between the left- and right-hand performance remained stable across ages for all tests. Principal Component Analysis (PCA) revealed threemotor componentsacross all tests that represented dexterity, force, and speed. These components were consistently present in young (21 – 40 years), middle-aged (41 – 60 years), and older (61 – 88 years) adults, as well as in women and men. Based on the threemotor components, K-means clustering analysis differentiated high- and low-performing participants across the adult life span.

The rich motor data set of 444 healthy participants revealed age- and sex-dependent changes in essential basic and complex motor functions. Notably, the comprehensive assessment allowed for generating robustmotor componentsacross the adult lifespan. Our data may serve as a reference for future studies of healthy subjects and patients with motor deficits. Moreover, these findings emphasize the importance of comprehensively assessing different motor functions, including dexterity, force, and speed, to characterize human motor abilities and their age-related decline.