bluuebunny/crossref_metadata_2025 huggingface dataset:
Reference values of strain-derived myocardial work indices in heart transplant patients
Authors: Mandoli G E , Landra F , Tanzi L , Martini L , Fusi C , Sciaccaluga C , Diviggiano E E , Barilli M , Pastore M C , Focardi M , Bernazzali S , Maccherini M , Cameli M , Henein M Y
Published: August 2024

Aims

Myocardial work (MW) is a relatively novel non-invasive echocardiographic method with increasing fields of application. Normal reference ranges of MW indices in patients who have undergone a heart transplant (HTx) have not been determined yet. The aim of this study was to obtain the reference ranges for 2D echocardiographic indices of MW for adult HTx patients and to compare them with the results of the European Association of Cardiovascular Imaging (EACVI) Normal Reference Ranges for Echocardiography (NORRE) study.

Methods and results

All consecutive HTx patients admitted at our institution (University Hospital of Siena, Italy) between September 2019 and May 2022 who underwent endomyocardial biopsy (EMB) were considered. Patients with a history of rejection, a history of coronary artery vasculopathy, either acute cellular rejection or acute antibody-mediated rejection at EMB, and donor-specific antibodies were excluded. MW retrospectively performed for the included patients was retrieved, and the results were compared with those from the EACVI NORRE study. Out of 176 HTx patients who underwent EMB, 94 patients were excluded. The study population consisted of 82 HTx patients [68.3% male, median age 53 (46–62) years]. The median duration from HTx was 5 (2–22) months. The main MW indices such as global work efficiency (GWE, 84 ± 8%), global work index (GWI, 1447 ± 409 mmHg%), global constructive work (GCW, 2067 ± 423 mmHg%), and global wasted work [GWW, 310 (217–499) mmHg%] did not differ according to gender. Each of these indices significantly differed from those reported in the EACVI NORRE study (P-value <0.001), with lower GWI, GCW, and GWE and higher GWW values in the HTx population.

Conclusion

This study provides reference ranges for MW indices in an adult HTx population free from transplant-related complications which proved to be different from those previously reported in healthy volunteers.
Obesity and cardiovascular disease: an ESC clinical consensus statement
Authors: Koskinas Konstantinos C , Van Craenenbroeck Emeline M , Antoniades Charalambos , Blüher Matthias , Gorter Thomas M , Hanssen Henner , Marx Nikolaus , McDonagh Theresa A , Mingrone Geltrude , Rosengren Annika , Prescott Eva B
Published: August 2024

The global prevalence of obesity has more than doubled over the past four decades, currently affecting more than a billion individuals. Beyond its recognition as a high-risk condition that is causally linked to many chronic illnesses, obesity has been declared a disease per se that results in impaired quality of life and reduced life expectancy. Notably, two-thirds of obesity-related excess mortality is attributable to cardiovascular disease. Despite the increasingly appreciated link between obesity and a broad range of cardiovascular disease manifestations including atherosclerotic disease, heart failure, thromboembolic disease, arrhythmias, and sudden cardiac death, obesity has been underrecognized and sub-optimally addressed compared with other modifiable cardiovascular risk factors. In the view of major repercussions of the obesity epidemic on public health, attention has focused on population-based and personalized approaches to prevent excess weight gain and maintain a healthy body weight from early childhood and throughout adult life, as well as on comprehensive weight loss interventions for persons with established obesity. This clinical consensus statement by the European Society of Cardiology discusses current evidence on the epidemiology and aetiology of obesity; the interplay between obesity, cardiovascular risk factors and cardiac conditions; the clinical management of patients with cardiac disease and obesity; and weight loss strategies including lifestyle changes, interventional procedures, and anti-obesity medications with particular focus on their impact on cardiometabolic risk and cardiac outcomes. The document aims to raise awareness on obesity as a major risk factor and provide guidance for implementing evidence-based practices for its prevention and optimal management within the context of primary and secondary cardiovascular disease prevention.
Asymptotically exact fit for linear mixed model in genetic association studies
Authors: Guan Yongtao , Levy Daniel
Published: August 2024

The linear mixed model (LMM) has become a standard in genetic association studies to account for population stratification and relatedness in the samples to reduce false positives. Much recent progresses in LMM focused on approximate computations. Exact methods remained computationally demanding and without theoretical assurance. The computation is particularly challenging for multiomics studies where tens of thousands of phenotypes are tested for association with millions of genetic markers. We present IDUL and IDUL† that use iterative dispersion updates to fit LMMs, where IDUL† is a modified version of IDUL that guarantees likelihood increase between updates. Practically, IDUL and IDUL† produced identical results, both are markedly more efficient than the state-of-the-art Newton–Raphson method, and in particular, both are highly efficient for additional phenotypes, making them ideal to study genetic determinants of multiomics phenotypes. Theoretically, the LMM likelihood is asymptotically unimodal, and therefore the gradient ascent algorithm IDUL† is asymptotically exact. A software package implementing IDUL and IDUL† for genetic association studies is freely available at https://github.com/haplotype/IDUL.
Changing interpretations of Ian Smith in the British press, 1980–2007
Authors: Pattenden Hugh
Published: August 2024

This article seeks to advance the debate surrounding contemporary attitudes to settler colonialism in Britain by looking at the reinvention of the reputation of the former Rhodesian prime minister Ian Smith in British print media. This is becoming an increasingly important area of historical debate, but one that has not yet been fully explored. In order to investigate these issues, this article uses journalistic sources to reconstruct the ways in which Smith was talked about in public debate during the period from Zimbabwean independence in 1980 to his death in 2007. It argues that, while in the 1980s Smith was generally dismissed and condemned for his role in Rhodesia’s Unilateral Declaration of Independence, by the later 1990s and 2000s assessments were far more mixed, with many people comparing him favourably against Robert Mugabe. Indeed, it suggests that the suffering of Zimbabwe under Mugabe was the catalyst for Smith’s rehabilitation. Ultimately, it posits that interest in Smith highlights the unusually extensive interest that opinion formers had in Zimbabwean affairs, which was a legacy of the unique status of Rhodesia within the British empire.
Research on automatic classification method of artistic styles based on attention mechanism convolutional neural network
Authors: Li Qing , Li Yue , Qiu Feng
Published: August 2024

In this article, we propose a convolutional neural network (CNN) based on an attention mechanism designed to automatically categorize artwork styles. The pyramid spatial attention (PSA) module is introduced into the traditional CNN, through which the weights of the feature maps are dynamically adjusted to enhance the model’s attention to the key features in the artworks. Experimental results show that the model proposed in this article significantly outperforms ResNet and DenseNet on the WikiArt dataset, reaching 91.52%, 90.49%, and 89.09% in accuracy, precision, and recall, respectively. This result validates the effectiveness of the PSA module in automatic classification of art styles. Future research directions may include incorporating more attention mechanisms to further improve the performance and generalization of the model.
Hopf Monoids of Ordered Simplicial Complexes
Authors: Castillo Federico , Martin Jeremy L , Samper José A
Published: August 2024

We study Hopf classes: families of pure ordered simplicial complexes that give rise to Hopf monoids under join and deletion/contraction. The prototypical Hopf class is the family of ordered matroids. The idea of a Hopf class leads to a systematic study of simplicial complexes related to matroids, including shifted complexes and broken-circuit complexes. We compute the Hopf antipodes in two cases: facet-initial complexes (which generalize shifted complexes) and unbounded ordered matroids. The latter calculation uses the topological method of Aguiar and Ardila, complicated by certain auxiliary simplicial complexes that we call Scrope complexes, whose Euler characteristics control the coefficients of the antipode. The resulting antipode formula is multiplicity-free and cancellation-free.
As Time Goes by: Action in the UN Security Council
Authors: Allen Susan Hannah , Yuen Amy T
Published: August 2024

When an armed conflict erupts, what determines how long it will take for the United Nations Security Council to act? As described in the UN Charter, numerous actors, including Council members, the Secretary General, other UN member states, and potentially even non-member states have, the ability to place items on the Security Council's agenda. No one, however, can force the Council to take action on a given item. Once an issue is introduced on the Council's agenda, how long does it take for the members to meet on the topic in informal consultations, which have minimal audience costs—either within the institution or with home constituencies—because there are no public records available regarding these meetings? How long until a formal meeting is held (for which a verbatim record will be available, thus increasing the political investment)? How long until a resolution is passed that obligates states on the Council as well as all UN member nations to take action? Using data on civil conflicts and Council behavior from 1993–2019, we consider the factors that influence the pace of international response, including the location of the conflict, the intensity of the conflict, the relationship between the conflictual country and the permanent members of the Council, and the relationship between the permanent members themselves. In our analysis, we find the pace of action is driven more by the characteristics of the conflict than the politics of the Council, which differs from existing research on agenda-setting, which finds the preferences of the Council are key drivers.
Effect of a bundle intervention on adherence to quality-of-care indicators and on clinical outcomes in patients with Staphylococcus aureus bacteraemia hospitalized in non-referral community hospitals
Authors: Escrihuela-Vidal Francesc , Chico Cristina , Borjabad González Beatriz , Vázquez Sánchez Daniel , Lérida Ana , De Blas Escudero Elisa , Sanmartí Montserrat , Linares González Laura , Simonetti Antonella F , Conde Ana Coloma , Muelas-Fernandez Magdalena , Diaz-Brito Vicens , Quintana Sara Gertrudis Horna , Oriol Isabel , Berbel Damaris , Càmara Jordi , Grillo Sara , Pujol Miquel , Cuervo Guillermo , Carratalà Jordi
Published: August 2024

Background

Although a significant number of cases of Staphylococcus aureus bacteraemia (SAB) are managed at non-referral community hospitals, the impact of a bundle-of-care intervention in this setting has not yet been explored.

Methods

We performed a quasi-experimental before–after study with the implementation of a bundle of care for the management of SAB at five non-referral community hospitals and a tertiary care university hospital. Structured recommendations for the five indicators selected to assess quality of care were provided to investigators before the implementation of the bundle and monthly thereafter. Primary endpoints were adherence to the bundle intervention and treatment failure, defined as death or relapse at 90 days of follow-up.

Results

One hundred and seventy patients were included in the pre-intervention period and 103 in the intervention period. Patient characteristics were similar in both periods. Multivariate analysis controlling for potential confounders showed that performance of echocardiography was the only factor associated with improved adherence to the bundle in the intervention period (adjusted OR 2.13; 95% CI 1.13–4.02). Adherence to the bundle, performance of follow-up blood cultures, and adequate duration of antibiotic therapy for complicated SAB presented non-significant improvements. The intervention was not associated with a lower rate of 90 day treatment failure (OR 1.11; 95% CI 0.70–1.77).

Conclusions

A bundle-of-care intervention for the management of SAB at non-referral community hospitals increased adherence to quality indicators, but did not significantly reduce rates of 90 day mortality or relapse.
A mixed animal and plant protein source replacing fishmeal affects bile acid metabolism and apoptosis in largemouth bass (Micropterus salmoides)
Authors: Chen Liutong , Qi Yu , Shi Menglin , Qu Kangyuan , Liu Yucheng , Tan Beiping , Xie Shiwei
Published: August 2024

Chicken meal, shrimp meal, blood meal, and soybean protein concentrate are common alternatives to fishmeal. This study used them to prepare three diets with different levels of fishmeal (FM48, FM40, and FM32) for largemouth bass (Micropterus salmoides). The results found no significant difference in the growth performance of largemouth bass fed different diets. Mixed protein increased the total cholesterol (T-CHO) content in plasma, and reduced the total superoxide dismutase (T-SOD) activity in plasma and liver. Targeted metabolomics analysis found that the low fishmeal diets affected the cholesterol and bile acid metabolism of largemouth bass. Mixed protein inhibited cyp7a1 and enhanced hmgcr and pparγ mRNA levels, as well as enhanced the expression levels of FXR in the liver. The fish-fed FM32 diet showed inhibited fxr, rxrα, and cyp7a1 mRNA levels in the intestine. The results of TUNEL fluorescence staining showed that mixed protein induced apoptosis in largemouth bass. The caspase 3 and caspase 9 mRNA levels in the fish-fed FM40 and FM32 diet significantly increased, as well as the expression levels of CASPASE 3. The experiment also found that it could induce oxidative stress and endoplasmic reticulum stress. In conclusion, the replacement of fishmeal with mixed animal and plant protein diets did not affect the growth performance, but the health and bile acid metabolism of largemouth bass was affected when the fishmeal level was reduced to 32%.
Comparison of different spectral ranges of UV-LED lighting for outdoor mosquito trapping in forested area in Thailand
Authors: Lhaosudto Suthat , Ngoen-Klan Ratchadawan , Meunworn Vithee , Kongmee Monthathip , Hii Jeffrey , Chareonviriyaphap Theeraphap
Published: August 2024

Mosquito surveillance is critical for actively tracking the location and monitoring population levels and the threat of mosquito-borne disease. Although light-emitting diodes (LEDs) light traps have grown in popularity, there is still a limited understanding of the application of light wavelengths for trapping nocturnally active wild mosquitoes in forest ecotypes. This study evaluated the performance of different UV wavelengths in trapping mosquito populations in a forested mountainous area in Nakhon Ratchasima province, Thailand. Traps with different UV wavelengths were deployed in 6 locations, following a 6 × 6 Latin square replicated 6 times over a total of 36 nights. Light traps were operated between 18:00 and 06:00 h from October 2022 to August 2023. Mosquitoes were separately collected from individual traps every 4 h at 22.00, 2.00, and 6.00 h. Mosquitoes were killed by placing in a freezer (− 20 °C) for at least 30 min and then were morphologically identified using illustrated keys for adult females. Traps fitted with the LED 365 wavelength light source were the most effective in capturing 790 (23.66%) of the total mosquitoes collected, followed by the UV fluorescent 632 (18.93%), with the other 4 LED wavelengths collecting between 16.89% (LED 385) and 12.64% (LED 375) of the mosquitoes. Culex was the most common genus, representing 56.00% of total mosquito abundance. LED 365 and LED 385 were comparable to the UV fluorescent traps (the standard reference). Optimal trapping times were during 18:00–22:00 h. Compared to the other wavelengths, LED 365 was significantly more effective at capturing Coquillettidia and Culex mosquitoes than the UV-based traps.
A Pilot Study of Minority, Beginning, and Young Logging Business Owners in the Carolinas and Surrounding States, USA
Authors: Khadka Shubhechchha , Hiesl Patrick , Timilsina Nilesh , Hagan Donald L , Conrad Joseph L
Published: August 2024

The logging industry in the United States faces a demographic shift with aging owners and a decline in intergenerational business transfers. This pilot study explores the potential for new businesses led by minority groups, beginning loggers, and young entrepreneurs in the southeastern United States. Interviews with nine minority, beginning, and young (MBY) logging business owners and four forestry/logging associations uncovered challenges, including high startup costs, limited access to financing and funds, difficulty hiring skilled workers, low profit margins, and a lack of established professional networks. These MBY loggers are well educated and exhibit productive businesses, with an average investment of between $100,000 and $499,999. Proposed solutions to help more MBY logging business owners get started encompass government grants, low-interest loans, marketing initiatives, and legislative measures. Results are limited, and this study serves as a first glimpse into MBY logging business owners’ challenges; additional attention is needed for this population of logging business owners.

Study Implications: Understanding the present status and challenges faced by minority, beginning, and young (MBY) logging business owners is instrumental for the industry, as the trend of intergenerational logging business transfer is declining. The study’s results suggest that support from the forest products industry and the government, such as government grants, low-interest loans, and strategic marketing, can enhance the sustainability of MBY logging businesses. These measures, coupled with legislative support, could help to address immediate challenges, such as high startup costs, and lay the groundwork for fostering a resilient logging industry.
Are shade tolerance and canopy gradient affecting twig-leaf trait scaling relationships in temperate forests?
Authors: Zeng Tao , Fan Hongkun , Jin Guangze , Liu Zhili
Published: August 2024

Scaling relationships among twig size, leaf size and leafing intensity is pivotal in understanding plant resource allocation and carbon investment strategies. However, it remained unclear how these relationships might maintain stability across genetic traits (shade tolerance) and canopy gradients (microclimates). We investigated eight different shade-tolerant tree species within five mixed broad-leaved-Korean pine (Pinus koraiensis) forests in Northeast China. Employing linear mixed-effects models and phylogenetically independent contrasts, we examined the scaling relationships between twig-leaf size and leafing intensity. Shade tolerance altered the scaling relationships between twig and leaf size, as well as leafing intensity. We discovered that the scaling relationships between twig cross-sectional area and individual leaf area, leafing intensity and between individual leaf mass and leafing intensity were allometric (slope ≠ −1 or 1). However, the relationship between individual leaf area and individual leaf mass was isometric (slope = 1). Moreover, these scaling relationships exhibited consistent trends across canopy gradients, with shade tolerance playing a critical role in the coordinated evolution of twigs and leaves across these gradients. These results emphasized the significant role of shade tolerance in coordinating the covariation patterns between plant leaves and twigs, adopting conservative strategies in heterogeneous microclimates.
The Utilization of Echocardiography in Children With Staphylococcus aureus Bacteremia
Authors: Bui Richard , Sommer Lauren M , Walther Meghan , Hulten Kristina G , Vallejo Jesus G , Kaplan Sheldon L , McNeil J Chase
Published: August 2024

The need for echocardiography in pediatric Staphylococcus aureus bacteremia (SAB) remains uncertain. We reviewed 331 pediatric SAB cases. Nine subjects, all with comorbidities, met the echocardiogram criteria for infective endocarditis (IE). IE was associated with congenital heart disease and prolonged bacteremia, suggesting that echocardiography is unnecessary in most children with SAB.
Understanding acute chyloperitoneum in appendicitis: case report and literature review
Authors: Bazuhair Abdulaziz A , AlSubeai Hessa S , AlKhardawi Sarah H , AlKhlaiwy Omar Y , Alkhums Khaldoon A
Published: August 2024

Chyloperitoneum is the presence of chyle in the peritoneal cavity. This study focuses on acute chyloperitoneum, a rare condition with an unclear incidence due to limited number of reported cases in the literature. Here, we present a 24-year-old Saudi female with chyloperitoneum diagnosed intraoperatively during a laparoscopic appendectomy for acute appendicitis that was managed successfully with a low-fat diet and drainage, alongside a literature review to elucidate the condition’s pathophysiology and therapeutic strategies. A conservative management approach is recommended for acute chyloperitoneum in the context of appendicitis, this includes intraperitoneal drainage, appendectomy when needed, and careful observation. Our proposed management strategy aligns with findings from the literature review and supports conservative management as a safe and effective treatment modality for this rare condition.
‘Nowhere home’
Authors: Zeffert Henrietta
Published: August 2024

The war in Gaza is killing home. Some are asking whether domicide should be a crime. But is there more at stake? This essay explores the concept of home in international law, the role of international law in the global regime of homemaking, and the prospects and limits of criminalising the destruction of home.
A Quantitative Computational Framework for Allopolyploid Single-Cell Data Integration and Core Gene Ranking in Development
Authors: Wang Meiyue , Li Zijuan , Wang Haoyu , Zhao Junwei , Zhang Yuyun , Lin Kande , Zheng Shusong , Feng Yilong , Zhang Yu'e , Teng Wan , Tong Yiping , Zhang Wenli , Xue Yongbiao , Mao Hude , Li Hao , Zhang Bo , Rasheed Awais , Bhavani Sridhar , Liu Chenghong , Ling Hong-Qing , Hu Yue-Qing , Zhang Yijing
Published: August 2024

Polyploidization drives regulatory and phenotypic innovation. How the merger of different genomes contributes to polyploid development is a fundamental issue in evolutionary developmental biology and breeding research. Clarifying this issue is challenging because of genome complexity and the difficulty in tracking stochastic subgenome divergence during development. Recent single-cell sequencing techniques enabled probing subgenome-divergent regulation in the context of cellular differentiation. However, analyzing single-cell data suffers from high error rates due to high dimensionality, noise, and sparsity, and the errors stack up in polyploid analysis due to the increased dimensionality of comparisons between subgenomes of each cell, hindering deeper mechanistic understandings. In this study, we develop a quantitative computational framework, called “pseudo-genome divergence quantification” (pgDQ), for quantifying and tracking subgenome divergence directly at the cellular level. Further comparing with cellular differentiation trajectories derived from single-cell RNA sequencing data allows for an examination of the relationship between subgenome divergence and the progression of development. pgDQ produces robust results and is insensitive to data dropout and noise, avoiding high error rates due to multiple comparisons of genes, cells, and subgenomes. A statistical diagnostic approach is proposed to identify genes that are central to subgenome divergence during development, which facilitates the integration of different data modalities, enabling the identification of factors and pathways that mediate subgenome-divergent activity during development. Case studies have demonstrated that applying pgDQ to single-cell and bulk tissue transcriptomic data promotes a systematic and deeper understanding of how dynamic subgenome divergence contributes to developmental trajectories in polyploid evolution.
Multimodal deep learning improves recurrence risk prediction in pediatric low-grade gliomas
Authors: Mahootiha Maryamalsadat , Tak Divyanshu , Ye Zezhong , Zapaishchykova Anna , Likitlersuang Jirapat , Climent Pardo Juan Carlos , Boyd Aidan , Vajapeyam Sridhar , Chopra Rishi , Prabhu Sanjay P , Liu Kevin X , Elhalawani Hesham , Nabavizadeh Ali , Familiar Ariana , Mueller Sabine , Aerts Hugo J W L , Bandopadhayay Pratiti , Ligon Keith L , Haas-Kogan Daphne , Poussaint Tina Y , Qadir Hemin Ali , Balasingham Ilangko , Kann Benjamin H
Published: August 2024

Background

Postoperative recurrence risk for pediatric low-grade gliomas (pLGGs) is challenging to predict by conventional clinical, radiographic, and genomic factors. We investigated if deep learning (DL) of magnetic resonance imaging (MRI) tumor features could improve postoperative pLGG risk stratification.

Methods

We used a pretrained DL tool designed for pLGG segmentation to extract pLGG imaging features from preoperative T2-weighted MRI from patients who underwent surgery (DL-MRI features). Patients were pooled from 2 institutions: Dana Farber/Boston Children’s Hospital (DF/BCH) and the Children’s Brain Tumor Network (CBTN). We trained 3 DL logistic hazard models to predict postoperative event-free survival (EFS) probabilities with (1) clinical features, (2) DL-MRI features, and (3) multimodal (clinical and DL-MRI features). We evaluated the models with a time-dependent Concordance Index (Ctd) and risk group stratification with Kaplan–Meier plots and log-rank tests. We developed an automated pipeline integrating pLGG segmentation and EFS prediction with the best model.

Results

Of the 396 patients analyzed (median follow-up: 85 months, range: 1.5–329 months), 214 (54%) underwent gross total resection and 110 (28%) recurred. The multimodal model improved EFS prediction compared to the DL-MRI and clinical models (Ctd: 0.85 (95% CI: 0.81–0.93), 0.79 (95% CI: 0.70–0.88), and 0.72 (95% CI: 0.57–0.77), respectively). The multimodal model improved risk-group stratification (3-year EFS for predicted high-risk: 31% versus low-risk: 92%, P < .0001).

Conclusions

DL extracts imaging features that can inform postoperative recurrence prediction for pLGG. Multimodal DL improves postoperative risk stratification for pLGG and may guide postoperative decision-making. Larger, multicenter training data may be needed to improve model generalizability.
Freedom of speech on campus
Authors: Marcoci Alexandru , Oprea Alexandra
Published: August 2024

What should be the rules governing campus speech in a liberal democratic society? On one side are those arguing for maximal protections for campus speech analogous to the First Amendment in the United States. On the other are those promoting stricter regulation of speech through formal and informal speech codes. This paper aims to carve a new path in the conversation. Both sides agree that the mission of the university is the discovery and dissemination of knowledge and that achieving this mission requires tolerant and open-minded students, faculty, and administrators. However, neither side has explicitly connected its advocacy for specific speech policies with these shared goals. Our paper advances the conversation by proposing a series of empirically testable mechanisms for connecting speech policies to the desired outcomes. We also argue that focusing on these mechanisms opens the way towards new and more tractable conceptual and normative debates.
Biomarkers for Psychosis: Are We There Yet? Umbrella Review of 1478 Biomarkers
Authors: Fuentes-Claramonte Paola , Estradé Andrés , Solanes Aleix , Ramella-Cravaro Valentina , Garcia-Leon Maria Angeles , de Diego-Adeliño Javier , Molins Conrad , Fung Eric , Valentí Marc , Anmella Gerard , Pomarol-Clotet Edith , Oliver Dominic , Vieta Eduard , Radua Joaquim , Fusar-Poli Paolo
Published: August 2024

Background and Hypothesis

This umbrella review aims to comprehensively synthesize the evidence of association between peripheral, electrophysiological, neuroimaging, neuropathological, and other biomarkers and diagnosis of psychotic disorders.

Study Design

We selected systematic reviews and meta-analyses of observational studies on diagnostic biomarkers for psychotic disorders, published until February 1, 2018. Data extraction was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Evidence of association between biomarkers and psychotic disorders was classified as convincing, highly suggestive, suggestive, weak, or non-significant, using a standardized classification. Quality analyses used the Assessment of Multiple Systematic Reviews (AMSTAR) tool.

Study Results

The umbrella review included 110 meta-analyses or systematic reviews corresponding to 3892 individual studies, 1478 biomarkers, and 392 210 participants. No factor showed a convincing level of evidence. Highly suggestive evidence was observed for transglutaminase autoantibodies levels (odds ratio [OR] = 7.32; 95% CI: 3.36, 15.94), mismatch negativity in auditory event-related potentials (standardized mean difference [SMD] = 0.73; 95% CI: 0.5, 0.96), P300 component latency (SMD = −0.6; 95% CI: −0.83, −0.38), ventricle-brain ratio (SMD = 0.61; 95% CI: 0.5, 0.71), and minor physical anomalies (SMD = 0.99; 95% CI: 0.64, 1.34). Suggestive evidence was observed for folate, malondialdehyde, brain-derived neurotrophic factor, homocysteine, P50 sensory gating (P50 S2/S1 ratio), frontal N-acetyl-aspartate, and high-frequency heart rate variability. Among the remaining biomarkers, weak evidence was found for 626 and a non-significant association for 833 factors.

Conclusions

While several biomarkers present highly suggestive or suggestive evidence of association with psychotic disorders, methodological biases, and underpowered studies call for future higher-quality research.
Exposure to prenatal excess or imbalanced micronutrients leads to long‐term perturbations in one‐carbon metabolism, trimethylamine‐N‐oxide and DNA methylation in Wistar rat offspring
Authors: Shelp Gia V. , Dong Jianzhang , Orlov Nikolai O. , Malysheva Olga V. , Bender Erica , Shoveller Anna K. , Bakovic Marica , Cho Clara E.
Published: August 2024

Prenatal multivitamins, including folic acid, are commonly consumed in excess, whereas choline, an essential nutrient and an important source of labile methyl groups, is underconsumed. Here, we characterized profiles of one‐carbon metabolism and related pathways and patterns of DNA methylation in offspring exposed to excess or imbalanced micronutrients prenatally. Pregnant Wistar rats were fed either recommended 1× vitamins (RV), high 10× vitamins (HV), high 10× folic acid with recommended choline (HFolRC), or high 10× folic acid with no choline (HFolNC). Offspring were weaned to a high‐fat diet for 12 weeks. Circulating metabolites were analyzed with a focus on the hypothalamus, an area known to be under epigenetic regulation. HV, HFolRC, and HFolNC males had higher body weight (BW) and lower plasma choline and methionine consistent with lower hypothalamic S‐adenosylmethionine (SAM):S‐adenosylhomocysteine (SAH) and global DNA methylation compared with RV. HV and HFolNC females had higher BW and lower plasma 5‐methyltetrahydrofolate and methionine consistent with lower hypothalamic global DNA methylation compared with RV. Plasma dimethylglycine (DMG) and methionine were higher as with hypothalamic SAM:SAH and global DNA methylation in HFolRC females without changes in BW compared with RV. Plasma trimethylamine and trimethylamine‐N‐oxide were higher in males but lower in females from HFolRC compared with RV. Network modeling revealed a link between the folate‐dependent pathway and SAH, with most connections through DMG. Final BW was negatively correlated with choline, DMG, and global DNA methylation. In conclusion, prenatal intake of excess or imbalanced micronutrients induces distinct metabolic and epigenetic perturbations in offspring that reflect long‐term nutritional programming of health.
Real-world evidence of allergen immunotherapy
Authors: Buta Federica , Paoletti Giovanni , Bragato Maria Chiara , Giovannini Mattia , Canonica Giorgio Walter , Heffler Enrico
Published: August 2024

Purpose of review

The full understanding of the long-term effectiveness and safety of allergen immunotherapy (AIT) for allergic respiratory diseases cannot be achieved through randomized controlled trials (RCTs) alone. However, real-world studies designed as registries can complement RCTs.

Recent findings

The significance of registries is highlighted by their potential to reassess contraindications and collect data on adult and pediatric patients with multiple comorbidities who are often excluded from RCTs.

AIT is the sole disease-modifying therapeutic approach capable of inducing tolerance and offering a long-term response to allergens. AIT has been shown to play a role in arresting the ‘allergic march’ in young people, which reduces the risk of developing asthmatic clinical manifestations. Although RCTs are considered the gold standard for evaluating the efficacy and safety of AIT, their duration is usually too short (seldom lasting more than 1 year) to assess the long-term effects of AIT. Several long-term studies show that AIT's effect depends strongly on its use duration.
Body Mass Index Changes Among Adolescents and Young Adults Using the Etonogestrel Contraceptive Implant
Authors: Wernick Hunter J. , Abdel-Rasoul Mahmoud , Berlan Elise D. , Bonny Andrea E.
Published: August 2024

OBJECTIVE:

To evaluate body mass index (BMI) over 36 months among adolescents and young adults using the etonogestrel implant compared with those using depot medroxyprogesterone acetate (DMPA) and a control group.

METHODS:

We conducted a retrospective longitudinal cohort study of postmenarchal adolescents and young adults assigned female at birth. The etonogestrel implant and DMPA groups initiated etonogestrel or DMPA between January 1, 2010, and December 31, 2017. Adolescents and young adults in the control group were prescribed a weight-neutral contraceptive or no contraceptive during the same timeframe. The primary outcome of BMI over time was estimated and compared between study groups with inverse probability of treatment weighting linear mixed-effects modeling. Changes in BMI weight category (underweight or normal weight, overweight, obesity) at 12, 24, and 36 months were also explored.

RESULTS:

Among the 20,409 eligible patients, 860 initiated etonogestrel, 1,817 initiated DMPA, and 17,732 made up the control group. Compared with individuals in the control group, those in the etonogestrel group had a significantly higher mean BMI difference at 9 months (+0.5, P<.01); at 36 months, the mean BMI difference was +1.0 (P<.01). Compared with individuals in the control group, those in the DMPA group had higher mean BMI at 6 months (+0.3, P<.01); at 36 months, the mean BMI difference was +1.3 (P<.01). Regardless of weight changes, increases in BMI weight categories were rare in all groups.

CONCLUSION:

Adolescent and young adult patients who initiated the etonogestrel implant demonstrated BMI changes like those on DMPA and higher than control patients; however, these differences may not be clinically concerning. This study provides important information that can help in counseling adolescent and young adult patients about expectations when starting and using etonogestrel.
A Comparison of ChatGPT and Expert Consensus Statements on Surgical Site Infection Prevention in High-Risk Paediatric Spine Surgery
Authors: Chester Aaron N. , Mandler Shay I.
Published: August 2024

Background:

Artificial intelligence (AI) represents and exciting shift for orthopaedic surgery, where its role is rapidly evolving. ChatGPT is an AI language model which is preeminent among those leading the mass consumer uptake of AI. Artamonov and colleagues compared ChatGPT with orthopaedic surgeons when considering the diagnosis and management of anterior shoulder instability; they found a limited correlation between them. This study aims to further explore how reliable ChatGPT is compared with orthopaedic surgeons.

Methods:

Twenty-three statements were extracted from the article “Building Consensus: Development of a Best Practice Guideline (BPG) for Surgical Site Infection (SSI) Prevention in High-risk Pediatric Spine Surgery” by Vitale and colleagues. These included 14 consensus statements and an additional 9 statements that did not reach consensus. ChatGPT was asked to state the extent to which it agreed with each statement.

Results:

ChatGPT appeared to demonstrate a fair correlation with most expert responses to the 14 consensus statements. It appeared less emphatic than the experts, often stating that it “agreed” with a statement, where the most frequent response from experts was “strongly agree.” It reached the opposite conclusion to the majority of experts on a single consensus statement regarding the use of ultraviolet light in the operating theatre; it may have been that ChatGPT was drawing from more up to date literature that was published subsequent to the consensus statement.

Conclusions:

This study demonstrated a reasonable correlation between ChatGPT and orthopaedic surgeons when providing simple responses. ChatGPT’s function may be limited when asked to provide more complex answers. This study adds to a growing body of discussion and evidence exploring AI and whether its function is reliable enough to enter the high-accountability world of health care.

Clinical Relevance:

This article is of high clinical relevance to orthopaedic surgery given the rapidly emerging applications of AI. This creates a need to understand the level to which AI can function in the clinical setting and the risks that would entail.
SCOPING: A Pilot Study Exploring the Role of A Series of Clinical Observational Parameters as Indicators of Nerve Regeneration
Authors: Beale Suzanne , Duraku Liron S. , McGhee Christopher C.G. , van der Oest Mark , Rotem Gilad , Power Dominic M.
Published: August 2024

Background:

Following the repair of a mixed peripheral nerve, functional recovery requires successful nerve regeneration across the repair site and, eventually, reinnervation of distal targets. Reliably determining a failing nerve repair so that revision may be performed before irreversible muscle atrophy remains a challenge in peripheral nerve surgery. This study aimed to ascertain whether any commonly used clinical examination tests during surveillance after nerve repair can detect a failing repair and prompt earlier salvage intervention.

Methods:

A prospective observational cohort study was performed to evaluate commonly used clinical determinants of neuron regeneration that may provide early surrogate recovery measures. Sequential cutaneous thermography was used to identify temperature differences between denervated and normal skin in the hand operated on, with the contralateral hand as a control.

Results:

Six out of nine patients completed between 6 and 18 months of follow-up. Tinel sign progression was observed in all subjects. Tinel progression rate was associated with motor and sensory Medical Research Council grade. The delta temperature was calculated to document the size and direction of any temperature differentials in the hand detected by thermography, but we did not have sufficient data to calculate any correlations with motor and sensory Medical Research Council grade.

Conclusions:

Specifically, the progression of Tinel sign is associated with recovery measured by progression of the British Medical Research Council motor and sensory grades. The use of thermographic imaging demonstrates that there is a difference in temperature between an injured and noninjured nerve. Future studies could investigate to what extent thermographic imaging predicts final nerve repair outcomes.
U=U: “Undetectable Equals Untransmittable” Perceptions Among Men Who Have Sex With Men Active Duty Service Members: A Cross-Sectional Study
Authors: Campbell Jessica T. , Gesselman Amanda N. , Staten M. Colten , Carter Gregory
Published: August 2024

Undetectable = Untransmittable (U=U) is a key message emphasizing that antiretroviral therapy suppresses HIV and prevents its sexual transmission. However, dissemination of U=U varies among health care providers, potentially leading to knowledge gaps among patients. Little research exists on the understanding of U=U among active duty men who have sex with men (MSM) in the U.S. military. Our cross-sectional, online study examines 222 active duty MSM to determine prevalence of accurate knowledge of U=U and demographic predictors of misinformation. Participants received a pre-exposure prophylaxis (PrEP) overview and were asked to indicate if the statement “Undetectable equals Untransmittable” was true or false. Although the majority accurately understood U=U (70%; n = 156), approximately 30% did not (n = 66); a binary logistic regression revealed lower U=U understanding among White, bisexual, unmarried, and Marines/Navy participants. Standardized education on U=U is crucial for resolving knowledge gaps and combating stigmas surrounding HIV treatment.
Critical Lower-Limb Ischemia and Arterial Thrombosis Following Intraarticular Corticosteroid Injection of the Knee
Authors: Evans Hamish , Ogunsanya Ngozi , Yii Ming , Bell Roger
Published: August 2024

We present a case of acute lower-limb arterial thrombosis following intra-articular steroid injection into the knee of a previously fit and active 41-year-old man. Symptoms of acute limb ischemia developed within 24 hours of treatment. Objective assessment with ultrasound arterial duplex and CT angiogram of the lower limb confirmed acute thrombosis of the popliteal artery in the treated leg. Although there is documented evidence of the association between steroid therapy and venous thromboembolic phenomena, there are no cases of arterial thrombosis in the literature. The temporal series of events that we report strongly suggest an association between the corticosteroid injection and the acute thrombotic event, the mechanism of which remains unclear. The patient underwent successful revascularization. It is important to document and disseminate this seemingly rare complication of a commonly associated procedure to increase awareness, invoke caution, and invite others to share similar cases.
The impact of hemoadsorption on antimicrobials
Authors: Furukawa Taku , Lankadeva Yugeesh , Bellomo Rinaldo
Published: August 2024

Hemoadsorption (HA) is used for supportive blood purification therapy for conditions such as sepsis and immunological diseases. However, it may cause unintentional removal of antimicrobial drugs, potentially offsetting its therapeutic benefits. This review provides an overview of the impact of HA on the clearance of antimicrobials. We reviewed in vitro and in vivo studies on antimicrobial drug removal by HA. Current evidence suggests that HA can significantly affect the clearance of antimicrobials. However, the adsorptive clearance varies widely across different drugs and sorbents, and these interactions cannot be predicted based on molecular weight or characteristics. Drug removal by HA typically decreases over time. Also, the impact of HA on overall clearances is likely highly heterogeneous, depending on the sorbents used, patient, and the intervention applied. Some clinical studies, though limited, suggests the necessity of dose adjustments during HA. Clinicians need to understand these effects and appreciate their magnitude to deliver optimal care. Further investigation is required to provide comprehensive information for dosing, timing, and monitoring strategies during HA.
Optimal timing of revascularization for patients with non-ST segment elevation myocardial infarction and severe left ventricular dysfunction
Authors: Shin Yoonmin , Lee Seung Hun , Lee Sang Hoon , Kim Ji Sung , Lim Yong Hwan , Ahn Joon Ho , Cho Kyung Hoon , Kim Min Chul , Sim Doo Sun , Hong Young Joon , Kim Ju Han , Hwang Jin-Yong , Oh Seok Kyu , Song Pil Sang , Park Yong Hwan , Hur Seung-Ho , Yoon Chang-Hwan , Lee Joo Myung , Song Young Bin , Hahn Joo-Yong , Jeong Myung Ho , Ahn Yongkeun ,   KAMIR-V Investigators
Published: August 2024

Optimal timing of revascularization for patients who presented with non-ST segment elevation myocardial infarction (NSTEMI) and severe left ventricular (LV) dysfunction is unclear. A total of 386 NSTEMI patients with severe LV dysfunction from the nationwide, multicenter, and prospective Korea Acute Myocardial Infarction Registry V (KAMIR-V) were enrolled. Severe LV dysfunction was defined as LV ejection fraction ≤ 35%. Patients with cardiogenic shock were excluded. Patients were stratified into two groups: PCI within 24 hours (early invasive group) and PCI over 24 hours (selective invasive group). Primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) including all-cause death, non-fatal MI, repeat revascularization, and stroke at 12 months after index procedure. Early invasive group showed higher incidence of in-hospital death (9.4% vs 3.3%, P = .036) and cardiogenic shock (11.5% vs 4.6%, P = .030) after PCI. Early invasive group also showed higher maximum troponin I level during admission (27.7 ± 44.8 ng/mL vs 14.9 ± 24.6 ng/mL, P = .001), compared with the selective invasive group. Early invasive group had an increased risk of 12-month MACCE, compared with selective invasive group (25.6% vs 17.1%; adjusted HR = 2.10, 95% CI 1.17–3.77, P = .006). Among NSTEMI patients with severe LV dysfunction, the early invasive strategy did not improve the clinical outcomes. This data supports that an individualized approach may benefit high-risk NSTEMI patients rather than a routine invasive approach.
Correlative expression of exosomal miRNAs in chemotherapy resistance of triple-negative breast cancer: An observational study
Authors: Yang Le , Fan Jingjing , Dong Chao , Wang Xiaoli , Ma Binlin
Published: August 2024

Drug resistance in tumors is the primary contributor to clinical treatment failures, and aberrant expression of small RNA molecules, specifically microRNAs (miRNAs), in tumor tissues is intricately associated with drug resistance. The aim of this study is to investigate the targets and mechanisms through which exosomal miRNAs from triple-negative breast cancer (TNBC) regulate chemotherapy resistance in tumor cells. Utilizing high-throughput sequencing technology, we conducted exosomal miRNA sequencing on serum samples obtained from TNBC patients who were either sensitive or resistant to AC-sequential T chemotherapy. Subsequently, we identified and screened differentially expressed miRNAs. The observed differences in miRNA expression were further validated through quantitative reverse transcription-polymerase chain reaction. In comparison to TNBC patients who exhibited sensitivity to the AC-sequential T regimen chemotherapy, we identified significant differences in the expression of 85 miRNAs within serum exosomes of patients displaying chemotherapy resistance. Furthermore, we observed a substantial difference in the expression of hsa-miR-6831-5p between TNBC patients who were responsive to chemotherapy and those who were drug-resistant and underwent treatment with the AC-sequential T regimen. hsa-miR-6831-5p holds the potential to serve as a diagnostic marker for assessing the chemosensitivity of the AC-sequential T regimen in TNBC.