bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effectiveness of Dialectical Behavior Therapy Compared to Schema Therapy for Borderline Personality Disorder: A Randomized Clinical Trial
Authors: Assmann Nele , Schaich Anja , Arntz Arnoud , Wagner Till , Herzog Philipp , Alvarez-Fischer Daniel , Sipos Valerija , Jauch-Chara Kamila , Klein Jan Philipp , Hüppe Michael , Schweiger Ulrich , Fassbinder Eva
Published: July 2024

Introduction: In the treatment of borderline personality disorder (BPD), there is empirical support for both dialectical behavior therapy (DBT) and schema therapy (ST); these treatments have never been compared directly. This study examines whether either of them is more effective than the other in treating patients with BPD. Methods: In this randomized, parallel-group, rater-blind clinical trial, outpatients aged between 18 and 65 years with a primary diagnosis of BPD were recruited in a tertiary outpatient treatment center (Lübeck, Germany). Participants were randomized to DBT or ST with one individual and one group session per week over 1.5 years. The primary outcome was the BPD symptom severity assessed with the mean score of the Borderline Personality Disorder Severity Index at 1-year naturalistic follow-up. Results: Between November 26, 2014, and December 14, 2018, we enrolled 164 patients (mean age = 33.7 [SD = 10.61] years). Of these, 81 (49.4%) were treated with ST and 83 (50.6%) with DBT, overall, 130 (79.3%) were female. Intention-to-treat analysis with generalized linear mixed models did not show a significant difference at 1-year naturalistic follow-up between DBT and ST for the BPDSI total score (mean difference 3.32 [95% CI: –0.58–7.22], p = 0.094, d = −24 [–0.69; 0.20]) with lower scores for DBT. Pre-to-follow-up effect sizes were large in both groups (DBT: d = 2.45 [1.88–3.02], ST: d = 1.78 [1.26–2.29]). Conclusion: Patients in both treatment groups showed substantial improvements indicating that even severely affected patients with BPD and various comorbid disorders can be treated successfully with DBT and ST. An additional non-inferiority trial is needed to show if both treatments are equally effective. The trial was retrospectively registered on the German Clinical Trials Register, DRKS00011534 without protocol changes.
The Glutamatergic Effects of Clinical Repetitive Transcranial Magnetic Stimulation in Depressed Populations: A Preliminary Meta-Analysis of Proton Magnetic Resonance Spectroscopy Studies
Authors: Pecsok Maggie K. , Mordy Arianna , Cristancho Mario A. , Oathes Desmond , Roalf David R.
Published: July 2024

Introduction: Repetitive transcranial magnetic stimulation (rTMS) alleviates symptoms of major depressive disorder, but its neurobiological mechanisms remain to be fully understood. Growing evidence from proton magnetic resonance spectroscopy (1HMRS) studies suggests that rTMS alters excitatory and inhibitory neurometabolites. This preliminary meta-analysis aims to quantify current trends in the literature and identify future directions for the field. Methods: Ten eligible studies that quantified Glutamate (Glu), Glu+Glutamine (Glx), or GABA before and after an rTMS intervention in depressed samples were sourced from PubMed, MEDLINE, PsychInfo, Google Scholar, and primary literature following PRISMA guidelines. Data were pooled using a random-effects model, Cohen’s d effect sizes were calculated, and moderators, such as neurometabolite and 1HMRS sequence, were assessed. It was hypothesized that rTMS would increase cortical neurometabolites. Results: Within-subjects data from 224 cases encompassing 31 neurometabolite effects (k) were analyzed. Active rTMS in clinical responders (n = 128; k = 22) nominally increased glutamatergic neurometabolites (d = 0.15 [95% CI: −0.01, 0.30], p = 0.06). No change was found in clinical nonresponders (p = 0.8) or sham rTMS participants (p = 0.4). A significant increase was identified in Glx (p = 0.01), but not Glu (p = 0.6). Importantly, effect size across conditions were associated with the number of rTMS pulses patients received (p = 0.05), suggesting dose dependence. Conclusions: Clinical rTMS is associated with a nominal, dose-dependent increase in glutamatergic neurometabolites, suggesting rTMS may induce Glu-dependent neuroplasticity and upregulate neurometabolism. More, larger scale studies adhering to established acquisition and reporting standards are needed to further elucidate the neurometabolic mechanisms of rTMS.
Is It Possible to Predict Systemic Adverse Effects in Subcutaneous Allergen Immunotherapy? Single-Center Experience
Authors: Bulbul Lida , Nursoy Mustafa Atilla
Published: July 2024

Introduction: Subcutaneous immunotherapy (SCIT) is the oldest and an efficient immunotherapy method that has been used for the treatment of allergic diseases. Systemic adverse effects (SAEs) may occur during the SCIT. For this reason, there may be problems in the continuing treatment. In this study, we primarily aimed to determine the frequency of SAEs, the risk factors that may be associated with SAEs, and clinical and laboratory parameters that can predict systemic reactions in the patients who underwent SCIT. Second, we aimed to evaluate the reasons for discontinuing SCIT and the conditions special to Turkey. Methods: The files of 295 patients who had received SCIT were evaluated retrospectively. Results: SCIT was administered against house dust mites (HDM) in almost all patients (n: 291, 98.6%). A total of 14,357 injections were administered to 295 patients included in the study, and 47.8% (n: 141) of the patients discontinued treatment. The most common reason for discontinuing treatment was the supply problem in Turkey for immunotherapy preparations (n: 70, 49.6%). The second reason was that the injection visits were not continued regularly, even though there were no adverse effects related to the treatment (n: 44, 31.2%). SAEs were observed in 16.6% of the patients and 0.66% of the injections. SAEs were more frequent in girls, in asthmatic patients, and in moderate asthmatic patients (p = 0.005, p = 0.016, p = 0.043, respectively). Treatment was terminated in 13 patients (4.4%) due to SAEs. The most common SAE was bronchoconstriction (n: 40, 85.1%). None of our patients developed hypotension or loss of consciousness. Median blood eosinophil count and basophil count and the skin prick test diameter for Dermatophagoides farinae were observed to be significantly higher in the group with SAE (p = 0.024, p = 0.034, p = 0.045, respectively). Conclusion: Although SAE may develop in pediatric patients undergoing HDM-specific SCIT, severe reactions are rare. Girls, asthmatic patients, especially moderate asthmatic patients, and patients with high blood eosinophil and basophil levels should be monitored more carefully for the development of SAE.
Association of Nail Psoriasis with Metabolic Syndrome: A Cross-Sectional Study
Authors: Bhoi Anil Kumar , Grover Chander , Singal Archana , Kashyap Bineeta , Dibyashree D.
Published: July 2024

Introduction: Metabolic syndrome is a forerunner for adverse cardiovascular events. Its association with nail psoriasis has not been much explored. We conducted a cross-sectional study to investigate metabolic syndrome in patients with nail psoriasis as compared to psoriasis patients without nail involvement and healthy controls. Materials and Methods: Thirty each adult participants with nail psoriasis (group-I), psoriasis without nail involvement (group-II) and healthy controls (group-III) were recruited. All participants were assessed for metabolic syndrome as per National Cholesterol Education Program-Adult Treatment Plan-III (NCEP-ATP-III) criteria. Disease severity assessment and serological assessment of high-sensitivity C-reactive protein (hsCRP) level was done. Results: Higher prevalence of metabolic syndrome was found in group-I compared to group-III (33.33 vs. 20%, p = 0.420) with equal prevalence in group-I and group-II. Significantly higher prevalence of hypertension was seen in group-I and group-II (p = 0.036) as compared to group-III. Mean serum hsCRP was significantly higher for group-I as compared to group-II (p = 0.027) and group-III (p = 0.001). Weak positive correlation was seen between hsCRP levels and PASI and NAPSI scores. Conclusions: Frequency of metabolic syndrome is similar in nail psoriasis patients and psoriasis patients without nail involvement. However, higher hsCRP levels with nail psoriasis may reflect increased risk of cardiovascular comorbidities. A baseline screening with correction of modifiable risk factors should be aimed at in patients with nail psoriasis.
Less Invasive Surfactant Administration in Preterm Infants in Tertiary Neonatal Intensive Care Units in Germany: A Survey
Authors: Maiwald Christian A. , Franz Axel R. , Poets Christian F. , Springer Laila ,   LISA-Survey-Team Germany
Published: July 2024

Introduction: The European guideline for treatment of respiratory distress syndrome recommends less invasive surfactant administration (LISA) as the preferred method of surfactant administration in spontaneously breathing preterm infants. However, there is limited evidence on practical aspects such as sedation and catheter types, leading to considerable variability between centers. Methods: An anonymous online survey (www.soscisurvey.de) was sent to 164 tertiary neonatal intensive care units (NICUs) in Germany including 43 questions on practical aspects of LISA. Results: Of 122 (74%) participating NICUs, 117 (96%) reported experience with LISA with 82% of those reporting LISA as their preferred method of surfactant administration. Indications for surfactant administration differed widely between NICUs. Most (89%) used FiO2-thresholds only or in combination with other criteria, such as Silverman score/signs of dyspnea (41%) or lung ultrasound findings (3%). Prophylactic surfactant was administered by 42%. Differences in use of LISA in extremely immature infants were reported (e.g., 36% did not perform LISA in infants below 24–26 weeks). Preferred drugs for sedation were (Es-)Ketamine, followed by Propofol and Midazolam. Minimum time interval between subsequent LISA procedures was 4 (2–6) h. Catheters specifically designed for LISA were used by most NICUs (69%). Conclusion: This survey shows that LISA is common practice in German NICUs, but with considerable variability in practical aspects. These data may serve as a guidance for NICUs that have not yet implemented LISA and might be helpful design clinical trials with the aim to standardize and/or optimize LISA.
Assessing the Acceptability and Effectiveness of a Novel Therapeutic Footwear in Reducing Foot Pain and Improving Function among Older Adults: A Crossover Randomized Controlled Trial
Authors: Finco MG , Ouattas Abderrahman , El-Refaei Nesreen , Momin Anmol Salim , Azarian Mehrnaz , Najafi Bijan
Published: July 2024

Introduction: Nearly, a quarter of older adults suffer from frequent foot pain, impacting their quality of life. While proper footwear can alleviate this, design issues often hinder regular use. This study evaluated novel therapeutic footwear, designed for aesthetics and custom fit, to reduce foot pain. We hypothesized that older adults would experience less foot pain and favor the new footwear over their own. Methods: This 12-week crossover randomized controlled trial evaluated the effectiveness of OrthoFeet therapeutic footwear on reducing foot pain in older adults (n = 50, age = 65 ± 5, 18% male) with moderate to severe pain. Participants were assigned to either the AB or BA sequence. In AB, they wore OrthoFeet shoes for 6 weeks and then their own shoes for another 6 weeks; BA followed the reverse order. Pain and function were measured using the Foot Function Index. Acceptability was assessed through a technology acceptance model (TAM) questionnaire. Data collected at baseline, six, and 12 weeks were analyzed using t tests, χ2 tests, and generalized linear model. Results: Compared to participants’ own shoes, OrthoFeet shoes significantly reduced foot pain and disability. Notable improvements were observed in “foot pain at its worst,” “foot pain at the end of the day,” “overall pain score,” and “overall Foot Function Index score,” all showing statistically significant reductions (p < 0.050). Participants reported high adherence to wearing the OrthoFeet shoes, averaging 8 h per day and 5.8 days per week. TAM scores favored OrthoFeet shoes over participants’ own shoes in terms of ease of use, perceived benefit, and intention to recommend. Significant differences were noted in components representing perceived joint pain relief (p < 0.001, χ2 = 21.228) and the intention of use as determined by the likelihood of recommending the shoes to a friend with a similar condition (p < 0.001, χ2 = 29.465). Additionally, a majority of participants valued the appearance of the shoes, with 66% prioritizing shoe appearance and 96% finding the study shoes more stylish than their previous ones. Conclusion: This study underscores the significance of design and custom fit in promoting continuous wear for effective foot pain reduction in older adults. More research is needed on the intervention’s long-term impacts.
MicroRNA-223-3p Targeting SGK1 Regulates Apoptosis and Inflammation in Sepsis-Associated Acute Kidney Injury
Authors: Chen Deyuan , Li Ke , Pan Liuhua , Chen Miaomiao , Zhang Xian , Chen Hua , Xu Junlong , Cai Feifei
Published: July 2024

Introduction: Sepsis and septic shock are significant contributors to the development of acute kidney injury (AKI) in critically ill patients. This study aims to elucidate the role and mechanism of microRNA-223-3p in sepsis-associated AKI (SA-AKI).
Methods: Bioinformatics methods were used to analyze the expression of microRNA-223-3p in sepsis patients, its correlation with inflammatory cytokines and to predict the binding site of microRNA-223-3p with SGK1. The binding relationship between microRNA-223-3p and SGK1 was validated using a dual-luciferase reporter gene assay. The expression of microRNA-223-3p was assayed using qPCR in patient serum or lipopolysaccharide (LPS)-treated HK-2 cells. Cell apoptosis, expression of Bax, Bcl-2, cleaved caspase-3, and levels of TNF-α, IL-1β, and IL-6 were measured using TUNEL assay, western blot (WB), and ELISA, respectively. SGK1 expression of HK-2 cells with different treatments was detected using qPCR and WB.
Results: The expression of microRNA-223-3p was found to be upregulated in sepsis patients and HK-2 cells treated with LPS. Furthermore, microRNA-223-3p promoted apoptosis and inflammation in LPS-induced HK-2 cells. This promotion was mediated by the negative regulation of SGK1 by microRNA-223-3p.
Conclusion: The microRNA-223-3p was found to regulate SGK1 and promote apoptosis and inflammation in LPS-induced HK-2 cells. Our study has elucidated the mechanism of microRNA-223-3p in SA-AKI, providing a potential target for sepsis treatment.
A Review of the Histopathology of Nail Unit Tumors Including Selection of the Optimal Surgical Sampling
Authors: Jin Annie , Haynes Dylan , Rodriguez Olaf , Park Ji Hye , Jellinek Nathaniel , Rubin Adam I.
Published: July 2024

Background: A wide variety of tumors can affect the nail unit, with some commonly mistaken as inflammatory or infectious diseases. Obtaining an optimal sample for histopathologic evaluation requires understanding of nail unit anatomy as well as the histopathology of the suspected nail tumor. Summary: This review discusses clinical and histopathologic features of a subset of benign and malignant nail tumors, including subungual melanoma, nail unit squamous cell carcinoma in situ, nail unit squamous cell carcinoma, onychomatricoma, onychopapilloma, onychocytic matricoma, and onychocytic carcinoma. Optimal surgical sampling techniques for each lesion are presented. Key Messages: In summary, the clinical and histopathologic features of several common and rare nail unit tumors and the optimal sampling techniques for each lesion are presented in this manuscript. Knowledge of the clinical and histopathologic features of these tumors informs the surgical approach to them and will produce the best patient outcomes.
Neurophysiologic Characteristics of the Anterior Nucleus of the Thalamus during Deep Brain Stimulation Surgery for Epilepsy
Authors: Ryan Megan V. , Satzer David , Ojemann Steven G. , Kramer Daniel R. , Thompson John A.
Published: July 2024

Introduction: Anterior nucleus of the thalamus (ANT) deep brain stimulation (DBS) is an increasingly promising treatment option for refractory epilepsy. Optimal therapeutic benefit has been associated with stimulation at the junction of ANT and the mammillothalamic tract (mtt), but electrophysiologic markers of this target are lacking. The present study examined microelectrode recordings (MER) during DBS to identify unique electrophysiologic characteristics of ANT and the ANT-mtt junction. Methods: Ten patients with medically refractory epilepsy underwent MER during ANT-DBS implantation under general anesthesia. MER locations were determined based on coregistration of preoperative MRI, postoperative CT, and a stereotactic atlas of the thalamus (Morel atlas). Several neurophysiological parameters including single unit spiking rate, bursting properties, theta and alpha power and cerebrospinal fluid (CSF)-normalized root mean square (NRMS) of multiunit activity were characterized at recording depths and compared to anatomic boundaries. Results: From sixteen hemispheres, 485 recordings locations were collected from a mean of 30.3 (15.64 ± 5.0 mm) recording spans. Three-hundred and ninety-four of these recording locations were utilized further for analysis of spiking and bursting rates, after excluding recordings that were more than 8 mm above the putative ventral ANT border. The ANT region exhibited discernible features including: (1) mean spiking rate (7.52 Hz ± 6.9 Hz; one-way analysis of variance test, p = 0.014 when compared to mediodorsal nucleus of the thalamus [MD], mtt, and CSF), (2) the presence of bursting activity with 40% of ANT locations (N = 59) exhibited bursting versus 24% the mtt (χ2; p < 0.001), and 32% in the MD (p = 0.38), (3) CSF-NRMS, a proxy for neuronal density, exhibited well demarcated changes near the entry and exit of ANT (linear regression, R = −0.33, p < 0.001). Finally, in the ANT, both theta (4–8 Hz) and alpha band power (9–12 Hz) were negatively correlated with distance to the ventral ANT border (linear regression, p < 0.001 for both). The proportion of recordings with spiking and bursting activity was consistently highest 0–2 mm above the ventral ANT border with the mtt. Conclusion: We observed several electrophysiological markers demarcating the ANT superior and inferior borders including multiple single cell and local field potential features. A local maximum in neural activity just above the ANT-mtt junction was consistent with the previously described optimal target for seizure reduction. These features may be useful for successful targeting of ANT-DBS for epilepsy.
The Greening of Hair: A Unique Case of Chlorotrichosis and Its Management
Authors: Lomelí-Legaspi Edgar , Corona-Rodarte Eduardo , Cano-Aguilar Luis Enrique , Villareal-Villareal César Daniel , Barrera-Ochoa Carlos , Asz Sigall Daniel
Published: July 2024

Introduction: Chlorotrichosis, commonly known as “green hair,” is an unusual trichological condition characterized by the accumulation of exogenous copper in individuals with light-colored hair and prior hair damage. It is primarily associated with inadequately maintained swimming pools. Case Presentation: We report a case of chlorotrichosis in a 16-year-old female who presented with a sudden and pronounced change in hair color after initiating regular swimming. Clinical examination revealed a distinctive greenish discoloration, primarily affecting the distal portions of her hair. The diagnosis of chlorotrichosis was confirmed based on clinical presentation and history. Treatment involved the use of an ethylenediaminetetraacetic acid (EDTA)-containing shampoo, leading to significant pigmentation regression within 8 weeks. Additionally, preventive measures included the application of a quaternary ammonium-enriched conditioner before exposure to copper-rich environments. Discussion/Conclusion: Chlorotrichosis remains underreported and potentially underdiagnosed, partly due to its cosmetic nature. Various factors, including occupational copper exposure and serum extravasation containing dipyridamole, have been associated with green hair. Treatment options encompass the use of EDTA-containing shampoos, among others. Dermatologists should be knowledgeable about its causes, predisposing factors, and effective management to enhance the diagnosis and treatment of this distinctive hair disorder.
Critically Ill Patients with COVID-19 Pneumonia Requiring Continuous Renal Replacement Therapy with oXiris® Membrane in a Third-Level Hospital in Northeast Mexico
Authors: Borbolla-Flores Paola , Villegas-Gutiérrez Luz Yareli , Samaniego-Segovia Bruno Maximiliano , Torres-Quintanilla Francisco Javier , Gómez-Villarreal Juan Pablo , Garza-Treviño Ricardo Abraham , Rizo-Topete Lilia María
Published: July 2024

Introduction: The coronavirus disease 2019 (COVID-19) pandemic represented a global public health problem with devastating consequences that have challenged conventional medical treatments. Continuous renal replacement therapy (CRRT), based on a spectrum of modalities and dialysis membranes, can modify cytokine storms, and improve the clearance of inflammatory factors. As severe COVID-19 can lead to acute kidney injury (AKI) requiring RRT, most patients require more than one extracorporeal organ support at this point. This is due to complications that lead to organ dysfunction. The aim of our study was to assess renal recovery and survival while use of the oXiris membrane, as well as a decrease in vasopressors and hemodynamic parameters. Methods: This was a retrospective, observational study. The population included adult patients (aged >18 years) with a real-time PCR COVID-19 positive test, admitted to the intensive care unit (ICU) with AKI KDIGO 3, which required CRRT, in a hospital in northern Mexico. The primary outcomes were renal recovery and survival, and the secondary outcomes were a decrease in the vasopressor requirements and changes in the hemodynamic parameters. Results: Thirteen patients were included from January 2020 to August 2021, all of whom met the inclusion criteria. oXiris, an AN69-modified membrane, was used for blood purification and cytokine storm control in all the patients. The primary outcome, renal recovery, and survival were observed in 23% of the patients. The secondary outcome was a decrease of 12% in the use of noradrenaline in the first 24 h of CRRT initiation with oXiris, in addition to a decrease in creatinine and C-reactive protein levels in all patients. Discussion: The use of the oXiris membrane in patients with severe COVID-19 improved hemodynamic parameters, with 23% of the patients achieving renal recovery. The decrease on the requirement of vasopressors in the overall patients in the first 24 h of CRRT with oXiris was achieved. The mean decrease was of 12%, accompanied by a decrease in inflammatory markers. There is literature on the benefit of CRRT with a modified AN69 membrane in Mexico; however, studies in this regard are scarce, and our research provides valuable information on our experience in this field.
Absence of the Peptide Transporter 1 Induces a Prediabetic and Depressive-Like Phenotype in Mice
Authors: Vily-Petit Justine , Taki Amelie , Sinet Flore , Soty Maud , Guiard Bruno , Zemdegs Juliane , Malleret Gael , Stefanutti Anne , Mithieux Gilles , Gautier-Stein Amandine
Published: July 2024

Introduction: Protein-enriched diets improve glycemic control in diabetes or emotional behavior in depressive patients. In mice, these benefits depend on intestinal gluconeogenesis activation by di-/tripeptides. Intestinal di-/tripeptides absorption is carried out by the peptide transporter 1, PEPT1. The lack of PEPT1 might thus alter glucose and emotional balance. Methods: To determine the effects of PEPT1 deficiency under standard dietary conditions or during a dietary challenge known to promote both metabolic and cognitive dysfunction, insulin sensitivity, anxiety, and depressive-like traits, hippocampal serotonin (5-HT) and insulin signaling pathway were measured in wild-type (WT) and Pept1−/− mice fed either a chow or a high-fat high-sucrose (HF-HS) diet. Results: Pept1−/− mice exhibited slight defects in insulin sensitivity and emotional behavior, which were aggravated by an HF-HS diet. Pept1−/− mice fed a chow diet had lower hippocampal 5-HT levels and exhibited cerebral insulin resistance under HF-HS diet. These defects were independent of intestinal gluconeogenesis but might be linked to increased plasma amino acids levels. Conclusion: Pept1−/− mice develop prediabetic and depressive-like traits and could thus be used to develop strategies to prevent or cure both diseases.
A four-years retrospective study: Clinical outcomes of XEN45 in patients with glaucoma
Authors: Bambó María Pilar , Tello Álvaro , Vicente María José , Mallén Víctor , Biescas-Merino Andrés , Yáñez Jacobo , Isanta Carlos , Ferrández Blanca , Fuentemilla Enrique , Pérez-Oliván Susana , Güerri Noemí , Larrosa José Manuel , Polo Vicente , Pablo Luis Emilio
Published: July 2024

Introduction: To evaluate the long-term effectiveness and safety of XEN45 implant, either alone or in combination with cataract surgery, in patients with glaucoma.
Methods: Retrospective and single center study conducted on consecutive patients who underwent a XEN45 implant, either alone or in combination with cataract surgery, between November 2016 and October 2021. The primary endpoint was the mean IOP lowering from preoperative values.
Results: Among the 230 screened patients, 206 eyes (176 patients) were included. Fifty-three (25.7%) eyes had undergone XEN-alone and 153 (74.3%) eyes had undergone a combined procedure (XEN+Phacoemulsification). The mean preoperative intraocular pressure (IOP) was significantly higher in the XEN-alone (22.2±5.9 mmHg) than in the XEN+Phaco (19.8±4.5 mmHg) group (p=0.0035). In the overall study population, the mean preoperative IOP was significantly lowered from 20.5±5.0 mmHg to 15.8±4.4 at year-4, p<0.0001. The mean preoperative (95% CI) IOP was significantly lowered from 22.2 (20.6 to 23.8) mmHg and 19.8 (19.1 to 20.6) mmHg to 15.6 (12.2 to 16.9) mmHg and 15.9 (15.2 to 16.5) mmHg at year-4 in the XEN-alone and XEN+Phaco groups, respectively (p<0.0001 each, respectively). The number of ocular hypotensive medications was significant reduced from 2.6±1.0 drugs to 1.3±1.3 drugs, with no significant differences between XEN-alone and XEN+Phaco groups (p=0.1671). On the first postoperative day, 62 (30.1%) eyes presented some type of complication. Fifteen (7.3%) eyes underwent a needling procedure.
Conclusion: XEN45, either alone or in combination with phacoemulsification, significantly lowered the IOP and reduce the need of ocular hypotensive medication in the long-term.
Cord Obstruction and Delayed Cord Clamping Do Not Affect Gut Function in Neonatal Piglets
Authors: Nordsten Mads J.B. , Yan Xudong , Secher Jan B.M. , Sangild Per T. , Thymann Thomas
Published: July 2024

Introduction: Birth-related obstruction of umbilical blood flow may induce hypoxic insults that affect postnatal organ adaptation. Using newborn cesarean-delivered pigs, we hypothesized that cord obstruction during delivery negatively affects physiological transition and gut maturation. Further, we investigated if delayed cord clamping (DCC) improves gut outcomes, including sensitivity to formula-induced necrotizing enterocolitis (NEC)-like lesions. Methods: In experiment 1, preterm (n = 24) and near-term (n = 29) piglets were subjected to umbilical cord obstruction (UCO, 5–7 min in utero), with corresponding pigs delivered without obstruction (CON, n = 17–22). Experiment 2 assessed preterm pigs subjected to delayed cord clamping (n = 30, 60 s) or immediate cord transection with umbilical cord milking (UCM, n = 34). Postnatal vital parameters were recorded, together with a series of gut parameters after 3 days of formula feeding. Results: UCO induced respiratory-metabolic acidosis in near-term pigs at birth (pH 7.16 vs. 7.32, pCO2 12.5 vs. 9.2 kPa, lactate 5.2 vs. 2.5 mmol/L, p < 0.05). In preterm pigs, UCO increased failure of resuscitation and mortality shortly after birth (88 vs. 47%, p < 0.05). UCO did not affect gut permeability, transit time, macromolecule absorption, six digestive enzymes, or sensitivity to NEC-like lesions. In experiment 2, DCC improved neonatal hemodynamics (pH 7.28 vs. 7.20, pCO2 8.9 vs. 9.9 at 2 h, p < 0.05), with no effects on gut parameters. Conclusion: UCO and DCC affect neonatal transition and hemodynamics, but not neonatal gut adaptation or sensitivity to NEC-like lesions. Our findings suggest that the immature newborn gut is highly resilient to transient birth-related changes in cord blood flow.
Building Better Models of Racial/Ethnic Identity Development: A Commentary on Satterthwaite-Freiman and Umaña-Taylor
Authors: Syed Moin , Westberg Dulce Wilkinson
Published: July 2024

Racial/ethnic identity is a central construct in developmental psychology that has been studied extensively over the past several decades. Despite this accumulation of knowledge, there are many lingering questions about the nature and relevance of racial/ethnic identity for youth development. In this commentary, we use the Satterthwaite-Freiman and Umaña-Taylor (2024) target article on White racial/ethnic identity to argue that a meta-scientific reason for the lack of major progress in understanding racial/ethnic identity is deficiencies in core theoretical, conceptual, and methodological considerations. We discuss each of these issues, in turn, and provide some suggestions for future theoretical and empirical work.
Long COVID: Erste praxisnahe Empfehlungen zur Trainingssteuerung erstellt
Authors: Kroll Daniela , Koczulla Andreas Rembert
Published: July 2024

People with long COVID may suffer from a wide range of ongoing symptoms including fatigue, exertional dyspnea, reduced exercise performance, and others. In particular, impaired exercise performance is a condition that can be recovered in many people through an individualized physical exercise training program. However, clinical experience has shown that the presence of post-exertional malaise (PEM) is a significant barrier to physical exercise training in people with long COVID. Currently, there is no guideline or consensus available on how to apply exercise training in this cohort. Therefore, we conducted a literature review in the PubMed library using the following search terms: «COVID», «post-COVID», «long COVID» and «exercise» searching for studies from January 2020 to January 2024. Data from 46 trials were included. Exercise training regimes were very heterogeneous and none of these studies reported on the management of PEM in the context of an exercise training program. Based on the feedback from an additional survey that was answered by 14 international experts in the field of exercise training in long COVID, combined with the authors´ own extensive practical experience, a best practice proposal for exercise training recommendations has been developed. This proposal differentiates exercise procedures according to the presence of no, mild/moderate or severe PEM in people with long COVID. These recommendations may guide allied healthcare professionals worldwide in initiating and adjusting exercise training programs for people with long COVID, stratified according to the presence and severity of PEM.
METTL14 promotes proliferation, migration, and invasion in endometriotic stromal cell growth by activating the ZEB1/MEK/ERK pathway
Authors: Lv Xuan , Li Fang
Published: July 2024

Objective: Endometriosis (EMs) commonly occurs in reproductive women. We explored the mechanism of methyltransferase-like 14 (METTL14) on human endometriotic stromal cell (ESC; HEM15A) proliferation, migration and invasion, to provide novel therapy for EMs.
Methods: HEM15A and human endometrial stromal cells (HESCs) were cultured in vitro. HEM15A cells were treated with oe-METTL14 and oe-zinc finger E-box-binding protein 1 (ZEB1) plasmids, N6-methyladenosine (m6A) inhibitor 3-deazaadenosine (3-DAA) and the mitogen-activated protein kinase kinase (MEK)/extracellular signal-regulated kinase (ERK) pathway inhibitor isoprenaline (ISO). After identifying HEM15A and HESCs, METTL14, ZEB1, p-ERK1/2/ERK1/2 and p-MEK/MEK levels, and cell proliferation, migration and invasion were assessed. The modification sites of ZEB1 and m6A were predicted using SRAMP database, with m6A modification level assessed by MeRIP. The binding of YT521-B homology domain 2 (YTHDF2) to ZEB1 messenger RNA (mRNA), and ZEB1 stability and mRNA level were tested.
Results: Compared with HESCs, METTL14 level in HEM15A was significantly reduced. METTL14 overexpression in HEM15A prominently increased its proliferation, migration and invasion. METTL14 overexpression notably elecated m6A-methylated ZEB1 mRNA level and reduced the stability and expression of ZEB1 mRNA. Further m6A modification inhibition increased ZEB1 mRNA stability and mRNA and protein levels, and decreased ZEB1 m6A modification level. ZEB1 upregulation partially reversed METTL14 overexpression-inhibited HEM15A proliferation, migration and invasion. METTL14 inhibited the MEK/ERK signaling activation by regulating ZEB1, and the MEK/ERK signaling activation partly averted METTL14-suppressed proliferation, migration and invasion.
Conclusion: METTL14 lowered ZEB1 expression by regulating ZEB1 m6A modification levels, thereby inhibiting the MEK/ERK pathway activation and ESC proliferation, migration and invasion.
Die Rolle von VCI-Filtern bei der Behandlung der akuten Lungenembolie
Authors: Asmar Samer , Michael George , Gallo Vincent , Weinberg Mitchell D.
Published: July 2024

Venöse Thromboembolien (VTE), zu denen die tiefe Venenthrombose (TVT) und die Lungenembolie (LE) gehören, sind eine weit verbreitete Herz-Kreislauf-Erkrankung, die weltweit an dritter Stelle nach Herzinfarkt und Schlaganfall steht. Das VTE-Risiko nimmt mit dem Alter zu und stellt in der alternden Bevölkerung ein wachsendes Problem dar. Die akute LE mit ihrer hohen Morbidität und Mortalität unterstreicht die Notwendigkeit einer frühzeitigen Diagnose und Intervention. In dieser Übersichtsarbeit werden prognostische Faktoren für die akute LE untersucht, um die LE anhand der hämodynamischen Stabilität und der rechtsventrikulären Belastung in die Kategorien geringes, mittleres und hohes Risiko einzuteilen. Die rechtzeitige Klassifizierung ist entscheidend für Triage- und Behandlungsentscheidungen. Heutzutage werden LE-Patienten mit geringem Risiko häufig mit direkten oralen Antikoagulanzien (direct oral anticoagulants, DOACS) behandelt und anschließend umgehend zur ambulanten Weiterbehandlung entlassen. Bei Patienten mit mittlerem und hohem Risiko können fortgeschrittene Therapien erforderlich sein, wie z.B. systemische Thrombolyse, kathetergeführte Thrombolyse, mechanische Thrombektomie und das Einsetzen eines Filters in die untere Hohlvene (Vena cava inferior, VCI). Letztere, insbesondere VCI-Filter, werden immer häufiger eingesetzt, wobei es neue Typen wie rückholbare und konvertierbare Filter gibt. Es gibt jedoch Bedenken hinsichtlich Komplikationen und der Notwendigkeit einer rechtzeitigen Entfernung. Diese Übersichtsarbeit befasst sich mit der Rolle von VCI-Filtern bei der Behandlung der akuten LE und geht auf ihre Indikationen, Typen, Komplikationen und Überlegungen zur Entfernung ein. Die anhaltende Debatte über den Einsatz von VCI-Filtern, insbesondere bei Patienten mit weniger konventionellen Indikationen, zeigt, dass weitere Forschung und Daten erforderlich sind. Trotz der Komplikationen deuten neuere Studien darauf hin, dass klinisch bedeutsame Probleme selten sind, was zu Diskussionen über den angemessenen und sicheren Einsatz von VCI-Filtern bei ausgewählten LE-Fällen geführt hat. Die Übersichtsarbeit umfasst abschließend aktuelle Trends, Wissenslücken und potenzielle Möglichkeiten zur Weiterentwicklung der Rolle von VCI-Filtern in der zukünftigen Behandlung der akuten LE.
Prevalence and Factors Associated with Carotid Stenosis in Acute Ischemic Stroke Patients with Atrial Fibrillation
Authors: Sagris Dimitrios , Korompoki Eleni , Strambo Davide , Mavraganis Georgios , Michel Patrik , Eskandari Ashraf , Vemmos Konstantinos , Lastras Clara , Rodriguez-Pardo Jorge , Fuentes Blanca , Díez-Tejedor Exuperio , Tiili Paula , Lehto Mika , Putaala Jukka , Cuadrado-Godia Elisa , Farington-Terrero Esmirna , Arauz Antonio , Kamel Hooman , Soledad Rosales Julieta , Rodriguez Perez Maria Soledad , Gomez Schneider Maia , Barboza Miguel , Tsiskaridze Alexander , Ntaios George
Published: July 2024

Introduction: Among stroke patients with atrial fibrillation (AF), it is not uncommon to identify carotid atherosclerosis. This study aimed to estimate the prevalence of, and factors associated with, carotid atherosclerosis among patients with AF and acute ischemic stroke. Patients and Methods: Prospectively collected data from consecutive patients with anterior ischemic stroke and AF who underwent carotid imaging from 10 stroke registries were categorized retrospectively according to the degree of stenosis in: no atherosclerosis, stenosis <50%, stenosis ≥50%, and occlusion. Logistic regression analysis was used to identify factors associated with ipsilateral carotid atherosclerosis. Results: Among 2,955 patients with ischemic stroke and AF, carotid atherosclerosis was evident in 1,022 (34.6%) patients, while carotid stenosis ≥50% and occlusion were identified in 204 (6.9%) and 168 (5.7%) patients, respectively. Ipsilateral carotid stenosis ≥50% or occlusion was associated with higher age (OR: 1.15, 95% CI: 1.01–1.32, per decade), previous ischemic stroke or transient ischemic attack (OR: 1.70, 95% CI: 1.29–2.25), peripheral artery disease (OR: 1.85, 95% CI: 1.23–2.78), coronary artery disease (OR: 1.53, 95% CI: 1.16–2.04), and statin treatment on admission (OR: 1.30, 95% CI: 1.01–1.67). Patients with lacunar stroke had a lower likelihood of stenosis ≥50% or occlusion (OR: 0.29, 95% CI: 0.13–0.68). Compared to the absence of atherosclerotic disease, atherosclerosis in one and two arterial beds was associated with the identification of ipsilateral carotid stenosis (OR: 1.49, 95% CI: 1.22–2.98 and OR: 3.18, 95% CI: 1.85–5.49, respectively). Conclusion: Among acute ischemic stroke patients with AF, 1 out of 3 had ipsilateral carotid atherosclerosis, and 1 out of 8 had ipsilateral carotid stenosis ≥50% or occlusion. Atherosclerosis in two arterial beds was the most important predictor for the identification of ipsilateral carotid stenosis. Among ischemic stroke patients with AF, carotid atherosclerosis is common, while carotid imaging should not be overlooked, especially in those with coronary or/and peripheral artery disease.
Performance Power: Boosting Saudi Arabia’s Health System Disaster Readiness (2017–2023)
Authors: Ali Dinar Hisham Hassan
Published: July 2024

Introduction: The 2016 self-assessment based on joint external evaluation (JEE) identified certain gaps, which prompted the need for additional improvement. This study attempted to address an approach to enhance preparedness using the performance management system’s components focusing on related areas in the JEE tool by the International Health Regulations (IHR). Methods: This was an observational cross-sectional study including all hospitals and regional health directorates within the Ministry of Health, Saudi Arabia. Entities preparedness was calculated using the JEE tool. Moreover, the implementation of the performance management system was also assessed for Saudi Arabia from the year 2017 to 2022. Additionally, the feedback was collected using the survey from the 11 National Preparedness Index (NPI) coordinators. Results: Total readiness was found to be 52% only, which was far less than the planned value of 75%. While regarding the implementation of the performance management system, it was noted that there was a progressive increase in the implementation from 10% in the year 2017 to 81.25% in the year 2022. Considering the feedback responses of NPI coordinators, it was found that 100% of coordinators agreed that the NPI has supported enhancing Health emergency preparedness and that the follow-up and support from the NPI team played an important role in NPI score improvement. Conclusion: The analysis indicated that while there are areas of progress, Saudi Arabia is still working on strengthening fundamental public health functions and emergency preparedness. This is evident when comparing a range of indicators with those of many countries under the purview of the World Health Organization (WHO).
Body Composition after Endoscopic Lung Volume Reduction with Endobronchial Valves: A Prospective Study
Authors: Brock Judith Maria , Rott Christina , Limen Eldridge Frederick , Kontogianni Konstantina , Gompelmann Daniela , Herth Felix J.F.
Published: July 2024

Introduction: Patients with chronic obstructive pulmonary disease (COPD) and emphysema experience malnutrition and pulmonary cachexia. Endoscopic lung volume reduction (ELVR) with endobronchial valves has not only improved lung function, exercise capacity, and quality of life but also influenced body weight. Only a few data are available on body composition changes after ELVR. Methods: This single-center prospective study of patients with advanced COPD investigates body composition before and after endoscopic valve treatment using multifrequency bioelectrical impedance analysis (BIA). The following parameters were evaluated in addition to clinical data and routine tests: body weight, body mass index (BMI), basal metabolic rate, total body water, body fat, cell percentage, phase angle, intracellular water (ICW), extracellular water (ECW), extracellular mass (ECM), body cell mass (BCM), lean body mass (ECM + BCM), and fat-free mass index. Results: A total of 23 patients (mean emphysema index 37.2 ± 7.5%, BMI 23.4 ± 4.3 kg/m2) experienced improvements in lung function and exercise capacity with ELVR. Complete lobar atelectasis was achieved in 39.1% of participants. A non-statistically significant increase in body weight and BMI was observed after ELVR (p = 0.111 and p = 0.102). BIA measurement revealed a worsening of phase angle, cell percentage and ECM/BCM and thus of body composition, but without statistical significance. This is mainly due to a statistically significant increase in ECM, ECW, and ICW (all p < 0.001). Conclusion: ELVR demonstrated no beneficial changes in body composition, although patients tend to gain weight. A larger cohort is warranted to confirm these findings.
Severe Dissociative Experiences beyond Detachment in a Large Clinical Sample of Inpatients with Post-Traumatic Stress Disorder: Diagnostic and Treatment Implications
Authors: Kratzer Leonhard , Tschöke Stefan , Schröder Johanna , Shevlin Mark , Hyland Philip , Eckenberger Christine , Heinz Peter , Karatzias Thanos
Published: July 2024

Introduction: The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) contains a dissociative subtype of post-traumatic stress disorder (PTSD) characterized by depersonalization and derealization. Yet, there is evidence that dissociative symptoms in PTSD go beyond this kind of detachment dissociation and that some patients present with additional compartmentalization dissociation in the form of auditory-verbal hallucination, amnesia, and identity alteration. Methods: Hence, in this study, we examined latent profiles of childhood trauma (Childhood Trauma Questionnaire), PTSD (Impact-of-Event Scale-Revised), and pathological dissociation (Dissociative Experiences Scale-Taxon; DES-T) in a large sample of severely traumatized inpatients with PTSD (N = 1,360). Results: Results support a three-class solution of the latent profile analysis with a PTSD class, a dissociative subtype class, and a third class characterized by more complex and more severe dissociative symptoms. Importantly, in our inpatient sample of patients with severe PTSD, the latter class was found to be the most prevalent. Both the exploratory character of our retrospective analysis of clinical routine data and the use of the DES-T limit the generalizability of our findings, which require methodologically more rigorous replication. Conclusion: In severe PTSD, dissociative symptoms beyond detachment are highly prevalent. Diagnostic and treatment implications are discussed.
Hurley Staging Training for Hidradenitis Suppurativa Patients
Authors: Dagenet Caitlyn B. , De Devea R. , Shih Terri , Brooks Brindley , Fixsen Denise , Park Sarah E. , Tran Khiem A. , Hsiao Jennifer L. , Shi Vivian Y.
Published: July 2024

Introduction: The Hurley staging system is a grading system utilized to measure hidradenitis suppurativa (HS) severity. Teaching patients to grade the severity of HS may aid in the accuracy of self-reporting for research and clinical purposes. Thus, this study aimed to determine the utility of a Hurley stage learning module (HSLM) for participants to grade images of HS. Methods: An anonymous survey was distributed online between October 2021 and January 2022. Participants completed a 5-min HSLM and a 9-item Hurley staging quiz with varying Fitzpatrick skin tones and HS severity. Comparative statistics were completed using t tests. p value of <0.05 was considered significant. Results: Majority of participants were female (95.2%, 263/276) and white (81.5%, 225/276). In terms of the percentage of quiz questions correct: 77.9% of respondents graded the Hurley stage 1 images correctly, 79.3% for Hurley stage 2, and 100% for Hurley stage 3. There was a significant difference in confidence of rating Hurley stage for any image (3.66 ± 1.18 vs. 4.39 ± 0.83; p < 0.0001) and own Hurley stage (3.90 ± 1.19 vs. 4.54 ± 0.81; p < 0.0001) pre- and post-HSLM. Conclusion: An HSLM provides high level of accuracy and increased participant confidence to grade their own disease and images of HS. An HSLM is an effective, cost-efficient, and valuable tool to facilitate clinical and survey research by allowing patients to report disease severity with increased confidence.
Nail Unit Melanoma: Uncommon Presentations to Keep in Mind
Authors: López-Jiménez Fanny Carolina , Michel-Avalos Alejandra , Domíguez-Cherit Judith Guadalupe , Corona-Herrera Judith Monserrat
Published: July 2024

Introduction: This article presents a case of nail unit melanoma (NUM), highlighting the unusual clinical presentations as those originating from the hyponychium. We discuss how dermoscopy is an essential tool for this pigmented lesion, and how the lack of a standardized guide for NUM underscores the importance of personalized approaches to ensure the best possible outcomes. Case Presentation: A 72-year-old woman presented with a melanocytic lesion on her right second finger, characterized by a hyperpigmented macule with irregular borders and a heterogeneous distribution of pigment. Biopsy confirmed acral lentiginous melanoma. Nail unit was exercised with a 5-mm margin toward the hyponychium. Conclusion: NUM is the predominant variant of malignant melanoma in certain ethnic groups and is influenced by factors such as trauma and chronic inflammation rather than sun exposure. Despite its higher incidence in areas like the great toe and thumb, NUM in the hyponychium is rare. Detection and treatment require thorough examination and individualized surgical approaches. Conservative surgeries may preserve limb function without compromising survival rates. Early detection remains challenging and necessitates attention to patient concerns and potential signs of melanoma.