bluuebunny/crossref_metadata_2025 huggingface dataset:
Temporal trends in mortality in patients with systemic lupus erythematosus: a Danish population-based matched cohort study
Authors: Kristensen Salome , Duch Kirsten , Soussi Bolette Gylden , de Saint-Aubain Constance Jensina , Laugesen Monika , Dreyer Lene
Published: April 2024

Objective

Excess mortality has been demonstrated in patients with SLE compared with the general population. We aimed to investigate the 5-year and 10-year all-cause mortality in patients with SLE compared with the general population in recent decades.

Methods

This was a Danish nationwide population-based exposure-matched cohort study. Incident cases of SLE diagnosed between 1996 and 2015 were identified using administrative health registries and followed until 2020, allowing for 5 and 10 years of follow-up. Patients with SLE were matched 1:5 on age and sex with individuals from the Danish general population. Time-to-event analyses were performed using the pseudo-observation approach.

Results

In total, 1351 incident cases of SLE and 6755 matched controls were identified. The crude risk difference (RD) for 5-year mortality decreased over the study period, from 10.3% (95% CI 6.5–14.1%) to 4.6% (95% CI 1.4–7.8%) for patients with SLE compared with controls. The relative risk (RR) for 5-year mortality decreased similarly in the same period. Adjustment for comorbidities revealed lower RD and RR for mortality in patients with SLE compared with controls, but the decreasing trend remained. The crude and adjusted RD and RR for 10-year mortality did not change over the calendar period. The 10-year RR was highest in young patients with SLE (<50 years of age).

Conclusion

The 5-year mortality risk decreased over time for both patients with SLE and matched controls. However, excess 5-year mortality for patients with SLE in the most recent calendar period and excess mortality late in their disease course remained. Continued focus on preventing disease progression and comorbidity is required.
Minimum Wage Policy and Poverty in Indonesia
Authors: Merdikawati Nurina , Izzati Ridho Al
Published: April 2024

This paper investigates whether minimum wage policy played any significant role in poverty reduction in Java Island, Indonesia, between 2002 and 2014. Its identification strategy exploits variation in minimum wages over time within pairs of geographically proximate districts. The study finds that the minimum wage has a distributional impact on wage workers just below the 20th percentile up to those in the middle of the wage distribution, with no overall loss of employment. However, the minimum wage policy has no distributional impact on per capita household expenditure, and a limited effect on changes in poverty status.
Biological Characterization of Physostegia Chlorotic Mottle Virus, an Emergent Virus Infecting Vegetables in Diversified Production Systems
Authors: Temple Coline , Blouin Arnaud G. , Boezen Dieke , Botermans Marleen , Durant Laurena , De Jonghe Kris , de Koning Pier , Goedefroit Thomas , Minet Laurent , Steyer Stephan , Verdin Eric , Zwart Mark , Massart Sebastien
Published: April 2024

In 2014, Physostegia chlorotic mottle virus (PhCMoV) was discovered in Austria in Physostegia virginiana. Subsequent collaborative efforts established a link between the virus and severe fruit symptoms on important crops such as tomato, eggplant, and cucumber across nine European countries. Thereafter, specific knowledge gaps, which are crucial to assess the risks PhCMoV can pose for production and how to manage it, needed to be addressed. In this study, the transmission, prevalence, and disease severity of PhCMoV were examined. This investigation led to the identification of PhCMoV presence in a new country, Switzerland. Furthermore, our research indicates that the virus was already present in Europe 30 years ago. Bioassays demonstrated PhCMoV can result in up to 100% tomato yield losses depending on the phenological stage of the plant at the time of infection. PhCMoV was found to naturally infect 12 new host plant species across eight families, extending its host range to 21 plant species across 15 plant families. The study also identified a polyphagous leafhopper (genus Anaceratagallia) as a natural vector of PhCMoV. Overall, PhCMoV was widespread in small-scale diversified vegetable farms in Belgium where tomato is grown in soil under tunnels, occurring in approximately one-third of such farms. However, outbreaks were sporadic and were associated at least once with the cultivation in tomato tunnels of perennial plants that can serve as a reservoir host for the virus and its vector. To further explore this phenomenon and manage the virus, studying the ecology of the vector would be beneficial.
TaCAP1 Interacts with TaLHCB1s and Positively Regulates Wheat Resistance Against Stripe Rust
Authors: Shi Beibei , Lian Qinggui , Gao Haifeng , Wang Yang , Ma Qing
Published: April 2024

Actin filaments and their associated actin-binding proteins play key roles in plant innate immune signaling. CAP1, or cyclase-associated protein 1, is an important regulatory factor of the actin cytoskeleton-associated signaling network and was hypothesized here to be involved in resistance against wheat stripe rust because TaCAP1 expression was upregulated in response to Puccinia striiformis f. sp. tritici ( Pst). Downregulation of TaCAP1 expression led to decreased resistance against Pst, in contrast to increased resistance upon TaCAP1 overexpressing, as demonstrated by the changes of phenotypes and hyphal growth. We found increased expression of pathogenesis-responsive or relative related genes and disease grade changed in TaCAP1 overexpressing plants. Our results also showed TaCAP1-regulated host resistance to Pst by inducing the production and accumulation of reactive oxygen species and mediating the salicylic acid signaling pathway. Additionally, TaCAP1 interacted with chlorophyll a/b-binding proteins TaLHCB1.3 and TaLHCB1.4, also known as the light-harvesting chlorophyll-protein complex II subunit B, which belong to the light-harvesting complex II protein family. Silencing of two TaLHCB1 genes showed higher susceptibility to Pst, which reduced wheat resistance against Pst. Therefore, the data presented herein further illuminate our understanding that TaCAP1 interacts with TaLHCB1s and functions as a positive regulator of wheat resistance against stripe rust.
The Effects of Perineural Dexamethasone on Rebound Pain After Nerve Block in Patients with Unicompartmental Knee Arthroplasty A Randomized Controlled Trial
Authors: Li Qingbao , Nie Hanxiao , Wang Zifan , Li Shihong , Wang Yibin , Chen Naiqi , Wang Wei , Xu Fei , Zhang Deli
Published: April 2024

Objectives:

A single nerve block provides excellent analgesia in a short time, but rebound pain after the nerve block disappears has attracted researchers’ attention. The aim of this study is to evaluate the effect of perineural dexamethasone on rebound pain after sciatic nerve block and femoral nerve block in patients undergoing unicompartmental knee arthroplasty (UKA).

Methods:

In a double-blinded fashion, We recruited 72 patients undergoing UKA, each of whom received sciatic and femoral nerve block. Patients were randomly assigned to two groups (n=36): X (ropivacaine only) and D (ropivacaine combined with dexamethasone). The primary outcome was the incidence of rebound pain. The secondary outcomes were rebound pain score, the duration of rebound pain, the duration of nerve block, pain score, sufentanil consumption and rescue analgesic, patient-controlled intravenous analgesia, distance walked, sleep quality score, C-reactive protein levels, and adverse effects.

Results:

Compared with group X, the incidence of rebound pain in group D was higher, the rebound pain score was higher and the duration of nerve block was prolonged (P<0.05). At 12, 16, and 20 hours postoperatively, the pain scores at rest in group D was lower. At 32 and 36 hours postoperatively, the pain scores at rest in group D was higher (P<0.05). Moreover, patients in group D had lower levels of C-reactive protein after surgery (P<0.05).

Discussion:

Addition of dexmedetomidine to ropivacaine for UKA effectively prolonged the duration of nerve block and decreased c-reactive protein levels, but increased the incidence of rebound pain and rebound pain score, and had no beneficial effects on the postoperative analgesia.
Bacterial Contamination Control with Sodium Hypochlorite and Jet Lavage Irrigation in a Severe Stage 4 Pelvic Pressure Injury: A Case Report
Authors: Stiehl James B.
Published: April 2024

This case report reviews the effect of combining a 250-cc bottle of standard antimicrobial, buffered sodium hypochlorite with a surgical method, low-pressure jet lavage irrigation in the outpatient setting to control difficult wound contamination. A 73-year-old man had been in treatment for over 8 years, undergoing at least 18 surgical wound debridement procedures for an extensive undermined pelvic pressure injury involving the sacrum, ischium, and greater trochanter. Cultures and polymerase chain reaction diagnostics revealed a multibacterial presence. Autofluorescent imaging (AFI) was used in 21 examinations performed after a 72-hour delay over a long weekend. The AFI contamination exceeded log 4 colony-forming units/g of tissue in all pretreatment examinations and was reduced to less than log 2 colony-forming units in 6 of 21 examinations, with the remaining 15 showing an estimated 80% or higher removal of the bacterial porphyrin “red” appearance. A total of 54 AFI examinations were performed using the combination treatment, and no adverse reactions were encountered. Treatment paradigms can be improved with a multifactorial approach.
Effect of Heated Saline Solution on Pain Intensity, Wound Bed Temperature, and Comfort during Chronic Wound Dressing Changes: Crossover Randomized Clinical Trial
Authors: Galdino-Júnior Hélio , Martins de Oliveira Segundo Emilson , Gomes Malaquias Suelen , Vinaud Marina Clare , Pereira Lilian Varanda , Guimarães Rafael Alves , Bachion Maria Márcia
Published: April 2024

Objective

To evaluate the use of heated saline solution during wound cleaning on the intensity of pain related to the procedure, the temperature of the wound bed, and the comfort of patients with chronic wounds. Further, to investigate patient preference in relation to the temperature of the solution used for cleaning.

Methods

Crossover, single-blind, clinical trial with 32 people with chronic wounds. Providers cleaned the wounds with room temperature and heated saline solution. Participants were randomized into group 1 A/B (heated solution first, room temperature second) or group 2 B/A (room temperature solution first, heated solution second), with a 10-minute washout period. Investigators evaluated pain intensity, wound bed temperature, and patient-reported comfort and preference.

Results

The heated solution was preferred (P = .04) and more often referred to as comfortable (P = .04) by the participants. There was no difference in pain intensity before and after cleaning with room temperature (2.03; P = .155) and heated saline (2.25; P = .44). The heated solution increased the temperature of the wound bed by 0.5 °C.

Conclusions

Although heating saline solution could be an important comfort measure during dressing changes, quantitatively, the temperature of the solution did not significantly change the temperature of the wound bed nor the intensity of pain patients experienced.
Randomized Double-blind Cost-effectiveness Comparison of Two 10% Urea Creams in Patients with Diabetic Foot Syndrome
Authors: Tejeda Ramírez Sol , Tardáguila-García Aroa , López-Moral Mateo , Sanz-Corbalán Irene , García-Madrid Marta , Lázaro-Martínez José Luis
Published: April 2024

OBJECTIVE

To evaluate the cost-effectiveness of two 10% urea creams in patients with diabetic foot syndrome.

METHODS

This was a prospective, longitudinal, single-center, randomized, double-blind, prospective clinical trial that evaluated the skin quality of 20 feet belonging to 10 patients with diabetic foot syndrome after the application of two 10% urea creams purchased from pharmacies and supermarkets.

RESULTS

At follow-up, 19 (95%) of the participants’ feet showed improved skin quality, irrespective of the cream applied. On visual inspection, participants had a decreased presence of xerosis, hyperkeratosis, and preulcerative signs such as subkeratotic bruising and areas of redness on the dorsum of the toes. At the 3-month follow-up, nine (90%) of the participants stated that they had continued to apply the cream as a method of self-management to prevent complications.

CONCLUSIONS

Creams containing 10% urea purchased in supermarkets improve foot skin quality in patients with diabetic foot syndrome, regardless of their cost. Based on these findings, the authors recommend creams containing 10% urea as a self-management tool for patients with diabetic foot syndrome.
Pretreatment CD8+PD-1+ to CD4+PD-1+ ratio is associated with the prognosis of advanced melanoma patients treated with PD-1 inhibitors
Authors: Gao Yao , Wang Yao , Luo Yueyue , Zhang Yong , Wang Saiqi , Tang Xiance , Qin Peng , Xu Benling , Gao Quanli , Li Tiepeng
Published: April 2024

The aim of this study is to determine whether the pretreatment CD8+PD-1+ to CD4+PD-1+ (PERLS) ratio is an independent risk prognostic factor of advanced melanoma patients. We retrospectively analyzed the efficacy and flow cytometry data from advanced melanoma patients who received PD-1 inhibitor as monotherapy between January 1, 2018 and January 26, 2022. Fifty-nine patients were enrolled, the PERLS cutoff was 1.125. PERLS did not correlate with clinical characteristics but were significantly associated with baseline CD8+, CD4+, and CD8+PD-1+ T cells. The mean overall survival and the progression-free survival were 45.8 and 17.1 months for the low PERLS group (n = 39), compared with 29.9 (P = 0.001) and 9.7 (P = 0.003) months for the high PERLS group (n = 20), respectively. Pretreatment PERLS might contribute to selecting patients before receiving anti-PD-1 therapy.
Comparison of Histopathological Findings in Psoriasis According to the Lesion Location From Biopsy
Authors: Kayaçetin Serra , Öcalan Devrim Tuba , Gül Ülker
Published: April 2024

The aim of this study was to investigate whether the histopathological findings of psoriasis varied by the biopsied lesion location. Age, gender, age at disease onset, lesion locations, presence or absence of a preliminary diagnosis of psoriasis, and histopathological findings of 307 patients were recorded. The sections prepared from the patients' paraffin blocks were reexamined microscopically, the severity of the observed findings was graded, and various histopathological features were recorded. The female-to-male ratio was 1.2 to 1. Family history for psoriasis was positive in 30% of patients. A clinically preliminary diagnosis of psoriasis was present in 232 patients. The most common histopathological features included hyperkeratosis, parakeratosis, Munro/Kogoj microabscesses, suprapapillary thinning–hypogranulosis, and vascular dilation–capillary proliferation. Hyperkeratosis was least common in the trunk. A linear and moderately strong correlation was found between the histopathological findings of inflammation, capillary proliferation, and suprapapillary thinning. For the first time, the clinical and demographic features of psoriasis are evaluated and the severity of the histopathological findings is compared by the biopsied lesion location in a large number of patients.
Combined Melanocytic Nevus and Nevus Sebaceus: A Case Series and Review of the Literature
Authors: Schroedl Liesl M. , Lullo Jenna J. , de Luzuriaga Arlene M. Ruiz , Shea Christopher R.
Published: April 2024

Nevus sebaceus is a rare congenital hamartoma with clinical and histopathological features that change with puberty. It has been associated with a number of secondary neoplasms, most of which are thought to derive from follicular germ cells. In this article, the authors describe a total of 3 cases of combined melanocytic nevus and nevus sebaceus to highlight this rare finding.
A Mimicker of Differentiated Vulvar Intraepithelial Neoplasia: Reactive Atypia From Noncompliance With Lichen Sclerosus Therapy
Authors: Chaudhari Advaita S. , McFadden Jason R. , Bentz Jessica , Evans Rebecca H. , Selim Maria A. , Sriharan Aravindhan
Published: April 2024

Differentiated vulvar intraepithelial neoplasia (d-VIN) is an HPV-independent precursor to vulvar squamous cell carcinoma. The histology of d-VIN lesions is difficult to differentiate from that of non–neoplastic epithelial disorders, especially lichen sclerosus (LS). The authors present a case of LS, where relying on histopathology alone could have led to misdiagnosis. The patient was a 17-year-old female patient with clinical features of vulvar dermatitis and LS for 2 years. She was counseled to apply clobetasol 0.05% to the affected area daily but reported no improvement after 6 months. A biopsy of the right labia majora revealed histologic findings typical of d-VIN and near-contiguous p53 expression. These features are characteristic of d-VIN. However, d-VIN is exceedingly rare in young patients. The case was reviewed by 6 dermatopathologists and gynecologic pathologists, who observed that the degree of inflammation would be unusual postclobetasol therapy and could be due to noncompliance. A review of the patient's chart revealed that she “does not always remember to apply” clobetasol. The patient's clinician confirmed that there were compliance issues, and the follow-up biopsy was negative for d-VIN. The case was signed out as LS, with a note describing the above, and to rebiopsy if concern persisted. The authors conjecture that inflammatory infiltrates in the biopsied area caused reactive atypia due to lack of adherence to treatment. Although the patient's age helped rule out d-VIN, similar cases in elderly patients may be occurring. Pathologists must be aware that reactive forms of untreated LS can mimic d-VIN, to avoid misdiagnosis.
Richter Syndrome Presenting as Subcutaneous Nodules and a Dermal Plaque
Authors: Nickles Melissa , Hunt Samantha , Turcios-Escobar Saul , Babwah Amaara , Mobayed Nisreen , Murga-Zamalloa Carlos , Bain Michelle , Quigley John , Rubinstein Paul , Galvez Carlos
Published: April 2024

Richter syndrome (RS) describes a phenomenon in which a patient with chronic lymphocytic leukemia (CLL) develops an aggressive lymphoma, most commonly diffuse large B-cell lymphoma (DLBCL). Reports of cutaneous RS remain exceedingly rare. We report a 61-year-old woman with relapsed/refractory CLL presenting with several subcutaneous nodules on her arms and legs and a single dermal plaque on her abdomen. Skin biopsy revealed a diagnosis of DLBCL, ABC-type, and her clinical status rapidly deteriorated following diagnosis. We review the variety of clinical presentations of cutaneous RS, its association with CLL, risk factors for RS development in CLL patients, and the distinctive histopathologic and immunophenotypic features of DLBCL. We hope to highlight the importance of prompt skin biopsy in patients with CLL presenting with progressive skin lesions and increase awareness of this aggressive clinical syndrome.
Apocrine Hidrocystoma of the Nail: A Unique Case
Authors: Salah Haneen , Duran Juanita , Russell Mark A. , Gru Alejandro A.
Published: April 2024

Apocrine hidrocystomas are benign, cystic neoplastic lesions resulting from the apocrine secretory component of the sweat gland. They most commonly occur on the head and neck, with predilection to the periorbital area. Less frequent sites include the axilla, nipple, external auditory canal, foreskin, conjunctiva, lower lip, and fingers, among others. The authors report a unique case of a nail bed hidrocystoma in a 55-year-old woman, a site not previously described.
Influence of Tacrolimus Intrapatient Variability on Allograft Rejection Frequency and Survival Following Liver Transplantation
Authors: Soares Maria Eduarda , Costa Gabriela , Guerra Laura , Morais Maria Clara , Vaz Nayana , Codes Liana , Bittencourt Paulo Lisboa
Published: April 2024

Background:

Tacrolimus is the primary calcineurin inhibitor used in immunosuppressive regimens to prevent allograft rejection (AR) after organ transplantation. Recent studies have linked intrapatient variability (IPV) of tacrolimus with AR occurrence and reduced survival, especially in kidney transplant recipients. However, limited data are available on the impact of tacrolimus IPV on adverse outcomes after liver transplantation (LT).

Aims:

The aim of this study was to assess the association between tacrolimus IPV using various methodologies with acute AR and long-term patient survival after LT.

Methods:

All patients who underwent LT from January 2010 to July 2021 were retrospectively evaluated. Tacrolimus IPV was calculated for each patient using the mean and SD, mean absolute deviation (MAD), coefficient of variation (CV), and time in therapeutic range (TTR). These measures were then compared with AR within the first 24 months after LT and to long-term survival.

Results:

Out of 234 patients, 32 (13.7%) developed AR and 183 (78.2%) survived, with a mean follow-up of 101 ± 43 months. Tacrolimus IPV, assessed by mean, SD, MAD, and CV, was 8.3 ± 2.1, 2.7 ± 1.3, 32.0% ± 11.7%, and 39.4% ± 15.4%, respectively. There was no statistically significant correlation between Tacrolimus IPV and AR or survival post-LT.

Conclusions:

In a large cohort of patients from diverse racial backgrounds, tacrolimus IPV was not associated with clinically relevant outcomes such as AR and survival after LT.
Factors Influencing Serum Posaconazole Concentrations in Patients With Hematologic Malignancies Receiving Delayed-Release Tablets
Authors: Yamada Takaaki , Belabbas Tassadit , Suetsugu Kimitaka , Hirota Takeshi , Mori Yasuo , Kato Koji , Akashi Koichi , Egashira Nobuaki , Ieiri Ichiro
Published: April 2024

Background:

Posaconazole (PCZ) plays a crucial role in the prophylaxis and treatment of invasive fungal infections in hematologic malignancies. PCZ concentrations reportedly vary among patients receiving delayed-release tablets (DRT). However, the factors influencing these concentrations remain insufficiently elucidated. Therefore, this study aimed to evaluate the factors influencing PCZ concentrations and their effect on the probability of target attainment (PTA) using a population pharmacokinetic (PPK) approach. We also explored the relationship between PCZ exposure and hepatotoxicity.

Methods:

This retrospective study included adult patients with hematologic malignancies who received PCZ DRT. A PPK model was developed based on observational data for 130 concentrations in 28 patients. Simulation analyses were performed to assess the PTA at standard doses of 0.7 and 1.0 mg/L for prophylaxis and treatment, respectively. Estimated concentrations were used to evaluate the correlation between PCZ exposure and hepatotoxicity.

Results:

Significant factors influencing PCZ concentrations included body weight, serum total protein levels, and diarrhea. Diarrhea correlated with decreased PCZ concentrations resulting in up to 26% lower PTA compared with that without diarrhea. Moreover, PTA declined markedly as the total protein levels decreased from 6.6 g/dL to 4.4 g/dL. The incidence of hepatotoxicity was 17.4% (4/23); no significant relationship could be established between the PCZ concentrations and hepatotoxicity (P = 0.188).

Conclusions:

We identified the factors affecting PCZ exposure, which could not be detected by PPK analysis using data from clinical trials. Our results suggest that the generally recommended dose of PCZ causes underexposure in patients with hematologic malignancies characterized by high body weight, hypoproteinemia, or concurrent diarrhea. Therapeutic drug monitoring for DRT may be recommended, especially in patients with these risk factors.
Retrospective Analysis of Steady-State Sodium Valproate Plasma Concentrations in Chinese Patients With Bipolar Disorder: Impact of Demographic and Clinical Characteristics
Authors: Qiming Qian , Ping Zheng , Huiqi Li , Leyu Xu , LIren Li , Ming Lei
Published: April 2024

Background:

This study comprehensively examined the demographic and clinical characteristics of patients undergoing valproic acid therapy and explored their potential impact on plasma valproic acid concentrations. All enrolled patients were administered the extended-release formulation. An in-depth investigation of factors, including dose, age, sex, body mass index, co-administered medications, and laboratory test findings, was conducted to evaluate their potential influence on study outcomes.

Methods:

In total, 164 patients met the inclusion criteria and were included in the analysis. The patient age ranged from 13 to 60 years, with a median age of 25.71 years. Most patients (89%) received a daily dose of 1 g valproic acid. Co-administered psychiatric medications included aripiprazole, quetiapine, and lorazepam. Laboratory test results, such as hemoglobin and transaminase levels, were also collected as part of the study.

Results:

The average plasma valproic acid plasma concentration was 79.8 mg/L. The dose significantly affected valproic acid concentrations, as a higher percentage of measurements exceeded the therapeutic range at a daily dose of 1 g. Furthermore, females exhibited significantly higher valproic acid concentrations compared with males at the same dose (P < 0.05). However, different age groups showed no statistically significant differences in valproic acid concentrations (P > 0.05). The co-administered antipsychotic and antidepressant medications significantly affected valproate concentrations, as reflected in the multiple regression model (P < 0.01).

Conclusions:

This study offers valuable insights into the demographic and clinical characteristics of patients undergoing valproic acid therapy. It highlights the influence of dose, sex, and concomitant medications on plasma valproic acid concentrations. Overall, these findings can help guide dose adjustments and implement personalized treatment strategies in valproic acid therapy.
Best Practice for Therapeutic Drug Monitoring of Infliximab: Position Statement from the International Association of Therapeutic Drug Monitoring and Clinical Toxicology
Authors: Alsoud Dahham , Moes Dirk Jan A. R. , Wang Zhigang , Soenen Rani , Layegh Zohra , Barclay Murray , Mizuno Tomoyuki , Minichmayr Iris K. , Keizer Ron J. , Wicha Sebastian G. , Wolbink Gertjan , Lambert Jo , Vermeire Séverine , de Vries Annick , Papamichael Konstantinos , Padullés-Zamora Núria , Dreesen Erwin
Published: April 2024

Background:

Infliximab, an anti–tumor necrosis factor monoclonal antibody, has revolutionized the pharmacological management of immune-mediated inflammatory diseases (IMIDs). This position statement critically reviews and examines existing data on therapeutic drug monitoring (TDM) of infliximab in patients with IMIDs. It provides a practical guide on implementing TDM in current clinical practices and outlines priority areas for future research.

Methods:

The endorsing TDM of Biologics and Pharmacometrics Committees of the International Association of TDM and Clinical Toxicology collaborated to create this position statement.

Results:

Accumulating data support the evidence for TDM of infliximab in the treatment of inflammatory bowel diseases, with limited investigation in other IMIDs. A universal approach to TDM may not fully realize the benefits of improving therapeutic outcomes. Patients at risk for increased infliximab clearance, particularly with a proactive strategy, stand to gain the most from TDM. Personalized exposure targets based on therapeutic goals, patient phenotype, and infliximab administration route are recommended. Rapid assays and home sampling strategies offer flexibility for point-of-care TDM. Ongoing studies on model-informed precision dosing in inflammatory bowel disease will help assess the additional value of precision dosing software tools. Patient education and empowerment, and electronic health record–integrated TDM solutions will facilitate routine TDM implementation. Although optimization of therapeutic effectiveness is a primary focus, the cost-reducing potential of TDM also merits consideration.

Conclusions:

Successful implementation of TDM for infliximab necessitates interdisciplinary collaboration among clinicians, hospital pharmacists, and (quantitative) clinical pharmacologists to ensure an efficient research trajectory.
Assessment and management of exaggerated blood pressure response to standing and orthostatic hypertension: consensus statement by the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability
Authors: Palatini Paolo , Kollias Anastasios , Saladini Francesca , Asmar Roland , Bilo Grzegorz , Kyriakoulis Konstantinos G. , Parati Gianfranco , Stergiou George S. , Grassi Guido , Kreutz Reinhold , Mancia Giuseppe , Jordan Jens , Biaggioni Italo , de la Sierra Alejandro
Published: April 2024

Recent evidence suggests that an exaggerated blood pressure (BP) response to standing (ERTS) is associated with an increased risk of adverse outcomes, both in young and old individuals. In addition, ERTS has been shown to be an independent predictor of masked hypertension. In the vast majority of studies reporting on the prognostic value of orthostatic hypertension (OHT), the definition was based only on systolic office BP measurements. This consensus statement provides recommendations on the assessment and management of individuals with ERTS and/or OHT. ERTS is defined as an orthostatic increase in SBP at least 20 mmHg and OHT as an ERTS with standing SBP at least 140 mmHg. This statement recommends a standardized methodology to assess ERTS, by considering body and arm position, and the number and timing of BP measurements. ERTS/OHT should be confirmed in a second visit, to account for its limited reproducibility. The second assessment should evaluate BP changes from the supine to the standing posture. Ambulatory BP monitoring is recommended in most individuals with ERTS/OHT, especially if they have high-normal seated office BP. Implementation of lifestyle changes and close follow-up are recommended in individuals with ERTS/OHT and normotensive seated office BP. Whether antihypertensive treatment should be administered in the latter is unknown. Hypertensive patients with ERTS/OHT should be managed as any other hypertensive patient. Standardized standing BP measurement should be implemented in future epidemiological and interventional studies.
An Analysis of ChatGPT4 to Respond to Glaucoma-Related Questions
Authors: Kerci Suleyman G. , Sahan Berna
Published: April 2024

Précis:

In recent years, ChatGPT has been widely used as a source of information. In our study, it was revealed that ChatGPT gives accurate information about glaucoma.

Purpose:

We examined the knowledge of ChatGPT about glaucoma.

Materials and Methods:

Frequently asked questions about glaucoma found on websites of ophthalmology associations and hospitals, and social media applications were assessed. Evidence-Based Recommendations in the European Glaucoma Society Terminology and Guidelines for Glaucoma, Fifth Edition were evaluated. Using the ChatGPT-4, each question was asked twice on different computers to assess the reproducibility of answers. The answers provided were recorded and 2 specialist ophthalmologists evaluated them independently, assigning scores ranging from 1 to 4.

Results:

The answers to all questions about glaucoma resulted in 88.7% completely correct, 7.5% correct but insufficient, and 3.8% misleading information and correct information. No question was answered completely incorrectly. While 85.8% of the general knowledge questions were answered correctly, 91.7%, 86.6%, and 91.7% of questions about diagnosis, treatment, and prevention were answered correctly, respectively. The number of questions prepared based on the European Glaucoma Society Terminology and Guidelines for Glaucoma was 16. The rate of completely correct answers to these questions was 75.0% (12). While 3 (18.8%) answers were correct but insufficient, 1 response (6.3%) contained false information and correct information.

Conclusions:

Our study revealed that ChatGPT answered 9 out of 10 questions about general information, diagnosis, treatment, and preventive and follow-up about glaucoma with acceptable and satisfactory accuracy rates. In addition, 3 of 4 answers given by ChatGPT were completely correct according to Terminology and Guidelines for Glaucoma.
Smoking Intensity is Associated With Progressive Optic Nerve Head Vessel Density Loss in Glaucoma
Authors: Nishida Takashi , Weinreb Robert N. , Tansuebchueasai Natchada , Wu Jo-Hsuan , Meller Leo , Mahmoudinezhad Golnoush , Gunasegaran Gopikasree , Adelpour Mohsen , Moghimi Sasan
Published: April 2024

Précis:

A lifetime history of greater smoking consumption was associated with faster vessel density loss over time. Smoking intensity should be considered when assessing the risk of glaucoma progression, as well as its management.

Purpose:

To investigate the relationship of smoking and smoking intensity, with the rate of optic nerve head (ONH) whole image capillary density (wiCD) loss in primary open angle glaucoma (POAG) and glaucoma suspect patients.

Methods:

In this longitudinal study, patients with POAG who had at least 2 years of follow-up and optical coherence tomography angiography (OCTA) performed at a minimum of 4 visits were selected for study. The smoking intensity was calculated as the pack-year at the baseline OCTA. Univariable and multivariable linear mixed models were used to determine the effect of each parameter on the rates of wiCD loss over time. Nonlinear least-squares estimation with piecewise regression model was used to investigate the cutoff point for the relationship between wiCD loss and smoking intensity.

Results:

One hundred sixty-four eyes (69 glaucoma suspect and 95 POAG) of 110 patients were included with a mean (95% CI) follow-up of 4.0 (3.9 to 4.1) years. Of the 110 patients, 50 (45.5%) had a reported history of smoking. Greater smoking intensity was associated with faster wiCD loss [−0.11 (−0.23 to 0.00)] %/year per 10 pack-year higher; P=0.048) after adjusting for covariates. The wiCD thinning became significantly faster when smoking intensity was greater than 22.2 pack-years. Smoking had no effect on the rate of wiCD thinning in patients who smoked <22.2 pack-years during their lifetime.

Conclusions:

A history of greater smoking consumption was associated with faster vessel density loss, suggesting smoking intensity as a potential risk factor for glaucoma.
Using machine learning to identify key subject categories predicting the pre-clerkship and clerkship performance: 8-year cohort study
Authors: Huang Shiau-Shian , Lin Yu-Fan , Huang Anna YuQing , Lin Ji-Yang , Yang Ying-Ying , Lin Sheng-Min , Lin Wen-Yu , Huang Pin-Hsiang , Chen Tzu-Yao , Yang Stephen J. H. , Lirng Jiing-Feng , Chen Chen-Huan
Published: April 2024

Background:

Medical students need to build a solid foundation of knowledge to become physicians. Clerkship is often considered the first transition point, and clerkship performance is essential for their development. We hope to identify subjects that could predict the clerkship performance, thus helping medical students learn more efficiently to achieve high clerkship performance.

Methods:

This cohort study collected background and academic data from medical students who graduated between 2011 and 2019. Prediction models were developed by machine learning techniques to identify the affecting features in predicting the pre-clerkship performance and clerkship performance. Following serial processes of data collection, data preprocessing before machine learning, and techniques and performance of machine learning, different machine learning models were trained and validated using the 10-fold cross-validation method.

Results:

Thirteen subjects from the pre-med stage and 10 subjects from the basic medical science stage with an area under the ROC curve (AUC) >0.7 for either pre-clerkship performance or clerkship performance were found. In each subject category, medical humanities and sociology in social science, chemistry, and physician scientist-related training in basic science, and pharmacology, immunology-microbiology, and histology in basic medical science have predictive abilities for clerkship performance above the top tertile. Using a machine learning technique based on random forest, the prediction model predicted clerkship performance with 95% accuracy and 88% AUC.

Conclusion:

Clerkship performance was predicted by selected subjects or combination of different subject categories in the pre-med and basic medical science stages. The demonstrated predictive ability of subjects or categories in the medical program may facilitate students’ understanding of how these subjects or categories of the medical program relate to their performance in the clerkship to enhance their preparedness for the clerkship.
Incidence, epidemiology, and outcomes of acute allograft rejection following liver transplantation in Australia
Authors: Tang Lauren C.Y. , Chetwood John D. , Lai Mandy S.M. , Yip Terry C.F. , Cao Rena , Powter Elizabeth , Salimi Shirin , Wu Rodger , Coulshed Andrew , Bowen David G. , Strasser Simone I. , Valliani Talal , Crawford Michael , Pulitano Carlo , McKenzie Catriona , Kench James , McCaughan Geoffrey W. , Liu Ken
Published: April 2024

Acute allograft rejection is a well-known complication of liver transplantation (LT). The incidence, epidemiology, and outcomes of acute rejection have not been well described in Australia. We retrospectively studied consecutive adults who underwent deceased donor LT at a single center between 2010 and 2020. Donor and recipient data at the time of LT and recipient outcomes were collected from a prospective LT database. Liver biopsy reports were reviewed, and only a graft’s first instance of biopsy-proven acute rejection was analyzed. During the study period, 796 liver transplants were performed in 770 patients. Biopsy-proven rejection occurred in 34.9% of transplants. There were no significant changes in the incidence of rejection over time (linear trend p=0.11). The median time to the first episode of rejection was 71 days after LT: 2.2% hyperacute, 50.4% early (≤90 d), and 47.5% late rejection (>90 d). Independent risk factors for rejection were younger recipient age at transplant (aHR 0.98 per year increase, 95% CI: 0.97–1.00, p=0.01), and ABO-incompatible grafts (aHR 2.55 vs. ABO-compatible, 95% CI: 1.27–5.09, p<0.01) while simultaneous multiorgan transplants were protective (aHR 0.21 vs. LT only, 95% CI: 0.08–0.58, p<0.01). Development of acute rejection (both early and late) was independently associated with significantly reduced graft (aHR 3.13, 95% CI: 2.21–4.42, p<0.001) and patient survival (aHR 3.42, 95% CI: 2.35–4.98, p<0.001). In this 11-year Australian study, acute LT rejection occurred in 35%, with independent risk factors of younger recipient age and ABO-incompatible transplant, while having a simultaneous multiorgan transplant was protective. Acute rejection was independently associated with reduced graft and patient survival after adjustment for other factors.
Comparison of 1-stage and 2-stage Managements for Common Bile Duct Stones and Gallstones (CBDS)
Authors: Zhou Jie , Chen Ye , Yu Songlin , Wang Hui , Wang Yufeng , Chen Quanning
Published: April 2024

Objective:

The aim of this study was to evaluate the efficacy, safety, and surgical outcomes of 2-stage management, namely preoperative endoscopic retrograde cholangiopancreatography (ERCP) + laparoscopic cholecystectomy (ERCP+LC) or LC + postoperative ERCP (LC+ERCP), as well as 1-stage management, LC + laparoscopic common bile duct exploration (LCBDE) for treating patients with gallstones and common bile duct stones (CBDS).

Methods:

This retrospective study analyzed the data of 180 patients with common bile duct stones (CBDS) who were admitted to the Department of General Surgery at Tongji Hospital, Tongji University, between January 2019 and June 2021. The study included 3 groups: ERCP+LC (group 1), LC+ERCP (group 2), and LC+LCBDE (group 3), each consisting of 60 patients. Clinical metrics of the patients were collected and compared among the groups.

Results:

Group 3 had the shortest operation duration and hospital stay compared with group 1 and group 2. In addition, group 3 had the lowest long-term postoperative complications, particularly the recurrence rate of CBDS. The total cost was also the lowest in group 3. Furthermore, patients in group 3 had the lowest postoperative amylase levels. All patients in the study achieved successful stone clearance. There were no significant differences in the conversion to other procedures rate, postoperative alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, and mortality among the three groups (P > 0.05).

Conclusions:

Both 1-stage management and 2-stage management are effective treatments for CBDS. The LC+LCBDE management is a safe treatment option, offering shorter hospital stays and operation duration, lower costs, and fewer complications.
An unusual case of acute cholecystitis complicated by haemobilia and Mirizzi-like obstruction: a case report and review of literature
Authors: Khawjah Ahmed , Khair Mugahid M. , Goubran R.
Published: April 2024

Introduction:

Cystic artery pseudoaneurysm rupture presents a rare yet potentially fatal aetiology for upper gastrointestinal (GI) bleed. While uncommon, its incidence has been rising with increased hepatobiliary surgical interventions, predominantly attributed to iatrogenic injury and rarely secondary to acute cholecystitis. Clinical manifestations typically include epigastric pain, upper GI haemorrhage, and obstructive jaundice. Due to its rarity, it is often excluded from initial differential diagnoses.

Case report:

This is an unusual case of a 54-year-old male who presented with acute cholecystitis complicated by haemobilia and Mirizzi-like obstruction, in the setting of cystic artery pseudoaneurysm rupture. Initially, urgent transcatheter angiographic embolization of the cystic artery was performed to achieve hemodynamic stability. However, a triphasic computed tomography (CT) scan revealed the first attempt was unsuccessful, necessitating a second embolization. Subsequent imaging confirmed satisfactory embolization; however, a small area of liver necrosis was observed adjacent to the gallbladder. The patient was stable at discharge from the hospital and had an uncomplicated interval cholecystectomy.

Discussion:

This case highlights the complexity and challenges associated with diagnosing and managing cystic artery pseudoaneurysm rupture. Diagnosis often relies on arterial phase contrast-enhanced CT scan. While no guideline currently exist, management typically involves achieving hemodynamic stability through Transcatheter angiographic embolization, followed by interval cholecystectomy.

Conclusion:

Early recognition and intervention are crucial in managing cystic artery pseudoaneurysm rupture to prevent life-threatening haemorrhagic shock. Clinicians need to consider this rare condition in patients with upper GI bleeding and abnormal liver function tests.
Evidence-based education to mitigate osteoporosis through diet and exercise
Authors: Bazaar Celina , Travers Jennifer , Karl Cherry , Breda Karen Lucas
Published: April 2024

By teaching bone loss mitigation strategies through diet and exercise to community-dwelling older adults, nurses can help prevent fractures and hospitalizations.
Decoding the endocrine system, a few glands at a time
Authors: Graulich Erin
Published: April 2024

The endocrine system is composed of glands located throughout the body that are implicated in multiple disorders, including those arising from thyroid, parathyroid, adrenal, and pituitary dysfunction.
Insulin resistance
Authors: Perkins Amanda
Published: April 2024

Insulin resistance is believed to be a precursor to type 2 diabetes mellitus, metabolic syndrome, and nonalcoholic fatty liver disease. Through education, nurses can understand their role in helping patients manage this condition.
It's better to give than receive
Authors: Hermann Maureen , Puetz Madison
Published: April 2024

Community engagement can foster a sense of purpose and promote a culture of reciprocity. By participating in a community engagement project, students can learn to identify healthcare disparities and work collaboratively toward positive outcomes and solutions.
Why Pursue a Doctorate? Findings From a Study of Doctorally Prepared RNs in an Integrated Healthcare System
Authors: Rosenfeld Peri , Glassman Kimberly S.
Published: April 2024

OBJECTIVE

The aim of this study was to examine the motivations and perceptions of RNs with completed doctorates in an integrated healthcare system.

BACKGROUND

Historically, PhD preparation was the primary doctorate available for nurses, preparing them to conduct research and hold leadership positions. The recent growth of Doctor of Nursing Practice (DNP) programs that focus on either advanced clinical practice or executive competencies has significant implications for the future of nursing in practice settings.

METHODS

A 30-item survey was sent to all 93 RNs at a healthcare system who have completed doctorates.

RESULTS

A response rate of 71% found DNPs outnumber PhDs 3 to 1. PhDs are significantly more likely to perceive concrete benefits associated with their degrees, and DNPs are more likely to report that their degrees have not made a difference in their jobs.

CONCLUSIONS

Leaders in practice and education must collaborate to ensure that both DNPs and PhDs are engaged in positions that use their highest level of competence in any setting.
Organizational Climate for Inclusion Among Nurses
Authors: Traver Jodi , Yeaman Sarah , Arenas Cecily A. , Daugherty JoAnn , Davidson Judy E.
Published: April 2024

OBJECTIVE

The aim of this study was to answer the research question: What factors predict sense of belonging among nurses?

The connection between inclusion (an element of diversity and equity) and a nurse's sense of belonging is poorly understood.

METHODS

In this mixed-methods research, regression analysis of Climate for Inclusion Scale subscales and Sense of Belonging score plus thematic content analysis of questions assessing sense of belonging were conducted. Nurses (n = 131) attending a research conference in June to July 2022 were invited to participate; 131 (72%) participated.

RESULTS

Climate for Inclusion Scale was positively associated with and predictive of sense of belonging (F
3,113 = 71.7, P < 0.001). Themes reflecting actions to enhance sense of belonging were as follows: authentic leadership, embracing social justice, team unification, feeling heard, being seen, professional development, developing a healthier work environment, and integration of differences.

CONCLUSIONS

Leaders can promote a sense of belonging among nurses by focusing on actions reflected in the themes.
A Comparison of Evidence-Based Practice Training With and Without Postimmersion Follow-up
Authors: Wayman Lisa M. , Walsh-Irwin Colleen , Sullivan Sheila Cox
Published: April 2024

OBJECTIVE

The aim of this study was to determine best practice for evidence-based practice (EBP) education that leads to implementation.

BACKGROUND

Current methods of teaching EBP do not reliably translate to implementation.

METHODS

Participants in an EBP immersion were compared with participants in EBP immersion plus a follow-up EBP course.

RESULTS

The EBP immersion group implemented 18% of their initiatives. The EBP immersion plus the follow-up EBP course implemented 35% of their initiatives, and an additional 22% were in the process of implementation.

CONCLUSION

Evidence-based practice education may not be sufficient in promoting EBP implementation. Additional ongoing support may be needed to bring EBP initiatives through implementation.