bluuebunny/crossref_metadata_2025 huggingface dataset:
Myocardial structural and functional changes in cardiac amyloidosis: insights from a prospective observational patient registry
Authors: Duca Franz , Rettl René , Kronberger Christina , Binder Christina , Mann Christopher , Dusik Fabian , Schrutka Lore , Dalos Daniel , Öztürk Begüm , Dachs Theresa Marie , Cherouny Bernhard , Camuz Ligios Luciana , Agis Hermine , Kain Renate , Koschutnik Matthias , Donà Carolina , Badr-Eslam Roza , Kastner Johannes , Beitzke Dietrich , Loewe Christian , Nitsche Christian , Hengstenberg Christian , Kammerlander Andreas Anselm , Bonderman Diana
Published: August 2023

Aims

The pathophysiological hallmark of cardiac amyloidosis (CA) is the deposition of amyloid within the myocardium. Consequently, extracellular volume (ECV) of affected patients increases. However, studies on ECV progression over time are lacking. We aimed to investigate the progression of ECV and its prognostic impact in CA patients.

Methods and results

Serial cardiac magnetic resonance (CMR) examinations, including ECV quantification, were performed in consecutive CA patients. Between 2012 and 2021, 103 CA patients underwent baseline and follow-up CMR, including ECV quantification. Median ECVs at baseline of the total (n = 103), transthyretin [(ATTR) n = 80], and [light chain (AL) n = 23] CA cohorts were 48.0%, 49.0%, and 42.6%, respectively. During a median period of 12 months, ECV increased significantly in all cohorts [change (Δ) +3.5% interquartile range (IQR): −1.9 to +6.9, P < 0.001; Δ +3.5%, IQR: −2.0 to +6.7, P < 0.001; and Δ +3.5%, IQR: −1.6 to +9.1, P = 0.026]. Separate analyses for treatment-naïve (n = 21) and treated (n = 59) ATTR patients revealed that the median change of ECV from baseline to follow-up was significantly higher among untreated patients (+5.7% vs. +2.3%, P = 0.004). Survival analyses demonstrated that median change of ECV was a predictor of outcome [total: hazard ratio (HR): 1.095, 95% confidence interval (CI): 1.047–1.0145, P < 0.001; ATTR: HR: 1.073, 95% CI: 1.015–1.134, P = 0.013; and AL: HR: 1.131, 95% CI: 1.041–1.228, P = 0.003].

Conclusion

The present study supports the use of serial ECV quantification in CA patients, as change of ECV was a predictor of outcome and could provide information in the evaluation of amyloid-specific treatments.
First impressions of a new face are shaped by infection concerns
Authors: Bressan Paola
Published: August 2023

Along with a classical immune system, we have evolved a behavioral one that directs us away from potentially contagious individuals. Here I show, using publicly available cross-cultural data, that this adaptation is so fundamental that our first impressions of a male stranger are largely driven by the perceived health of his face. Positive (likeable, capable, intelligent, trustworthy) and negative (unfriendly, ignorant, lazy) first impressions are affected by facial health in adaptively different ways, inconsistent with a mere halo effect; they are also modulated by one’s current state of health and inclination to feel disgusted by pathogens. These findings, which replicated across two countries as different as the USA and India, suggest that instinctive perceptions of badness and goodness from faces are not two sides of the same coin but reflect the (nonsymmetrical) expected costs and benefits of interaction. Apparently, pathogens run the show—and first impressions come second. Lay Summary: Our first impressions of strangers (whether they seem trustworthy, intelligent, unfriendly, or aggressive) are shaped by how healthy their faces look and by our unconscious motivation to avoid infections. Bad and good impressions turn out to reflect the concrete, potentially vital, expected costs and benefits of interacting with our fellow humans. Apparently, pathogens run the show—and first impressions come second.
Exchange rate and inflation under weak monetary policy: Turkey verifies theory
Authors: Gürkaynak Refet S , Kısacıkoğlu Burçin , Lee Sang Seok
Published: August 2023

For the academic audience, this paper presents the outcome of a well-identified, large change in the monetary policy rule from the lens of a standard New Keynesian model and asks whether the model properly captures the effects. For policymakers, it presents a cautionary tale of the dismal effects of ignoring basic macroeconomics. In doing so, it also clarifies how neo-Fisherian disinflation may work or fail, in theory and in practice. The Turkish monetary policy experiment of the past decade, stemming from a belief of the government that higher interest rates cause higher inflation, provides an unfortunately clean exogenous variance in the policy rule. The mandate to keep rates low, and the frequent policymaker turnover orchestrated by the government to enforce this, led to the Taylor principle not being satisfied and eventually a negative coefficient on inflation in the policy rule. In such an environment, was the exchange rate still a random walk? Was inflation anchored? Does the “standard model” suffice to explain the broad contours of macroeconomic outcomes in an emerging economy with large identifying variance in the policy rule? There are no surprises for students of open-economy macroeconomics; the answers are no, no and yes.
On the effect of the New Year’s Eve sexual assaults on anti-refugee violence: a rejoinder to Schwitter and Liebe (2023)
Authors: Frey Arun
Published: August 2023

In their comment on my 2020 ESR article, Schwitter and Liebe suggest that the increase in anti-refugee attacks following the 2015 New Year’s Eve sexual assaults (NYE) could be due to a simultaneous broadening of the German Federal Criminal Police Office definition of anti-refugee violence. I address Schwitter and Liebe’s concerns by (i) removing attacks that were included because of the new definition and (ii) restricting the analysis to attacks that were sourced from non-governmental sources. In both cases, the NYE event continues to have a profound effect on anti-refugee attacks, but the revised estimates are smaller than those reported in the original study: for example, in this analysis, the probability of an attack more than doubles in the first week of January 2016, as opposed to tripling in the original study. In line with the original findings, the impact of the NYE event is also more pronounced in districts with low prior levels of anti-refugee hostility.
Laboratory investigation of high-frequency electromagnetic induction measurements for macro-scale relaxation signatures
Authors: Glaser Dan R , Barrowes Benjamin E , Shubitidze Fridon , Slater Lee D
Published: August 2023

Direct contact, frequency-dependent, electrical relaxation effects in soils are well documented in both conductivity and dielectric permittivity-dominated frequency regimes. These relaxation signatures result from charge displacement in physical processes at varying scales ranging from conductivity-dominated ionic transport at soil–grain pore-fluid interfaces to permittivity-dominated water molecule rotation. Given the physical mechanisms associated with these relaxation signatures, it is possible to gain vital soil characteristics needed for a variety of civil and environmental applications. Yet, at the field scale, these direct contact geophysical methods are generally time-consuming and cumbersome hindering the extent at which data can be reasonably acquired. Here, we evaluate a standoff high-frequency electromagnetic induction (HFEMI) instrument, designed for remote, non-contact detection of non-metallic unexploded ordinance and repurposed as a means to measure soil relaxation effects remotely. The instrument offers a proven interrogation range of 100 kHz–10 MHz but has the ability to record data as low as 100 Hz. In this laboratory study, we demonstrate the effects of sample volume using NaCl solutions, where greater volume samples are necessary to overcome low signal-to-noise signatures. Further, pyrite, a mineral known to exhibit relaxation signatures at low frequencies was used in sand mixtures of varying concentrations and varying pore-fluid conductivity to explore the lower frequency range of the HFEMI instrument. The resulting measured HFEMI responses demonstrated sensitivity to the changes in conductivity due to increased pyrite and pore-fluid NaCl concentrations at high frequencies, but the lower frequency range of 100 Hz to 100 kHz was dominated by system noise, disallowing interrogation of low-frequency relaxation effects. This initial investigation compiles the comparative knowledge for relaxation responses in both direct electrical and standoff electromagnetic measurements while demonstrating high-frequency signatures of low-conductivity soils and sample volume effects. As a result of this research, a new EMI system is in development addressing a lower range of frequencies for continued relaxation process investigations.
Teachers’ Self-Reported Classroom Practices Regarding Dictionary Use: The Role of Teachers’ Attitude and School Level
Authors: Tremblay Ophélie , Plante Isabelle , Fréchette-Simard Catherine
Published: August 2023

This study examined the self-reported practices of 300 elementary and high school Quebec teachers regarding dictionary use (paper and electronic) in the classroom as a function of teaching level and attitudes towards dictionaries. ANOVA results highlighted the diversity of teachers’ pedagogical intentions and students’ learning goals while consulting dictionaries. Results, however, revealed a traditional portrait of dictionary use (e.g., correcting spelling, finding a word definition). In addition, teaching levels did not significantly influence teaching content and activities, nor teachers’ perceptions of students’ goals while using a dictionary. Nonetheless, teachers’ attitudes towards dictionary use were found to significantly predict their classroom practices: those with a positive attitude reported a greater variety of pedagogical intentions (e.g., searching for synonyms) and reported more frequent and diversified dictionary-related activities. In sum, findings underscore the importance of training students and teachers in dictionary use to acquire (and teach) proper and diversified dictionary skills.
Generalization error bounds for iterative recovery algorithms unfolded as neural networks
Authors: Schnoor Ekkehard , Behboodi Arash , Rauhut Holger
Published: August 2023

Motivated by the learned iterative soft thresholding algorithm (LISTA), we introduce a general class of neural networks suitable for sparse reconstruction from few linear measurements. By allowing a wide range of degrees of weight-sharing between the flayers, we enable a unified analysis for very different neural network types, ranging from recurrent ones to networks more similar to standard feedforward neural networks. Based on training samples, via empirical risk minimization, we aim at learning the optimal network parameters and thereby the optimal network that reconstructs signals from their low-dimensional linear measurements. We derive generalization bounds by analyzing the Rademacher complexity of hypothesis classes consisting of such deep networks, that also take into account the thresholding parameters. We obtain estimates of the sample complexity that essentially depend only linearly on the number of parameters and on the depth. We apply our main result to obtain specific generalization bounds for several practical examples, including different algorithms for (implicit) dictionary learning, and convolutional neural networks.
Follicular regulatory T cell subsets in mice and humans: origins, antigen specificity and function
Authors: Sokolova Sophia , Grigorova Irina L
Published: August 2023

Follicular regulatory T (Tfr) cells play various roles in immune responses, contributing to both positive and negative regulation of foreign antigen-specific B cell responses, control over autoreactive antibody responses and autoimmunity, and B cell class-switching to IgE and allergy development. Studies conducted on mice uncovered various subsets of CXCR5+FoxP3+CD4+ Tfr cells that could differently contribute to immune regulation. Moreover, recent studies of human Tfr cells revealed similar complexity with various subsets of follicular T cells of different origins and immunosuppressive and/or immunostimulatory characteristics. In this review we will overview and compare Tfr subsets currently identified in mice and humans and will discuss their origins and antigen specificity, as well as potential modes of action and contribution to the control of the autoimmune and allergic reactions.
Mucosal-associated invariant T cells from Clostridioides difficile-infected patients exhibit a distinct proinflammatory phenotype and enhanced cytotoxic activity
Authors: Brauns Steffen , Marquardt Isabel , Thon Cosima , Frentzel Sarah , Jakob Josefine , Färber Jacqueline , Philipsen Lars , Jänsch Lothar , Link Alexander , Bruder Dunja
Published: August 2023

Mucosal-associated invariant T (MAIT) cells are innate-like T cells mainly found in the mucosa and peripheral blood. We have recently demonstrated that Clostridioides difficile activates MAIT cells in vitro. However, their role in the pathogenesis of C. difficile infection (CDI) in human patients remains elusive to date. In this study, we performed comprehensive immunophenotyping of MAIT cells derived from CDI patients and compared their phenotype to that of patients with inflammatory bowel diseases (IBD) and healthy controls. Our study revealed that blood MAIT cells from CDI patients exhibit an interleukin 17a (IL-17a)-dominated proinflammatory phenotype and an increased readiness to synthesize the proinflammatory cytokine interferon γ (IFN-γ) following in vitro re-stimulation. Moreover, the cytotoxic activity of MAIT cells, as measured by surface CD107a and intracellular granzyme B expression, was strongly increased in CDI. Multi epitope ligand cartography (MELC) analysis of intestinal biopsies from CDI patients revealed that MAIT cells exhibit an increased production of granzyme B and increased cytotoxicity compared to the control group. Together with previously published in vitro data from our group, our findings suggest that MAIT cells are functionally involved in the immune response against C. difficile and contribute to the pathogenesis of CDI.
A comparison between above-ground bait stations and experimental caulk baits for elimination of field colonies of the Asian subterranean termite, Coptotermes gestroi (Blattodea: Rhinotermitidae)
Authors: Su Nan-Yao , Mullins Aaron
Published: August 2023

Survey stakes and in-ground (IG) stations have failed to intercept underground tunnels of the Asian subterranean termite, Coptotermes gestroi (Wasmann), in southeastern Florida, rendering nearly useless the IG bait station that is the main tool of commercial baiting systems. When placed over an active infestation, above-ground (AG) bait stations were readily fed on by C. gestroi, resulting in colony elimination. A new experimental type of AG bait application being studied is an injectable caulk bait. In this study, we compared the efficacy of AG bait stations and an experimental AG caulk bait against field colonies of C. gestroi. Following the applications of AG bait stations at 3 sites with infested houses and trees, C. gestroi colonies were eliminated 7.1–28.1 wk later. The experimental AG caulk bait was applied at 7 sites including 4 houses, 2 office buildings, and 1 docked sailboat. Colony elimination times at caulk bait sites ranged from 3.1 to 13.6 wk, but there was no statistical difference in mean colony elimination time between AG station bait sites (17.4 ± 10.5 wk) and AG caulk bait sites (8.4 ± 3.8 wk). This study showed that AG caulk bait applications were equally efficacious in eliminating existing C. gestroi in structures as AG bait stations and will offer another tool for termite control professionals to better manage subterranean termites including C. gestroi.
Disparate roles for C. elegans DNA translocase paralogs RAD-54.L and RAD-54.B in meiotic prophase germ cells
Authors: Yamaya Kei , Wang Bin , Memar Nadin , Odiba Arome Solomon , Woglar Alexander , Gartner Anton , Villeneuve Anne M
Published: August 2023

RAD54 family DNA translocases partner with RAD51 recombinases to ensure stable genome inheritance, exhibiting biochemical activities both in promoting recombinase removal and in stabilizing recombinase association with DNA. Understanding how such disparate activities of RAD54 paralogs align with their biological roles is an ongoing challenge. Here we investigate the in vivo functions of Caenorhabditis elegans RAD54 paralogs RAD-54.L and RAD-54.B during meiotic prophase, revealing distinct contributions to the dynamics of RAD-51 association with DNA and to the progression of meiotic double-strand break repair (DSBR). While RAD-54.L is essential for RAD-51 removal from meiotic DSBR sites to enable recombination progression, RAD-54.B is largely dispensable for meiotic DSBR. However, RAD-54.B is required to prevent hyperaccumulation of RAD-51 on unbroken DNA during the meiotic sub-stage when DSBs and early recombination intermediates form. Moreover, DSB-independent hyperaccumulation of RAD-51 foci in the absence of RAD-54.B is RAD-54.L-dependent, revealing a hidden activity of RAD-54.L in promoting promiscuous RAD-51 association that is antagonized by RAD-54.B. We propose a model wherein a division of labor among RAD-54 paralogs allows germ cells to ramp up their capacity for efficient homologous recombination that is crucial to successful meiosis while counteracting potentially deleterious effects of unproductive RAD-51 association with unbroken DNA.
Utility of a prognostic assessment tool to predict survival following surgery for brain metastases
Authors: Cuthbert Hadleigh , Riley Max , Bhatt Shreya , Au-Yeung Claudia Kate , Arshad Ayesha , Eladawi Sondos , Zisakis Athanasios , Tsermoulas Georgios , Watts Colin , Wykes Victoria
Published: August 2023

Background

Brain metastases account for more than 50% of all intracranial tumors and are associated with poor outcomes. Treatment decisions in this highly heterogenous cohort remain controversial due to the myriad of treatment options available, and there is no clearly defined standard of care. The prognosis in brain metastasis patients varies widely with tumor type, extracranial disease burden and patient performance status. Decision-making regarding treatment is, therefore, tailored to each patient and their disease.

Methods

This is a retrospective cohort study assessing survival outcomes following surgery for brain metastases over a 50-month period (April 1, 2014–June 30, 2018). We compared predicted survival using the diagnosis-specific Graded Prognostic Assessment (ds-GPA) with actual survival.

Results

A total of 186 patients were included in our cohort. Regression analysis demonstrated no significant correlation between actual and predicted outcome. The most common reason for exclusion was insufficient information being available to the neuro-oncology multidisciplinary team (MDT) meeting to allow GPA calculation.

Conclusions

In this study, we demonstrate that “predicted survival” using the ds-GPA does not correlate with “actual survival” in our operated patient cohort. We also identify a shortcoming in the amount of information available at MDT in order to implement the GPA appropriately. Patient selection for aggressive therapies is crucial, and this study emphasizes the need for treatment decisions to be individualized based on patient and cancer clinical characteristics.
Metabolic Disorders Are Associated With Drug-Induced Liver Injury During Antituberculosis Treatment: A Multicenter Prospective Observational Cohort Study in Korea
Authors: Lim Jihye , Kim Ju Sang , Kim Hyung Woo , Kim Yong Hyun , Jung Sung Soo , Kim Jin Woo , Oh Jee Youn , Lee Heayon , Kim Sung Kyoung , Kim Sun-Hyung , Lyu Jiwon , Ko Yousang , Kwon Sun Jung , Jeong Yun-Jeong , Kim Do Jin , Koo Hyeon-Kyoung , Jegal Yangjin , Kyung Sun Young , An Tai Joon , Min Jinsoo
Published: August 2023

Background

Drug-induced liver injury (DILI) may lead to the discontinuation of antituberculosis (anti-TB) treatment (ATT). Some studies have suggested that metabolic disorders increase the risk of DILI during ATT. This study aimed to identify risk factors for DILI, particularly metabolic disorders, during ATT.

Methods

A multicenter prospective observational cohort study to evaluate adverse events during ATT was conducted in Korea from 2019 to 2021. Drug-susceptible patients with TB who had been treated with standard ATT for 6 months were included. The patients were divided into 2 groups depending on the presence of 1 or more metabolic conditions, such as insulin resistance, hypertension, obesity, and dyslipidemia. We monitored ATT-related adverse events, including DILI, and treatment outcomes. The incidence of DILI was compared between individuals with and without metabolic disorders, and related factors were evaluated.

Results

Of 684 patients, 52 (7.6%) experienced DILI, and 92.9% of them had metabolic disorders. In the multivariable analyses, underlying metabolic disorders (adjusted hazard ratio [aHR], 2.85; 95% CI, 1.01–8.07) and serum albumin <3.5 g/dL (aHR, 2.26; 95% CI, 1.29–3.96) were risk factors for DILI during ATT. In the 1-month landmark analyses, metabolic disorders were linked to an elevated risk of DILI, especially significant alanine aminotransferase elevation. The treatment outcome was not affected by the presence of metabolic disorders.

Conclusions

Patients with metabolic disorders have an increased risk of ATT-induced liver injury compared with controls. The presence of metabolic disorders and hypoalbuminemia adversely affects the liver in patients with ATT.
Real-world Use of Mold-Active Triazole Prophylaxis in the Prevention of Invasive Fungal Diseases: Results From a Subgroup Analysis of a Multicenter National Registry
Authors: Nguyen M Hong , Ostrosky-Zeichner Luis , Pappas Peter G , Walsh Thomas J , Bubalo Joseph , Alexander Barbara D , Miceli Marisa H , Jiang Jeanette , Song Yi , Thompson George R
Published: August 2023

Background

Antifungal prophylaxis can prevent invasive fungal diseases (IFDs) in high-risk, immunocompromised patients. This study assessed the real-world use of mold-active triazoles (MATs) for the prevention of IFDs.

Methods

This subgroup analysis of a multicenter, observational, prospective registry in the United States from March 2017 to April 2020 included patients who received MATs for prophylaxis (isavuconazole, posaconazole, and voriconazole) at study index/enrollment. The primary objective was to describe patient characteristics and patterns of MAT use. Exploratory assessments included the frequency of breakthrough IFDs and MAT-related adverse drug reactions (ADRs).

Results

A total of 1177 patients (256 isavuconazole, 397 posaconazole, 272 voriconazole, and 252 multiple/sequenced MATs at/after index/enrollment) were included in the prophylaxis subgroup analysis. Patient characteristics were similar across MAT groups, but risk factors varied. Hematological malignancy predominated (76.5%) across all groups. Breakthrough IFDs occurred in 7.1% (73/1030) of patients with an investigator's assessment (5.0% [11/221] isavuconazole; 5.3% [20/374] posaconazole; 4.0% [9/226] voriconazole; and 15.8% [33/209] multiple/sequenced MATs). Aspergillus (29.5% [18/61]) and Candida (36.1% [22/61]) species were the most common breakthrough pathogens recovered. ADRs were reported in 14.1% of patients, and discontinuation of MATs due to ADRs was reported in 11.1% of patients (2.0% [5/245] isavuconazole; 8.2% [30/368] posaconazole; and 10.1% [27/267] voriconazole).

Conclusions

Breakthrough IFDs were uncommon in patients who received MATs for prophylaxis. Candida and Aspergillus species were the most commonly reported breakthrough pathogens. The discontinuation of MATs due to ADRs was infrequent. These findings support prophylactic strategies with isavuconazole, posaconazole, and voriconazole in high-risk patients.
Highlights of ASCO 2023
Authors: Neugut Alfred I , Bates Susan E
Published: August 2023

Considering presentations at this year’s ASCO annual meeting, this editorial highlights a number of studies of interest, from adjuvant therapy studies to tumor agnostic therapy.
Astaxanthin protects the radiation-induced lung injury in C57BL/6 female mice
Authors: Li Junshi , She Xiandong , Ding Zijian , Yao Liuhuan , Yang Yajie , Tang Haibo , Liu Hu , Zhao Deyun , Li Bailong
Published: August 2023

Radiation-induced lung injury (RILI) is one of the common complications of radiotherapy for chest tumors and nuclear radiation accidents. The excessive reactive oxygen species induced by radiation is the main mediator. So far, the effective prevention and treatment for RILI are still lacking. Astaxanthin is a carotenoid that belongs to red natural lutein family and is commonly found in Marine organisms such as shrimp, oysters and salmon. It has been confirmed that astaxanthin has strong antioxidant and anti-inflammatory properties, therefore we speculated that astaxanthin may be a potential treatment for RILI. First, with a mice model of RILI, the protected effects of astaxanthin were observed. Furthermore, the experiments in vitro were performed by detecting apoptosis. As a result, astaxanthin protects the RILI, inhibits the process of pulmonary fibrosis, and reduces the elevation of inflammatory factors. The experiments in vitro demonstrated that astaxanthin could reduce radiation-induced apoptosis and especially inhibit activation of apoptosis pathway. In conclusion, astaxanthin could protect RILI of mice, which is mediated by inhibiting activation of apoptosis pathway.
Epidemiology of anaphylaxis: is the trend still going up?
Authors: Tanno Luciana Kase , Caminati Marco , Pouessel Guillaume , Senna Gianenrico , Demoly Pascal
Published: August 2023

Purpose of review

To understand the current global scale of anaphylaxis and identify possible strategies to increase the accuracy of epidemiological data.

Recent findings

Anaphylaxis mortality and morbidity statistics may gain new perspectives with the global implementation of the ICD-11. Improving the quality of epidemiological data related to anaphylaxis should clarify some areas of uncertainty about risk factors, leading to better targeting of strategies to protect those patients at risk, and support decision-making to facilitate health care planning and implementation of public health measures to prevent anaphylaxis.

The true rate of anaphylaxis is unknown due to a number of factors, such as misdiagnosis, miscoding and undernotification. Moreover, there is lack of information about anaphylaxis epidemiology in many countries. Difficulties on collecting accurate and comparable data should be acknowledged and anaphylaxis data can vary widely. Currently, most robust data are derived from hospitalization datasets and national mortality databases. Anaphylaxis accounts for up to 0.26% of overall hospital admissions. It is suggested that the number of hospital admissions for anaphylaxis is increasing in many countries, both with respect to all-causes of anaphylaxis and by trigger, but the mortality rate remains low. However, there are still great challenges in capturing quality anaphylaxis mortality and morbidity statistics. Better understanding of anaphylaxis trends should clarify some areas of uncertainty about risk factors and prospect effective prevention strategies. As the knowledge derived from populations is key information for more realistic decision-making, the construction of the new section addressed to anaphylaxis in the ICD-11 will allow the collection of more accurate epidemiological data to support high quality management of patients, and to better facilitate health care planning to implement public health measures, reduce the morbidity and mortality attributable to anaphylaxis.
Situational Confidence and Recovery Capital Among Recovery Residents Taking Medications for Opioid Use Disorder in Texas
Authors: Obekpa Elizabeth O. , McCurdy Sheryl A. , Schick Vanessa , Markham Christine , Gallardo Kathryn R. , Wilkerson J. Michael
Published: August 2023

Objectives

Situational confidence, that is, confidence to resist substance use in high-risk situations, and recovery capital (RC) are resources that individuals can draw upon to initiate and sustain their recovery from opioid use disorder. We assessed the associations between total, social, and personal RC and situational confidence among recovery residents taking medications for opioid use disorder.

Methods

Cross-sectional associations between the Brief Situational Confidence Questionnaire and Assessment of Recovery Capital scores were assessed among participants (N = 267) enrolled in a longitudinal study in 13 recovery homes for persons taking medications for opioid use disorder in Texas using χ2 tests and multivariable logistic regression.

Results

Most participants were 35 years or older (51.7%), male (59.4%), non-Hispanic White (71.5%), and unemployed (66.0%); used more than one substance (77.9%); and had higher educational levels (53.8%). The majority had high situational confidence (66.7%), social (63.7%), physical (67.0%), and total (64.8%) RC. Education (model 1: adjusted odds ratio [aOR], 1.96; confidence interval [CI], 1.13–3.40; model 2: aOR, 2.03; CI, 1.17–3.51) and social (aOR, 2.08; CI, 1.11–3.92), personal (aOR, 2.06; CI, 1.08–3.93), and total (aOR, 2.98; CI, 1.71–5.20) RC were associated with situational confidence.

Conclusions

Our findings highlight the need for recovery housing operators to be trained on the relevance of RC and situational confidence to practice to improve recovery outcomes among residents with opioid use disorder. Health planners, recovery housing administrators, and policymakers should strengthen recovery residence-based services and systems to improve individual RC and situational confidence.
Safety and Efficacy of Rapid Methadone Titration for Opioid Use Disorder in an Inpatient Setting: A Retrospective Cohort Study
Authors: Klaire Sukhpreet , Fairbairn Nadia , Ryan Andrea , Nolan Seonaid , McLean Mark , Bach Paxton
Published: August 2023

Objectives

Inpatient guidelines for methadone titration do not exist, whereas outpatient guidelines lack flexibility and do not consider individual opioid tolerance. The evaluation of rapid, adaptable titration protocols may allow more patient-centered and effective treatment for opioid use disorder in the fentanyl era.

Methods

This study performed a retrospective chart review of patients 18 years or older with opioid use disorder who were initiated on methadone at a single academic urban hospital using a rapid divided dose protocol between November 2019 and November 2020. The primary outcome was adverse events associated with methadone, specifically opioid toxicity or sedation requiring increased medical observation or intervention. The secondary outcome was total daily dose of methadone received on day 7 of titration.

Results

Ninety-eight patients were included for a total of 168 visits. Sixty-five (66%) were male, with a median age of 38 years (interquartile range, 31–42 years). Sedation occurred in 2 patients (1%), who required either naloxone administration or transfer to an intensive care unit for monitoring. Of the 135 visits where patients received at least 7 days of methadone, the mean dose on day 1 was 41 mg (SD, 9.6 mg) and on day 7 was 65 mg (SD, 20.9 mg).

Conclusions

In this inpatient cohort, rapid methadone titration was well tolerated and resulted in patients reaching higher doses of methadone than would be possible with a standard schedule, with few adverse events. Given the known effective dose range, this approach may result in shorter time to clinical stabilization and suggests that alternative methadone titration schedules may be safe and effective in appropriately selected patients.
Normal values of scapholunate distance in Turkish children aged 5–14 years
Authors: Yerli Mustafa , Bayraktar Tahsin Olgun , Yüce Ali , Erkurt Nazim , Saygili Mehmet Selçuk , Ocak Olcayto
Published: August 2023

Wrist kinematic indices and scapholunate distance play an essential role in diagnosing and treating injury and disease of the carpus. It can be challenging to measure and diagnose scapholunate ligament injury in the immature skeleton. The aim of this study was to measure the normal ranges of the carpal indices on radiographs in the Turkish population aged 5–14 years. This retrospective study examined children aged 5–14 years between 2021 and 2022. Children aged 5–14 years with a wrist anteroposterior X-ray, children admitted to the hospital for nontraumatic reasons, and children who had not had a wrist fracture before were included in the study. The distance between the scaphoid and the lunate, the distance between the lunate and the triquetrum, the carpal height, the length of the third metacarpal, and the ratio of the carpal height to the length of the third metacarpal were measured. It was found that the scapholunate distance was significantly higher in boys aged 7–8 years and 9–10 years (P = 0.001, P = 0.004). When the averages of the lunotriquetral distances were analyzed according to age groups, it was found that it was significantly higher in boys of 7–8 years old, 11–12 years old, and 13–14 years old groups compared with girls (P = 0.003, P < 0.001, P = 0.004). In this study aiming to find the average values of scapholunate distance, lunotriquetral distance, and carpal indices in children, we concluded that we should examine the wrist X-ray in terms of carpal injuries by considering age and gender.
Outcomes of ankle joint distraction in a paediatric and young adult cohort presenting with symptomatic ankle arthritis
Authors: Lineham Beth , Maggs Rebecca , Pandit Hemant , Sharma Hemant , Foster Patrick
Published: August 2023

Ankle arthritis in paediatric and young adult patients causes significant morbidity; therefore, joint-preserving procedures are preferable. Ankle joint distraction (AJD) is a technique that preserves the native joint. However, only short-term outcomes are reported in paediatric patients. Therefore, this study reports on intermediate-term outcomes in a paediatric cohort. Demographics for all patients who underwent AJD at two centres were prospectively collected. Case records were reviewed retrospectively for complications and further intervention. Mean joint space at baseline and follow-up radiographs were evaluated by two independent observers. All patients were contacted for completion of a Foot and Ankle Outcome Score (FAOS). Seven patients received AJD between February 2016 and June 2019. Median age at surgery was 15 years (9.0–24.6 years). Complications included one superficial pin-site infection and one patient death due to complications from juvenile idiopathic arthritis 6.2 years post-operatively. Two patients were converted to fusion, at 12.6 months and 26.2 months following frame removal; one patient underwent spontaneous fusion at 9 months following frame removal. The four patients who continued without further intervention achieved 2.59 mm mean joint space at last follow-up (0.65–5.08 mm) and FAOS of 35–79%. Mean follow-up length was 4.3 years (2.9–6.3 years) with final radiographs at mean 2.6 years. While recognising the limitations of this retrospective review, several patients had significant, sustained improvements in joint space with good clinical outcome. Complications for this procedure are minimal, and it is a potential joint-preserving option for managing end-stage ankle arthritis in young patients.
A Transcriptomic Classifier Model Identifies High-Risk Endotypes in a Prospective Study of Sepsis in Uganda*
Authors: Cummings Matthew J. , Bakamutumaho Barnabas , Tomoiaga Alin S. , Owor Nicholas , Jain Komal , Price Adam , Kayiwa John , Namulondo Joyce , Byaruhanga Timothy , Muwanga Moses , Nsereko Christopher , Nayiga Irene , Kyebambe Stephen , Sameroff Stephen , Che Xiaoyu , Lutwama Julius J. , Lipkin W. Ian , O’Donnell Max R.
Published: August 2023

OBJECTIVES:

In high-income countries (HICs), sepsis endotypes defined by distinct pathobiological mechanisms, mortality risks, and responses to corticosteroid treatment have been identified using blood transcriptomics. The generalizability of these endotypes to low-income and middle-income countries (LMICs), where the global sepsis burden is concentrated, is unknown. We sought to determine the prevalence, prognostic relevance, and immunopathological features of HIC-derived transcriptomic sepsis endotypes in sub-Saharan Africa.

DESIGN:

Prospective cohort study.

SETTING:

Public referral hospital in Uganda.

PATIENTS:

Adults (n = 128) hospitalized with suspected sepsis.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Using whole-blood RNA sequencing data, we applied 19-gene and 7-gene classifiers derived and validated in HICs (SepstratifieR) to assign patients to one of three sepsis response signatures (SRS). The 19-gene classifier assigned 30 (23.4%), 92 (71.9%), and 6 (4.7%) patients to SRS-1, SRS-2, and SRS-3, respectively, the latter of which is designed to capture individuals transcriptionally closest to health. SRS-1 was defined biologically by proinflammatory innate immune activation and suppressed natural killer-cell, T-cell, and B-cell immunity, whereas SRS-2 was characterized by dampened innate immune activation, preserved lymphocyte immunity, and suppressed transcriptional responses to corticosteroids. Patients assigned to SRS-1 were predominantly (80.0% [24/30]) persons living with HIV with advanced immunosuppression and frequent tuberculosis. Mortality at 30-days differed significantly by endotype and was highest (48.1%) in SRS-1. Agreement between 19-gene and 7-gene SRS assignments was poor (Cohen’s kappa 0.11). Patient stratification was suboptimal using the 7-gene classifier with 15.1% (8/53) of individuals assigned to SRS-3 deceased at 30-days.

CONCLUSIONS:

Sepsis endotypes derived in HICs share biological and clinical features with those identified in sub-Saharan Africa, with major differences in host–pathogen profiles. Our findings highlight the importance of context-specific sepsis endotyping, the generalizability of conserved biological signatures of critical illness across disparate settings, and opportunities to develop more pathobiologically informed sepsis treatment strategies in LMICs.
Effect of arteriosclerotic intracranial arterial vessel wall enhancement on downstream collateral flow
Authors: Yan Liqun , Wang Zhenchang , Wang Guoshi , Li Zhenzhong , Yan Jin , Hou Yaping , Huang Boyuan , Dong Qianbo , Mu Xiaodan , Cao Wei , Zhao Pengfei
Published: August 2023

Background:

The effect of arteriosclerotic intracranial arterial vessel wall enhancement (IAVWE) on downstream collateral flow found in vessel wall imaging (VWI) is not clear. Regardless of the mechanism underlying IAVWE on VWI, damage to the patient's nervous system caused by IAVWE is likely achieved by affecting downstream cerebral blood flow. The present study aimed to investigate the effect of arteriosclerotic IAVWE on downstream collateral flow.

Methods:

The present study recruited 63 consecutive patients at the Second Hospital of Hebei Medical University from January 2021 to November 2021 with underlying atherosclerotic diseases and unilateral middle cerebral artery (MCA) M1-segment stenosis who underwent an magnetic resonance scan within 3 days of symptom onset. The patients were divided into 4 groups according to IAVWE and the stenosis ratio (Group 1, n = 17; Group 2, n = 19; Group 3, n = 13; Group 4, n = 14), and downstream collateral flow was analyzed using three-dimensional pseudocontinuous arterial spin labeling (3D-pCASL) and RAPID software. The National Institutes of Health Stroke Scale (NIHSS) scores of the patients were also recorded. Two-factor multivariate analysis of variance using Pillai's trace was used as the main statistical method.

Results:

No statistically significant difference was found in baseline demographic characteristics among the groups. IAVWE, but not the stenosis ratio, had a statistically significant significance on the late-arriving retrograde flow proportion (LARFP), hypoperfusion intensity ratio (HIR), and NIHSS scores (F = 20.941, P <0.001, Pillai's trace statistic = 0.567). The between-subject effects test showed that IAVWE had a significant effect on the three dependent variables: LARFP (R
2 = 0.088, F = 10.899, P = 0.002), HIR (R
2 = 0.234, F = 29.354, P <0.001), and NIHSS (R
2 = 114.339, F = 33.338, P <0.001).

Conclusions:

Arteriosclerotic IAVWE significantly reduced downstream collateral flow and affected relevant neurological deficits. It was an independent factor affecting downstream collateral flow and NIHSS scores, which should be a focus of future studies.

Trial Registration:

ChiCTR.org.cn, ChiCTR2100053661
Safety and Efficacy of Nondihydropyridine Calcium Channel Blockers for Acute Rate Control in Atrial Fibrillation with Rapid Ventricular Response and Comorbid Heart Failure with Reduced Ejection Fraction
Authors: Montana Paul C. , Rubin Phillip , Dyal Michael D. , Goldberger Jeffrey
Published: August 2023

The use of nondihydropyridine calcium channel blockers (NDCCBs) to achieve rate control in atrial fibrillation with the rapid ventricular rate (AF RVR) is not recommended in patients with comorbid heart failure with reduced ejection fraction (HFrEF) due to the concern for further blunting of contractility. However, these recommendations are extrapolated from data examining chronic NDCCB use in HFrEF patients, and comorbid AF was not analyzed. These recommendations also do not cite the hemodynamic effects or clinical outcomes of NDCCBs for acute rate control in HFrEF patients with AF RVR. It is our goal to open the discussion concerning the hemodynamic effects and safety profile of NDCCBs for acute rate control in this specific patient population. In the acute setting of AF RVR and HFrEF, there is a paucity of low-quality data on the safety and hemodynamic effects of NDCCBs, with mixed results. There has not been a clear signal toward adverse outcomes with NDCCBs, particularly for diltiazem. Data in this scenario is similarly limited for beta blockers, which provide the additional hemodynamic effect of the neurohormonal blockade, which provides a long-term mortality benefit to HFrEF patients. We support the cautious use of beta blockers as first-line therapy in clinical settings where an acute rate control strategy for AF RVR is warranted. We also support diltiazem as a reasonable second-line option, though the relative paucity of data calls for further research to validate this conclusion. Verapamil in this setting should be avoided until more data are available.
Influence of Regional Nerve Block in Addition to General Anesthesia on Postoperative Delirium, Pain, and In-hospital Stay in Patients Undergoing Cardiothoracic Surgery: A Meta-analysis
Authors: Li Li , Liu Min , Li Songsong , Xu Jiahui , Zheng Jun , Lv Chengwei , Wu Linlin , Heng Lei
Published: August 2023

This study aims to investigate whether venous injection of sedative agent or regional nerve block in alliance with major anesthesia could decrease the risk of postoperative delirium occurrence in patients receiving cardiothoracic surgery. Electronic academic databases were retrieved for related publications, and statistical software was used for data pooling and analysis. Forest plot was used to show the pooled sensitivity, specificity, and diagnostic odds ratio. Combined receiver operating characteristic curve was used to show the area under the curve of complex data. Seven studies were included for analysis. The risk of occurrence of delirium still showed no difference (risk rate = 0.93, 95% CI, 0.85–1.03) between the intervention group and placebo group. Postoperative pain feeling was more alleviated in patients with prophylactic application of regional nerve block. In addition, prophylactic application of regional nerve block could decrease the risk of postoperative in-hospital stay (risk rate = 0.28, 95% CI, 0.02–0.54). Our study demonstrated that, in elderly patients or pediatric patients undergoing cardiac surgery, prophylactic application of regional nerve block failed to decrease the incidence of postoperative delirium. However, the option of regional nerve block could decrease the duration of in-hospitalization stay and alleviate the acute pain during the postoperative period after open-heart surgery.
Minimal Scar Autologous Breast Reconstruction with Skin-sparing Mastectomy
Authors: Matsumine Hajime , Niimi Yosuke , Jibiki Norie , Sakurai Hiroyuki
Published: August 2023

Background:

A skin paddle severely impairs the appearance of the reconstructed breast. We have established a new technique called “minimal scar autologous breast reconstruction” involving delayed nipple reconstruction using a local flap designed on the skin paddle and simultaneous resection of the residual skin paddle.

Methods:

We analyzed 20 patients with unilateral breast cancer who underwent skin-sparing mastectomy followed by immediate breast reconstruction using a free flap (deep inferior epigastric perforator flap in 13 patients and profunda artery perforator flap in seven). Approximately 1 year after primary reconstruction, nipple reconstruction using an arrow flap designed on the skin paddle and resection of the residual skin paddle were performed. Several months later, medical areola tattooing was performed. Bilateral breast symmetry scores, obtained from the distances between anatomic landmarks, were compared before and after breast reconstruction.

Results:

Postoperative complications such as necrosis of the reconstructed nipple were not observed after two-stage reconstruction, and all procedures including total resection of the skin paddle, nipple reconstruction, and medical tattooing were performed successfully in all cases. Aesthetic outcomes were excellent: comparison of symmetry scores showed no significant differences in any parameters between before surgery and after reconstruction of the nipple-areola complex.

Conclusions:

We have established step-by-step strategies for mastectomy, autologous breast reconstruction, and then nipple reconstruction, keeping in mind that the skin paddle would later be totally resected in nipple reconstruction, and thereby achieved breast reconstruction with markedly reduced postoperative scarring compared with conventional autologous breast reconstruction.
METTL14 reverses liver fibrosis by inhibiting NOVA2 through an m6A-YTHDF2–dependent mechanism
Authors: Hou Xiaoxue , Li Yuwen , Song Jiali , Peng Linya , Zhang Wen , Liu Rui , Yuan Hui , Feng Tiantong , Li Jieying , Li Wenting , Zhu Chuanlong
Published: August 2023

Background:

N6-methyladenosine (m6A), the most prevalent internal RNA modification in eukaryotic cells, is dynamically regulated in response to a wide range of physiological and pathological states. Nonetheless, the involvement of METTL14-induced m6A in liver fibrosis (LF) has yet to be established.

Methods:

In vitro, HSC cell lines with knock-down and overexpression of METTL14 were constructed, and the effects of METTL14 gene on the phenotypic function of activated HSCs were observed. The proliferation rate was measured by CCK8 and EDU, the cell proliferation cycle was measured by flow detector, the migration rate was measured by Transwell, and the contractility of F-actin was observed after phalloidin staining. The downstream target gene NOVA2 of METTL14 was screened by combined sequencing of MeRIP-seq and RNA-seq, combined with signal analysis. Adeno-associated virus (AAV) was injected into the tail vein in vivo to knock down the expression of METTL14, so as to further observe the role of METTL14 in the progress of LF.

Results:

our research showed that the methylase METTL14 content was decreased in hepatic tissue from patients with LF, leading to a lowered degree of m6A modification. Functionally, we discovered that knocking down m6A methyltransferase METTL14 led to increased HSC activation and a substantial worsening of LF. Mechanically, as shown in a multiomics study of HSCs, depleting METTL14 levels decreased m6A deposition onNOVA2 mRNA transcripts, which prompted the activation of YTHDF2 to detect and degrade the decrease of NOVA2 mRNA

Conclusions:

METTL14 functioned as a profibrotic gene by suppressing NOVA2 activity in a mechanism dependent on m6A-YTHDF2. Moreover, knocking down METTL14 exacerbated LF, while NOVA2 prevented its development and partly reversed the damage.