bluuebunny/crossref_metadata_2025 huggingface dataset:
Periodontitis is associated with the increased levels of visfatin: a meta-analysis
Authors: Zhu Junfei , Zhang Suhan , Shi Jing , ning Ning , Wei Ying , Zhang Ye
Published: October 2023

Objective

Periodontitis is a common inflammatory disease associated with systemic factors. Visfatin is a pleiotropic adipokine that exerts metabolic and immune functions. Studies have shown visfatin played roles in the development of periodontitis. The present study aims to compare the levels of visfatin in body fluids including serum, saliva, and gingival crevicular fluid (GCF) between periodontitis patients and healthy individuals, and to elucidate the alteration of visfatin levels after periodontal treatments.

Materials and methods

The database searched included Pubmed, Embase, Web of Science, and Cochrane Library. According to the Eligibility criteria, the records were screened and the eligible studies were included. The methodological qualities of the included case-controlled studies were assessed according to the Newcastle–Ottawa scale (NOS). The Methodological Index for Nonrandomized Studies (MINORS) was applied for assessing the qualities of the included clinical trials. The statistical analyses were processed using STATA 15.0.

Results

Twenty-three studies were included in the statistical analyses. The meta-analysis showed significantly elevated visfatin levels of GCF, serum, and saliva in the periodontitis population compared with the controls (GCF: SMD = 5.201, 95% CI: 3.886–6.516, Z = 7.75, P < 0.05; Serum: SMD = 7.417, 95% CI: 3.068–11.767, Z = 3.34, P = P < 0.05; Saliva: SMD = 2.683, 95% CI: 1.202–4.163, Z = 3.34, P < 0.05). Visfatin levels of saliva serum and GCF were significantly decreased after periodontal treatment.

(Saliva: SMD = -1.338, 95% CI: -2.289—0.487, Z = 39.77, P < 0.05; Serum: SMD = -2.890, 95% CI: -5.300–0.480, Z = 2.35, P < 0.05; GCF: SMD = -6.075, 95% CI: -11.032—1.117, Z = 2.40, P = 0.016; I 2 = 95.9%, P < 0.05).

Conclusions

Periodontitis elevated the visfatin levels in GCF, serum, and saliva. Additionally, GCF, serum, and saliva visfatin levels could be reduced after periodontal treatment.
Spiritual care from the perspective of family caregivers and nurses in palliative care: a qualitative study
Authors: Kurtgöz Aslı , Edis Elif Keten
Published: October 2023

Background

The palliative care period not only affects patients but also family caregivers in many ways. Palliative care units are places where the spiritual needs of family caregivers become important. According to a holistic care approach, palliative care nurses should determine the spiritual needs of family caregivers and help meet these needs.

Objective

This study aims at exploring nurses’ and family caregivers’ experiences of spiritual care.

Methods

A phenomenological study was designed in this qualitative research. A total of 10 nurses working in palliative care and 11 family caregivers participated in the study. Nurses’ experiences of delivering spiritual care and family caregivers’ experiences of receiving spiritual care were examined through the in-depth interviewing method on a one-to‐one basis. The data were examined using thematic analysis.

Results

Four main themes were obtained by the data analysis: (I) Impacts of being in a palliative care unit; (II) Coping methods; (III) Importance of spirituality and spiritual care; (IV) Spiritual care. The results were presented according to the COREQ criteria.

Conclusion

Although spiritual care is very necessary for family caregivers, it is not offered sufficiently due to nurse-and institution-related reasons. Palliative care nurses should determine the spiritual needs of family caregivers in line with the holistic care approach. Nurse managers should determine factors preventing nurses from offering spiritual care and create solutions for these factors. The lack of nurses’ knowledge about spiritual care should be resolved by providing continuous training and therefore, nurses’ competencies in spiritual care should be improved.
Appetite and its association with mortality in patients with advanced cancer – a Post-hoc Analysis from the Palliative D-study
Authors: Goodrose-Flores Charlotte , Bonn Stephanie E. , Klasson Caritha , Frankling Maria Helde , Lagerros Ylva Trolle , Björkhem-Bergman Linda
Published: October 2023

Background

Loss of appetite is a common nutrition symptom in patients with cancer. Understanding the trajectory of appetite could be of clinical use for prognostication in palliative cancer care. Our primary aim was to explore the association between self-assessed appetite and mortality in patients suffering from advanced cancer. Secondary aims included the relation between fatigue, albumin levels and CRP/albumin ratio and mortality. We also aimed to study potential sex-differences in the associations.

Methods

Post-hoc analyses were performed using data from the Palliative D-study comprising 530 patients with cancer admitted to palliative care. Appetite and fatigue were assessed with the Edmonton Symptom Assessment System (ESAS). Cox proportional hazards models were used to calculate Hazard ratios (HR) with 95% confidence intervals (CI) for exposures of appetite, fatigue, albumin and CRP/albumin ratio, and time from study inclusion to death or censoring. Analyses were also performed stratified by sex.

Results

The follow-up time ranged between 7 to 1420 days. Moderate and poor appetite were significantly associated with a higher mortality rate compared to reporting a good appetite; HR 1.44 (95%CI: 1.16–1.79) and HR 1.78 (95%CI: 1.39–2.29), respectively. A higher mortality rate was also seen among participants reporting severe fatigue compared to those reporting no fatigue; HR 1.84 (95%CI:1.43–2.36). Participants with low albumin levels (< 25 g/L) and those in the highest tertile of CRP/albumin ratio, had higher mortality rates, HR 5.35 (95%CI:3.75–7.63) and HR 2.66 (95%CI:212–3.35), compared to participants with high albumin levels (> 36 g/L) and those in lowest tertile of CRP/albumin ratio. These associations were more pronounced in men than in women.

Conclusion

Poor appetite, severe fatigue, low albumin level and a high CRP/albumin ratio were associated with increased mortality rates among patients with advanced cancer. All these variables might be clinically useful for prognostication in palliative cancer care.

Trial registration

Clinicaltrial.gov. Identifier: NCT03038516;31, January 2017.
Non-invasive prenatal testing (NIPT): is routinization problematic?
Authors: Rehmann-Sutter Christoph , Timmermans Daniëlle R. M. , Raz Aviad
Published: October 2023

Background

The introduction and wide application of non-invasive prenatal testing (NIPT) has triggered further evolution of routines in the practice of prenatal diagnosis. ‘Routinization’ of prenatal diagnosis however has been associated with hampered informed choice and eugenic attitudes or outcomes. It is viewed, at least in some countries, with great suspicion in both bioethics and public discourse. However, it is a heterogeneous phenomenon that needs to be scrutinized in the wider context of social practices of reproductive genetics. In different countries with their different regulatory frameworks, different patterns of routines emerge that have different ethical implications.

This paper discusses an ethics of routines informed by the perspectives of organizational sociology and psychology, where a routine is defined as a repetitive, recognizable pattern of interdependent organizational actions that is carried out by multiple performers. We favour a process approach that debunks the view – which gives way to most of the concerns – that routines are always blindly performed. If this is so, routines are therefore not necessarily incompatible with responsible decision-making. Free and informed decision-making can, as we argue, be a key criterion for the ethical evaluation of testing routines. If free and informed decision-making by each pregnant woman is the objective, routines in prenatal testing may not be ethically problematic, but rather are defensible and helpful. We compare recent experiences of NIPT routines in the context of prenatal screening programmes in Germany, Israel and the Netherlands. Notable variation can be observed between these three countries (i) in the levels of routinization around NIPT, (ii) in the scope of routinization, and (iii) in public attitudes toward routinized prenatal testing.

Conclusion

An ethics of routines in the field of prenatal diagnostics should incorporate and work with the necessary distinctions between levels and forms of routines, in order to develop sound criteria for their evaluation.
Assessment of the availability, accessibility, and quality of sexual and reproductive health services for young people in conflict affected zones of Cameroon: a mixed method study
Authors: Dine Roseline Dzekem , Uwamahoro Valentine , Oladapo James Olasunkanmi , Eshun Gilbert , Effiong Fortune Benjamin , Kyei-Arthur Frank , Tambe Ayuk Bertrand
Published: October 2023

Introduction

Despite ongoing programs to improve young people’s Sexual and Reproductive Health Services (SRHS) in the conflict plagued North West and South West Regions of Cameroon, there is limited evidence-based information evaluating SRHS. This study, therefore, aims to investigate the availability, accessibility, and quality of SRHS provided to young people in the North West and South West Regions of Cameroon.

Method

This is a cross-sectional mixed-methods sequential explanatory study conducted among healthcare providers and young people between 10 and 24 years in 6 selected urban and rural areas in North West and South West regions. Data was collected between December 2021 and September 2022 using an adopted checklist. A descriptive analysis was conducted for quantitative data. An inductive analysis was conducted for the qualitative data to construct themes. The findings from the quantitative and qualitative responses were triangulated.

Results

There were 114 participants, 28 healthcare providers and 86 young people. Most provider participants were nurses (n = 18, 64.3%), working in religious facilities (n = 14, 50.0%), with diplomas as state registered nurses (n = 9, 32.1%). Also, more than half of young people (51.2%) were less than 20 years old, while there were more male young people (51.2%) than female young people (48.8%). Most respondents agreed that SRHS services were available, though they think they are not designed for young people and have limited awareness campaigns about the services. Reasons such as limited use of written guidelines, affected quality of SRHS. Participants revealed shyness, resistance from religious groups and families, insecurities from political instability, and inadequate training, among others, as barriers to SRH accessibility.

Conclusion

The study shows that SRHS are available but are not specifically designed for young people. Inadequate publicity for these services, coupled with the political crises and the ongoing COVID-19 pandemic, has increased young people’s inaccessibility to SRHS. Young people usually have to finance the cost of most of the SRHS. The quality of service delivery in the facilities is inadequate and must therefore be improved by developing safe, youth-friendly centers staffed with well-trained service providers.
Shoulder replacement surgery’s rising demand, inequality of provision, and variation in outcomes: cohort study using Hospital Episode Statistics for England
Authors: Valsamis Epaminondas Markos , Pinedo-Villanueva Rafael , Sayers Adrian , Collins Gary S. , Rees Jonathan L.
Published: October 2023

Background

The aim of this study was to forecast future patient demand for shoulder replacement surgery in England and investigate any geographic and socioeconomic inequalities in service provision and patient outcomes.

Methods

For this cohort study, all elective shoulder replacements carried out by NHS hospitals and NHS-funded care in England from 1999 to 2020 were identified using Hospital Episode Statistics data. Eligible patients were aged 18 years and older. Shoulder replacements for malignancy or acute trauma were excluded. Population estimates and projections were obtained from the Office for National Statistics. Standardised incidence rates and the risks of serious adverse events (SAEs) and revision surgery were calculated and stratified by geographical region, socioeconomic deprivation, sex, and age band. Hospital costs for each admission were calculated using Healthcare Resource Group codes and NHS Reference Costs based on the National Reimbursement System. Projected rates and hospital costs were predicted until the year 2050 for two scenarios of future growth.

Results

A total of 77,613 elective primary and 5847 revision shoulder replacements were available for analysis. Between 1999 and 2020, the standardised incidence of primary shoulder replacements in England quadrupled from 2.6 to 10.4 per 100,000 population, increasing predominantly in patients aged over 65 years. As many as 1 in 6 patients needed to travel to a different region for their surgery indicating inequality of service provision. A temporal increase in SAEs was observed: the 30-day risk increased from 1.3 to 4.8% and the 90-day risk increased from 2.4 to 6.0%. Patients from the more deprived socioeconomic groups appeared to have a higher risk of SAEs and revision surgery. Shoulder replacements are forecast to increase by up to 234% by 2050 in England, reaching 20,912 procedures per year with an associated annual cost to hospitals of £235 million.

Conclusions

This study reports a rising incidence of shoulder replacements, regional disparities in service provision, and an overall increasing risk of SAEs, especially in more deprived socioeconomic groups. These findings highlight the need for better healthcare planning to match local population demand, while more research is needed to understand and prevent the increase observed in SAEs.
A universal CRISPR-Cas14a responsive triple-sensitized upconversion photoelectrochemical sensor
Authors: Wang Yu , Peng Yuan , Zhou Huanying , Gao Zhixian
Published: October 2023

It has recently been discovered that, like other members of the Cas family (12a and 13a), the clustered regularly interspaced short palindrome repeat CRISPR-Cas14a system not only mediates high-sensitivity detection with exceptionally strong gene editing ability but is also generally useful for DNA detection via fluorescence. Photoelectrochemical (PEC) sensors have been widely applied as efficient analytical tools. Measuring electrical signals is more cost-effective and the necessary equipment is more easily portable than fluorescence signal detectors, but their stability still needs to be improved. The high base resolution of CRISPR-Cas14a can compensate for such shortcomings. Therefore, electrical signals and fluorescence signals were combined, and the development of a universal CRISPR-Cas14a-responsive ultrasensitive upconversion PEC sensor is described in this paper. Moreover, strand displacement amplification (SDA) and a near-infrared (NIR) light source were utilized to further improve the stability and sensitivity of the photoelectric signals. At the same time, the modified working electrode (UCNPs-ssDNA-CdS@Au/ITO) on the three-electrode disposable sensor was used as the reporter probe, which cooperates with the trans-cleavage activity of Cas14a endonuclease. To verify the universality of this sensor, the UCNPs-Cas14a-based PEC sensor was applied for the detection of the small-molecule toxin T2 and protein kinase PTK7. Here, we report that the limit of detection of this reagent was within the fg range, successfully applied to the detection of T2 in oats and PTK7 in human serum. We propose that by combining PEC and CRISPR-14a, UCNPs-Cas14a-based PEC sensors could become powerful drivers for the extensive development of ultrasensitive, accurate and cost-effective universal sensors for detection and diagnosis.
Houselessness and syringe service program utilization among people who inject drugs in eight rural areas across the USA: a cross-sectional analysis
Authors: Ballard April M. , Falk Dylan , Greenwood Harris , Gugerty Paige , Feinberg Judith , Friedmann Peter D. , Go Vivian F. , Jenkins Wiley D. , Korthuis P. Todd , Miller William C. , Pho Mai T. , Seal David W. , Smith Gordon S. , Stopka Thomas J. , Westergaard Ryan P. , Zule William A. , Young April M. , Cooper Hannah L. F.
Published: October 2023

Background

Research conducted in urban areas has highlighted the impact of housing instability on people who inject drugs (PWID), revealing that it exacerbates vulnerability to drug-related harms and impedes syringe service program (SSP) use. However, few studies have explored the effects of houselessness on SSP use among rural PWID. This study examines the relationship between houselessness and SSP utilization among PWID in eight rural areas across 10 states.

Methods

PWID were recruited using respondent-driven sampling for a cross-sectional survey that queried self-reported drug use and SSP utilization in the prior 30 days, houselessness in the prior 6 months and sociodemographic characteristics. Using binomial logistic regression, we examined the relationship between experiencing houselessness and any SSP use. To assess the relationship between houselessness and the frequency of SSP use, we conducted multinomial logistic regression analyses among participants reporting any past 30-day SSP use.

Results

Among 2394 rural PWID, 56.5% had experienced houselessness in the prior 6 months, and 43.5% reported past 30-day SSP use. PWID who had experienced houselessness were more likely to report using an SSP compared to their housed counterparts (adjusted odds ratio [aOR] = 1.24 [95% confidence intervals [CI] 1.01, 1.52]). Among those who had used an SSP at least once (n = 972), those who experienced houselessness were just as likely to report SSP use two (aOR = 0.90 [95% CI 0.60, 1.36]) and three times (aOR = 1.18 [95% CI 0.77, 1.98]) compared to once. However, they were less likely to visit an SSP four or more times compared to once in the prior 30 days (aOR = 0.59 [95% CI 0.40, 0.85]).

Conclusion

This study provides evidence that rural PWID who experience houselessness utilize SSPs at similar or higher rates as their housed counterparts. However, housing instability may pose barriers to more frequent SSP use. These findings are significant as people who experience houselessness are at increased risk for drug-related harms and encounter additional challenges when attempting to access SSPs.
Single-port three-dimensional (3D) endoscopic-assisted breast surgery—preliminary results and patient-reported satisfaction in 145 breast cancer and gynecomastia cases
Authors: Chia Clement Luck Khng , Sae-lim Chayanee , Lai Hung-Wen , Chandrachamnong Korawan , Huang Hsin-I. , Chen Dar-Ren , Chen Shou-Tung
Published: October 2023

Background

Minimal-accessed (robotic and endoscopic) breast cancer surgery is increasingly performed due to better cosmetic results and acceptable oncological outcomes. This study aims to demonstrate the clinical safety and patient-reported cosmetic satisfaction of single-port three-dimensional endoscopic-assisted breast surgery (S-P 3D EABS), which is our new endoscopic surgical innovation, in both malignant and benign breast conditions.

Methods

Patients who underwent S-P 3D EABS from 1 August 2018 to 31 July 2022 in a single institution were enrolled. Clinical outcomes of this procedure were retrospectively reviewed, and the patient-reported cosmetic satisfaction was evaluated by a questionnaire and reported herein.

Results

During the study period, 145 patients underwent 164 procedures of S-P 3D EABS. One hundred fifty (91.5%) procedures were endoscopic-assisted nipple-sparing mastectomy (S-P 3D E-NSM; 117 therapeutic procedures for breast cancer, 13 prophylactic mastectomies, 20 procedures for gynecomastia). Fourteen (8.5%) procedures of endoscopic-assisted breast-conserving surgery (S-P 3D E-BCS) were performed (12 S-P 3D E-BCS, 2 S-P 3D E-BCS with 3D videoscope-assisted partial breast reconstruction, which was 1 case of latissimus dorsi flap and 1 case of omental flap). The mean operative time was 245 ± 110 min in S-P 3D E-NSM and 260 ± 142 min in S-P 3D E-BCS. The mean intraoperative blood loss was 49.7 ± 46.9 ml in S-P 3D E-NSM and 32.8 ± 17.5 ml in S-P 3D E-BCS. Subnipple biopsy showed positive malignancy in 3 (2.6%) S-P 3D E-NSM patients. None of the S-P 3D E-BCS patients found margin involvement; however, 3 (2.6%) reported margin involvement in S-P 3D E-NSM patients. Thirty-two complications were found (24.6%): 7 (5.3%) transient nipple-areolar complex (NAC) ischemia, 7 (5.3%) partial NAC necrosis, 1 (0.7%) total NAC necrosis, and 1 (0.7%) implant loss. During the mean follow-up time of 34 months, there were 2 (1.5%) patients with locoregional recurrence, 9 (6.9%) distant metastasis, and 2 (1.5%) mortality. 78.6% (77/98) of patients answering the cosmetic-evaluated questionnaire reported good and excellent overall satisfaction.

Conclusions

S-P 3D EABS is a novel surgical innovation, which is able to perform safely in either malignant or benign breast conditions and offer promising cosmetic results.
Fasting mimicking diet inhibits tumor-associated macrophage survival and pro-tumor function in hypoxia: implications for combination therapy with anti-angiogenic agent
Authors: Wang Lei , Wang Yu-jie , Wang Rong , Gong Fu-lian , Shi Yu-huan , Li Sheng-nan , Chen Pan-pan , Yuan Yong-fang
Published: October 2023

Background

Recent research shows that tumor-associated macrophages (TAMs) are the primary consumers of glucose in tumor tissue, surpassing that of tumor cells. Our previous studies revealed that inhibiting glucose uptake impairs the survival and tumor-promoting function of hypoxic TAMs, suggesting that glucose reduction by energy restriction (calorie restriction or short-term fasting) may has a significant impact on TAMs. The purpose of this study is to verify the effect of fasting-mimicking diet (FMD) on TAMs, and to determine whether FMD synergizes with anti-angiogenic drug apatinib via TAMs.

Methods

The effect of FMD on TAMs and its synergistic effects with apatinib were observed using an orthotopic mouse breast cancer model. An in vitro cell model, utilizing M2 macrophages derived from THP-1 cell line, was intended to assess the effects of low glucose on TAMs under hypoxic and normoxic conditions. Bioinformatics was used to screen for potential mechanisms of action, which were then validated both in vivo and in vitro.

Results

FMD significantly inhibit the pro-tumor function of TAMs in vivo and in vitro, with the inhibitory effect being more pronounced under hypoxic conditions. Additionally, the combination of FMD-mediated TAMs inhibition with apatinib results in synergistic anti-tumor activity. This effect is partially mediated by the downregulation of CCL8 expression and secretion by the mTOR-HIF-1α signaling pathway.

Conclusions

These results support further clinical combination studies of FMD and anti-angiogenic therapy as potential anti-tumor strategies.

Graphical Abstract
Inflammatory signaling in NASH driven by hepatocyte mitochondrial dysfunctions
Authors: Myint Melissa , Oppedisano Francesca , De Giorgi Valeria , Kim Byeong-Moo , Marincola Francesco M. , Alter Harvey J. , Nesci Salvatore
Published: October 2023

Liver steatosis, inflammation, and variable degrees of fibrosis are the pathological manifestations of nonalcoholic steatohepatitis (NASH), an aggressive presentation of the most prevalent chronic liver disease in the Western world known as nonalcoholic fatty liver (NAFL). Mitochondrial hepatocyte dysfunction is a primary event that triggers inflammation, affecting Kupffer and hepatic stellate cell behaviour. Here, we consider the role of impaired mitochondrial function caused by lipotoxicity during oxidative stress in hepatocytes. Dysfunction in oxidative phosphorylation and mitochondrial ROS production cause the release of damage-associated molecular patterns from dying hepatocytes, leading to activation of innate immunity and trans-differentiation of hepatic stellate cells, thereby driving fibrosis in NASH.
Epidemiology and clinical severity of the serotypes of human parainfluenza virus in children with acute respiratory infection
Authors: Wang Le , Lu Sukun , Guo Yinghui , Liu Jianhua , Wu Peng , Yang Shuo
Published: October 2023

Background

Acute respiratory infections (ARI) are a threat to human health and survival, resulting in many paediatric hospitalisations. However, the epidemiological and clinical severity characteristics of the human parainfluenza virus (PIV), one of the most prevalent respiratory viruses, are not well understood in children.

Methods

To identify the epidemiological features of PIV infection, in 2019, hospitalised children with ARI were screened using multiplex polymerase chain reaction (PCR) for PIV and 10 other common respiratory pathogens. Subtyping of randomly selected PIV-positive samples was performed using reverse transcription-PCR. Demographics, epidemiology, clinical manifestations, diagnosis, and outcomes were compared between PIV subtypes.

Results

The annual detection rate for PIV was 14.9%, with a peak from April to September. Children under one year of age had the highest rate of PIV infection (45.5%) compared to other age groups. Of the 121 sequenced samples, 58.7%, 36.4% and 4.9% were positive for PIV-3, PIV-1 and PIV-2, respectively, and no PIV-4 was detected. Severe infections were associated with pre-existing underlying diseases and co-infections, but not with PIV serotype. After excluding cases of co-infection, we found that PIV-2 infection was associated with upper respiratory tract infections, whereas PIV-1 and PIV-3 mainly caused lower respiratory tract infections. Apart from the proportion of patients with fever, there were no significant differences among the three subtypes in terms of clinical symptoms, severity, and outcome.

Conclusion

Here, PIV was the main pathogen causing ARI in hospitalised children. Appropriate attention should be paid to children with underlying diseases and co-infections to prevent the worsening of severe PIV infection.
Clinically‐accessible and laboratory‐derived predictors of biomechanical response to standalone and supported lateral wedge insoles in people with knee osteoarthritis
Authors: Hunt Michael A. , Tse Calvin T. F. , Ryan Michael B. , Scott Alexander , Sayre Eric C.
Published: October 2023

Background

Lateral wedge insoles (both standalone and those incorporating individualized arch support) have been frequently studied for the effects on knee joint loading and pain in people with knee osteoarthritis. It has been shown that many people who use these insoles do not obtain the intended biomechanical effect, and thus may not experience a clinical benefit. The ability to identify biomechanical responders to lateral wedge insoles before research or clinical intervention is an important objective for efficient resource use and optimizing patient outcomes. The purpose of our exploratory, hypothesis‐generating study was to provide an initial assessment of variables that are associated with the biomechanical response to lateral wedge insoles in people with knee osteoarthritis.

Methods

We collected a number of demographic (age, sex, body mass index, foot posture), clinical (knee pain, foot pain, radiographic disease severity), and walking‐related (speed, knee alignment, frontal plane subtalar movement, and foot rotation) outcomes from 53 individuals with painful, radiographically‐confirmed knee osteoarthritis. The walking‐related outcomes were obtained using equipment both from the research laboratory and the clinical setting. We used logistic regression to generate predictive models to determine candidate variables associated with a reduction in the knee adduction moment during walking – a surrogate for tibiofemoral load distribution, and a known biomechanical risk factor for osteoarthritis progression – with the use of standalone and arch‐supported lateral wedge insoles. Three different response thresholds (2%, 6%, and 10% reductions in the knee adduction moment) were used.

Results

In general, biomechanical responders were those who walked faster, were female, had less varus alignment, and had less severe radiographic severity. Findings were similar between the standalone and arch‐supported lateral wedge insoles, as well as between models using the laboratory‐derived or clinically‐available measures of walking performance.

Conclusions

Our hypothesis‐generating study provides valuable information that will inform future research into the efficient and effective use of lateral wedge insoles in the conservative management of knee osteoarthritis.
i-MoMCARE: Innovative Mobile Technology for Maternal and Child Health Care in Cambodia—study protocol of a cluster randomized controlled trial
Authors: Saing Chan Hang , Ung Mengieng , Suy Sovanthida , Oy Sreymom , Dary Chhavarath , Yam Esabelle Lo Yan , Chhorn Sophea , Nagashima-Hayashi Michiko , Khuon Dyna , Mam Sovatha , Kim Rattana , Saphonn Vonthanak , Yi Siyan
Published: October 2023

Background

The Government of Cambodia established the village health support groups (VHSGs) in 2003 to facilitate primary healthcare activities, including maternal and child health (MCH) services. However, VHSGs face several challenges that hinder them from performing optimally, including a lack of regular structured training and remuneration and limited and inconsistent support and supervision from the health centers (HCs). This implementation research aims to develop, implement, and evaluate a digital health intervention to improve the performance of VHSGs through better support and supervision and increase the MCH service coverage in rural Cambodia.

Methods

i-MoMCARE, a two-arm cluster randomized controlled trial, will be conducted between 2022 and 2025. Five operational districts (ODs) have been randomized to an intervention arm and the other five ODs to the control arm. The intervention will last for 24 months. Around 200 VHSGs in the intervention arm will be equipped with a mobile application as a job aid and 20 HC staff with a web interface to improve support and supervision of VHSGs. The potential beneficiaries will include pregnant women, mothers, and children under 2 years old. We will measure the outcomes at baseline and endline. The primary outcomes will consist of a composite MCH index constructed from maternal and newborn care indicators, child immunization, and treatment of under-two children. Secondary outcomes will include coverage of selected MCH services. We will conduct the intention-to-treat and per-protocol analyses. We will conduct qualitative interviews with selected beneficiaries and stakeholders to evaluate the intervention’s acceptability, feasibility, and scalability. We will also conduct a cost-effective analysis using decision-analytic modeling incorporating a societal perspective that explores different time horizons, intervention effects, and when scaled up to the national level.

Discussion

i-MoMCARE is expected to increase MCH service access and coverage in rural Cambodia. It will contribute to advancing digital health use in primary healthcare interventions, which remains in its infancy in the country. Furthermore, the study findings will be a valuable addition to a growing body of literature on the effectiveness and feasibility of mobile health to improve coverage of MCH services in rural low- and middle-income country settings.

Trial registration

ClinicalTrial.gov NCT05639595. Registered on 06 December 2022.
Effect of peripheral nerve block versus general anesthesia on the hemodynamics and prognosis of diabetic patients undergoing diabetic foot Surgery
Authors: Zhu Gehua , Xu Jiamin , Dai Hanying , Min Dinghong , Guo Guanghua
Published: October 2023

Background

Diabetic foot ulcers (DFUs) represent a significant foot-related concern for patients with multiple co-morbidities, and surgical intervention is often employed. Notably, peripheral nerve block anesthesia (PNB) has emerged as a new approach for the surgical management of DFUs, providing sustained hemodynamic stability and superior postoperative pain control compared to general anesthesia (GEA).

Methods

The present study utilized a retrospective analysis of hospitalized patients who met the inclusion criteria for DFUs over a period of 7 years. Patients were categorized into two groups based on the type of anesthesia employed during the procedure: GEA or PNB. Extensive patient information was gathered and analyzed, such as demographics, intraoperative hemodynamic parameters, numeric rating scale (NRS) scores, and healing outcomes. The preliminary results assessed in this study were intraoperative hemodynamic stability and postoperative analgesic efficacy.

Results

During the study period, 117 patients received surgical therapy based on GEA, while 145 patients received PNB. Notably, the mean intraoperative blood pressure was significantly lower in the GEA group, and this difference remained statistically significant even after Bonferroni adjustment using linear mixed models. Additionally, the frequency of hypotensive episodes was higher in the GEA group (P < 0.05). Furthermore, the perioperative transfusion volume, overall intraoperative fluid input, and intraoperative bleeding volume were significantly more significant in the GEA group than in the PNB group. The postoperative pain NRS scores differed considerably between the two groups (Bonferroni corrected P < 0.01), with the GEA group exhibiting higher opioid consumption on the day of surgery and the first postoperative day when using patient-controlled intravenous analgesia (PCIA). Supplemental analgesic medication was more significant in the GEA group 24 h postoperatively. However, the two groups had no difference in hospital stay or treatment outcomes. There was no difference between the two groups regarding secondary surgery and amputation procedures. Although the 5-year mortality rate is 30.5%, no significant difference in mortality rates between the two groups was observed.

Conclusions

Compared to GEA, PNB is a safe and effective alternative therapy for managing DFUs. Our findings suggest that PNB administration during surgical intervention for this condition results in more stable intraoperative hemodynamics and superior postoperative analgesic effects, despite no significant difference in overall treatment outcomes between the two groups. The two groups did not differ in re-surgery, amputation, or 5-year mortality.
Preferable effects of pemafibrate on liver function and fibrosis in subjects with type 2 diabetes complicated with liver damage
Authors: Nomoto Hiroshi , Kito Kenichi , Iesaka Hiroshi , Handa Takahisa , Yanagiya Shingo , Miya Aika , Kameda Hiraku , Cho Kyu Yong , Takeuchi Jun , Nagai So , Sakuma Ichiro , Nakamura Akinobu , Atsumi Tatsuya
Published: October 2023

Background

Pemafibrate has been reported to ameliorate lipid profiles and liver dysfunction. However, which patients derive benefit from the hepatoprotective effects of pemafibrate is unclear.

Methods

We conducted a sub-analysis of the PARM-T2D study where subjects with type 2 diabetes complicated by hypertriglyceridemia were prospectively treated with pemafibrate or conventional therapies for 52 weeks. From the original cohort, subjects who had metabolic-associated fatty liver disease without changing their treatment regimens for comorbidities were analyzed. Eligible subjects (n = 293) (average age 61.2 ± 11.7 years, 37.5% female) treated with pemafibrate (pemafibrate, n = 152) or controls who did not change their treatment regimens (controls, n = 141) were divided into three groups based on their alanine aminotransferase (ALT) levels: ALT ≤ upper normal limit (UNL) (pemafibrate, n = 65; controls, n = 50), UNL < ALT ≤ 2×UNL (pemafibrate, n = 58; controls, n = 54), and 2×UNL < ALT (pemafibrate, n = 29; controls, n = 27).

Results

Pemafibrate treatment significantly ameliorated ALT levels (from 29 to 22 U/L, p < 0.001 by Wilcoxon’s signed-rank test) in the total cohort and subjects with high ALT levels (2×ULN < ALT), and improved liver fibrosis as assessed by the Fibrosis-4 index (mean change − 0.05 (95% confidence interval: −0.22 to − 0.02), p < 0.05 versus baseline by the Mann-Whitney U-test and p < 0.05 versus the ALT ≤ UNL group by the Kruskal–Wallis test followed by Dunn’s post-hoc analysis).

Conclusions

The hepatoprotective effects of pemafibrate were dominant in subjects with type 2 diabetes complicated with liver dysfunction.

Trial registration

This study was registered with the University Hospital Medical Information Network Center Clinical Trials Registry (UMIN000037385).
CT and MR imaging of primary biliary cholangitis: a pictorial review
Authors: Zhang Yun , Zheng Tianying , Huang Zixing , Song Bin
Published: October 2023

Primary biliary cholangitis (PBC) is a rare chronic autoimmune-mediated cholestatic liver disease involving medium and small bile ducts that can lead to liver fibrosis and cirrhosis. To date, the pathogenesis of PBC remains elusive, and there is currently no curative medical treatment. Computed tomography (CT) and magnetic resonance (MR) imaging, as common technical tools that allow non-invasive monitoring of liver tissue in vivo, play crucial roles in the diagnosis, staging, and prognosis prediction in PBC by enabling assessment of abnormalities in liver morphology and parenchyma, irregular configuration of bile ducts, lymphadenopathy, portal hypertension, and complications of cirrhosis. Moreover, CT and MRI can be used to monitor the disease progression after treatment of PBC (e.g. the onset of cirrhotic decompensation or HCC) to guide the clinical decisions for liver transplantation. With the optimization of imaging technology, magnetic resonance elastography (MRE) offers additional information on liver stiffness, allows for the identification of early cirrhosis in PBC and provides a basis for predicting prognosis. Gadoxetic acid-enhanced MRI enables the assessment of liver function in patients with PBC. The purpose of this review is to detail and illustrate the definition, pathological basis, and clinical importance of CT and MRI features of PBC to help radiologists and clinicians enhance their understanding of PBC.

Critical Relevance Statement

Characteristic CT and MR imaging manifestations of primary biliary cholangitis may reflect the course of the disease and provide information associated with histological grading and altered cellular function.

Key points

• Imaging has become highly useful for differentiating PBC from other diseases.

• Key pathological alterations of PBC can be captured by CT and MRI.

• Characteristic manifestations provide information associated with histological grade and cellular function.

• Despite this, the CT or MRI features of PBC are not specific.

Graphical Abstract
Prognostic utility of body composition parameters based on computed tomography analysis of advanced non-small cell lung cancer treated with immune checkpoint inhibitors
Authors: Park Ji Eun , Jo Jaemin , Youk Jeonghwan , Kim Miso , Yoon Soon Ho , Keam Bhumsuk , Kim Tae Min , Kim Dong-Wan
Published: October 2023

Objective

The purpose of this study was to evaluate the prognostic impact of body composition parameters based on computed tomography (CT) in patients with non-small cell lung cancer (NSCLC) who received ICI treatment.

Methods

This retrospective study analyzed the data from advanced NSCLC patients treated with ICI therapy between 2013 and 2019. We included patients with NSCLC who underwent baseline CT scans. The exclusion criteria included patients who received three or more lines of chemotherapy, those with insufficient clinical information, or those without treatment response evaluation.

Results

A total of 136 patients were enrolled. Among the volumetric body composition parameters, patients in the highest quartiles (Q2–4) of the visceral fat index (VFI) exhibited a higher response rate to ICI therapy than those in the lowest quartile (Q1) of VFI (Q1 vs. Q2–4: 18.2% vs. 43.1%, p = 0.012). Patients with a VFI in Q2–4 had significantly prolonged progression-free survival (PFS) and overall survival (OS) (PFS, Q1 vs. Q2–4: 3.0 months vs. 6.4 months, p = 0.043; OS, Q1 vs. Q2–4: 5.6 months vs. 16.3 months, p = 0.004). Kaplan–Meier analysis based on the VFI and visceral fat Hounsfield unit (HU) revealed that patients with VFI in Q1 and HU in Q2–4 had the worst prognosis.

Conclusions

Visceral fat volume is significantly associated with treatment outcomes in ICI-treated patients with NSCLC. Moreover, fat quality may impact the treatment outcomes. This finding underscores the potential significance of both fat compartments and fat quality as prognostic indicators.

Critical relevance statement

Visceral fat volume is significantly associated with treatment outcomes in ICI-treated patients with non-small cell lung cancer. Moreover, fat quality may impact the treatment outcomes. This finding underscores the potential significance of both fat compartments and fat quality as prognostic indicators.

Graphical Abstract

Key points

• We found that visceral fat volume positively correlated with treatment response and survival in patients with non-small cell lung cancer receiving immune checkpoint inhibitors.

• Additionally, a trend toward a negative correlation between visceral fat attenuation and survival was observed.

• The findings highlight the prognostic utility of fat compartments and fat quality.
Optimal combination periprosthetic vasculature visualization and metal artifact reduction by spectral computed tomography using virtual monoenergetic images in total hip arthroplasty
Authors: Zhao Jie , Cheng Qiang , Liu Chuan , Wang Qiqi , Lv Yuchan , Tang Ziyi , Luo Yuxi , Yang Haitao
Published: October 2023

Objectives

To investigate the optimal parameters of spectral CT for preferably visualizing the periprosthetic vasculature and metal artifact reduction (MAR) in total hip arthroplasty (THA).

Methods

A total of 34 THA of 30 patients were retrospectively included. Image reconstructions included conventional image (CI), CI combined with MAR (CIMAR), and virtual monoenergetic images (VMI) combined with MAR (VMIMAR) at 50–120 keV. The attenuation and standard deviation of the vessel and artifact, and the width of artifact were measured. Qualitative scoring was evaluated including the vascular contour, the extent of artifact, and overall diagnostic evaluation.

Results

The attenuation, noise of the vessel and artifact, and the width of artifact decreased as the energy level increased (p < 0.001). The downtrend was relatively flat at 80–120 keV, and the vascular attenuation dropped to 200 HU at 90 keV. The qualitative rating of vascular contour was significantly higher at CIMAR (3.47) and VMIMAR 60–80 keV (2.82–3.65) compared with CI (2.03) (p ≤ 0.029), and the highest score occurred at 70 and 80 keV (3.65 and 3.56). The score of the extent of artifact was higher at VMIMAR 80 keV than CIMAR (3.53 VS 3.12, p = 0.003). The score of the overall diagnostic evaluation was higher at VMIMAR 70 and 80 keV (3.32 and 3.53, respectively) than CIMAR (3.12) (p ≤ 0.035).

Conclusion

Eighty kiloelectron volts on VMIMAR, providing satisfactorily reduced metal artifacts and improved vascular visualization, can be an optimal recommended parameter of spectrum CT for the assessment of periprosthetic vasculature in THA patients.

Critical relevance statement

The metal artifact is gradually reducing with increasing energy level; however, the vascular visualization is worsening. The vascular visualization is terrible above 100 keV, while the vessel is disturbed by artifacts below 70 keV. The best performance is found at 80 keV.

Key points

• VMIMAR can provide both reduced metal artifacts and improved vascular visualization.

• Eighty kiloelectron volts on VMIMAR performs best in vascular visualization of total hip arthroplasty patients.

• Energy spectrum CT is recommended for routine use in patients with total hip arthroplasty.

Graphical Abstract
Baseline 18F-FDG PET/CT radiomics for prognosis prediction in diffuse large B cell lymphoma
Authors: Jing Fenglian , Liu Yunuan , Zhao Xinming , Wang Na , Dai Meng , Chen Xiaolin , Zhang Zhaoqi , Zhang Jingmian , Wang Jianfang , Wang Yingchen
Published: October 2023

Background

Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma in adults. Standard treatment includes chemoimmunotherapy with R-CHOP or similar regimens. Despite treatment advancements, many patients with DLBCL experience refractory disease or relapse. While baseline 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) parameters have shown promise in predicting survival, they may not fully capture lesion heterogeneity. This study aimed to assess the prognostic value of baseline 18F-FDG PET radiomics features in comparison with clinical factors and metabolic parameters for assessing 2-year progression-free survival (PFS) and 5-year overall survival (OS) in patients with DLBCL.

Results

A total of 201 patients with DLBCL were enrolled in this study, and 1328 radiomics features were extracted. The radiomics signatures, clinical factors, and metabolic parameters showed significant prognostic value for individualized prognosis prediction in patients with DLBCL. Radiomics signatures showed the lowest Akaike information criterion (AIC) value and highest Harrell’s concordance index (C-index) value in comparison with clinical factors and metabolic parameters for both PFS (AIC: 571.688 vs. 596.040 vs. 576.481; C-index: 0.732 vs. 0.658 vs. 0.702, respectively) and OS (AIC: 339.843 vs. 363.671 vs. 358.412; C-index: 0.759 vs. 0.667 vs. 0.659, respectively). Statistically significant differences were observed in the area under the curve (AUC) values between the radiomics signatures and clinical factors for both PFS (AUC: 0.768 vs. 0.681, P = 0.017) and OS (AUC: 0.767 vs. 0.667, P = 0.023). For OS, the AUC of the radiomics signatures were significantly higher than those of metabolic parameters (AUC: 0.767 vs. 0.688, P = 0.007). However, for PFS, no significant difference was observed between the radiomics signatures and metabolic parameters (AUC: 0.768 vs. 0.756, P = 0.654). The combined model and the best-performing individual model (radiomics signatures) alone showed no significant difference for both PFS (AUC: 0.784 vs. 0.768, P = 0.163) or OS (AUC: 0.772 vs. 0.767, P = 0.403).

Conclusions

Radiomics signatures derived from PET images showed the high predictive power for progression in patients with DLBCL. The combination of radiomics signatures, clinical factors, and metabolic parameters may not significantly improve predictive value beyond that of radiomics signatures alone.
Metabolites of non-aureus staphylococci affect the ability of Staphylococcus aureus to adhere to and internalize into bovine mammary epithelial cells
Authors: Toledo-Silva Bruno , Oliveira Ana Cláudia Dumont , Souza Fernando N. , Haesebrouck Freddy , De Vliegher Sarne
Published: October 2023

This study investigated whether cell-free supernatants (SN) from four bovine non-aureus staphylococcal (NAS) isolates prevent Staphylococcus aureus adhesion to and internalization into bovine mammary epithelial cells (MAC-T cells) and if so, to determine whether such effects were potentially associated with the S. aureus accessory gene regulator (agr) system. Overall, we demonstrated that all SN obtained from the NAS isolates promoted adhesion of a S. aureus agr+ strain to, yet reduced the internalization into MAC-T cells, while similar effects were not observed for its agr− mutant strain. Our findings provide novel anti-virulence strategies for treating and controlling bovine S. aureus mastitis.