bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of different inspiratory muscle training protocols on functional exercise capacity and respiratory and peripheral muscle strength in patients with chronic kidney disease: a randomized study
Authors: Katayıfçı Nihan , Hüzmeli̇ İrem , İri̇ş Döndü , Turgut Faruk Hilmi
Published: May 2024

Background

Pathological changes were observed in the diaphragm due to abnormal renal function in chronic kidney disease (CKD). Inspiratory muscle training (IMT) has been suggested for patients with CKD; however, the most appropriate intensity for IMT has not been determined. Therefore, this study aimed to investigate the effects of different IMT protocols on respiratory muscle strength, quadriceps femoris muscle strength (QMS), handgrip muscle strength (HGS), functional exercise capacity, quality of life (QoL), pulmonary function, dyspnoea, fatigue, balance, and physical activity (PA) levels in patients with CKD.

Methods

This randomized, controlled, single-blind study included 47 patients and they were divided into three groups: Group 1 (n = 15, IMT with 10% maximal inspiratory pressure (MIP)), Group 2 (n = 16, IMT with 30% MIP), and Group 3(n = 16; IMT with 60% MIP). MIP, maximal expiratory pressure (MEP), 6-min walking test (6-MWT), QMS, HGS, QoL, pulmonary function, dyspnoea, fatigue, balance, and PA levels were assessed before and after eight weeks of IMT.

Results

Increases in MIP, %MIP, 6-MWT distance, and %6-MWT were significantly higher in Groups 2 and 3 than in Group 1 after IMT (p < 0.05). MEP, %MEP, FEF25-75%,QMS, HGS, and QoL significantly increased; dyspnoea and fatigue decreased in all groups (p < 0.05). FVC, PEF, and PA improved only in Group 2, and balance improved in Groups 1 and 2 (p < 0.05).

Conclusions

IMT with 30% and 60% MIP similarly improves inspiratory muscle strength and functional exercise capacity. IMT with 30% is more effective in increasing PA. IMT is a beneficial method to enhance peripheral and expiratory muscle strength, respiratory function, QoL and balance, and reduce dyspnoea and fatigue. IMT with %30 could be an option for patients with CKD who do not tolerate higher intensities.

Trial registration

This study was retrospectively registered (NCT06401135, 06/05/2024).
Dose-response association of obesity and risk of mental health among tehranian residents: result of a cross-sectional study
Authors: Jibril Aliyu Tijani , Ganjeh Bahareh Jabbarzadeh , Mirrafiei Amin , Firouzi Mahsa , Norouziasl Reyhane , Ghaemi Shadi , Bafkar Negar , Jayedi Ahmad , Djafarian Kurosh , Shab-Bidar Sakineh
Published: May 2024

Background

Obesity and mental health issues are two of the most prevalent global public health issues for a significant portion of people. The purpose of this study was to investigate the relationship between obesity indicators and mental health in Tehran-dwelling Iranian adults.

Methods

We conducted a cross-sectional study on healthy Iranian adults using a convenience sampling technique. The short form of the Depression Anxiety and Stress Scale (DASS-21) was used to measure the outcome, and independent variables included body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body adiposity index (BAI), and a body shape index (ABSI). The relationship between obesity and mental health was investigated using a multivariate logistic regression model. The non-linear dose-response relationships were evaluated using restricted cubic splines (RCS) with three knots. The Benjamini-Hochberg procedure was used to adjust for multiple testing.

Results

In our study of 434 participants, females made up 52% of the participants, with a mean age of 38.57 years. In all, 54.6%, 53.9%, and 56.6% were classified as having anxiety, depression, and stress respectively. Logistic regression analysis showed that the odds of mental health components including anxiety, depression, or stress was not significantly different across the tertiles of the obesity indicators. We observed a significant dose-response relationship between BAI and ABSI and the risk of anxiety (PBenjamini-Hochberg 0.028 > Pdose-response 0.023) and stress (PBenjamini-Hochberg 0.028 > Pdose-response 0.003) but not depression (PBenjamini-Hochberg 0.014 < Pdose-response 0.018). The lowest risk for anxiety was observed in people with a BAI of 28% and ABSI equal to 0.079. The risk of stress seemed to increase beyond an ABSI of 0.086.

Conclusion

Our findings showed no direct linear association between obesity indices and anxiety. However, a dose-response relationship was observed between BAI and ABSI and the risk of anxiety and stress, indicating the need for further investigation.
Work & life stress experienced by professional workers during the pandemic: a gender-based analysis
Authors: Corrente Melissa , Park Jungwee , Akuamoah-Boateng Henrietta , Atanackovic Jelena , Bourgeault Ivy Lynn
Published: May 2024

The COVID-19 pandemic impacted work and home life exacerbating pre-existing stressors and introducing new ones. These impacts were notably gendered. In this paper, we explore the different work and home life related stressors of professional workers specifically as a result of the COVID-19 pandemic through the gender-based analysis of two pan Canadian surveys: The Canadian Community Health Survey (2019, 2020, 2021) and the Healthy Professional Worker Survey (2021). Analyses revealed high rates of work stress among professional workers compared to other workers and this was particularly notable for women. Work overload emerged as the most frequently selected source of work stress, followed by digital stress, poor work relations, and uncertainty. Similar trends were noted in life stress among professional workers, particularly women. Time pressure consistently stood out as the primary source of non-work stress, caring for children and physical and mental health conditions. These findings can help to develop more targeted and appropriate workplace mental health promotion initiatives that are applicable to professional workers taking gender more fully into consideration.
The diabetes mellitus multimorbidity network in hospitalized patients over 50 years of age in China: data mining of medical records
Authors: Chen Chao , Zheng Xueting , Liao Shaobing , Chen Shimin , Liang Minyi , Tang Kang , Yin Mingjuan , Liu Huansheng , Ni Jindong
Published: May 2024

Objective

Many diabetes mellitus (DM) patients suffer from multimorbidity. Understanding the DM multimorbidity network should be given priority. The purpose of this study is characterize the DM multimorbidity network in people over 50 years.

Methods

Data on 75 non-communicable diseases (NCDs) were extracted from electronic medical records of 309,843 hospitalized patients older than 50 years who had at least one NCD. The association rules analysis was used as a novel classification method and combined with the Chi-square tests to identify associations between NCDs and DM.

Result

A total of 12 NCDs were closely related to DM, {cholelithiasis, DM} was an unexpected combination. {dyslipidemia, DM} and {gout, DM} had the largest $$\text{lift}$$
lift
in the male and female groups, respectively. The negative related group included 7 NCDs. There were 9 NCDs included in the strong association rules. Most combinations were different by age and sex. In males, the strongest rule was {peripheral vascular disease (PVD), dyslipidemia, DM}, while {hypertension, dyslipidemia, chronic liver disease (CLD), DM} was the strongest in females. In patients younger than 70 years, hypertension, CLD, and dyslipidemia were the most dominant NCDs in the DM multimorbidity network. In patients 70 years or older, chronic kidney disease (CKD), CVD, CHD, and heart disease (HD) frequently co-occurred with DM.

Conclusion

Future primary healthcare policies for DM should be formulated based on age and sex. In patients younger than 70 years, more attention to hypertension, CLD, and dyslipidemia is required, while attention to CKD, CVD, CHD and HD is needed in patients older than 70 years.
Appropriateness of exercise therapy delivery in chronic low back pain management: cross-sectional online survey of physiotherapy practice in Germany
Authors: Kühn Lukas , Rosen Diane , Reiter Nils Lennart , Prill Robert , Choi Kyung-Eun
Published: May 2024

Background

In Germany, exercise therapy represents the most commonly prescribed physiotherapy service for non-specific, chronic low back pain (NSCLBP). So far, little is known about current practice patterns of German physiotherapists in delivering this intervention. Thus, the aim of this study was to investigate the appropriateness of exercise therapy delivered to NSCLBP patients in German physiotherapy care and to identify practitioner-related drivers of appropriate exercise delivery.

Methods

We used a vignette-based, exploratory, cross-sectional, online-survey study design (76-items; data collection between May and July 2023). Eligible participants were required to hold a professional degree in physiotherapy and were required to be practicing in Germany. Access links to anonymous online surveys were spread via established German physiotherapy networks, educational platforms, social media, e-mail lists, and snowball sampling. Appropriateness of exercise therapy was calculated by an equally weighted total score (400 points) including scales on shared-decision-making, exercise dose selection, pain knowledge and self-management promotion. “Appropriate exercise delivery” was determined by a relative total score achievement of > 80%. “Partly appropriate exercise delivery” was determined by a relative total score achievement of 50–79%, and “inappropriate exercise delivery” by a score achievement of < 50%. Practitioner-related drivers of exercise appropriateness were calculated by bivariate and multiple linear regression analyses.

Results

11.9% (N = 35) of 298 physiotherapists’ exercise delivery was considered “appropriate”, 83.3% (N = 245) was “partly appropriate”, and 4.8% (N = 14) was “inappropriate”. In the final multiple regression model, most robust parameters positively influencing appropriate delivery of exercise therapy were increased scientific literacy (B = 10.540; 95% CI [0.837; 20.243]), increased average clinical assessment time (B = 0.461; 95% CI [0.134; 0.789]), increased self-perceived treatment competence (B = 7.180; 95% CI [3.058; 11.302], and short work experience (B = − 0.520; 95% CI [-0.959; − 0.081]).

Conclusion

Appropriate exercise delivery in NSCLBP management was achieved by only 11.9% of respondents. However, the vast majority of 95.2% of respondents was classified to deliver exercise therapy partly appropriate. Long work experience seemed to negatively affect appropriate exercise delivery. Positive influences were attributed to scientific literacy, the average clinical assessment time per patient as well as the perceived treatment competence in NSCLBP management.

Registration

Open science framework: https://doi.org/10.17605/OSF.IO/S76MF.
A combination technique of strip free gingival grafts and xenogeneic collagen matrix in augmenting keratinized mucosa around dental implants: a single-arm clinical trial
Authors: Huang Jia-Ping , Wang Yi-Yu , Dai Anna , Sun Ping , Ding Pei-Hui
Published: May 2024

Background

The aim of this study was to assess the outcomes of the combination technique of strip free gingival grafts (SFGG) and xenogeneic collagen matrix (XCM) in augmenting the width of keratinized mucosa (KMW) around dental implants, and compare its efficacy with the historical control group (FGG).

Methods

Thirteen patients with at least one site with KMW ≤ 2 mm after implant surgery were included and received SFGG in combination with XCM. Another thirteen patients with the same inclusion and exclusion criteria from the previous trial received FGG alone. The same outcomes as the previous trial were evaluated. KMW, thickness of keratinized mucosa (KMT), gingival index (GI) and probing depth (PD) were measured at baseline, 2 and 6 months. Postoperative pain, patient satisfaction and aesthetic outcomes were also assessed.

Results

At 6 months after surgery, the combination technique could attain 3.3 ± 1.6 mm of KMW. No significant change could be detected in GI or PD at 6 months compared to those at 2 months (p > 0.05). The postoperative pain and patient satisfaction in VAS were 2.6 ± 1.2 and 9.5 ± 1.2. The total score of aesthetic outcomes was 3.8 ± 1.2. In the historical FGG group, 4.6 ± 1.6 mm of KMW was reported at 6 months, and the total score of aesthetic outcomes was higher than the combination technique (4.8 ± 0.7 vs. 3.8 ± 1.2, p < 0.05).

Conclusions

The combination technique of SFGG and XCM could increase KMW and maintain peri-implant health. However, this combination technique was associated with inferior augmentation and aesthetic outcomes compared with FGG alone.

Trial registration

This clinical trial was registered in the Chinese Clinical Trial Registry with registration number ChiCTR2200057670 on 15/03/2022.
Identification and assessment of factors that impact the demand for and supply of dental hygienists amidst an evolving workforce context: a scoping review
Authors: Dobrow Mark J. , Valela Angela , Bruce Eric , Simpson Keisha , Pettifer Glenn
Published: May 2024

Background

This study involved a scoping review to explore factors influencing dental hygienist demand and supply in high-income countries.

Methods

A six-stage scoping review was conducted with separate search strategies tailored to four databases (MEDLINE, CINAHL, Google Scholar, and Google) plus a targeted scan of dental hygienist organization websites. This yielded 2,117 unique citations, leading to 148 articles included in the review.

Results

Nearly half of the articles (47%) focused on the United States, with 11% on Canada. Most articles (91%) were in English, alongside 13 in Korean and one in French. Journal articles comprised 62% of the publications, followed by reports/working papers (11%) and websites (11%). Other types included conference abstracts, policy briefs, and presentation slides. Content-wise, 47% were original research, with analysis articles (14%), commentaries (11%), and reviews (8%) also present. The articles were coded into three main categories: workforce characteristics/projections, factor-specific analyses, and workforce opportunities. The articles on workforce characteristics covered demographic, geographic, and employment aspects of dental hygienists, along with projections for supply and demand using simulation modelling and geospatial analyses. Factor-specific articles investigated the (1) working environment, (2) policy/regulatory/training environment, (3) job/career satisfaction and related human resource issues, and (4) scope of practice. The third key category of articles highlighted opportunities for expanding the workforce through alternative models in different sectors/settings (e.g., public health, primary care, long-term care, hospitals, mobile outreach, and non-clinical roles including research, education and leadership) and for a range of vulnerable or underserved populations (e.g., geriatric and pediatric populations, persons with disabilities, those living in rural/remote areas, Indigenous peoples, and incarcerated people).

Conclusions

This review provides a comprehensive documentation of the current state of the dental hygienist workforce, compiling factors affecting demand and supply, and highlighting opportunities for the dental hygienist workforce in Canada and other high-income countries. The findings offer a foundation for future research, highlighting the need for more focused and rigorous reviews and underscoring the necessity of high-quality studies to verify the effectiveness of various interventions and policies. This is crucial to address dental hygienist workforce challenges and ensure the sustainability and effectiveness of oral health care delivery.
Effects of dental anxiety and anesthesia on vital signs during tooth extraction
Authors: Zhang Diya , Li Shenglai , Zhang Rui
Published: May 2024

Background

Anxiety is common preceding tooth extraction; hence, it is crucial to identify patients with dental anxiety (DA) and to manage DA. This study assessed the level of DA and influencing factors in tooth extraction patients in a dental hospital in China and changes in their blood pressure (BP) and heart rate (HR) during the tooth-extraction procedure.

Methods

The study was a cohort study. The Dental Anxiety Scale (DAS) was used to assess the level of DA of 120 patients before tooth extraction. A Demographics and Oral Health Self-Assessment Form was used to assess factors influencing DA. The correlations of DAS scores with HR and BP were measured. The effects of local anesthesia and general anesthesia on HR and BP were also compared using a Datex-Ohmeda anesthesia monitor to detect HR and BP continuously before and after anesthesia. Independent sample t-tests, OLS multiple regression model and one-way analysis of variance were applied to analysis the results.

Results

Based on the DAS score, 12.5% of the participants were identified as suffering from DA. DA was related to age, gender, and the self-assessment of oral health. The DAS score was correlated with increased BP (P < 0.05). BP showed an overall upward trend after local anesthesia, while it was generally stable after general anesthesia. The systolic BP at 4 and 5 min and the HR at 2 and 4 min increased remarkably (P < 0.05) after local anesthesia compared with those before anesthesia. The HR and BP of patients under local anesthesia were generally higher than those of patients under general anesthesia were during the operation.

Conclusions

The prevalence of DA in adults was 12.5% in this study population. DA was related to gender, age, and the self-assessment of oral health. The score of DAS was correlated with BP. Compare to local anesthesia, general anesthesia can make the vital signs of tooth extraction patients more stable.
Development and psychometric evaluation of the death risk perception scale for advanced cancer patients
Authors: Chen Guojuan , Zhang Xiaoling , Chen Zhangxian , Yang Shangwang , Zheng Jianwei , Xiao Huimin
Published: May 2024

Background

An accurate perception of death risk is a prerequisite for advanced cancer patients to make informed end-of-life care decisions. However, there is to date no suitable scale to measure death risk perception. This study was to develop and psychometrically test the death risk perception scale (DRPS) for advanced cancer patients.

Methods

Process of instrument development and psychometric evaluation were used. First, qualitative research, a literature review, brainstorming, a Delphi study, and cognitive interviews were conducted to construct a pretest scale of death risk perception. Second, a scale-based survey was administered to 479 advanced cancer patients. Item, exploratory factor, and confirmatory factor analyses were employed to optimize the scale. The Cronbach’s alpha was calculated as a reliability analysis. The validity analysis included construct, convergent, discriminant, and content validity values.

Results

A three-dimension, 12-item scale was developed, including deliberative, affective, and experiential risk perception. The confirmatory factor analysis supported the three-factor model with satisfactory convergent and discriminant validity levels. The Cronbach's alpha coefficient for internal consistency was 0.807 and scale-level content validity index was 0.98.

Conclusions

The 12-item DRPS is a reliable and valid instrument for assessing the level of death risk perception in advanced cancer patients. More studies are needed to examine its structure and robustness prior to use.
Translation and psychometric evaluation of composite feedback-seeking behavior questionnaire among Iranian medical residents
Authors: Shavoun Amin Hoseini , Mirzazadeh Azim , Kashani Homa , Raeeskarami Seyed Reza , Gandomkar Roghayeh
Published: May 2024

Background

Proactively seeking feedback from clinical supervisors, peers or other healthcare professionals is a valuable mechanism for residents to obtain useful information about and improve their performance in clinical settings. Given the scant studies investigating the limited aspects of psychometrics properties of the feedback-seeking instruments in medical education, this study aimed to translate the feedback-seeking behavior scales (frequency of feedback-seeking, motives of feedback-seeking, and promotion of feedback-seeking by supervisors) into Persian and evaluate the psychometric properties of the composite questionnaire among medical residents at Tehran University of Medical Sciences in Iran.

Methods

In this cross-sectional study, feedback-seeking behavior scales were translated through the forward–backward method, and its face validity and content validity were assessed by 10 medical residents and 18 experts. The test-retest reliability was evaluated by administering the questionnaire to 20 medical residents on two testing occasions. A convenience sample of 548 residents completed the questionnaire. Construct validity was examined by exploratory factor analysis and confirmatory factor analysis and concurrent validity was determined by Pearson’s correlation coefficient.

Results

Content validity assessment showed that the CVR (0.66 to 0.99) and CVI (0.82 to 0.99) values for items and S-CVI values (0.88 to 0.99) for scales were satisfactory. The exploratory and confirmatory factor analysis demonstrated that the models were confirmed with eight items and two factors (explaining 70.98% of the total variance) for the frequency of feedback-seeking scale, with 16 items and four factors (explaining 73.22% of the total variance) for the motives of feedback seeking scale and with four items and one factor (explaining 69.46% of the total variance) for promotion of feedback-seeking by supervisors. AVE values greater than 0.5 and discriminant validity correlations significantly less than 1.0 demonstrated that the total scores of the composite feedback-seeking behavior questionnaire had a favorable fit and the questions could fit their respective factors, and the latent variables were distinct. We found positive and significant correlations between the three scales and their subscales.

Conclusion

The results of the present study supported the validity and reliability of the Persian composite feedback-seeking behavior questionnaire for assessing feedback-seeking behaviors in medical residents. Applying the questionnaire in residency programs may enhance the quality of clinical education.
Cost-effectiveness analysis of tislelizumab vs. camrelizumab for the treatment of second-line locally advanced or metastatic esophageal squamous cell carcinoma
Authors: Chen Pingyu , Fu Chang , Shen Lin , Fei Zhengyang , Luo Mengjie , Chen Yanqiu , Li Hongchao
Published: May 2024

Background

Esophageal carcinoma is a type of cancer that occurs in the esophagus. For patients with locally advanced or metastatic esophageal squamous cell carcinoma who have either experienced disease progression following first-line standard chemotherapy or are intolerant to it, the prognosis is typically poor. Additionally, these patients often bear a substantial economic burden during the course of their treatment. Tislelizumab is a selective PD-1 inhibitor with efficacy proven in locally advanced or metastatic esophageal squamous cell carcinoma. The study aims to evaluate the cost-effectiveness of tislelizumab versus camrelizumab as the second-line treatment in locally advanced or metastatic esophageal squamous cell carcinoma (ESCC) patients in China.

Methods

From the perspective of China’s healthcare system, the partitioned survival model with three health states was established in a 3-week cycle and a lifetime horizon. Anchored matching adjusted indirect comparison was used for survival analyses based on individual patient data from RATIONALE 302 trial and the published ESCORT study due to the lack of head-to-head clinical trials. Only direct medical costs were included. Costs and utility values were derived from local charges, the published literature, and related databases. Sensitivity analyses and a scenario analysis were also performed to verify the robustness of the model results.

Results

Compared with camrelizumab monotherapy, tislelizumab monotherapy incurred a lower lifetime cost ($8,346 vs. $8,851) and yielded higher quality-adjusted life-years (QALYs) (0.87 vs. 0.63), which resulted in an incremental cost-effectiveness ratio (ICER) of -$2,051/QALY. Tislelizumab monotherapy is a dominant option over camrelizumab monotherapy in China. The three primary parameters upon which this result was most sensitive were the unit cost of camrelizumab, the unit cost of tislelizumab, and the duration of reactive cutaneous capillary endothelial proliferation (RCCEP). According to the probabilistic sensitivity analysis (PSA), tislelizumab monotherapy was 100% cost-effective when the WTP was 1–3 times GDP per capita in China($11,207/QALY∼$33,621/QALY). Scenario analysis showed that the result was consistent.

Conclusion

Tislelizumab monotherapy is a dominant option compared with camrelizumab monotherapy as the second-line treatment for locally advanced or metastatic ESCC in China.
The potential role of RNA sequencing in diagnosing unexplained insensitivity to conventional chemotherapy in pediatric patients with B-cell acute lymphoblastic leukemia
Authors: Li Xinyu , Huang Zaoli , Zhu Liwen , Lai Weixin , Li Yunyao , Chen Han , Liu Diandian , Huang Junjiu , Zhou Dunhua , Li Yang , Weng Wenjun , Xu Honggui , Xu Luhong , Luo Zhenhua , Fang Jianpei
Published: May 2024

Pediatric B-cell acute lymphoblastic leukemia (B-ALL) is a highly heterogeneous disease. According to large-scale RNA sequencing (RNA-seq) data, B-ALL patients can be divided into more than 10 subgroups. However, many genomic defects associated with resistance mechanisms have not yet been identified. As an individual clinical tool for molecular diagnostic risk classification, RNA-seq and gene expression pattern-based therapy could be potential upcoming strategies. In this study, we retrospectively analyzed the RNA-seq gene expression profiles of 45 children whose molecular diagnostic classifications were inconsistent with the response to chemotherapy. The relationship between the transcriptome and chemotherapy response was analyzed. Fusion gene identification was conducted for the included patients who did not have known high-risk associated fusion genes or gene mutations. The most frequently detected fusion gene pair in the high-risk group was the DHRSX duplication, which is a novel finding. Fusions involving ABL1, LMNB2, NFATC1, PAX5, and TTYH3 at onset were more frequently detected in the high-risk group, while fusions involving LFNG, TTYH3, and NFATC1 were frequently detected in the relapse group. According to the pathways involved, the underlying drug resistance mechanism is related to DNA methylation, autophagy, and protein metabolism. Overall, the implementation of an RNA-seq diagnostic system will identify activated markers associated with chemotherapy response, and guide future treatment adjustments.
Highly diverse sputum microbiota correlates with the disease severity in patients with community-acquired pneumonia: a longitudinal cohort study
Authors: Yang Jing , Li Jinman , Zhang Linfeng , Shen Zijie , Xiao Yan , Zhang Guoliang , Chen Mingwei , Chen Fuhui , Liu Ling , Wang Ying , Chen Lan , Wang Xinming , Zhang Li , Wang Lu , Wang Zhang , Wang Jianwei , Li Mingkun , Ren Lili
Published: May 2024

Background

Community-acquired pneumonia (CAP) is a common and serious condition that can be caused by a variety of pathogens. However, much remains unknown about how these pathogens interact with the lower respiratory commensals, and whether any correlation exists between the dysbiosis of the lower respiratory microbiota and disease severity and prognosis.

Methods

We conducted a retrospective cohort study to investigate the composition and dynamics of sputum microbiota in patients diagnosed with CAP. In total, 917 sputum specimens were collected consecutively from 350 CAP inpatients enrolled in six hospitals following admission. The V3-V4 region of the 16 S rRNA gene was then sequenced.

Results

The sputum microbiota in 71% of the samples were predominately composed of respiratory commensals. Conversely, 15% of the samples demonstrated dominance by five opportunistic pathogens. Additionally, 5% of the samples exhibited sterility, resembling the composition of negative controls. Compared to non-severe CAP patients, severe cases exhibited a more disrupted sputum microbiota, characterized by the highly dominant presence of potential pathogens, greater deviation from a healthy state, more significant alterations during hospitalization, and sparser bacterial interactions. The sputum microbiota on admission demonstrated a moderate prediction of disease severity (AUC = 0.74). Furthermore, different pathogenic infections were associated with specific microbiota alterations. Acinetobacter and Pseudomonas were more abundant in influenza A infections, with Acinetobacter was also enriched in Klebsiella pneumoniae infections.

Conclusion

Collectively, our study demonstrated that pneumonia may not consistently correlate with severe dysbiosis of the respiratory microbiota. Instead, the degree of microbiota dysbiosis was correlated with disease severity in CAP patients.
Incidence rate of occult lymph node metastasis in clinical T1−2N0M0 small cell lung cancer patients and radiomic prediction based on contrast-enhanced CT imaging: a multicenter study
Authors: Jiang Xu , Luo Chao , Peng Xin , Zhang Jing , Yang Lin , Liu Li-Zhi , Cui Yan-Fen , Liu Meng-Wen , Miao Lei , Jiang Jiu-Ming , Ren Jia-Liang , Yang Xiao-Tang , Li Meng , Zhang Li
Published: May 2024

Background

This study aimed to explore the incidence of occult lymph node metastasis (OLM) in clinical T1 − 2N0M0 (cT1 − 2N0M0) small cell lung cancer (SCLC) patients and develop machine learning prediction models using preoperative intratumoral and peritumoral contrast-enhanced CT-based radiomic data.

Methods

By conducting a retrospective analysis involving 242 eligible patients from 4 centeres, we determined the incidence of OLM in cT1 − 2N0M0 SCLC patients. For each lesion, two ROIs were defined using the gross tumour volume (GTV) and peritumoral volume 15 mm around the tumour (PTV). By extracting a comprehensive set of 1595 enhanced CT-based radiomic features individually from the GTV and PTV, five models were constucted and we rigorously evaluated the model performance using various metrics, including the area under the curve (AUC), accuracy, sensitivity, specificity, calibration curve, and decision curve analysis (DCA). For enhanced clinical applicability, we formulated a nomogram that integrates clinical parameters and the rad_score (GTV and PTV).

Results

The initial investigation revealed a 33.9% OLM positivity rate in cT1 − 2N0M0 SCLC patients. Our combined model, which incorporates three radiomic features from the GTV and PTV, along with two clinical parameters (smoking status and shape), exhibited robust predictive capabilities. With a peak AUC value of 0.772 in the external validation cohort, the model outperformed the alternative models. The nomogram significantly enhanced diagnostic precision for radiologists and added substantial value to the clinical decision-making process for cT1 − 2N0M0 SCLC patients.

Conclusions

The incidence of OLM in SCLC patients surpassed that in non-small cell lung cancer patients. The combined model demonstrated a notable generalization effect, effectively distinguishing between positive and negative OLMs in a noninvasive manner, thereby guiding individualized clinical decisions for patients with cT1 − 2N0M0 SCLC.
Nebulised interferon beta-1a (SNG001) in the treatment of viral exacerbations of COPD
Authors: Monk Phillip D. , Brookes Jody L. , Tear Victoria J. , Batten Toby N. , Newall Clare , Mankowski Marcin , Crooks Michael G. , Singh Dave , Chaudhuri Rekha , Leaker Brian , Lunn Kerry , Reynolds Sophie , Dudley Sarah , Gabbay Felicity J. , Holgate Stephen T. , Djukanovic Ratko , Wilkinson Thomas MA
Published: May 2024

Background

Respiratory viral infections are major drivers of chronic obstructive pulmonary disease (COPD) exacerbations. Interferon-β is naturally produced in response to viral infection, limiting replication. This exploratory study aimed to demonstrate proof-of-mechanism, and evaluate the efficacy and safety of inhaled recombinant interferon-β1a (SNG001) in COPD. Part 1 assessed the effects of SNG001 on induced sputum antiviral interferon-stimulated gene expression, sputum differential cell count, and respiratory function. Part 2 compared SNG001 and placebo on clinical efficacy, sputum and serum biomarkers, and viral clearance.

Methods

In Part 1, patients (N = 13) with stable COPD were randomised 4:1 to SNG001 or placebo once-daily for three days. In Part 2, patients (N = 109) with worsening symptoms and a positive respiratory viral test were randomised 1:1 to SNG001 or placebo once-daily for 14 days in two Groups: A (no moderate exacerbation); B (moderate COPD exacerbation [i.e., acute worsening of respiratory symptoms treated with antibiotics and/or oral corticosteroids]).

Results

In Part 1, SNG001 upregulated sputum interferon gene expression. In Part 2, there were minimal SNG001–placebo differences in the efficacy endpoints; however, whereas gene expression was initially upregulated by viral infection, then declined on placebo, levels were maintained with SNG001. Furthermore, the proportion of patients with detectable rhinovirus (the most common virus) on Day 7 was lower with SNG001. In Group B, serum C-reactive protein and the proportion of patients with purulent sputum increased with placebo (suggesting bacterial infection), but not with SNG001. The overall adverse event incidence was similar with both treatments.

Conclusions

Overall, SNG001 was well-tolerated in patients with COPD, and upregulated lung antiviral defences to accelerate viral clearance. These findings warrant further investigation in a larger study.

Trial registration

EU clinical trials register (2017-003679-75), 6 October 2017.
Snoring-generated fluid droplets as a potential mechanistic link between sleep-disordered breathing and pneumonia
Authors: Kakeshpour Tayeb , Fennelly Kevin P. , Bax Adriaan
Published: May 2024

The soft palate and back of the throat represent vulnerable early infection sites for SARS-CoV-2, influenza, streptococci, and many other pathogens. We demonstrate that snoring causes aerosolization of pharyngeal fluid that covers these surfaces, which previously has escaped detection because the inspired airstream carries the micron-sized droplets into the lung, inaccessible to traditional aerosol detectors. While many of these droplets will settle in the lower respiratory tract, a fraction of the respirable smallest droplets remains airborne and can be detected in exhaled breath. We distinguished these exhaled droplets from those generated by the underlying breathing activity by using a chemical tracer, thereby proving their existence. The direct transfer of pharyngeal fluids and their pathogens into the deep lung by snoring represents a plausible mechanistic link between the previously recognized association between sleep-disordered breathing and pneumonia incidence.
Inhibition of Slc39a14/Slc39a8 reduce vascular calcification via alleviating iron overload induced ferroptosis in vascular smooth muscle cells
Authors: Aierken Yierpani , He Huqiang , Li Runwen , Lin Zipeng , Xu Tongjie , Zhang Li , Wu Ya , Liu Yong
Published: May 2024

Background

Vascular calcification (VC) is an independent risk factor for cardiovascular diseases. Recently, ferroptosis has been recognised as a novel therapeutic target for cardiovascular diseases. Although an association between ferroptosis and vascular calcification has been reported, the role and mechanism of iron overload in vascular calcification are still poorly understood. Specifically, further in-depth research is required on whether metalloproteins SLC39a14 and SLC39a8 are involved in ferroptosis induced by iron overload.

Methods

R language was employed for the differential analysis of the dataset, revealing the correlation between ferroptosis and calcification. The experimental approaches encompassed both in vitro and in vivo studies, incorporating the use of iron chelators and models of iron overload. Additionally, gain- and loss-of-function experiments were conducted to investigate iron’s effects on vascular calcification comprehensively. Electron microscopy, immunofluorescence, western blotting, and real-time polymerase chain reaction were used to elucidate how Slc39a14 and Slc39a8 mediate iron overload and promote calcification.

Results

Ferroptosis was observed in conjunction with vascular calcification (VC); the association was consistently confirmed by in vitro and in vivo studies. Our results showed a positive correlation between iron overload in VSMCs and calcification. Iron chelators are effective in reversing VC and iron overload exacerbates this process. The expression levels of the metal transport proteins Slc39a14 and Slc39a8 were significantly upregulated during calcification; the inhibition of their expression alleviated VC. Conversely, Slc39a14 overexpression exacerbates calcification and promotes intracellular iron accumulation in VSMCs.

Conclusions

Our research demonstrates that iron overload occurs during VC, and that inhibition of Slc39a14 and Slc39a8 significantly relieves VC by intercepting iron overload-induced ferroptosis in VSMCs, providing new insights into the VC treatment.

Graphical Abstract
Effects of physical activity on infertility in reproductive females
Authors: Zhang Hanzhi , Hua Lan , Liu Dan , Su Xin , Chen Jianlin , Chen Jingfei
Published: May 2024

Objectives

To explore the relationship between different types of physical activity and female infertility.

Methods

This study analyzed data from 2,796 female participants aged 18–44 years in the United States, obtained from the National Health and Nutrition Examination Survey (NHANES) database spanning the years 2013 to 2020. Multiple logistic regression analyses and generalized linear models were used to explore the relationship between different types of physical activity and infertility after adjusting for potential confounding factors.

Results

We found a non-linear relationship between recreational activities and infertility with an inflection point of 5.83 h/week (moderate intensity), while work activities and traffic-related activities did not. On the left side of the inflection point, there was no significant association between recreational activity time and infertility (OR = 0.93, 95% CI: 0.86 to 1.02, P = 0.1146), but on the right side of the inflection point, there was a positive association between recreational activity time and the risk of infertility (OR = 1.04, 95% CI: 1.02 to 1.06, P = 0.0008).

Conclusions

The relationship between different types of physical activity and female infertility varies. We acknowledge the potential influence of confounding variables on this relationship. However, we have already adjusted for these potential variables in our analysis. Therefore, our findings suggest that appropriate recreational activity programs are essential for promoting reproductive health in women of reproductive age. Nevertheless, it is important to note that the observed association does not imply causality. Given the limitations of cross-sectional studies, further prospective cohort studies are needed to explore the causal relationship while accounting for additional confounding factors.
Early outcomes of MR-guided SBRT for patients with recurrent pancreatic adenocarcinoma
Authors: Poiset Spencer J. , Shah Sophia , Cappelli Louis , Anné Pramila , Mooney Karen E. , Werner-Wasik Maria , Laufer Talya S. , Posey James A. , Lin Daniel , Basu Mallick Atrayee , Lavu Harish , Bashir Babar , Yeo Charles J. , Mueller Adam C.
Published: May 2024

Background

Local treatment options for locally recurrent pancreatic adenocarcinoma (LR-PAC) are limited, with median survival time (MST) of 9–13 months (mos) following recurrence. MRI-guided stereotactic body radiation therapy (MRgSBRT) provides the ability to dose escalate while sparing normal tissue. Here we report on the early outcomes of MRgSBRT for LR-PAC.

Methods

Patients with prior resection of pancreatic adenocarcinoma with local recurrence treated with MRgSBRT at a single tertiary referral center from 5-2021 to 2-2023 were identified from our prospective database. MRgSBRT was delivered to 40–50 Gy in 4–5 fractions with target and OAR delineation per institutional standards. Endpoints included local control per RECIST v1.1, distant failure, overall survival (OS), and acute and chronic toxicities per Common Terminology Criteria for Adverse Events, v5.

Results

Fifteen patients with LR-PAC were identified with median follow-up of 10.6 mos (2.8–26.5 mos) from MRgSBRT. There were 8 females and 7 males, with a median age of 69 years (50–83). One patient underwent neoadjuvant radiation for 50.4 Gy in 28 fractions followed by resection, and one underwent adjuvant radiation for 45 Gy in 25 fractions prior to recurrence. MRgSBRT was delivered a median of 18.8 mos (3.5–52.8 mos) following resection. OS following recurrence at 6 and 12 mos were 87% and 51%, respectively, with a median survival time of 14.1 mos (3.2–27.4 mos). Three patients experienced local failure at 5.9, 7.8, and 16.6 months from MgSBRT with local control of 92.3% and 83.9% at 6 and 12 months. 10 patients experienced distant failure at a median of 2.9 mos (0.3–6.7 mos). Grade 1–2 acute GI toxicity was noted in 47% of patients, and chronic GI toxicity in 31% of patients. No grade > 3 toxicities were noted.

Conclusions

This is the first report on toxicity and outcomes of MRgSBRT for LR-PAC in the literature. MRgSBRT is a safe, feasible treatment modality with the potential for improved local control in this vulnerable population. Future research is necessary to better identify which patients yield the most benefit from MRgSBRT, which should continue to be used with systemic therapy as tolerated.

Trial Registration: Jefferson IRB#20976, approved 2/17/21.
Retrograde cerebral perfusion reduces embolic and watershed lesions after acute type a aortic dissection repair with deep hypothermic circulatory arrest
Authors: Ede Jacob , Teurneau-Hermansson Karl , Ramgren Birgitta , Moseby-Knappe Marion , Åström Daniel Oudin , Larsson Mårten , Sjögren Johan , Wierup Per , Nozohoor Shahab , Zindovic Igor
Published: May 2024

Background

To assess whether retrograde cerebral perfusion reduces neurological injury and mortality in patients undergoing surgery for acute type A aortic dissection.

Methods

Single-center, retrospective, observational study including all patients undergoing acute type A aortic dissection repair with deep hypothermic circulatory arrest between January 1998 and December 2022 with or without the adjunct of retrograde cerebral perfusion. 515 patients were included: 257 patients with hypothermic circulatory arrest only and 258 patients with hypothermic circulatory arrest and retrograde cerebral perfusion. The primary endpoints were clinical neurological injury, embolic lesions, and watershed lesions. Multivariable logistic regression was performed to identify independent predictors of the primary outcomes. Survival analysis was performed using Kaplan-Meier estimates.

Results

Clinical neurological injury and embolic lesions were less frequent in patients with retrograde cerebral perfusion (20.2% vs. 28.4%, p = 0.041 and 13.7% vs. 23.4%, p = 0.010, respectively), but there was no significant difference in the occurrence of watershed lesions (3.0% vs. 6.1%, p = 0.156). However, after multivariable logistic regression, retrograde cerebral perfusion was associated with a significant reduction of clinical neurological injury (OR: 0.60; 95% CI 0.36–0.995, p = 0.049), embolic lesions (OR: 0.55; 95% CI 0.31–0.97, p = 0.041), and watershed lesions (OR: 0.25; 95%CI 0.07–0.80, p = 0.027). There was no significant difference in 30-day mortality (12.8% vs. 11.7%, p = ns) or long-term survival between groups.

Conclusion

In this study, we showed that the addition of retrograde cerebral perfusion during hypothermic circulatory arrest in the setting of acute type A aortic dissection repair reduced the risk of clinical neurological injury, embolic lesions, and watershed lesions.
Biological effects of corticosteroids on pneumococcal pneumonia in Mice—translational significance
Authors: Taenaka Hiroki , Wick Katherine D. , Sarma Aartik , Matsumoto Shotaro , Ghale Rajani , Fang Xiaohui , Maishan Mazharul , Gotts Jeffrey E. , Langelier Charles R. , Calfee Carolyn S. , Matthay Michael A.
Published: May 2024

Background

Streptococcus pneumoniae is the most common bacterial cause of community acquired pneumonia and the acute respiratory distress syndrome (ARDS). Some clinical trials have demonstrated a beneficial effect of corticosteroid therapy in community acquired pneumonia, COVID-19, and ARDS, but the mechanisms of this benefit remain unclear. The primary objective of this study was to investigate the effects of corticosteroids on the pulmonary biology of pneumococcal pneumonia in a mouse model. A secondary objective was to identify shared transcriptomic features of pneumococcal pneumonia and steroid treatment in the mouse model and clinical samples.

Methods

We carried out comprehensive physiologic, biochemical, and histological analyses in mice to identify the mechanisms of lung injury in Streptococcus pneumoniae with and without adjunctive steroid therapy. We also studied lower respiratory tract gene expression from a cohort of 15 mechanically ventilated patients (10 with Streptococcus pneumoniae and 5 controls) to compare with the transcriptional studies in the mice.

Results

In mice with pneumonia, dexamethasone in combination with ceftriaxone reduced (1) pulmonary edema formation, (2) alveolar protein permeability, (3) proinflammatory cytokine release, (4) histopathologic lung injury score, and (5) hypoxemia but did not increase bacterial burden. Transcriptomic analyses identified effects of steroid therapy in mice that were also observed in the clinical samples.

Conclusions

In combination with appropriate antibiotic therapy in mice, treatment of pneumococcal pneumonia with steroid therapy reduced hypoxemia, pulmonary edema, lung permeability, and histologic criteria of lung injury, and also altered inflammatory responses at the protein and gene expression level. The transcriptional studies in patients suggest that the mouse model replicates some of the features of pneumonia in patients with Streptococcus pneumoniae and steroid treatment. Overall, these studies provide evidence for the mechanisms that may explain the beneficial effects of glucocorticoid therapy in patients with community acquired pneumonia from Streptococcus Pneumoniae.