bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment outcomes for ARUBA-eligible brain arteriovenous malformations: a comparison of real-world data from the NVQI-QOD AVM registry with the ARUBA trial
Authors: Alrohimi Anas , Achey Rebecca L , Thompson Nicolas , Abdalla Ramez N , Patterson Thomas , Moazeni Yasaman , Rasmussen Peter A , Toth Gabor , Bain Mark D , Ansari Sameer A , Hussain Shazam M , Moore Nina Z
Published: January 2024

Background

Significant controversy exists about the management of unruptured cerebral arteriovenous malformations (AVMs). Results from A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA) suggested that intervention increases the risk of stroke/death compared with medical management. However, numerous study limitations raised concerns about the trial’s generalizability.

Objective

To assess the rate of stroke/death and functional outcomes in ARUBA-eligible patients from a multicenter database, the Neurovascular Quality Initiative-Quality Outcomes Database (NVQI-QOD).

Methods

We performed a retrospective analysis of prospectively collected data of ARUBA-eligible patients who underwent intervention at 18 participating centers. The primary endpoint was stroke/death from any cause. Secondary endpoints included neurologic, systemic, radiographic, and functional outcomes.

Results

173 ARUBA-eligible patients underwent intervention with median follow-up of 269 (25–722.5) days. Seventy-five patients received microsurgery±embolization, 37 received radiosurgery, and 61 received embolization. Baseline demographics, risk factors, and general AVM characteristics were similar between groups. A total of 15 (8.7%) patients experienced stroke/death with no significant difference in primary outcome between treatment modalities. Microsurgery±embolization was more likely to achieve AVM obliteration (P<0.001). Kaplan-Meier survival curves demonstrated no difference in overall death/stroke outcomes between the different treatment modalities' 5-year period (P=0.087). Additionally, when compared with the ARUBA interventional arm, our patients were significantly less likely to experience death/stroke (8.7% vs 30.7%; P<0.001) and functional impairment (mRS score ≥2 25.4% vs 46.2%; P<0.01).

Conclusion

Our results suggest that intervention for unruptured brain AVMs at comprehensive stroke centers across the United States is safe.
Intraoperative direct venous puncture and embolization for arteriovenous shunt below the conus medullaris: a prospective cohort study
Authors: Fan Yuxiang , Yang Chengbin , Meng Xiaosheng , Hu Peng , Ye Ming , Zhang Peng , Ma Yongjie , Zhang Hongqi
Published: January 2024

Background

Arteriovenous shunt below the conus medullaris (AVS-BC) is easily misdiagnosed and mistreated due to its rarity. Achieving an anatomical cure solely through endovascular or surgical means is challenging. This study aimed to summarize the clinical and radiological features of AVS-BC and evaluate the safety and efficacy of hybrid techniques represented by intraoperative direct venous puncture and embolization (IVPE).

Methods

The patients with AVS-BC were grouped into those with dural, intradural, and paravertebral shunts. The patients undergoing hybrid procedures were consecutively recruited between August 2016 and July 2022. The modified Aminoff and Logue’s Scale (mALS) and the modified Denis Pain and Numbness Scale (mDS) were used to evaluate motor and sensation disturbances.

Results

A total of 42 patients (35 males, 83.3%) were included with an average age of 57.38±10.79 years. Most patients presented with lower limb weakness and sphincter disturbances. Their preoperative average mALS score was 7.17±2.61 and the preoperative average mDS score was 3.88±1.76. There were 28 patients (66.7%) who received IVPE. The mean clinical follow-up reached 41.30±21.10 months. All patients achieved anatomical cures without permanent neurological complications. It showed a significant improvement in mALS scores after the intervention in the spinal dural arteriovenous fistula only (P=0.026). No recurrences were reported.

Conclusions

Differentiating AVS-BC mainly relied on identifying supplying arteries, shunt placements, and draining veins. The hybrid technique typified by IVPE conferred a safe anatomical cure for AVS-BC.
How to use the Contour intrasaccular device: two illustrative cases
Authors: Biondi Alessandra , Primikiris Panagiotis , Di Caterino Fortunato , Vancheri Sergio , Vitale Giovanni , Charbonnier Guillaume
Published: January 2024

Contour (Stryker, Kalamazoo, MI) is a relatively new endosaccular device for the treatment of intracranial aneurysms.1 2 Its unique cup-like shape permits treatment of most lesions, including wide-necked, irregular, and shallowed-shaped aneurysms. The sizing of the device only requires two parameters: neck size and equatorial plane (width). It must be positioned at the neck of the aneurysm with the device proximal marker in the parent artery. In our experience, dual antiplatelet therapy is usually not required for intrasaccular devices and this is also an advantage of the Contour device. We report two illustrative cases of wide-neck aneurysms in the anterior and posterior circulation, respectively (video 1). In this video we demonstrate the feasibility of this treatment in a middle cerebral artery bifurcation with atypical triangular shape and typical tip-basilar aneurysm.

Video 1
Vanguard Study: Initial experience with the new fourth generation Pipeline Vantage Flow Diverter (PVFD): 6-month results, technical and clinical considerations
Authors: de Villiers Laetitia , Carraro do Nascimento Vinicius , Domitrovic Luis , Dhillon Permesh Singh , Rice Hal
Published: January 2024

Background

The Pipeline Embolization Device has proven to be a safe and effective device for the treatment of intracranial aneurysms. The Pipeline Vantage Flow Diverter (PVFD) with Shield Technology is the new fourth generation of this implant, with modifications made compared to previous iterations. We aimed to evaluate the mechanical properties and clinical safety and efficacy of this device.

Methods

Vanguard is a single arm, single center, prospective study. Between April 2021 and April 2023, all consecutive patients with an unruptured aneurysm treated with Pipeline Vantage flow-diverting stents were included. There were no aneurysm size or location exclusion criteria. Safety (neurological serious adverse events) and efficacy (device deployment and aneurysm occlusion) were independently reviewed. Imaging follow-up data, and immediate, early (<30 days), and delayed (>30 days) neurological serious adverse events were independently assessed.

Results

101 consecutive patients with a total of 115 aneurysms were included. The aneurysms were situated in the anterior (90.4%) or posterior (9.6%) circulations. A total of 124 devices were implanted. The deployment success rate was 100%. In four (4.0%) cases post-deployment angioplasty was required to optimize device wall apposition. Occlusion rates at 1 month were 54.7%, at 3 months 72.1%, and at 6 months 81.7%. Morbidity and mortality were 4.9% and 0%, respectively, at 6 months. Eight cases (6.9%) demonstrated in-stent stenosis, four of which had ‘fish mouth’ deformity.

Conclusion

Initial results of the new generation PVFD for unruptured intracranial aneurysm treatment demonstrate overall satisfactory device performance, safety profile, and effectiveness.
Inclusive leadership in the health professions and health professions education
Authors: Kusurkar Rashmi A
Published: January 2024

What is inclusion and inclusive leadership?

In this article, based on the literature and my own experiences, I try to shed light on the concepts of inclusion and inclusive leadership, as well as what leaders need to do in order to be inclusive. Inclusion means the act of including or being included in a group, which creates a sense of belonging as well as empowers individuals to contribute in an authentic and meaningful manner. Inclusive leadership is important in the health professions and health professions education so that health professionals and faculty in health professions education are able to contribute to their work in ways that they find meaningful.

What do leaders need to do to be inclusive?

To be inclusive leaders need to to do the following: truly believe in inclusion, define the boundaries of acceptable behaviours, make difficult diversity conversations possible, build authentic diverse relationships, develop shared leadership, drive and role model inclusive practices in the organisation, and find the right balance between individual and institutional EDI initiatives. Driving inclusion in a health professions (education) organisation demands changes in the concept of leadership, as well as the organisational policy and culture.
Leadership development as part of quality improvement in district general hospitals
Authors: Cook Patrick , Purohit Akul
Published: January 2024

Objective

Effective clinical leadership is crucial for the delivery of high-quality medical care. However, the extent to which current leadership development effectively enhances leadership competencies for junior doctors remains uncertain.

Methods

This study aimed to investigate the utilisation of quality improvement projects (QIPs) to enhance leadership skills among junior doctors in a District General Hospital. Additionally, the feasibility of implementing a leadership programme in a smaller District General Hospital alongside didactic learning, reflection and stakeholder engagement was assessed. The Medical Leadership Competency Framework Self-Evaluation Tool was used to assess current leadership qualities and develop personal action plans.

Results

While the majority of junior doctors completed QIPs, only a few engaged in reflective practice. Moreover, limited participation in formal leadership programmes was observed.

Conclusion

The study suggests that effective interpersonal development combined with long-term leadership training can be a resource-intensive yet valuable approach to adequately prepare future leaders even within District General Hospitals. The findings highlight the need for a structured leadership curricula utilising longitudinal project-based learning.
Risk factors of first thrombosis in obstetric antiphospholipid syndrome
Authors: Luo Liang , Cai Qingmeng , Liu Xiangjun , Hou Yuke , Li Chun
Published: January 2024

Objective

There is limited evidence on long-term thrombosis risk in patients with obstetric antiphospholipid syndrome (OAPS). This study aimed to investigate the clinical features and risk factors associated with the first thrombosis in patients with isolated OAPS.

Methods

Data from patients with isolated OAPS were collected. All patients were followed up until the first thrombotic event during or after delivery or until the end of the study. Logistic regression analysis identified independent risk factors associated with the first thrombosis in patients with isolated OAPS.

Results

The study enrolled 186 patients with OAPS. During a mean 5.4-year follow-up, 11 (5.9%) patients experienced thrombotic events. Multivariate binary logistic regression analysis revealed that triple-positive antiphospholipid antibodies (aPLs, OR=11.662, 95% CI=2.117 to 64.243, p=0.005) and hypocomplementemia (OR=9.047, 95% CI=1.530 to 53.495, p=0.015) were identified as independent risk factors for the first thrombosis in OAPS, after adjustment for low-dose aspirin and hydroxychloroquine.

Conclusions

Triple-positive aPLs and hypocomplementemia are risk factors for the first thrombosis in patients with OAPS.
What benefit–risk trade-offs are acceptable to rheumatoid arthritis patients during treatment selection? Evidence from a multicountry choice experiment
Authors: Alten Rieke , Nieto-Gonzalez Juan Carlos , Jacques Peggy , Montecucco Carlomaurizio , Moots Robert , Radner Helga , Vonkeman Harald E , Heidenreich Sebastian , Whichello Chiara , Krucien Nicolas , Van Beneden Katrien
Published: January 2024

Objective

Understanding preferences of patients with rheumatoid arthritis (RA) can facilitate tailored patient-centric care. This study elicited trade-offs that patients with RA were willing to make during treatment selection.

Methods

Patients with RA completed an online discrete choice experiment, consisting of a series of choices between hypothetical treatments. Treatment attributes were selected based on literature review and qualitative patient interviews. Eligible patients were ≥18 years old, diagnosed with RA, receiving systemic disease-modifying antirheumatic drug therapy, and residents of Europe or USA. Male patients were oversampled for subgroup analyses. Data were analysed using a correlated mixed logit model.

Results

Of 2090 participants, 42% were female; mean age was 45.2 years (range 18–83). Estimated effects were significant for all attributes (p<0.001) but varied between patients. Average relative attribute importance scores revealed different priorities (p<0.001) between males and females. While reducing pain and negative effect on semen parameters was most important to males, females were most concerned by risk of blood clots and serious infections. No single attribute explained treatment preferences by more than 30%. Preferences were also affected by patients’ age: patients aged 18–44 years placed less importance on frequency and mode of treatment administration (p<0.05) than older age groups. Patients were willing to accept higher risk of serious infections and blood clots in exchange for improvements in pain, daily activities or administration convenience. However, acceptable trade-offs varied between patients (p<0.05).

Conclusion

Treatment preferences of patients with RA were individual-specific, but driven by benefits and risks, with no single attribute dominating the decision-making.
Hormonal and reproductive factors in relation to the risk of rheumatoid arthritis in women: a prospective cohort study with 223 526 participants
Authors: Jiang Ling-Qiong , Zhang Ruo-Di , Musonye Harry Asena , Zhao Hao-Yun , He Yi-Sheng , Zhao Chan-Na , He Tian , Tian Tian , Gao Zhao-Xing , Fang Yang , Wang Peng , Ni Jing , Pan Hai-Feng
Published: January 2024

Objective

This study aimed to examine rheumatoid arthritis (RA) risk associated with hormonal and reproductive factors in women from the large cohort of the UK Biobank.

Methods

Data on hormonal and reproductive factors in women were collected from a prospective cohort of 223 526 UK Biobank participants. The potential relationship between reproductive factors and RA risk was assessed using restricted cubic spline. Hazard ratios (HR) were estimated using Cox proportional hazard regressions.

Results

During a median follow-up of 12.39 years, 3313 women with RA were identified. Age at menarche >14 years was associated with a greater RA risk (HR 1.13, 95% CI 1.02 to 1.26) compared with menarche at 13. The multiple adjusted HR for RA in women with menopause at <45 years was 1.46. Reproductive years <33 increased the risk of RA (HR 1.39, 95% CI 1.21 to 1.59). Compared with those with 2 children, women with ≥4 children were associated with a higher risk of RA (HR 1.18, 95% CI 1.04 to 1.34). Women who had a hysterectomy (HR 1.40, 95% CI 1.25 to 1.56) or oophorectomy (HR 1.21, 95% CI 1.08 to 1.35) had a higher risk of RA than those without a hysterectomy or oophorectomy. Both hormone replacement therapy (HRT) use (HR 1.46, 95% CI 1.35 to 1.57) and HRT duration (HR 1.02, 95% CI 1.01 to 1.03) were associated with a higher risk of RA.

Conclusions

Some hormonal and reproductive factors were associated with a higher risk of RA. Hormonal and reproductive factors should be considered in risk assessment and formulating management plans in female patients with RA.
Characteristics and disease course of untreated patients with interstitial lung disease associated with systemic sclerosis in a real-life two-centre cohort
Authors: Scheidegger Moritz , Boubaya Marouane , Garaiman Alexandru , Barua Imon , Becker Mike , Bjørkekjær Hilde Jenssen , Bruni Cosimo , Dobrota Rucsandra , Fretheim Håvard , Jordan Suzana , Midtvedt Oyvind , Mihai Carina , Hoffmann-Vold Anna-Maria , Distler Oliver , Elhai Muriel
Published: January 2024

Background

Interstitial lung disease (ILD) is the leading cause of death in systemic sclerosis (SSc). According to expert statements, not all SSc-ILD patients require pharmacological therapy.

Objectives

To describe disease characteristics and disease course in untreated SSc-ILD patients in two well characterised SSc-ILD cohorts.

Methods

Patients were classified as treated if they had received a potential ILD-modifying drug. ILD progression in untreated patients was defined as (1) decline in forced vital capacity (FVC) from baseline of ≥10% or (2) decline in FVC of 5%–9% associated with a decline in diffusing capacity for carbon monoxide (DLCO)≥15% over 12±3 months or (3) start of any ILD-modifying treatment or (4) increase in the ILD extent during follow-up. Multivariable logistic regression was performed to identify factors associated with non-prescription of ILD-modifying treatment at baseline. Prognostic factors for progression in untreated patients were tested by multivariate Cox regression.

Results

Of 386 SSc-ILD included patients, 287 (74%) were untreated at baseline. Anticentromere antibodies (OR: 6.75 (2.16–21.14), p=0.001), limited extent of ILD (OR: 2.39 (1.19–4.82), p=0.015), longer disease duration (OR: 1.04 (1.00–1.08), p=0.038) and a higher DLCO (OR: 1.02 (1.01–1.04), p=0.005) were independently associated with no ILD-modifying treatment at baseline. Among 234 untreated patients, the 3 year cumulative incidence of progression was 39.9% (32.9–46.2). Diffuse cutaneous SSc and extensive lung fibrosis independently predicted ILD progression in untreated patients.

Conclusion

As about 40% of untreated patients show ILD progression after 3 years and effective and safe therapies for SSc-ILD are available, our results support a change in clinical practice in selecting patients for treatment.
Neoehrlichia mikurensisis uncommon in rheumatological patients receiving tumour necrosis factor inhibitors and in blood donors: a retrospective cohort study
Authors: Gynthersen Rosa , Ørbæk Mathilde , Høgdall Estrid , Glintborg Bente , Ostrowski Sisse Rye , Harritshøj Lene , Hetland Merete Lund , Lebech Anne-Mette , Mens Helene
Published: January 2024

Introduction

Neoehrlichia mikurensisis a tick-borne bacterium that primarily causes disease in immunocompromised patients. The bacterium has been detected in ticks throughout Europe, with a 0%–25% prevalence.N. mikurensisinfection presents unspecific symptoms, which can easily be mistaken for inflammatory disease activity. We aimed to determine the prevalence ofN. mikurensisin rheumatological patients receiving tumour necrosis factor inhibitors (TNFi) and a cohort of healthy individuals.

Materials and methods

This retrospective cohort study included 400 rheumatological patients treated with TNFi and 400 healthy blood donors. Plasma samples were retrieved from the Danish Rheumatological Biobank and the Danish Blood Donor Study between 2015 and 2022. Age, sex, diagnosis and duration of TNFi treatment were recovered from the Danish Rheumatological Database, DANBIO. Data on age and sex were available for the blood donors. One plasma sample per individual was tested forN. mikurensisDNA-specific real-time PCR targeting thegroELgene.

Results

In the rheumatological patients, the median age was 61 years (IQR 55–68 years), 62% were women, and 44% had a diagnosis of seropositive rheumatoid arthritis. In total, 54% of the patients were treated with infliximab. The median time from TNFi initiation to blood sampling was 20 months (IQR, 5–60 months).N. mikurensisDNA was not detected in any samples from patients or blood donors.

Conclusion

N. mikurensisinfection does not appear to represent a prevalent risk in Danish rheumatological patients receiving TNFi or in blood donors.
Prevalence, risk factors and echocardiographic predictors of pulmonary hypertension in systemic lupus erythematosus: towards a screening protocol
Authors: Álvarez Troncoso Jorge , Soto Abánades Clara , Robles-Marhuenda Ángel , Alcolea Batres Sergio , Fernández Velilla Peña María , Jiménez Valero Santiago , Sorriguieta Torre Raquel , Rios-Blanco Juan José
Published: January 2024

Background

Systemic lupus erythematosus (SLE) significantly affects the lungs and heart, and pulmonary hypertension (PH) is a severe manifestation that leads to considerable morbidity and mortality.

Objectives

We aimed to determine the prevalence and risk factors of probable SLE-PH, assess the main echocardiographic predictors and develop a potential screening strategy.

Methods

A prospective single-centre study was conducted on 201 patients with SLE who underwent transthoracic echocardiography. Patients meeting PH criteria were referred for right heart catheterisation (RHC).

Results

Among patients, 88.56% were women, 85.57% were of Spanish origin and 43.78% had structural heart disease. Out of these, 16 (7.96%) had intermediate or high probability criteria for PH according to European Society of Cardiology (ESC) 2022. Six RHCs confirmed PH with a prevalence of 2.99% for SLE-PH and 1.99% for SLE-pulmonary arterial hypertension (PAH).

Key risk factors

Key risk factors included age, cardiorespiratory symptoms, serositis, anti-Ro, cardiac biomarkers and altered pulmonary function tests (PFTs). PH was linked to a higher Systemic Lupus International Collaborative Clinics/American College of Rheumatology Damage Index (SDI) (mean SDI 4.75 vs 2.05, p<0.001) and increased mortality risk in a 2-year follow-up (12.50% vs 1.08%, p=0.002).

Conclusion

In our cohort, 7.96% of patients with SLE had an intermediate or high PH probability. By RHC, six patients (2.99%) met the ESC/European Respiratory Society criteria for PH and four (1.99%) for PAH. The main risk factors were older age, cardiorespiratory symptoms, serositis, anti-Ro, cardiac biomarkers and altered PFTs. PH was a severe SLE complication, suggesting the need for earlier diagnosis through data-driven screening to reduce associated morbidity and mortality.
Palliative medicine specialist and general practitioner interactions: national survey
Authors: Biesiada Aleksander , Ciałkowska-Rysz Aleksandra , Mastalerz-Migas Agnieszka
Published: January 2024

Objectives

The purpose of the study was to investigate the collaboration between primary care and palliative care physicians, which is key to providing comprehensive care, and to identify potential difficulties and needs in referring patients to palliative care.

Methods

The study was conducted as an online survey, available to primary care and palliative care physicians. The data collected during the survey were used to compare perceptions of different specialty physicians’ perspectives on various aspects regarding palliative care.

Results

The results of the study showed significant differences in the assessment of the palliative care services availability (73% of primary care physicians rate it poorly comparing to high rating of 60% by palliative care specialists), as well as disparities between the declarations regarding the criteria used to decide on referral to palliative care (achieving the best quality of life) and the actual referral of patients (primary care physicians are third on the list of specialists referring patients to palliative care). Despite the need for adequate cooperation between family physicians and palliative care physicians, some difficulties were identified, such as primary care physicians’ lack of knowledge of the patient palliative care referral criteria, and financial as well as personnel and palliative care facilities’ limitations, were identified.

Conclusions

The study confirms the need for better cooperation between primary care physicians and palliative care specialists in Poland. It suggests that educating primary care physicians about palliative care referral criteria can improve the patient referrals accuracy.
Commentary on gaps in prehospital trauma care: education and bioengineering innovations to improve outcomes in hemorrhage and traumatic brain injury
Authors: Brown Joshua B , Schreiber Martin , Moore Ernest E , Jenkins Donald H , Bank Eric A , Gurney Jennifer M
Published: January 2024

Hemorrhage remains the leading cause of preventable death on the battlefield and the civilian arena. Many of these deaths occur in the prehospital setting. Traumatic brain injury also represents a major source of early mortality and morbidity in military and civilian settings. The inaugural HERETIC (HEmostatic REsuscitation and Trauma Induced Coagulopathy) Symposium convened a multidisciplinary panel of experts in prehospital trauma care to discuss what education and bioengineering advancements in the prehospital space are necessary to improve outcomes in hemorrhagic shock and traumatic brain injury. The panel identified several promising technological breakthroughs, including field point-of-care diagnostics for hemorrhage and brain injury and unique hemorrhage control options for non-compressible torso hemorrhage. Many of these technologies exist but require further advancement to be feasibly and reliably deployed in a prehospital or combat environment. The panel discussed shifting educational and training paradigms to clinical immersion experiences, particularly for prehospital clinicians. The panel discussed an important balance between pushing traditionally hospital-based interventions into the field and developing novel intervention options specifically for the prehospital environment. Advancing prehospital diagnostics may be important not only to allow more targeted applications of therapeutic options, but also to identify patients with less urgent injuries that may not need more advanced diagnostics, interventions, or transfer to a higher level of care in resource-constrained environments. Academia and industry should partner and prioritize some of the promising advances identified with a goal to prepare them for clinical field deployment to optimize the care of patients near the point of injury.
Blood product use for radiological/nuclear trauma: product development and US regulatory considerations
Authors: Silverman Toby A , Shadiack Annette M , Hofmeyer Kimberly A , Cecere Ashley E , Eisnor Derek L , Hoffman Corey M , Loelius Shannon G , Patel Aditiben , Homer Mary J
Published: January 2024

Blood products are likely to be critical components of the medical response to nuclear detonation, as the hematopoietic subsyndrome of acute radiation syndrome (H-ARS) includes depletion of platelets and red blood cells that can lead to lethal hemorrhage and anemia. There is, however, only limited clinical information on the use of blood products to treat H-ARS. As currently configured, the US blood supply cannot meet the predicted surge in blood product demand that is likely to occur short-term and possibly long-term in the event of a large nuclear detonation. As part of the Administration for Strategic Preparedness and Response within the US Department of Health and Human Services, the Biomedical Advanced Research and Development Authority (BARDA) is addressing this preparedness gap by supporting the development of novel blood products and devices with characteristics that improve blood product storage and use in austere operational environments. The US Food and Drug Administration’s Center for Drug Evaluation and Research (CDER) recently issued draft guidance on the development of drugs and biologics regulated by CDER to prevent or treat Acute Radiation Syndrome under the provisions of the “Animal Rule.” The commentary provided here discusses the unique regulatory scheme for transfusion components and blood products regulated as biological drugs by Center for Biologics Evaluation and Research, including the ambiguity surrounding the evidentiary requirements for their approval for H-ARS, and whether, under certain circumstances, a specific H-ARS indication is necessary if relevant commercial indications are approved.
Safety of Bioplasma FDP and Hemopure in rhesus macaques after 30% hemorrhage
Authors: Pusateri Anthony E , Morgan Clifford G , Neidert Leslie E , Tiller Michael M , Glaser Jacob J , Weiskopf Richard B , Ebrahim Ismaeel , Stassen Willem , Rambharose Sanjeev , Mahoney Scott H , Wallis Lee A , Hollis Ewell M , Delong Gerald T , Cardin Sylvain
Published: January 2024

Objectives

Prehospital transfusion can be life-saving when transport is delayed but conventional plasma, red cells, and whole blood are often unavailable out of hospital. Shelf-stable products are needed as a temporary bridge to in-hospital transfusion. Bioplasma FDP (freeze-dried plasma) and Hemopure (hemoglobin-based oxygen carrier; HBOC) are products with potential for prehospital use. In vivo use of these products together has not been reported. This study assessed the safety of intravenous administration of HBOC+FDP, relative to normal saline (NS), in rhesus macaques (RM).

Methods

After 30% blood volume removal and 30 minutes in shock, animals were resuscitated with either NS or two units (RM size adjusted) each of HBOC+FDP during 60 minutes. Sequential blood samples were collected. After neurological assessment, animals were killed at 24 hours and tissues collected for histopathology.

Results

Due to a shortage of RM during the COVID-19 pandemic, the study was stopped after nine animals (HBOC+FDP, seven; NS, two). All animals displayed physiologic and tissue changes consistent with hemorrhagic shock and recovered normally. There was no pattern of cardiovascular, blood gas, metabolic, coagulation, histologic, or neurological changes suggestive of risk associated with HBOC+FDP.

Conclusion

There was no evidence of harm associated with the combined use of Hemopure and Bioplasma FDP. No differences were noted between groups in safety-related cardiovascular, pulmonary, renal or other organ or metabolic parameters. Hemostasis and thrombosis-related parameters were consistent with expected responses to hemorrhagic shock and did not differ between groups. All animals survived normally with intact neurological function.

Level of evidence

Not applicable.
Another piece of the hemolytic disease of the fetus and newborn puzzle after RhD-positive transfusion in trauma resuscitation: the proportion of pregnant women who produce high titer anti-D
Authors: Yazer Mark H , Emery Stephen P , Triulzi Darrell J , Spinella Philip , Leeper Christine
Published: January 2024

Background

After the transfusion of RhD-positive red blood cell (RBC)-containing products to an RhD-negative woman of childbearing potential (WCP) during trauma resuscitation, there are several events that must occur for that WCP to have a future pregnancy affected by hemolytic disease of the fetus and newborn (HDFN). This study identified and quantitated the frequency of a novel event in the sequence from RhD-positive transfusion during trauma resuscitation to an HDFN outcome, that is, the development of a high titer anti-D among women who were D-alloimmunized.

Methods

The transfusion service records at one maternity hospital were searched to locate all anti-D titers that had been performed on pregnant women between 1996 and 2022. The highest titer score during each pregnancy was recorded for this study. The critical titer threshold at this institution was ≥16. Passive anti-D caused by Rh immunoglobulin were excluded from analysis.

Results

There were 97 pregnancies in 85 patients who had an immune-stimulated anti-D; in 60 of 97 (62%) pregnancies, the highest titer score was ≥16. There were 12 patients who had titers performed in two pregnancies during the study period; the correlation between the maximum titer in each pregnancy was not statistically significant (Spearman rank correlation r=0.42, p=0.17).

Conclusion

In this single center study, 62% of D-alloimmunized pregnant women had a high titer antibody. When considering all of the events that must occur for HDFN to happen, the rate of perinatal mortality was calculated to be 0.04% and the rate of perinatal death or serious adverse event from HDFN was 0.24%.
Keeping Things Real with Peter Kariuki
Authors: Sturdee Miriam
Published: January 2024

The CHI '23 Keynote Speaker on process, people, sketchbooks, and what a better world might look like with technology as aide rather than antagonist
Occlusion Boundary Prediction and Transformer Based Depth-Map Refinement From Single Image
Authors: Hambarde Praful , Wadhwa Gourav , Vipparthi Santosh Kumar , Murala Subrahmanyam , Dhall Abhinav
Published: January 2024

Due to the numerous applications of boundary maps and occlusion orientation maps (ORI-maps) in high-level vision problems, accurate estimation of these maps is a crucial task. The existing deep networks employ a single-stream network to estimate the relation between boundary map and ORI-map estimation. However, these networks fail to explore significant individual information separately. To resolve this problem, in this paper, we propose a novel two-stream generative adversarial network (GAN) for boundary map and ORI-map estimation, named OBP-GAN. The proposed OBP-GAN consists of two streams known as BP-GAN and OR-GAN. The BP-GAN estimates the boundary map, and the OR-GAN predicts the ORI-map. The boundary and ORI-map can also be useful cues for the task of depth-map refinement from single images. Therefore, in this work, we propose a transformer-based depth-map refinement network (TRANSDMR-GAN) for refining the depth estimated from monocular images using boundary and ORI-map. We conducted extensive analyses on indoor and outdoor datasets to validate our proposed OBP-GAN and TRANSDMR-GAN. The extensive experimental analysis and ablation study demonstrate the ability of the proposed OBP-GAN to generate state-of-the-art occlusion boundary maps. Furthermore, we show that the proposed network, TRANSDMR-GAN, can generate an edge-enhanced depth map without degrading the accuracy of the initial depth map.
Oocyte and cumulus cell cooperativity and metabolic plasticity under the direction of oocyte paracrine factors
Authors: Richani Dulama , Poljak Anne , Wang Baily , Mahbub Saabah B. , Biazik Joanna , Campbell Jared M. , Habibalahi Abbas , Stocker William A. , Marinova Maria B. , Nixon Brett , Bustamante Sonia , Skerrett-Byrne David , Harrison Craig A. , Goldys Ewa , Gilchrist Robert B.
Published: January 2024

Oocyte-secreted factors (OSFs) promote oocyte and cumulus cell cooperativity by altering the molecular composition of both cell types. OSFs downregulate protein catabolic processes and upregulate processes associated with DNA binding, translation, and ribosome assembly in oocytes. In cumulus cells, OSFs alter mitochondrial number, morphology, and function, and enhance metabolic plasticity by upregulating anabolic pathways. Hence, the oocyte via OSFs, instructs cumulus cells to increase metabolic processes on its behalf, thereby subduing oocyte metabolism.
Switching neuron contributions to second network activity
Authors: Fahoum Savanna-Rae H. , Blitz Dawn M.
Published: January 2024

We used small, well-characterized networks to investigate interactions between rhythmic networks and neurons that switch their network participation. For a neuron switching into dual-network activity, only the second network regulated its activity in that network. In addition, the switching neuron was sufficient but not necessary to coordinate second network neurons and regulated their activity levels. Thus, regulation of switching neurons may be selective, and a switching neuron is not necessarily simply a follower in additional networks.
Research on Path Optimization of Vehicle-Drone Joint Distribution considering Customer Priority
Authors: Zhou Xiaoye , Feng Yuhao
Published: January 2024

To meet the personalized distribution needs of customers, comprehensively consider customer value, the urgency of customer needs, and the impact of priority distribution to the customer on the enterprise, and based on regional restrictions, put forward vehicle-drone joint distribution path optimization problem considering customer priority. First, the goal is to minimize the sum of total distribution cost and customer priority cost integrating soft time windows and constructing a path optimization model of the vehicle-drone joint distribution. Second, a two-stage hybrid algorithm is proposed for the problem model. In the first stage, the deep neural network and the grid search improved support vector machine algorithm (DNN-GSM-SVM) are used to screen and classify customer priority features, and in the second stage, adaptive large-scale neighborhood search improved genetic algorithms (ALNS-GA) are used to solve the problem of vehicle-drone joint distribution path planning problem. Finally, combined with the numerical example, the optimization scheme of the vehicle-drone joint distribution path considering priority is analyzed. Compared with the three algorithms and error analysis, the effectiveness of the model and the two-stage algorithm was verified. Compared with the results of the scheme that does not consider priority, the results show that priority can significantly improve customer satisfaction. The efficiency of the vehicle-drone joint distribution was verified by comparing the three scenarios.
Figure S2 from Analysis of Changes in Plasma Cytokine Levels in Response to IL12 Therapy in Three Clinical Trials
Authors: Schwarz Emily , Benner Brooke , Yu Lianbo , Tounkara Fode , Carson William E.
Published: January 2024

Extended cytokine expression timelines according to clinical study.
A Revised Molecular Model of Ovarian Cancer Biomarker CA125 (MUC16) Enabled by Long-read Sequencing
Authors: Wang Chien-Wei , Weaver Simon D. , Boonpattrawong Nicha , Schuster-Little Naviya , Patankar Manish , Whelan Rebecca J.
Published: January 2024

The biomarker CA125, a peptide epitope located in several tandem repeats of the mucin MUC16, is the gold standard for monitoring regression and recurrence of high-grade serous ovarian cancer in response to therapy. However, the CA125 epitope along with several structural features of the MUC16 molecule are ill defined. One central aspect still unresolved is the number of tandem repeats in MUC16 and how many of these repeats contain the CA125 epitope. Studies from the early 2000s assembled short DNA reads to estimate that MUC16 contained 63 repeats.

Here, we conduct Nanopore long-read sequencing of MUC16 transcripts from three primary ovarian tumors and established cell lines (OVCAR3, OVCAR5, and Kuramochi) for a more exhaustive and accurate estimation and sequencing of the MUC16 tandem repeats.

The consensus sequence derived from these six sources was confirmed by proteomics validation and agrees with recent additions to the NCBI database. We propose a model of MUC16 containing 19—not 63—tandem repeats. In addition, we predict the structure of the tandem repeat domain using the deep learning algorithm, AlphaFold.

The predicted structure displays an SEA domain and unstructured linker region rich in proline, serine, and threonine residues in all 19 tandem repeats. These studies now pave the way for a detailed characterization of the CA125 epitope. Sequencing and modeling of the MUC16 tandem repeats along with their glycoproteomic characterization, currently underway in our laboratories, will help identify novel epitopes in the MUC16 molecule that improve on the sensitivity and clinical utility of the current CA125 assay.

Significance:

Despite its crucial role in clinical management of ovarian cancer, the exact molecular sequence and structure of the biomarker, CA125, are not defined. Here, we combine long-read sequencing, mass spectrometry, and in silico modeling to provide the foundational dataset for a more complete characterization of the CA125 epitope.
Fetal Dose Evaluation for Pregnant Patients on Leksell Gamma Knife Perfexion/Icon
Authors: Hamáčková Lucie , Novotný Jr. Josef , Šimonová Gabriela , Liščák Roman , Chytka Tomáš
Published: January 2024

Introduction: It is a normal procedure to avoid the application of ionizing radiation during pregnancy. In very rare occasions, treatment can be performed, but doses to the fetus must be evaluated and reported, and the patient must sign informed consent. There can occur two types of damage caused by ionizing radiation – deterministic and stochastic effects. Deterministic effects may occur after reaching a certain threshold (100 mGy for this study); meanwhile, stochastic effects have no limit and their probability rises with dose. This study focuses on deterministic effects. Case Presentations: This study compares the dose measured on phantom for the area of the pelvis and the dose measured on 3 patients with dosimeters positioned on the pelvis irradiated on Leksell Gamma Knife Perfexion/Icon. The mean dose for measurement on phantom for the pelvis was 0.73 ± 0.76 mGy, and for the patients, it was 1.28 mGy, 0.493 mGy, and 0.549 mGy which is 80 times lower, 200 times lower, and 180 times lower than the threshold for deterministic effects, respectively. Conclusion: The measurement carried on phantom served as the base for drafting informed consent and provided initial proof that treatment can be safely delivered. Measurements performed on patients only confirmed that irradiation of pregnant patients on Leksell Gamma Knife Perfexion/Icon is safe relative to the deterministic effects. Nevertheless, pregnant patients should be treated with ionizing radiation only in very extraordinary situations.
The Agreement between Consumer-Driven Self-Assessment of Psoriasis Severity and Physician-Assessed Severity Based on Patient-Taken Photographs Is Weak: A Cross-Sectional Study
Authors: Ali Zarqa , Al-Mousawi Ali , Björnsson Benóný Þór , Egeberg Alexander , Riemer Christian , Thomsen Simon Francis
Published: January 2024

Introduction: Digital advancements have given access to huge amounts of real-world data (RWD) widely used for dermatological research. Objectives: The objective of this study was to investigate the agreement between consumer-driven self-assessed psoriasis severity and physician-assessed severity based on photographs. Methods: Customer IDs in the NØIE database (Danish skincare company) from 2009 to 2022 with a smartphone photograph of psoriasis vulgaris on the body and a corresponding completed questionnaire were included. Smartphone photographs were evaluated by a physician-assessing erythema, induration, and scaling on a scale from 0 to 4 based on Psoriasis Area Severity Index (PASI). Self-assessment was done on a scale from 0 to 10 and converted to 0–4 scale (0 converted to 0; 1–3 to 1; 4–6 to 2; 7–8 to 3; and 9–10 to 4). Intraclass correlation coefficients with 95% confidence intervals (CIs) were calculated. Results: In total, 187 patients (63% women) with mean age of 38 years were included. Self-assessment scores were higher than physicians’ assessment scores for all groups, and scaling was closest to the physicians’ assessment, while erythema and induration had a greater distance between the physicians’ and patients’ assessment. The correlation between self-assessed and physician-assessed psoriasis severity for all patients was 0.23 (95% CI: 0.0–0.92); 0.34 (95% CI: 0.0–0.95) for chronic patients; and 0.09 (−0.01 to 0.82) for non-chronic patients. The agreement was better for men (0.53 [−0.02 to 0.98]) than for women (0.12 [−0.01 to 0.84]). Conclusion: There was weak agreement between self-assessed psoriasis severity and photographically assessed severity by the physician. Consumer-driven RWD should be interpreted with caution.
Afetividades marginais em contextos de violência armada: notas sobre a experiência dos moradores da Maré
Authors: Ribeiro Eduardo , Oliveira Eduardo Moura , Ramos Junior Eduardo
Published: January 2024

Este artigo investiga as experiências emocionais dos moradores da Maré, e como estas são influenciadas pela exposição à violência armada. No estudo, assumimos que a categoria “afetividades marginais” conjuga distintos marcadores sociais, refletindo situações de exclusão, obstáculos estruturais e formas de discriminação, estigmatização e desigualdade. Neste sentido, é observado como certos tipos de afetos (desconfiança e medo, tristeza e raiva, aflição) variam conforme o nível pessoal de exposição à violência armada. Realiza ainda uma breve discussão sobre afetividades inscritas em diferentes tipos de governança criminal. De cunho descritivo e exploratório, a análise empírica utilizou dados quantitativos da pesquisa “Construindo Pontes: impactos sociais da exposição à violência armada na Maré”, para mostrar um panorama socioemocional dessa população, além de propor algumas hipóteses sobre as figurações emocionais e relacionais das pessoas residentes em áreas conflagradas e territórios periféricos brasileiros, como o conjunto de favelas da Maré, na cidade do Rio de Janeiro.
MEBRAINS 1.0: a new population-based macaque atlas
Authors: Balan Puiu F , Zhu Qi , Li Xiaolian , Niu Meiqi , Rapan Lucija , Funck Thomas , Bakker Rembrandt , Palomero-Gallagher Nicola , Vanduffel Wim
Published: January 2024

Due to their fundamental relevance, the number of anatomical macaque brain templates is constantly growing. Novel templates aim to alleviate limitations of previously published atlases and offer the foundation to integrate multiscale multimodal data. Typical limitations of existing templates include their reliance on one subject, their unimodality (usually only T1 or histological images), or lack of anatomical details. The MEBRAINS template overcomes these limitations by using a combination of T1 and T2 images, from the same 10 animals (Macaca mulatta), which are averaged by the multi-brain toolbox for diffeomorphic registration and segmentation. The resulting volumetric T1 and T2 templates are supplemented with high quality white and gray matter surfaces built with FreeSurfer. Human-curated segmentations of pial surface, white/gray matter interface and major subcortical nuclei were used to analyse the relative quality of the MEBRAINS template. Additionally, 9 CT scans of the same monkeys were registered to the T1 modality and co-registered to the template. Through its main features (multi-subject, multi-modal, volume-and-surface, traditional and deep learning-based segmentations), MEBRAINS aims to improve integration of multi-modal multi-scale macaque data and is quantitatively equal to, or better than, currently widely used macaque templates. We provide a detailed description of the algorithms/methods used to create the template aiming to furnish future researchers with a map-like perspective which should facilitate identification of an optimal pipeline for the task they have at hand. Finally, recently published 3D maps of the macaque inferior parietal lobe, (pre)motor and prefrontal cortex were warped to the MEBRAINS surface template, thus populating it with a parcellation scheme based on cyto- and receptor architectonic analyses. The template is integrated in the EBRAINS and Scalable Brain Atlas web-based infrastructures, each of which comes with its own suite of spatial registration tools.
The Role of the Colonial State in the Spread and Strengthening of Christianity in Colonial Tanganyika, Circa 1890–1961
Authors: Seimu Somo M.L. , Komba Yustina Samwel
Published: January 2024

This paper makes an essential contribution by arguing that shifts in German colonial educational policy, which continued under British control, consistently favoured the spread of Christianity over Islam in Tanganyika. The paper also looks at how the two colonial powers used Article 6 of the Berlin Act 1884–1885, Article 438 of the Versailles Treaty, and Article 22 of the League of Nations Covenant, as well as Command Paper No. 2374 of I925 that emphasised the protection of Christian missionaries and the provision of education by missionaries across British colonies in Africa. The aforementioned articles established colonial state-missionary partnerships and provided security to missionaries. The colonial authority’s protection of missionaries was essential to investing in the education sector, which became a centre for the spread of Christianity in the country. As a result, the spread of Christianity throughout the territory accelerated. The paper relies heavily on secondary and primary sources for this analysis.