bluuebunny/crossref_metadata_2025 huggingface dataset:
Multidisciplinary combined treatment based on bariatric surgery for metabolic syndrome: a review article
Authors: Xie Jiaji , Wang Yong
Published: March 2024

As a chronic, multifactorial disease, obesity is associated with a global social and economic burden. This condition significantly affects normal daily life and healthy social interactions, and shortens the life expectancy of patients. Compared with traditional weight-loss methods, the emergence of bariatric surgery has effectively improved the management of obesity. Furthermore, bariatric surgery can also inhibit the progression of multiple metabolic diseases. Despite its potential advantages, bariatric surgery cannot completely eliminate the possibility of weight regain and inadequate weight loss following the procedure. For super-obese patients, bariatric surgery still remains a surgical risk. In addition, the psychological problems and poor eating habits of obese patients also affect the weight loss effect and daily life. Thus, various adjuvant therapies involving multiple disciplines have attracted people’s attention. Recently, it has been recognized that the combination of multiple interventions based on bariatric surgery is more advantageous than a single intervention in alleviating the complex and diverse metabolic diseases associated with obesity. The combined therapy considerably enhances the long-term efficacy of bariatric surgery and plays a positive role in the mental health and social lives of patients. In this article, the authors review this multidisciplinary combination therapy to enhance the current understanding of the treatment of obesity.
Microbiome and its impact on fetal and neonatal brain development: current opinion in pediatrics
Authors: Frerichs Nina M. , de Meij Tim G.J. , Niemarkt Hendrik J.
Published: March 2024

Purpose of review

Emerging evidence suggests that the gut microbiota and its metabolites regulate neurodevelopment and cognitive functioning via a bi-directional communication system known as the microbiota-gut-brain axis (MGBA).

Recent findings

The MGBA influences brain development and function via the hypothalamic-pituitary axis, the vagal nerve, immune signaling, bacterial production of neurotransmitters, and microbial metabolites like short-chain fatty acids, tryptophan derivatives, and bile acids. Animal studies show fetal neurodevelopment is mediated by maternal microbiota derivatives, immune activation, and diet. Furthermore, manipulation of the microbiota during critical windows of development, like antibiotic exposure and fecal microbiota transplantation, can affect cognitive functioning and behavior in mice. Evidence from human studies, particularly in preterm infants, also suggests that a disrupted gut microbiota colonization may negatively affect neurodevelopment. Early microbial signatures were linked to favorable and adverse neurodevelopmental outcomes.

The link between the gut microbiota and the brain is evident. Future studies, including experimental studies, larger participant cohort studies with longitudinal analyses of microbes, their metabolites, and neurotransmitters, and randomized controlled trials are warranted to further elucidate the mechanisms of the MGBA. Identification of early, predictive microbial markers could pave the way for the development of novel early microbiota-based intervention strategies, such as targeted probiotics, and vaginal or fecal microbiota transplantation, aimed at improving infant neurodevelopment.
Research into the anatomy of the subaxial cervical pedicle for ensuring screw insertion safety
Authors: Dong Wei-Xin , Hu Yong , Yuan Zhen-Shan
Published: March 2024

The study aimed to determine the optimal entry points and trajectories for posterior subaxial cervical pedicle screw (CPS) fixation. Computed tomography (CT) and Mimics software were used to evaluate the subaxial cervical pedicle in 42 cervical spine CT scans. The width of the cervical pedicle was measured and compared at medial angulations of 30°, 35°, 40°, 45°, 50°, 55°, and 60° relative to the midline sagittal plane. Based on an observational examination of the positions of all cervical 3-dimensional models and screws, the proposed entry point for C3–7 CPS was analyzed. Although the variations in C3–6 pedicle width (PW) among 45°, 50°, and 55° were not statistically significant, they were significantly larger than the differences among 30°, 35°, 40°, and 60° angles (P < .05). The differences in C7 PW between the 30°, 35°, 40°, and 45° angles were not statistically different even though the 30°, 35°, 40°, and 45° angles were significantly bigger. (P < .05). The proposed entry point for C3–7 CPS was below the junction of the lateral and lower borders of the superior articular process joint surface. The entry point for C3–7 levels was below the junction of the lateral and lower borders of the superior articular process joint surface. The optimal medial angulation for the posterior C3–6 CPS was 45°–55° and that for the posterior C7 CPS was 30°–45°. The sagittal angle of the posterior C3–7 CPS was parallel to the corresponding upper endplate.
Association of rs5051 and rs699 polymorphisms in angiotensinogen with coronary artery disease in Iranian population: A case-control study
Authors: Mirahmadi Maryam , Salehi Aref , Golalipour Masoud , Bakhshandeh Azam , Shahbazi Majid
Published: March 2024

Coronary artery disease (CAD) is the third most common cause of mortality globally (with 17.8 million deaths annually). Angiotensinogen (AGT) and polymorphisms in this gene can be considered as susceptibility factors for CAD. We performed a retrospective case-control study to determine the correlation of AGT rs5051 and rs699 polymorphisms with CAD in an Iranian population. We genotyped 310 CAD patients and 310 healthy subjects using polymerase chain reaction-based methods. To confirm the accuracy of the screening approach, 10% of genotyped subjects were validated using gold-standard Sanger Sequencing. To evaluate the effect of the candidate polymorphisms, white blood cells were randomly purified from the subjects and AGT expression was measured by quantitative reverse transcriptase-polymerase chain reaction. Sex stratification indicated a significant correlation between CAD and male sex (P = .0101). We found a significant association between the rs5051 A allele (P = .002) and the rs699 C allele, and CAD (P = .0122) in recessive and dominant models. Moreover, our findings showed a significant association of the haplotype, including the rs5051 A/A and rs699 T/C genotypes, with CAD (P = .0405). Finally, AGT mRNA levels were significantly decreased in patients harboring the candidate polymorphisms (P = .03). According to our findings The AGT rs5051 A and AGT rs699 C alleles are predisposing variants of CAD risk and severity in the Iranian population.
Nail-preserving excision of glomus tumor in the second toe: Case report and literature review
Authors: Park Young Uk , Han Jongseong , Seo Young Wook
Published: March 2024

Introduction:

This case report describes the diagnosis of a glomus tumor in the second toe of a 38-year-old female, followed by surgical treatment utilizing a transungual approach to preserve the nail. This study highlights the diagnostic challenges and surgical strategies to treat such tumors while preserving nail integrity.

Patient concerns:

Pain occurred once a week, but over time, it increased, and just before seeking medical attention, she experienced pain more than 5 times a day. The pain worsened when cold water touched her toe.

Diagnosis:

We observed a slight hump indicating nail plate deformity, and the patient exhibited severe pinpoint tenderness (positive Love test) in the affected area. Color duplex ultrasound was performed for further investigation, revealing a hypervascular hypoechoic nodule measuring 0.5 cm in size at the nail bed of the right second toe.

Intervention:

The surgery was performed under digital nerve block anesthesia using a modified transungual nail-preserving approach for the excision of the glomus tumor.

Outcomes:

The pain that was reported prior to the surgery has improved postoperatively, and the recovery has been uneventful without any other complication.

Conclusion:

This paper provides a comprehensive examination of a rare glomus tumor in the second toe, elucidating both diagnostic intricacies and treatment modalities. It emphasizes the dual necessity of achieving total tumor excision while also considering aesthetic outcomes. The insights presented herein are intended to serve as valuable guidance for clinicians confronted with similar clinical scenarios, underlining the delicate interplay between effective tumor management and the preservation of cosmetic integrity.
Causal effect of education on bone mineral density: A Mendelian randomization study
Authors: Mou Xiaoqing , Sun Mingqi , Chen Xiaojun
Published: March 2024

Education level may have some association with the incidence of osteoporosis, but it is elusive if this association is causal. This two-sample Mendelian randomization analysis focused on the causal effect of education level on femoral neck bone mineral density (FN-BMD), forearm BMD, lumbar spine BMD, and heel BMD. Twelve single nucleotide polymorphisms were used as instrumental variables. The results suggested that high education level was associated with improved FN-BMD (beta-estimate: 0.406, 95% confidence interval: 0.061 to 0.751, standard error: 0.176, P-value = .021). There were null association between education and other sites of bone mineral density. Our results found the causal effect of high education level on improved FN-BMD, and improved educational attainment may be beneficial to prevent osteoporosis.
Comprehensive analysis of the clinical and biological significances for chemokine CXCL3 in cholangiocarcinoma
Authors: Ren Hongyue , Yang Xiaofan , Hou Wenrong , Meng Jiarong , Luo Deqing , Zhang Chunbin
Published: March 2024

Cholangiocarcinoma (CHOL) is a race malignant cancer arising from bile duct epithelial cells in clinical practice. C-X-C motif chemokine ligand 3 (CXCL3) is a member of chemokines family, which participates in the pathogenesis of various tumors. However, the association between CXCL3 and CHOL is unclear. This present study was to assess the role of CXCL3 expression in the progress of CHOL. TIMER, GEPIA, UALCAN, GSCA, LinkedOmics, Metascape and STRING databases were performed to evaluate the clinical and biological significances for CXCL3 with CHOL patients including expression, clinicopathological factors, immune cell infiltration, GO enrichment and KEGG pathway analyses, as well as PPI network analysis. The immunohistochemistry analysis of tissue microarray was conducted to detect the protein expression level, subcellular localization, clinicopathological factors and prognosis of CXCL3 in CHOL. The mRNA and protein expression levels of CXCL3 were markedly increased in CHOL tissues. The overexpression of CXCL3 was strongly associated with maximum tumor diameter of patients with CHOL. Additionally, there were negative correlations between the expression of CXCL3 and monocyte as well as Th17. Low infiltration of neutrophil indicated significantly shorter cumulative survival in CHOL patients. And CXCL3 was significantly associated with arm-level deletion of CD8+ T cell. Furthermore, functional network analysis suggested that CXCL3 and its associated genes were mainly enriched for chemotaxis, secretory granule membrane, cytokine activity and IL-17 signaling pathway. CXCL3 might potentially participate in the carcinogenesis of CHOL, which provided a direction for future research on the mechanism of CXCL3 in CHOL.
C3AR1 is a regulatory factor associated with coagulation cascade and inflammation in sepsis
Authors: Ren Xuanrong , Fu Qinghui
Published: March 2024

Sepsis is a leading cause of mortality in intensive care units. Sepsis is associated with activation of the coagulation cascade and inflammation. The aim of this study was to identify coagulation-related genes in sepsis that may provide translational potential therapeutic targets. The datasets GSE28750, GSE95233, and GSE65682 were downloaded from the gene expression omnibus database. Consensus-weighted gene co-expression network analysis (WGCNA) was used to identify sepsis modules. Gene set enrichment analysis was used to identify genes enriched in the coagulation cascade. The value of hub-gene in immunological analysis was tested in the validation sets (GSE95233). The value of hub-gene in clinical prognosis was tested in the validation sets (GSE65582). One thousand one hundred seventy-six genes with high connectivity in the clinically significant module were identified as hub genes. Ten genes were found to be enriched in coagulation-related signaling pathways. C3AR1 was selected for further analysis. The immune infiltration analysis showed that lower expression of C3AR1 was associated with immune response in sepsis and could be an independent predictor of survival status in sepsis patients. Meanwhile, univariate and multivariate Cox analysis showed that C3AR1 had a significant correlation with survival. C3AR1 may become an effective biomarker for worse outcomes in sepsis patients associated with immune and coagulation cascade.
Investigating awareness of artificial intelligence in healthcare among medical students and professionals in Pakistan: a cross-sectional study
Authors: Umer Mohammad , Naveed Aiman , Maryam Qanita , Malik Arif Rasheed , Bashir Naghmana , Kandel Kamal
Published: March 2024

Objective:

The purpose of this study is to find out the level of awareness and acceptance of artificial intelligence (AI) in Pakistan’s medical community so as to comment on its future in our healthcare system.

Methods:

A survey consisting of 15 close-ended questions was conducted. The questions inquired about awareness about AI and discovered the opinions of healthcare professionals regarding its benefits and expected problems. The data were analyzed using SPSS version 26, and descriptive statistics for percentage and frequency were computed. χ2 test was used to analyze the subgroups (Significant p value <0.05).

Results:

A total of 351 participants were included in this study. General familiarity with AI was low. Only 75 (21.3%) participants answered that they had good familiarity with AI, and only 56 (16%) of them had good familiarity with the role of AI in medicine. One hundred sixty-eight (47.9%) participants disagreed that AI would out-compete the physician in the important traits of professionalism. Only 71 (20.2%) participants believed AI to be diagnostically superior to the physician. Two hundred fourteen (61.0%) were worried about completely trusting AI in its decisions, and 204(58.1%) believed that AI systems lacking human traits would not be able to mirror the doctor-patient relationship. Two hundred sixty-one (74.4%) participants believed that AI would be useful in Administrative tasks. A majority, 162 (46.2%), do not believe that AI would replace them. Finally, a huge majority of participants [225 (64.1%)] demanded the integration of AI in Pakistan’s healthcare system.

Conclusion:

This study suggests that a majority of healthcare professionals in Pakistan do not believe that they are sufficiently aware of the role of AI in healthcare. This was corroborated by their answers to various questions regarding the capabilities of AI. This study indicates the need for a more comprehensive ascertainment of healthcare professionals’ perceptions regarding the role of Artificial Intelligence in medicine and bridging the gap between doctors and technology to further promote a patient-centred approach to medicine.
Generalization of In-Place Balance Perturbation Training in People With Parkinson Disease
Authors: Monaghan Andrew S. , Hooyman Andrew , Dibble Leland E. , Mehta Shyamal H. , Peterson Daniel S.
Published: March 2024

Background and Purpose:

Reactive balance training improves reactive postural control in people with Parkinson disease (PwPD). However, the extent to which reactive balance training generalizes to a novel, unpracticed reactive balance task is unknown. This study aimed to determine whether reactive training stepping through support surface translations can be generalized to an unpracticed, instrumented tether-release task.

Methods:

Twenty-five PwPD (70.52 years ± 7.15; Hoehn and Yahr range 1-3) completed a multiple baseline, open-label, uncontrolled pre-post intervention study. Stepping was trained through a 2-week (6-session) intervention with repeated support surface translations. Performance on an untrained tether-release task (generalization task) was measured at 2 baseline assessments (B1 and B2, 2 weeks apart), immediately after the intervention (P1), and 2 months after training (P2). The tether-release task outcomes were the anterior-posterior margin of stability (MOS), step length, and step latency during backward and forward steps.

Results:

After support surface translation practice, tether-release stepping performance improved in MOS, step length, and step latency for both backward and forward steps compared to baseline (P < 0.05). Improvements in MOS and step length during backward and forward steps in the tether-release task, respectively, were related to stepping changes in the practiced task. However, the improvements in the generalization task were not retained for 2 months.

Discussion and Conclusions:

These findings support short-term generalization from trained balance tasks to novel, untrained tasks. These findings contribute to our understanding of the effects and generalization of reactive step training in PwPD.

Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content available at http://links.lww.com/JNPT/A465).
Silver carboxylate-TiO2/polydimethyl siloxane is a safe and effective antimicrobial with significant wound care potential
Authors: Allu Sai , Whitaker Colin , Stone Benjamin , Vishwanath Neel , Clippert Drew , Jouffroy Elia , Antoci Valentin , Born Christopher , Garcia Dioscaris R.
Published: March 2024

Introduction:

With the rise in antibiotic resistance, new methodologies are needed to combat musculoskeletal infections. Silver is an antimicrobial that can be synthesized in different forms, but its pharmacokinetics are difficult to control. This study details the antibacterial efficacy and cellular cytotoxicity of a formulation consisting of silver carboxylate (AgCar) released through a titanium dioxide/polydimethylsiloxane matrix with a predictable release profile on Pseudomonas aeruginosa, Acinetobacterium baumannii, and human-derived primary osteoblasts.

Methods:

Through an Institutional Animal Care and Use Committee and IRB-approved protocol, AgCar was applied to live Yucatan porcine skin and histologically analyzed for skin penetration. Graphite Furnace Atomic Absorption Spectroscopy (GFAAS) was used to measure elution of AgCar. Dose–response curves were generated through optical density to assess potency. Finally, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay was used to quantify the cellular cytotoxicity of the novel formulation. The results were subject to statistical analysis using analysis of variance and post hoc Tukey tests.

Results:

The silver carboxylate coating demonstrated deep penetration into the epithelium at the level of the deep pilosebaceous glands in animal models. GFAAS testing demonstrated the extended elution profile of silver carboxylate over 96 hours, while 100% silver with no titanium dioxide-polydimethylsiloxane matrix fully eluted within 48 hours. 10x silver carboxylate demonstrated superior antimicrobial activity to antibiotics and other silver formulations and showed minimal cytotoxicity compared with other silver formulations.

Discussion/Clinical Relevance:

Current antimicrobial therapies in wound care and surgical antisepsis, such as chlorhexidine gluconate, have pitfalls including poor skin penetration and short duration of efficacy. The broad antimicrobial activity, extended elution, and deep skin penetration of this AgCar formulation show great promise for surgical site infection and wound care treatment. Novel technology to fight the growing threat of microbial resistance should be at the forefront of orthopaedic surgical site infection prevention and treatment.
Social media use and vision impairment in adults between the ages of 18 and 35 years in India
Authors: Subramanian Ahalya , Kodavati Krishna Priya , Kanchustambam Jahnavi , Gothwal Vijaya K.
Published: March 2024

SIGNIFICANCE

Social media is used by >4.48 billion people worldwide. Despite its popularity, vision-impaired individuals struggle to use social media given visual inaccessibility of content and lack of access to Internet/Wireless-Fidelity–enabled devices. Our study explores visually impaired adult's use of social media in comparison to a control group.

PURPOSE

This study aimed to report the demographic profile and patterns of social media use among adults with vision impairment (VI) aged 18 to 35 years and compare it with an age-matched normally sighted group in India. In addition, we explored barriers to use of social media among adults with VI.

METHODS

Vision-impaired and normally sighted adults (controls) aged 18 to 35 years at L V Prasad Eye Institute, Hyderabad, India, answered a questionnaire about social media use (e.g., platform used).

RESULTS

Four hundred twenty-two individuals (201 VI, 221 controls) participated. Normally sighted adults (98%) used social media more than the VI group (81%; p<0.001). Vision-impaired users were predominantly male (85%) and unemployed (57%; p<0.00001 for both). There was no significant difference in educational level between groups (p=0.17). Smartphones were the most popular device used (VI, 161 [99%]; control, 206 [95%]), with tablet PC/iPad being the least popular (VI, 5 [3%]; control, 12 [6%]). Adults with VI and controls commonly used WhatsApp as communication platforms, and Facebook and Twitter as networking platforms. Approximately one-third of individuals across both social media user groups reported barriers to use (VI, 48 [30%]; control, 74 [34%]; p<0.001). Vision-impaired individuals cited accessibility issues of having to rely on audio over vision to navigate social media, whereas controls reported having to share a phone.

CONCLUSIONS

The proportion of social media usage among VI adults is high (81%) and is substantially higher than the 33% reported in the general Indian population. Vision-impaired adults who used social media were male with moderate VI and were less likely to be employed compared with controls.
Cost Analysis of Short Messaging Service and Peer Navigator Interventions for Linking and Retaining Adults Recently Diagnosed With HIV in Care in South Africa
Authors: Shade Starley B. , Gutin Sarah A. , Agnew Emily , Grignon Jessica S. , Gilmore Hailey , Ratlhagana Mary-Jane , Sumitani Jeri , Steward Wayne T. , Lippman Sheri A.
Published: March 2024

Introduction:

Large proportions of people living with HIV (PLHIV) in sub-Saharan Africa are not linked to or retained in HIV care. There is a critical need for cost-effective interventions to improve engagement and retention in care and inform optimal allocation of resources.

Methods:

We estimated costs associated with a short message service (SMS) plus peer navigation (SMS+PN) intervention; an SMS-only intervention; and standard of care (SOC), within the I-Care cluster-randomized trial to improve HIV care engagement for recently diagnosed PLHIV. We employed a uniform cost data-collection protocol to quantify resources used and associated costs for each intervention.

Results:

Compared with SOC, the SMS+PN intervention cost $1284 ($828–$2859) more per additional patient linked to care within 30 days and $1904 ($1158–$5343) more per additional patient retained in care at 12 months, while improving linkage by 24% (95% CI: 11 to 36) and retention by 16% (95% CI: 6 to 26). By contrast, the SMS-only intervention cost $198 ($93-dominated) more per additional patient linked to care and $697 ($171-dominated) more per additional patient retained in care but was not significantly associated with improvements in linkage (12%; 95% CI: −1 to 25) or retention (3%; 95% CI: −7 to 14) compared with SOC. The efficiency of the SMS+PN intervention could be improved by 46%, to $690 more per additional patient linked and $1023 more per additional patient retained in care, if implemented within the Department of Health using more efficient distribution of staff resources.

Discussion:

Findings suggest that scale-up of the SMS+PN intervention could benefit patients, improving care and health outcomes while being cost-effective.
Age Matters
Authors: Wehrle Chase J. , Maspero Marianna , Pinna Antonio D. , Dutkowski Philipp , Miller Charles , Hashimoto Koji , Clavien Pierre-Alain , Schlegel Andrea
Published: March 2024

Objective:

To assess factors affecting the cumulative lifespan of a transplanted liver.

Background:

Liver aging is different from other solid organs. It is unknown how old a liver can actually get after liver transplantation.

Methods:

Deceased donor liver transplants from 1988 to 2021 were queried from the United States UNOS registry. Cumulative liver age was calculated as donor age + recipient graft survival.

Results:

In total, 184,515 livers were included. Most were donation after brain death donors (n = 175,343). The percentage of livers achieving >70, 80, 90, and 100 years cumulative age was 7.8% (n = 14,392), 1.9% (n = 3576), 0.3% (n = 528), and 0.01% (n = 21), respectively. The youngest donor age contributing to a cumulative liver age >90 years was 59 years, with posttransplant survival of 34 years. In pediatric recipients, 736 (4.4%) and 282 livers (1.7%) survived >50 and 60 years overall, respectively. Transplanted livers achieved cumulative age >90 years in 2.86 per 1000 and >100 years in 0.1 per 1000. The U.S. population at large has a cumulative “liver age” >90 years in 5.35 per 1000 persons, and >100 years in 0.2 per 1000. Livers aged >60 years at transplant experienced both improved cumulative survival (P < 0.0001) and interestingly improved survival after transplantation (P < 0.0001). Recipient warm ischemia time of >30 minutes was most predictive of reduced cumulative liver survival overall (n = 184,515, hazard ratio = 1.126, P < 0.001) and excluding patients with mortality in the first 6 months (n = 151,884, hazard ratio = 0.973, P < 0.001).

Conclusions:

In summary, transplanted livers frequently get as old as those in the average population despite ischemic-reperfusion-injury and immunosuppression. The presented results justify using older donor livers regardless of donation type, even in sicker recipients with limited options.
Disseminated hydatidosis an unusual presentation:  A case report

Authors: ZIAD Fatima , ZOUAOUI Imane , EL MAMOUNE Mostaine , AOUFI Sarra
Published: March 2024

Hydatidosis, also known as cystic Echinococcosis, is a widespread zoonosis, caused by a tapeworm of the genus Echinococcus. It presents a significant public health concern, particularly in endemic areas. The occurrence of disseminated hydatid disease is uncommon, even in regions where it is endemic, with an incidence ranging from 1 to 8%. The definitive diagnosis relies on parasitological method.
In this work, we present an unusual case of disseminated hydatid disease that was diagnosed in the central parasitology-mycology laboratory of “The Ibn Sina University Hospital”.
This is a 21-year-old patient, residing in a rural area, who presented with heaviness-type pain in the right hypochondrium, accompanied with nausea and vomiting. During the examination, the patient mentioned the contact with dogs. Abdominal radiography (Ultrasound and CT) revealed findings suggestive of multiple hydatid cysts located in the liver and peritoneum. This suspicion was confirmed by positive hydatid serology.
After 9 months of treatment with albendazole, the patient underwent surgery for excision of the cysts shown on the x-ray, as well as other cysts incidentally discovered intraoperatively at the pelvic and rectal levels. All of the extracted specimens were sent to the parasitology laboratory. The direct examination, along with the viability test, revealed the presence of hooks and scolex of non-viable Echinococcus granulosus.
Disseminated hydatidosis is a rare but serious presentation, and the positive diagnosis relies on several epidemiological, clinical, radiological and parasitological arguments. Medical and surgical treatments play a crucial role in determining the patient's prognosis.
Cardiovascular outcomes and fracture risk after the discontinuation of preventative medications in older patients with complex health needs: a self-controlled case series analysis
Authors: Prieto-Alhambra Daniel , Dernie Francesco , Delmestri Antonella , Rathod-Mistry Trishna , Tan Eng Hooi , Jödicke Annika M.
Published: March 2024

Objective

To assess the effect of stopping statins, antihypertensives, and bisphosphonates on the risk of cardiovascular events and fractures in older patients with complex health needs (CHN).

Methods

Patients aged >65 years, registered in CPRD GOLD for ≥1 year before study start (01/01/2010) and with CHN (non-elective hospitalisation/s, frailty or polypharmacy) were selected.

Self-controlled case series (SCCS) analyses were subsequently conducted among people who did not use the respective preventative treatment in the year before study start.

Incidence rate ratios (IRR) were calculated for myocardial infarction (MI) and stroke [antihypertensives, statins] and fractures [bisphosphonates] comparing event rates for the respective outcomes during treatment vs. post-discontinuation periods.

Results

198,039 people were included to the CHN cohort. Among those, 6,245 individuals were included for the analysis of bisphosphonate discontinuation and fracture risk; 738 and 669 persons for the analysis of antihypertensive therapy discontinuation and MI/stroke risk; and 1,408 and 1,361 people for statin discontinuation and MI/stroke risk.

Risk of MI was substantially increased following discontinuation of antihypertensives (IRR 2.6 [95%CI 1.56-4.33]) and statins (IRR 1.75 [1.16-2.62]). No significant association for treatment discontinuation and stroke risk was seen. Likewise, no increased fracture risk was seen after discontinuing bisphosphonates. However, discontinuation among people with >1 year history of bisphosphonate therapy pointed towards increased fracture risk.

Conclusions

Our study showed risks associated with discontinuing preventative medications in people with CHN, likely explained by the continued efficacy of these medications. Further research focussing on the risk-benefit of these treatments for most vulnerable older adults is needed.

Key points

Self-controlled case series showed substantially increased risk for myocardial infarction following discontinuation of antihypertensives and statins.

Fracture risk was not increased during treatment with bisphosphonates vs. post-discontinuation, but in people with >1 year of treatment a trend towards increased risk was seen.

Future research is required to study further conditions, medications, and sequalae in older patients with complex health needs.
Changes in lung function and dyspnea perception in Colombian Covid-19 patients after a 12-week pulmonary rehabilitation program
Authors: Páez-Mora Carlos D , Zona-Rubio Carolina , Angarita-Sierra Teddy , Rojas-Paredes Matilde E , Cano-Trejos Daniela
Published: March 2024

BACKGROUND

Although moderate and severe COVID-19 patients have shown obstructive and restrictive disorders in pulmonary function after recovery from the disease, studies evaluating the effectiveness of rehabilitation programs that seek to improve lung function are scarce.

AIM

Herein, we evaluate changes in lung function and perceived dyspnea in Covid-19 patients after undergoing 12 weeks of a PR program.

DESIGN

Retrospective observational study

SETTING

Cesar, Colombia Neumocesar Pneumological Center.

POPULATION

100 outpatients with a history of Covid-19

METHODS

We evaluated respiratory function using spirometry parameters, as well as the mMRC dyspnea scale for perceived dyspnea in 100 patients with a history of Covid-19. We used univariate and multivariate statistical approaches to assess changes in lung function and perceived dyspnea before and after a PR program to determine whether gender, age, height, weight, comorbidities, and oxygen delivery system affect the recovery of lung function and perceived dyspnea.

RESULTS

We found that PR treatment has positive effects on respiratory pathologies caused by SARS-CoV-2 infection regardless of patient gender, indicating that rehabilitation provided benefits regardless of the physical characteristics of the patients. Both univariate and multivariate statistical analyses indicated that FVC, FEV1, FEF 25-75, and mMRC are robust diagnostic indicators of lung function recovery and perceived dyspnea. Both invasive and non-invasive positive pressure ventilatory support had deleterious effects on lung function prolongating patient recovery.

CONCLUSIONS

Rehabilitation programs can benefit patients facing respiratory pathologies caused by SARS-CoV-2 infection. Additional research on the long-term effects of the sequelae of Covid-19 is needed. A large sample of patients is needed to clarify the effects of therapy on respiratory function.

CLINICAL REHABILITATION IMPACT

PR programs have positive effects on patients facing respiratory pathologies caused by SARS-CoV-2 infection.
Integrating Real-Time Location Systems with Electronic Medical Records: A Machine Learning Approach for In-Hospital Fall Risk Prediction
Authors: Kim Dong Won , Seo Jihoon , Kwon Sujin , Park Chan Min , Han Changho , Kim Yujeong , Yoon Dukyong , Kim Kyoung Min
Published: March 2024

Hospital falls are the most prevalent adverse event in healthcare, posing significant risks to patient health outcomes and institutional care quality. The effectiveness of several fall prediction models currently in use is limited by various clinical factors. This study explored the efficacy of merging real-time location system (RTLS) data with clinical information to enhance the accuracy of in-hospital fall predictions. The model performances were compared based on the clinical data, RTLS data, and a hybrid approach using various evaluation metrics. The RTLS and integrated clinical data were obtained from 22,201 patients between March 2020 and June 2022. From the initial cohort, 118 patients with falls and 443 patients without falls were included. Predictive models were developed using the XGBoost algorithm across three distinct frameworks: clinical model, RTLS model, and clinical + RTLS model. The model performance was evaluated using metrics, such as AUROC, AUPRC, accuracy, PPV, sensitivity, specificity, and F1 score. Shapley additive explanation values were used to enhance the model interpretability. The clinical model yielded an AUROC of 0.813 and AUPRC of 0.407. The RTLS model demonstrated superior fall prediction capabilities, with an AUROC of 0.842 and AUPRC of 0.480. The clinical + RTLS model excelled further, achieving an AUROC of 0.853 and AUPRC of 0.497. Feature importance analysis revealed that movement patterns of patients on the last day of their stay were significantly associated with falls, together with elevated RDW levels, sedative administration, age. This study underscored the advantages of combining RTLS data with clinical information to predict in-hospital falls more accurately. This innovative technology-driven approach may enhance early fall risk detection during hospitalization, potentially preventing falls, improving patient safety, and contributing to more efficient healthcare delivery.
Deoxynivalenol induced inflammation and increased the adherence of entero-invasiveEscherichia colito intestinal epithelial cells via modulation of mucin and pro-inflammatory cytokine production
Authors: Wan Murphy LY , Anna Vanessa Co , Turner Paul C , Nagendra Shah P , El-Nezami Hani
Published: March 2024

Deoxynivalenol (DON) is a mycotoxin that commonly occurs in crops. It was hypothesized that DON could trigger intestinal inflammation and increase the susceptibility of intestinal epithelial cells (IECs) to pathogen infection. Accordingly, the aim of this study was to investigate the effects of DON on intestinal susceptibility to pathogen infection. Semiconfluent Caco-2 cells were exposed to DON followed by acute entero-invasiveEscherichia coli(EIEC) infection. The effects of DON and EIEC contamination on mucin, cytokines and related signal transduction pathways were examined as part of the local immune system. Caco-2 cells were able to generate a rapid immune response against DON with or without EIEC post-challenge. An increase in EIEC attachment to DON-exposed cells was observed, probably in part, mediated by modulation of secretory MUC5AC mucins and membrane bound MUC4 and MUC17 mucins. Cells were also able to express and produce important mediators of inflammation, such as cytokines as a result of activation of toll-like receptors signalling cascades, modulation of nuclear factor κ-light chain-enhancer of activated B cells (NK-κB) and/or mitogen-activated protein kinase (MAPK) pathways. These data indicate that DON may exert immunomodulatory effects on intestinal epithelial cells, which might thereby modify the susceptibility to bacterial infection.
A bias in transsaccadic perception of spatial frequency changes
Authors: Sharvashidze Nino , Hübner Carolin , Schütz Alexander C.
Published: March 2024

Visual processing differs between the foveal and the peripheral visual field. These differences can lead to different appearances of objects in the periphery and the fovea, which poses a challenge to perception across saccades. Differences in the appearance of visual features between the peripheral and foveal visual field may bias change discrimination across saccades. Previously it has been reported that spatial frequency (SF) appears higher in the periphery compared to the fovea (Davis et al., 1987). In this study, we investigated the visual appearance of SF before and after a saccade and the discrimination of SF changes implemented during saccades. In addition, we tested the contributions of pre- and postsaccadic information to change discrimination performance. In the first experiment, we found no differences in the appearance of SF before and after a saccade. However, participants showed a clear bias to report SF increases. Interestingly, a 200-ms postsaccadic blank period improved the precision of the responses but did not affect the bias. In the second experiment, participants showed lower thresholds for SF increases than for decreases, suggesting that the bias in the first experiment was not just a response bias. Finally, we asked participants to discriminate the SF of stimuli presented before a saccade. Thresholds in the presaccadic discrimination task were lower than thresholds in the change discrimination task, suggesting that transsaccadic change discrimination is not merely limited by presaccadic discrimination in the periphery. The change direction bias might stem from more effective masking or overwriting of the presaccadic stimulus by the postsaccadic low SF stimulus.
A Machine Learning-based approach for Simultaneous Detection of Interfering Analytes in Electrochemical Nanobiosensors
Authors: Jain Ritwik , Verma Srishti , Dutta Gorachand
Published: March 2024

Electrochemical biosensors can be used to detect analytes of importance precisely. These sensors generate rapid and accurate electrical signals that reveal the presence and concentration of the targeted analyte. Detecting multiple analytes simultaneously with an electrochemical biosensor is advantageous. It provides cost and time efficiency, multiplexing capability, and flexibility, making it valuable in diverse applications such as medical diagnostics, environmental monitoring, and industrial processes. However, simultaneous detection of analytes may suffer from the problem of interference. The interference effect causes the signal of an analyte at a particular concentration to deviate from the expected one. We observe a similar effect in the simultaneous detection of Folic Acid and Uric Acid using a nanomaterial-based electrochemical sensor. To address this effect, we propose a machine learning (ML) approach. ML algorithms handle complex interactions by autonomously identifying patterns, dependencies, and nonlinear relationships within data, enabling it to make predictions and decisions in intricate and dynamic scenarios. Our approach can be generalised to any two analytes showing interference and would scale well to interference between multiple analytes. We test several regression algorithms and compare their performance to the standard calibration plot method. As compared to the standard method, our approach shows a 4.49 µM decrease in concentration prediction error.
Type I interferon alters invasive extravillous trophoblast function
Authors: Simoni Michael K. , Negatu Seble G. , Park Ju Young , Mani Sneha , Arreguin Montserrat C. , Amses Kevin , Huh Dan Dongeun , Mainigi Monica , Jurado Kellie A.
Published: March 2024

Inappropriate type I interferon (IFN) signaling during embryo implantation and placentation is linked to poor pregnancy outcomes. Here, we evaluated the consequence of elevated type I IFN exposure on implantation using a biomimetic model of human implantation in an organ-on-a-chip device. We found that type I IFN reduced extravillous trophoblast (EVT) invasion capacity. Analyzing single-cell transcriptomes, we uncovered that IFN truncated endovascular EVT emergence in the implantation-on-a-chip device by stunting EVT epithelial-to-mesenchymal transition. Disruptions to the epithelial-to-mesenchymal transition is associated with the pathogenesis of preeclampsia, a life-threatening hypertensive disorder of pregnancy. Strikingly, unwarranted IFN stimulation induced genes associated with increased preeclampsia risk and a preeclamptic gene-like signature in EVTs. These dysregulated EVT phenotypes ultimately reduced EVT-mediated endothelial cell vascular remodeling in the implantation-on-a-chip device. Overall, our work indicates IFN signaling can alter EVT epithelial-to-mesenchymal transition progression which results in diminished EVT-mediated spiral artery remodeling and a preeclampsia gene signature upon sustained stimulation. Our work implicates unwarranted type I IFN as a maternal disturbance that can result in abnormal EVT function that could trigger preeclampsia.
Incidence, risk factors, and clinical symptom profile of reinfection during Omicron-dominated COVID-19 outbreak in Hong Kong: A retrospective cohort study
Authors: Huang Ziyang , Luo Jingyuan , Li Haoran , Cheng Xingye , Zhang Jialing , Tang Hiu To , Wong Hoi Ki , Cheung Chun Hoi , Bian Zhaoxiang , Lyu Aiping , Tian Liang
Published: March 2024

Background

Despite the World Health Organization’s declaration of the end of the COVID-19 pandemic, reinfection persists and continues to strain the global healthcare system. With the emergence of the most recent variant of SARS-CoV-2 named JN.1, retrospective analysis of epidemiological characteristics of previous cases involving the Omicron variant is essential to provide references for preventing reinfection caused by the ongoing new SARS-Cov-2 variants.

Methods

This retrospective cohort study included 6325 patients infected with SARS-CoV-2 during the Omicron-dominated outbreak (from December 2021 to May 2022) in Hong Kong. Statistical analysis was conducted to demonstrate the epidemiological characteristics and a logistic regression model was utilized to identify risk factors associated with reinfection.

Results

The Omicron reinfection incidence was 5.18% (n = 353). No significant difference was observed in receiving mRNA (BNT162b2) vaccine and inactivated (CoronaVac) vaccine between reinfection and non-reinfection groups (p>0.05). Risk factors were identified as female gender (p<0.001), longer infection duration (p<0.05), comorbidity of eyes, ear, nose, throat disease (p<0.01), and severe post-infection impact on daily life and work (p<0.05), while ≥70 years old (p<0.05) and vaccination after primary infection (p<0.01) were associated with a lower risk of reinfection. The prevalence of most symptoms after reinfection was lower than the first infection, except for fatigue.

Conclusion

No significant difference in mRNA (BNT162b2) vaccine and inactivated (CoronaVac) vaccine against reinfection. Post-infection vaccination could lower the risk of reinfection, which potentially inform the development of preventive measures including vaccination policies against potential new SARS-Cov-2 variants.
Artificial intelligence-enhanced risk stratification of cancer therapeutics-related cardiac dysfunction using electrocardiographic images
Authors: Oikonomou Evangelos K. , Sangha Veer , Dhingra Lovedeep S. , Aminorroaya Arya , Coppi Andreas , Krumholz Harlan M. , Baldassarre Lauren A. , Khera Rohan
Published: March 2024

Background

Risk stratification strategies for cancer therapeutics-related cardiac dysfunction (CTRCD) rely on serial monitoring by specialized imaging, limiting their scalability.

Objectives

To examine an artificial intelligence (AI)-enhanced electrocardiographic (AI-ECG) surrogate for imaging risk biomarkers, and its association with CTRCD.

Methods

Across a five-hospital U.S.-based health system (2013-2023), we identified patients with breast cancer or non-Hodgkin lymphoma (NHL) who received anthracyclines (AC) and/or trastuzumab (TZM), and a control cohort receiving immune checkpoint inhibitors (ICI). We deployed a validated AI model of left ventricular systolic dysfunction (LVSD) to ECG images (≥0.1, positive screen) and explored its association with i) global longitudinal strain (GLS) measured within 15 days (n=7,271 pairs); ii) future CTRCD (new cardiomyopathy, heart failure, or left ventricular ejection fraction [LVEF]<50%), and LVEF<40%. In the ICI cohort we correlated baseline AI-ECG-LVSD predictions with downstream myocarditis.

Results

Higher AI-ECG LVSD predictions were associated with worse GLS (−18% [IQR:-20 to −17%] for predictions<0.1, to −12% [IQR:-15 to −9%] for ≥0.5 (p<0.001)). In 1,308 patients receiving AC/TZM (age 59 [IQR:49-67] years, 999 [76.4%] women, 80 [IQR:42-115] follow-up months) a positive baseline AI-ECG LVSD screen was associated with ∼2-fold and ∼4.8-fold increase in the incidence of the composite CTRCD endpoint (adj.HR 2.22 [95%CI:1.63-3.02]), and LVEF<40% (adj.HR 4.76 [95%CI:2.62-8.66]), respectively. Among 2,056 patients receiving ICI (age 65 [IQR:57-73] years, 913 [44.4%] women, follow-up 63 [IQR:28-99] months) AI-ECG predictions were not associated with ICI myocarditis (adj.HR 1.36 [95%CI:0.47-3.93]).

Conclusion

AI applied to baseline ECG images can stratify the risk of CTRCD associated with anthracycline or trastuzumab exposure.

CONDENSED ABSTRACT

There is an unmet need for scalable and affordable biomarkers to stratify the risk of cancer therapeutics-related cardiac dysfunction (CTRCD). In this hospital system-based, decade-long cohort of patients without cardiomyopathy receiving anthracyclines or trastuzumab, a validated artificial intelligence algorithm applied to baseline electrocardiographic (AI-ECG) images identified individuals with a 2-fold and 4.8-fold risk of developing any cardiomyopathy or left ventricular ejection fraction <40%, respectively. This supports a role for AI-ECG interpretation of images as a scalable approach for the baseline risk stratification of patients initiating cardiotoxic chemotherapy.