bluuebunny/crossref_metadata_2025 huggingface dataset:
Emergency department visits as a potential opportunity to promote primary care attachment and modify utilization patterns – results of a pilot study in Berlin, Germany
Authors: Holzinger Felix , Kümpel Lisa , Resendiz Cantu Rebecca , Alberter Anja , Möckel Martin , Heintze Christoph
Published: August 2024

Background

Utilization by low acuity patients contributes to emergency department (ED) crowding. Both knowledge deficits about adequate care levels and access barriers in primary care are important promoters of such presentations. Concurrently, not having a general practitioner (GP) increases the likelihood of low-acuity ED utilization. This pilot study thus investigated feasibility, acceptance, and potential effects of an ED-delivered intervention for low-acuity patients with no regular primary care provider, consisting of an educational leaflet on acute care options and an optional GP appointment scheduling service.

Methods

Low-acuity ED consulters not attached to a GP were given an information leaflet about alternative care offers for acute health problems and offered optional personal appointment scheduling at a local GP practice. Patients were surveyed on demographics, medical characteristics, health care utilization, valuation of the intervention, and reasons for not being attached to a GP and visiting the ED. A follow-up survey was conducted after twelve months. Trends in health and health care utilization were evaluated.

Results

Between December 2020 and April 2022, n = 160 patients were enrolled, n = 114 were followed up. The study population was characterized by young age (mean 30.6 years) and predominantly good general health. Besides good health, personal mobility was a central reason for not being attached to a GP, but general preference for specialists and bad experiences with primary care were also mentioned. Most frequently stated motives for the ED consultation were subjective distress and anxiety, a belief in the superiority of the hospital, and access problems in primary care. The interventional offers were favorably valued, 52.5% (n = 84) accepted the GP appointment scheduling service offer. At follow-up, GP utilization had significantly increased, while there were no significant changes regarding utilization of other providers, including ED. An additional practice survey showed a 63.0% take-up rate for the appointment service.

Conclusions

With this pilot study, we were able to show that a personalized appointment scheduling service seems to be a promising approach to promote GP attachment and increase primary care utilization in patients without a regular GP in a highly urbanized setting. Further larger-scale studies are needed to investigate potential quantitative effects on ED visits.

Trial Registration

German Clinical Trials Register (DRKS00023480); date 2020/11/27.
A functional intervention within a cognitive approach to chronic cervical radiculopathy
Authors: Engebretsen Kaia B. , Taso Mirad , Bjorland Siri , Jenssen Hanne K. , Skaara Helene Engberg , Brox Jens Ivar
Published: August 2024

Background

Most patients with cervical radiculopathy improve within the first months without treatment or with non-surgical treatment. A systematic review concluded that these patients improve, regardless of their intervention. Still, many patients are offered surgery, despite limited evidence regarding the indications for surgical treatments. The aim of this article is to describe the intervention that is going to be followed in the non-surgical treatment arm of a randomised controlled trial (RCT) comparing the effectiveness of surgical and non-surgical treatment for patients with cervical radiculopathy.

Methods

The non-surgical intervention is a functional intervention within a cognitive approach founded on previous experiences, and current recommendations for best practice care of musculoskeletal pain and cervical radiculopathy. It is based on the biopsychosocial rather than a biomedical perspective, comprises an interdisciplinary approach (physicians, physiotherapy specialists), and includes brief intervention and graded activities. The intervention consists of 6 sessions over 12 weeks. The primary goals are first, to validate the patients´ symptoms and build a therapeutic alliance, second, to explore the understanding and promote alternatives, and third, to explore problems and opportunities based on patients´ symptoms and function. Motivational factors toward self-management are challenging. We will attempt shared decision-making in planning progress for the individual patient and emphasise learning of practical self-help strategies and encouragement to stay active (reinforcing the positive natural course). General physical activities such as walking will be promoted along with simple functional exercises for the neck- and shoulder region. We will also explore social activity, comorbidities, pain location, sleep, and work-related factors. The health providers will set individualised goals together with each patient.

Discussion

The aim of the intervention is to describe a functional intervention within a cognitive approach for patients with chronic cervical radiculopathy. The effectiveness of the present program will be compared to surgery in a randomised controlled trial.
Five years of radiographic evaluation for the peri-implant bone changes of all-on-four implant prostheses constructed from different framework materials using different digital construction techniques
Authors: Mourad Khloud Ezzat , Rashed Noha Hassan Atwa Hassan , Altonbary Gilan Youssef , Fattah Hegazy Salah Abdel
Published: August 2024

Background

There is insufficient evidence recommending a framework material and a CAD/CAM manufacturing technique for mandibular implant-supported prostheses. The study objective was to evaluate the clinical application of different materials and construction techniques used for mandibular All-on-4 prosthesis on circumferential peri-implant bony changes after 5 years.

Methods

Thirty-six male patients with all-on-4 mandibular implant-supported prostheses were recalled and divided into three groups. Group PK (patients with frameworks milled from PEEK blocks), Group PSM (patients with frameworks milled from soft metal blocks), and Group SLM (patients with frameworks constructed with additive manufacturing; selective laser melting). The circumferential bone level on all implant faces was assessed with a CBCT. Two-way repeated measures ANOVA was used to compare vertical bone loss (VBL) and horizontal bone loss (HBL) between different groups, implant positions, and observation times followed by Tukey’s multiple comparisons.

Results

For all observation times, there was a significant difference in VBL between groups for both anterior and posterior implants (P < .001). For anterior implants, group PSM showed the lowest VBL while group PK showed the highest for anterior and posterior implants. For all groups, HBL significantly increased after 5 years for both anterior and posterior implants (P < .001). For anterior implants, group PSM showed the highest HBL. For posterior implants, group PK and SLM showed the highest.

Conclusion

Within the study’s limitations, mandibular implant-supported fixed frameworks fabricated with either milling from PEEK or soft metal blocks, or additive manufacturing (laser melting technology) exhibited significant vertical and horizontal bone height changes after 5 years.

Clinical Trial Registry Number

(NCT06071689) (11/10/2023).
Assessment during clinical education among nursing students using two different assessment instruments
Authors: Tomas Nilsson , Italo Masiello , Eva Broberger , Veronica Lindström
Published: August 2024

Background

Assessment of undergraduate students using assessment instruments in the clinical setting is known to be complex. The aim of this study was therefore to examine whether two different assessment instruments, containing learning objectives (LO`s) with similar content, results in similar assessments by the clinical supervisors and to explore clinical supervisors’ experiences of assessment regarding the two different assessment instruments.

Method

A mixed-methods approach was used. Four simulated care encounter scenarios were evaluated by 50 supervisors using two different assessment instruments. 28 follow-up interviews were conducted. Descriptive statistics and logistic binary regression were used for quantitative data analysis, along with qualitative thematic analysis of interview data.

Result

While significant differences were observed within the assessment instruments, the differences were consistent between the two instruments, indicating that the quality of the assessment instruments were considered equivalent. Supervisors noted that the relationship between the students and supervisors could introduce subjectivity in the assessments and that working in groups of supervisors could be advantageous. In terms of formative assessments, the Likert scale was considered a useful tool for evaluating learning objectives. However, supervisors had different views on grading scales and the need for clear definitions. The supervisors concluded that a complicated assessment instrument led to limited very-day usage and did not facilitate formative feedback. Furthermore, supervisors discussed how their experiences influenced the use of the assessment instruments, which resulted in different descriptions of the experience. These differences led to a discussion of the need of supervisor teams to enhance the validity of assessments.

Conclusion

The findings showed that there were no significant differences in pass/fail gradings using the two different assessment instruments. The quantitative data suggests that supervisors struggled with subjectivity, phrasing, and definitions of the LO´s and the scales used in both instruments. This resulted in arbitrary assessments that were time-consuming and resulted in limited usage in the day-to-day assessment. To mitigate the subjectivity, supervisors suggested working in teams and conducting multiple assessments over time to increase assessment validity.
Evaluating barriers to reaching women with public health information in remote communities in Mali
Authors: Jones Robert T. , Spencer Freya I. , Paris Laura A. , Soumaïla Diarra , Kamara Nanthilde , Hiscox Alexandra , Logan James G.
Published: August 2024

Telecommunications offers an alternative or supplement to community-based interventions as a means of extending healthcare services and improving health outcomes in remote settings but can fail to reach target communities and achieve the desired impact if barriers to access are not overcome. We conducted seven focus group discussions and 26 interviews with community health workers, community leaders, and female members of the public who declared that they had or had not previously accessed free audio health messages provided via a mobile platform in two rural communities of Mali, Koulikoro and Bougouni. A content analysis showed that participants accessed and trusted health information from a range of sources, including radio, telephone and television, as well as town criers, local relays and community health centres. Barriers to access faced by women included economic factors, lack of network or electricity, and social factors such as illiteracy, cultural restrictions and being unaware of mobile communication. Through analysis and interpretation of the participants’ responses, we have made recommendations for future campaigns for the dissemination of health-related information for women in remote settings.
All-cause mortality and hospital admissions for nursing home residents during the COVID-19 pandemic: a Norwegian register-based cohort study
Authors: Øien Henning , Gjesvik Jonas , Skyrud Katrine Damgaard , Rotevatn Torill Alise , Grøsland Mari
Published: August 2024

Background

This paper investigates the consequences of the COVID-19 pandemic on mortality and hospitalization among nursing home residents in Norway. While existing evidence shows that nursing home residents were overrepresented among COVID-19-related deaths, suggesting inadequate protection measures, this study argues that the observed overrepresentation in mortality and hospitalization may partly stem from the inherent frailty of this demographic. Using nationwide administrative data, we assessed excess deaths and hospitalization by comparing pandemic-era rates to those of a pre-pandemic cohort.

Methods

We compared mortality and hospitalization rates between a pandemic cohort of nursing home residents as of September 2019 (N = 30,052), and a pre-pandemic cohort as of September 2017 (N = 30,429). Both cohorts were followed monthly for two years, beginning in September 2019 and 2017, respectively. This analysis was conducted at the national level and separately for nursing home residents in areas with low, medium, and high SARS-CoV-2 community transmission. Event studies and difference-in-difference models allowed us to separate the impact of the pandemic on mortality and hospitalization from secular and seasonal changes.

Results

The pandemic cohort experienced a non-significant 0.07 percentage points (95% confidence interval (CI): − 0.081 to 0.221) increase in all-cause mortality during the 18 months following pandemic onset, compared to the pre-pandemic cohort. Moreover, our findings indicate a substantial reduction in hospitalizations of 0.27 percentage points (95% CI: − 0.464 to − 0.135) and a non-significant decrease of 0.80 percentage points (95% CI: − 2.529 to 0.929) in the proportion of nursing home residents hospitalized before death. The effect on mortality remained consistent across regions with both high and low levels of SARS-CoV-2 community transmission.

Conclusions

Our findings indicate no clear evidence of excess all-cause mortality in Norway during the pandemic, neither nationally nor in areas with high infection rates. This suggests that early implementation of nationwide and nursing home-specific infection control measures during the pandemic effectively protected nursing home residents. Furthermore, our results revealed a decrease in hospitalizations, both overall and prior to death, suggesting that nursing homes adhered to national guidelines promoting on-site treatment for residents.
The regulatory effects of water probiotic supplementation on the blood physiology, reproductive performance, and its related genes in Red Tilapia (Oreochromis niloticus X O. mossambicus)
Authors: Eissa El-Sayed Hemdan , El-Sayed Abdel-Fattah M. , Hendam Basma M. , Ghanem Sara F. , Abd Elnabi Heba E. , Abd El-Aziz Yasmin M. , Abdelnour Sameh A. , Eissa Moaheda E.H. , Dighiesh Hagar Sedeek
Published: August 2024

Probiotics are becoming increasingly popular as eco-friendly alternatives in aquaculture. However, there is limited research on their impacts on the reproductive efficiency of Red Tilapia (Oreochromis niloticus x O. mossambicus) broodstock. Therefore, this experiment aimed to explore the combined effects of selective probiotics Bacillus subtilis and B. licheniformis (BSL; 1:1) added to water on blood hematology, serum metabolites, gonadal histology, reproductive performance, and reproductive associated genes in Red Tilapia broodstock. Tilapia broodfish weighing 140–160 g were stocked in four treatment groups: control (T0), and the other three groups were added different levels of BSL to the water as follows: T1 (0.01 g/m3), T2 (0.02 g/m3), and T3 (0.03 g/m3), respectively. Results indicate that BSL administration significantly improved RBCs, hemoglobin, hematocrit, MCH, and MCHC, with the highest improvement seen in the T3 group (P < 0.05). BSL added to the fish water significantly enhanced serum protein fractions (total protein, albumin, and globulins), while AST, ALT, ALP, creatinine, uric acid, and glucose were significantly diminished in a dose-dependent way (P < 0.05). Adding 0.02–0.03 g/ m3 of BSL resulted in higher antioxidant status (superoxide dismutase and catalase) compared to other groups (P < 0.05). Testosterone levels were higher in T3 than in other groups (P < 0.05). All female hormones (LH, FSH, estradiol, and progesterone) were substantially augmented by the addition of BSL. Additionally, the BSL groups exhibited higher GSI, HSI, VSI (male only), egg diameter (mm), mean number of fry/fish, and mean fry weight (g) compared to the control group (P < 0.05). Expression of reproductive-associated genes (vasa, nanos1a, nanos2, dnd1, pum1, AMH, and vtg) were significantly up-regulated in the gonads of fish in the 0.03 g/m3 treatment. The histological gonadal structure exhibited that BSL improved gonad maturation in both genders of Tilapia fish. Overall, adding a mixture of B. subtilis and B. licheniformis (0.03 g/m3 water) can accelerate reproductive performance in Red Tilapia through up-regulation of reproductive genes and enhance the health profile.
TNKS1BP1 mediates AECII senescence and radiation induced lung injury through suppressing EEF2 degradation
Authors: Zhu Jiaojiao , Ao Xingkun , Liu Yuhao , Zhou Shenghui , Hou Yifan , Yan Ziyan , Zhou Lin , Chen Huixi , Wang Ping , Liang Xinxin , Xie Dafei , Gao Shanshan , Zhou Ping-Kun , Gu Yongqing
Published: August 2024

Background

Although recent studies provide mechanistic understanding to the pathogenesis of radiation induced lung injury (RILI), rare therapeutics show definitive promise for treating this disease. Type II alveolar epithelial cells (AECII) injury in various manner results in an inflammation response to initiate RILI.

Results

Here, we reported that radiation (IR) up-regulated the TNKS1BP1, causing progressive accumulation of the cellular senescence by up-regulating EEF2 in AECII and lung tissue of RILI mice. Senescent AECII induced Senescence-Associated Secretory Phenotype (SASP), consequently activating fibroblasts and macrophages to promote RILI development. In response to IR, elevated TNKS1BP1 interacted with and decreased CNOT4 to suppress EEF2 degradation. Ectopic expression of EEF2 accelerated AECII senescence. Using a model system of TNKS1BP1 knockout (KO) mice, we demonstrated that TNKS1BP1 KO prevents IR-induced lung tissue senescence and RILI.

Conclusions

Notably, this study suggested that a regulatory mechanism of the TNKS1BP1/CNOT4/EEF2 axis in AECII senescence may be a potential strategy for RILI.
The effects of modern housing on malaria transmission in different endemic zones: a systematic review and meta-analysis
Authors: Nawa Mukumbuta , Mupeyo-Mudala Catherine , Banda-Tembo Sylvia , Adetokunboh Olatunji
Published: August 2024

Background

Modern housing has been shown to reduce the risk of malaria infections compared to traditional houses; however, it is unclear if the effects differ in different malaria transmission settings. This study evaluated the effects of modern housing on malaria among different endemic areas.

Methods

Electronic databases, clinical trial registries and grey literature were searched for randomized controlled trials, cohort studies, case–control studies, and cross-sectional surveys on housing done between 1987 and 2022. Forest plots were done, and the quality of evidence was assessed using the Grading of Recommendations, Assessments, Development and Evaluation Framework.

Results

Twenty-one studies were included; thirteen were cross-sectional, four were case–control and four were cohort studies. Cohort studies showed an adjusted risk ratio of 0.68 (95% CI 0.48–0.96), and cross-sectional studies indicated an adjusted odds ratio (aOR) of 0.79 (95%CI 0.75–0.83). By endemic transmission regions, the adjusted odds ratio in the high endemic settings was 0.80 (95%CI 0.76–085); in the moderate transmission regions, aOR = 0.76 (95%CI 0.67–0.85) and in the low transmission settings, aOR = 0.67 (95%CI 0.48–0.85).

Conclusions

The evidence from observational studies suggests that there are no differences in the protective effects of modern houses compared to traditional houses on malaria by endemicity level. This implies that good quality modern housing protects against malaria regardless of the malaria transmission settings.
TFEB controls sensitivity to chemotherapy and immuno-killing in non-small cell lung cancer
Authors: Akman Muhlis , Monteleone Ciro , Doronzo Gabriella , Godel Martina , Napoli Francesca , Merlini Alessandra , Campani Virginia , Nele Valeria , Balmas Elisa , Chontorotzea Tatiana , Fontana Simona , Digiovanni Sabrina , Barbu Francesca Alice , Astanina Elena , Jafari Niloufar , Salaroglio Iris Chiara , Kopecka Joanna , De Rosa Giuseppe , Mohr Thomas , Bertero Alessandro , Righi Luisella , Novello Silvia , Scagliotti Giorgio Vittorio , Bussolino Federico , Riganti Chiara
Published: August 2024

Background

In non-small cell lung cancer (NSCLC) the efficacy of chemo-immunotherapy is affected by the high expression of drug efflux transporters as ABCC1 and by the low expression of ABCA1, mediating the isopentenyl pyrophosphate (IPP)-dependent anti-tumor activation of Vγ9Vδ2 T-lymphocytes. In endothelial cells ABCA1 is a predicted target of the transcription factor EB (TFEB), but no data exists on the correlation between TFEB and ABC transporters involved in the chemo-immuno-resistance in NSCLC.

Methods

The impact of TFEB/ABCC1/ABCA1 expression on NSCLC patients’ survival was analyzed in the TCGA-LUAD cohort and in a retrospective cohort of our institution. Human NSCLC cells silenced for TFEB (shTFEB) were analyzed for ABC transporter expression, chemosensitivity and immuno-killing. The chemo-immuno-sensitizing effects of nanoparticles encapsulating zoledronic acid (NZ) on shTFEB tumors and on tumor immune-microenvironment were evaluated in Hu-CD34+ mice by single-cell RNA-sequencing.

Results

TFEBlowABCA1lowABCC1high and TFEBhighABCA1highABCC1low NSCLC patients had the worst and the best prognosis, respectively, in the TCGA-LUAD cohort and in a retrospective cohort of patients receiving platinum-based chemotherapy or immunotherapy as first-line treatment. By silencing shTFEB in NSCLC cells, we demonstrated that TFEB was a transcriptional inducer of ABCA1 and a repressor of ABCC1. shTFEB cells had also a decreased activity of ERK1/2/SREBP2 axis, implying reduced synthesis and efflux via ABCA1 of cholesterol and its intermediate IPP. Moreover, TFEB silencing reduced cholesterol incorporation in mitochondria: this event increased the efficiency of OXPHOS and the fueling of ABCC1 by mitochondrial ATP. Accordingly, shTFEB cells were less immuno-killed by the Vγ9Vδ2 T-lymphocytes activated by IPP and more resistant to cisplatin. NZ, which increased IPP efflux but not OXPHOS and ATP production, sensitized shTFEB immuno-xenografts, by reducing intratumor proliferation and increasing apoptosis in response to cisplatin, and by increasing the variety of anti-tumor infiltrating cells (Vγ9Vδ2 T-lymphocytes, CD8+T-lymphocytes, NK cells).

Conclusions

This work suggests that TFEB is a gatekeeper of the sensitivity to chemotherapy and immuno-killing in NSCLC, and that the TFEBlowABCA1lowABCC1high phenotype can be predictive of poor response to chemotherapy and immunotherapy. By reshaping both cancer metabolism and tumor immune-microenvironment, zoledronic acid can re-sensitize TFEBlow NSCLCs, highly resistant to chemo- and immunotherapy.
Can clinicians identify community-acquired pneumonia on ultralow-dose CT? A diagnostic accuracy study
Authors: Heltborg Anne , Mogensen Christian Backer , Skjøt-Arkil Helene , Giebner Matthias , Al-Masri Ayham , Khatry Usha Bc , Khatry Sangam , Heinemeier Ina Isabell Kathleen , Andreasen Jonas Jannick , Hariesh Sanne Sarmila Sivalingam , Termansen Tenna , Kolnes Anna Natalie , Lorentzen Morten Hjarnø , Laursen Christian Borbjerg , Posth Stefan , Andersen Michael Brun , Mussmann Bo , Spile Camilla Stræde , Graumann Ole
Published: August 2024

Background

Without increasing radiation exposure, ultralow-dose computed tomography (CT) of the chest provides improved diagnostic accuracy of radiological pneumonia diagnosis compared to a chest radiograph. Yet, radiologist resources to rapidly report the chest CTs are limited. This study aimed to assess the diagnostic accuracy of emergency clinicians’ assessments of chest ultralow-dose CTs for community-acquired pneumonia using a radiologist’s assessments as reference standard.

Methods

This was a cross-sectional diagnostic accuracy study. Ten emergency department clinicians (five junior clinicians, five consultants) assessed chest ultralow-dose CTs from acutely hospitalised patients suspected of having community-acquired pneumonia. Before assessments, the clinicians attended a focused training course on assessing ultralow-dose CTs for pneumonia. The reference standard was the assessment by an experienced emergency department radiologist. Primary outcome was the presence or absence of pulmonary opacities consistent with community-acquired pneumonia. Sensitivity, specificity, and predictive values were calculated using generalised estimating equations.

Results

All clinicians assessed 128 ultralow-dose CTs. The prevalence of findings consistent with community-acquired pneumonia was 56%. Seventy-eight percent of the clinicians’ CT assessments matched the reference assessment. Diagnostic accuracy estimates were: sensitivity = 83% (95%CI: 77–88), specificity = 70% (95%CI: 59–81), positive predictive value = 80% (95%CI: 74–84), negative predictive value = 78% (95%CI: 73–82).

Conclusion

This study found that clinicians could assess chest ultralow-dose CTs for community-acquired pneumonia with high diagnostic accuracy. A higher level of clinical experience was not associated with better diagnostic accuracy.
Association of polygenic scores for autism with volumetric MRI phenotypes in cerebellum and brainstem in adults
Authors: Mohammad Salahuddin , Gentreau Mélissa , Dubol Manon , Rukh Gull , Mwinyi Jessica , Schiöth Helgi B.
Published: August 2024

Previous research on autism spectrum disorders (ASD) have showed important volumetric alterations in the cerebellum and brainstem. Most of these studies are however limited to case-control studies with small clinical samples and including mainly children or adolescents. Herein, we aimed to explore the association between the cumulative genetic load (polygenic risk score, PRS) for ASD and volumetric alterations in the cerebellum and brainstem, as well as global brain tissue volumes of the brain among adults at the population level. We utilized the latest genome-wide association study of ASD by the Psychiatric Genetics Consortium (18,381 cases, 27,969 controls) and constructed the ASD PRS in an independent cohort, the UK Biobank. Regression analyses controlled for multiple comparisons with the false-discovery rate (FDR) at 5% were performed to investigate the association between ASD PRS and forty-four brain magnetic resonance imaging (MRI) phenotypes among ~ 31,000 participants. Primary analyses included sixteen MRI phenotypes: total volumes of the brain, cerebrospinal fluid (CSF), grey matter (GM), white matter (WM), GM of whole cerebellum, brainstem, and ten regions of the cerebellum (I_IV, V, VI, VIIb, VIIIa, VIIIb, IX, X, CrusI and CrusII). Secondary analyses included twenty-eight MRI phenotypes: the sub-regional volumes of cerebellum including the GM of the vermis and both left and right lobules of each cerebellar region. ASD PRS were significantly associated with the volumes of seven brain areas, whereby higher PRS were associated to reduced volumes of the whole brain, WM, brainstem, and cerebellar regions I-IV, IX, and X, and an increased volume of the CSF. Three sub-regional volumes including the left cerebellar lobule I-IV, cerebellar vermes VIIIb, and X were significantly and negatively associated with ASD PRS. The study highlights a substantial connection between susceptibility to ASD, its underlying genetic etiology, and neuroanatomical alterations of the adult brain.
Imaging findings of thoracic manifestations of Crohn’s disease and ulcerative colitis
Authors: Cassius De Linval Quentin , Barat Maxime , Aissaoui Mathilde , Talabard Marie-Pauline , Martin Clémence , Malamut Georgia , Canniff Emma , Soyer Philippe , Revel Marie-Pierre , Chassagnon Guillaume
Published: August 2024

Thoracic manifestations of inflammatory bowel disease (IBD) are rare, occurring in less than 1% of patients. Unlike most other extra-intestinal manifestations, they predominate in patients with ulcerative colitis rather than in Crohn’s disease. In most patients, thoracic involvement follows the onset of IBD by several years. However, thoracic involvement may also occur synchronously or even precede the onset of digestive symptoms. The thoracic manifestations of IBD include airway involvement and parenchymal lung abnormalities. Airways are the most frequent anatomical site for thoracic involvement in IBD. Airway manifestations usually develop several years after the onset of intestinal manifestations, preferentially when the latter are stable or in remission. Airway manifestations include bronchial wall thickening, bronchiectasis, small airway disease, and tracheal wall thickening. Parenchymal lung abnormalities are less prevalent in IBD and include organizing pneumonia, necrobiotic nodules, noncaseating granulomatous nodules, drug-induced pneumonia, and rarely interstitial lung diseases. The differential diagnosis between organizing pneumonia, necrobiotic nodules, and noncaseating granulomatous nodules is difficult and usually requires histopathological analysis for a definite diagnosis. Radiologists play a key role in the detection of thoracic manifestations of Crohn’s disease and ulcerative colitis and, therefore, need to be familiar with their imaging findings. This article aims to offer an overview of the imaging findings of thoracic manifestations in patients with Crohn’s disease or ulcerative colitis.

Critical relevance statement

Thoracic manifestations of Crohn’s disease and ulcerative colitis include tracheal involvement, bronchiectasis, small airway disease, and parenchymal lung abnormalities such as organizing pneumonia and necrobiotic nodules. These rare manifestations (< 1% of patients) more often affect patients with ulcerative colitis.

Key Points

Thoracic manifestations of inflammatory bowel disease are rare, occurring in less than 1% of patients.

Thoracic manifestations are more frequent in patients with ulcerative colitis than Crohn’s disease.

Bronchial disease is the most frequent thoracic manifestation of Crohn’s disease and ulcerative colitis.

Graphical Abstract
Beyond the otoscope: an imaging review of congenital cholesteatoma
Authors: Vangrinsven Guillaume , Bernaerts Anja , Deckers Filip , van Dinther Joost , Zarowski Andrzej , De Foer Bert
Published: August 2024

Congenital cholesteatoma (CC) is a non-neoplastic lesion of keratin debris lined by epithelium found in the temporal bone. It is the lesser-known sibling of the acquired cholesteatoma and may be classified as congenital middle ear cholesteatoma and congenital petrous bone cholesteatoma. The incidence is rising, probably owing to increased recognition and advances in imaging modalities. Cone beam CT provides detailed anatomical information, highlighting quadrant location, ossicular involvement, and mastoid extension. MRI aids in lesion characterization and detection of complications. The classification systems for congenital middle ear and petrous bone cholesteatoma are helpful in the preoperative workup and have a role in predicting postoperative recurrence rates. Management almost invariably involves surgical intervention aimed at preserving middle and inner ear function. Follow-up of CC is mainly based on MRI together with otoscopic examination. Non-echo planar diffusion-weighted imaging, especially, has proven essential for detecting residual disease. This review article emphasizes the significance of imaging in the timely diagnosis and management of CCs.

Clinical relevance statement

This article underscores the crucial role of imaging for prompt detection, preoperative assessment, and postoperative follow-up of CCs, a condition with rising incidence associated with potentially severe complications.

Key Points

Timely diagnosis of CCs is imperative for avoiding complications.

Imaging is key in detection, preoperative evaluation, and postoperative management.

Cone Beam CT and non-echo planar DWI represent state-of-the-art imaging techniques.

Graphical Abstract
Fasting before contrast-enhanced CT and the incidence of acute adverse reactions: a single-center randomized clinical trial
Authors: Zitan Saidi Laila , Moreira Cabrera Maricela , Góngora Lencina Teresa , Marín Morón Fuensanta , Alarcón Rodríguez Raquel , García González Jessica
Published: August 2024

Objectives

To evaluate the effect of eliminating the traditional preparatory fasting policy before contrast-enhanced CT on acute adverse reactions and to identify potential risk factors in a Spanish population sample, since many European patients still experience this unnecessary measure in clinical practice.

Methods

Outpatients who underwent non-emergency CT to either 6 h of solid food fasting (control group) or an unrestricted consumption of solids (intervention group). Adverse reactions during contrast media administration and up to 30 min afterward were recorded and their incidence was calculated. Using univariate and multivariate logistic regression analyses, various patient-related and technical factors were evaluated to identify risk factors for nausea and vomiting.

Results

One thousand one hundred three patients were evaluated, 560 patients in the control group, and 543 patients in the intervention group. Moderate and severe acute adverse reactions were not identified in either group. No statistical difference was found in the overall acute adverse reactions (hypersensitivity and chemotoxicity) incidence between groups (3.21% vs 2.30% p = 0.36). The total incidence of emetic adverse reactions (nausea and vomiting) was significantly lower in the intervention group than in the control group (0.92% vs 2.86% p = 0.02). Multivariate logistic regression analysis revealed that fasting, age, allergies, neurological diseases, and contrast media concentration were independent risk factors for nausea and vomiting.

Conclusion

Unrestricted food intake did not increase the overall incidence of acute adverse reactions and diminished the incidence of nausea and vomiting.

Trial registration

ANZCTR, ACTRN12623000071628. Registered 23 January 2023—retrospectively registered, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384985&showOriginal=true&isReview=true.

Critical relevance statement

This randomized clinical trial carried out in adults undergoing a non-emergent CT scan demonstrates that fasting as a preparation before a contrast-enhanced CT scan should be discontinued and reserved only for certain specific imaging tests.

Key Points

Despite low osmolar CT contrast media becoming ubiquitous, preparatory fasting is still widely practiced.

The overall incidence of acute adverse reactions was unchanged after abolishing preparative fasting.

Traditional preparatory fasting should be discontinued and reserved only for certain specific imaging tests.

Graphical Abstract
Rates of, and factors associated with, common mental disorders in homeworking UK Government response employees’ during COVID-19: a cross-sectional survey and secondary data analysis
Authors: Hall Charlotte E. , Brooks Samantha K. , Potts Henry W.W , Greenberg Neil , Weston Dale
Published: August 2024

Introduction

Working on the frontline during the COVID-19 pandemic has been associated with increased risk to mental health and wellbeing in multiple occupations and contexts. The current study aimed to provide an insight into the rate of probable mental health problems amongst United Kingdom (UK) Government employees who contributed to the COVID-19 response whilst working from home, and to ascertain what factors and constructs, if any, influence mental health and wellbeing in the sample population.

Method

This paper reports on the findings from two studies completed by UK Government employees. Study 1: A cross-sectional online survey, containing standardised and validated measures of common mental health disorders of staff who actively contributed to the COVID-19 response from their own homes. Binary logistic regression was used to assess factors associated with mental health outcomes. Study 2: A secondary data analysis of cross-sectional survey data collected across three timepoints (May, June, and August) in 2020 focusing on the wellbeing of employees who worked from home during the COVID-19 pandemic.

Results

Study 1: 17.9% of participants met the threshold criteria for a probable moderate anxiety disorder, moderate depression, or post-traumatic stress disorder. Younger, less resilient, less productive individuals, with lower personal wellbeing and less enjoyment of working from home, were more likely to present with poorer mental health. Study 2: Found lower wellbeing was consistently associated with having less opportunities to look after one’s physical and mental health, and having unsupportive line managers and colleagues.

Conclusion

It is important to ensure UK Government employees’ psychological needs are met whilst working from home and responding to enhanced incidents. It is recommended that workplaces should be seeking to continually build and improve employee resilience (e.g., through opportunities to increase social ties and support networks), essentially ensuring employees have necessary resources and skills to support themselves and others.
Face validity and washback effects of the shortened PTE Academic: insights from teachers in Mainland China
Authors: Wang Jingwen , Zheng Ying , Zou Yi
Published: August 2024

Pearson Test of English Academic (PTE Academic), a high-stakes English language proficiency test, underwent substantial revisions in 2021. The test duration was reduced from 3 h to 2 h by reducing specific task numbers and sections. This study investigates the impact of these changes on teachers’ perceptions and teaching practices, areas previously underexplored in language assessment literature. It focuses on the implications of the test’s modifications, examining the face validity and washback effects through the lens of teachers in mainland China. Semi-structured interviews with four experienced PTE Academic test trainers, who were familiar with both the original and revised test formats, reveals that the revised PTE Academic is perceived to maintain strong face validity, particularly noted in its academic authenticity, balanced skill structure, and perceived result accuracy. Additionally, most teachers perceived an increase in test difficulty. A mixed washback effect was observed: while improvements in students’ language competence—a positive outcome—were noted, teachers also reported a continued reliance on teaching test-oriented strategies for higher-scoring tasks, indicating negative washback. This study highlights the significant implications of reducing PTE Academic’s duration and offers targeted recommendations for its future improvement. These suggestions aim to enhance students’ academic language skills, thereby better aligning PTE Academic with the practical language abilities required in university settings.
Revisiting interseismic deformation in Nankai: focusing on slip-deficit accumulation in the ETS zone and comparison with Cascadia
Authors: Li Shaoyang , Chen Ling
Published: August 2024

Various stress-releasing phenomena, such as episodic tremor and slip (ETS) and low-frequency earthquakes, occur at the downdip seismogenic zone in southwest Japan. However, it is unclear how much net stress and slip deficit accumulate at these depths during the interseismic phase. Here, we perform both elastic and viscoelastic earthquake-cycle forward models and reassess the locking state in Nankai from a synthesized perspective with the aid of geodetic modeling results. Our results suggest that the overestimation of the locking depth due to ignoring Earth’s viscoelasticity is much smaller (less than 5 km) in this early interseismic subduction zone compared to that (~ 10 km) of late-interseismic margins. Considering viscoelastic modeling results and other physical arguments, the preferred steady-state viscosities for the continental and oceanic mantle are 5 × 1019 Pa s and 1020 Pa s, respectively. We find a clear trade-off between the full locking depth and the width of the transition zone when explaining both horizontal and vertical geodetic data, demanding other data to further resolve this inherent ambiguity. Unlike in Cascadia, partial megathrust locking in Nankai likely penetrates into the ETS zone, leaving no intervening gap between the shallow megathrust, where hosts large earthquakes, and the ETS zone. Assuming locking extends into the downdip of the ETS zone (i.e., 40 km), we propose a preferred viscoelastic locking model with a full locking depth of 18 km and a broad transition zone spanning a 22-km depth range. In this model, the downdip half portion of the transition zone corresponds to the ETS zone, which can accumulate certain slip deficit in a largely creeping and partially locked state. However, most of the accumulated slip deficit in the ETS zone may be accommodated aseismically simultaneously by stress-releasing phenomena, leaving limited to no budget to release during future megathrust earthquakes. We suggest that precise documentation of total slip during slow slip events, along with refinement of viscoelastic locking models, will provide new insights into the net slip budget available in the ETS zone. This will help assess the potential of future coseismic and/or postseismic slip penetrating into the ETS zone in Nankai, Cascadia and other subduction zones.

Graphical Abstract
Effects of a supplemented diet containing 7 probiotic strains (Honeybeeotic) on honeybee physiology and immune response: analysis of hemolymph cytology, phenoloxidase activity, and gut microbiome
Authors: Robino Patrizia , Galosi Livio , Bellato Alessandro , Vincenzetti Silvia , Gonella Elena , Ferrocino Ilario , Serri Evelina , Biagini Lucia , Roncarati Alessandra , Nebbia Patrizia , Menzio Chiara , Rossi Giacomo
Published: August 2024

Background

In this study, a probiotic mixture (Honeybeeotic) consisting of seven bacterial strains isolated from a unique population of honeybees (Apis mellifera ligustica) was used. That honeybee population was located in the Roti Abbey locality of the Marche Region in Italy, an area isolated from human activities, and genetic contamination from other honeybee populations. The aim was to investigate the effects of this probiotic mixture on the innate immunity and intestinal microbiome of healthy common honeybees in two hives of the same apiary. Hive A received a diet of 50% glucose syrup, while hive B received the same syrup supplemented with the probiotics, both administered daily for 1 month. To determine whether the probiotic altered the immune response, phenoloxidase activity and hemolymph cellular subtype count were investigated. Additionally, metagenomic approaches were used to analyze the effects on gut microbiota composition and function, considering the critical role the gut microbiota plays in modulating host physiology.

Results

The results revealed differences in hemocyte populations between the two hives, as hive A exhibited higher counts of oenocytoids and granulocytes. These findings indicated that the dietary supplementation with the probiotic mixture was safe and well-tolerated. Furthermore, phenoloxidase activity significantly decreased in hive B (1.75 ± 0.19 U/mg) compared to hive A (3.62 ± 0.44 U/mg, p < 0.005), suggesting an improved state of well-being in the honeybees, as they did not require activation of immune defense mechanisms. Regarding the microbiome composition, the probiotic modulated the gut microbiota in hive B compared to the control, retaining core microbiota components while causing both positive and negative variations. Notably, several genes, particularly KEGG genes involved in amino acid metabolism, carbohydrate metabolism, and branched-chain amino acid (BCAA) transport, were more abundant in the probiotic-fed group, suggesting an effective nutritional supplement for the host.

Conclusions

This study advocated that feeding with this probiotic mixture induces beneficial immunological effects and promoted a balanced gut microbiota with enhanced metabolic activities related to digestion. The use of highly selected probiotics was shown to contribute to the overall well-being of the honeybees, improving their immune response and gut health.
Ethical considerations in public engagement: developing tools for assessing the boundaries of research and involvement
Authors: Garcia-Iglesias Jaime , Beange Iona , Davidson Donald , Goopy Suzanne , Huang Huayi , Murray Fiona , Porteous Carol , Stevenson Elizabeth , Rhodes Sinead , Watson Faye , Fletcher-Watson Sue
Published: August 2024

Public engagement with research (PEwR) has become increasingly integral to research practices. This paper explores the process and outcomes of a collaborative effort to address the ethical implications of PEwR activities and develop tools to navigate them within the context of a University Medical School. The activities this paper reflects on aimed to establish boundaries between research data collection and PEwR activities, support colleagues in identifying the ethical considerations relevant to their planned activities, and build confidence and capacity among staff to conduct PEwR projects. The development process involved the creation of a taxonomy outlining key terms used in PEwR work, a self-assessment tool to evaluate the need for formal ethical review, and a code of conduct for ethical PEwR. These tools were refined through iterative discussions and feedback from stakeholders, resulting in practical guidance for researchers navigating the ethical complexities of PEwR. Additionally, reflective prompts were developed to guide researchers in planning and conducting engagement activities, addressing a crucial aspect often overlooked in formal ethical review processes. The paper reflects on the broader regulatory landscape and the limitations of existing approval and governance processes, and prompts critical reflection on the compatibility of formal approval processes with the ethos of PEwR. Overall, the paper offers insights and practical guidance for researchers and institutions grappling with ethical considerations in PEwR, contributing to the ongoing conversation surrounding responsible research practices.
Peritoneal dialysis-associated peritonitis caused by Tsukamurella inchonensis: a case report and literature review
Authors: Yamaguchi Ryo , Kashiwagi Mana , Ichijo Kiyomi , Kobayashi Yu , Matsuoka Tomomi , Horikoshi Shu , Takashima Hiroyuki , Abe Masanori
Published: August 2024

Background

Peritoneal dialysis (PD)-associated peritonitis is a serious complication that can lead to PD discontinuation and mortality. Tsukamurella species are uncommon opportunistic pathogens that can cause peritonitis, often necessitating catheter removal.

Case presentation

A 46-year-old woman with a 1.5-year history of PD presented with fever and lower abdominal pain, along with cloudy peritoneal effluent showing an elevated cell count. Empiric antibiotic therapy with ciprofloxacin, cefazolin, and ceftazidime was started for PD-associated peritonitis. The peritoneal effluent culture yielded a gram-positive rod with weak acid-fast staining. A rebound in the cell count necessitated a switch of antibiotics to meropenem and vancomycin. This led to improvement, and the treatment was switched to oral levofloxacin on day 30 and the patient was discharged on day 35. Subsequently, 16S rRNA gene sequencing confirmed the isolate as Tsukamurella inchonensis.

Conclusion

This case highlights the challenges in identifying and treating Tsukamurella peritonitis. Successful treatment without catheter removal in this case suggests that early detection and appropriate antibiotics may enable catheter salvage in this rare infection. However, further research is needed to establish optimal treatment strategies.