bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment patterns and outcomes in follicular lymphoma with POD24: an analysis from the LEO Consortium
Authors: Day Jonathan R. , Larson Melissa C. , Durani Urshila , Koff Jean L. , Wang Yucai , Habermann Thomas M. , Lossos Izidore S. , Nastoupil Loretta J. , Strouse Christopher , Chihara Dai , Martin Peter , Leonard John P. , Cohen Jonathon B. , Kahl Brad S. , Ruan Jia , Burack W. Richard , Friedberg Jonathan W. , Cerhan James R. , Flowers Christopher R. , Link Brian K. , Maurer Matthew J. , Casulo Carla
Published: November 2024

Progression of disease within 24 months of initial immunochemotherapy (POD24) is a negative prognostic factor for patients with follicular lymphoma (FL). There is no standard treatment after POD24. Assembling an academic-based cohort from the Lymphoma Epidemiology of Outcomes Consortium for Real World Evidence, we evaluated patterns of care and outcomes for 220 patients with FL with POD24 and retained FL histology. Therapy after POD24 was heterogeneous, with no treatment category accounting for >25% of the total. Among patients initially treated with bendamustine-rituximab, rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP) was the predominant second-line choice (48%). Among patients initially treated with R-CHOP, aggressive salvage therapy was the predominant second-line choice (38%). Overall response rate to therapy after POD24 was 64% (95% confidence interval [CI], 56-70); complete response rate was 39% (95% CI, 32-46). The median event-free survival for therapy after POD24 was 9.8 months (95% CI, 7.3-12.1); 5-year overall survival (OS) was 71% (95% CI, 65-78). OS was inferior for patients aged >70 years (hazard ratio [HR], 2.31; 95% CI, 1.27-4.20) and those with high-risk FL International Prognostic Index scores at diagnosis (HR, 2.10; 95% CI, 1.23-3.60). No treatment category stood out with more favorable results. Cause of death was predominantly lymphoma related. Patients with follicular histology at their POD24 event had a low cumulative incidence of transformation (1.1% at 5 years). Our study is among the largest cohorts describing contemporary patterns of care for patients with POD24, providing a focused data set useful for interpreting and designing prospective clinical trials in this population.
Comparable outcomes after busulfan- or treosulfan-based conditioning for allo-HSCT in children with ALL: results of FORUM
Authors: Kalwak Krzysztof , Moser Laura M. , Pötschger Ulrike , Bader Peter , Kleinschmidt Katharina , Meisel Roland , Dalle Jean-Hugues , Yesilipek Akif , Balduzzi Adriana , Krivan Gergely , Goussetis Evgenios , Staciuk Raquel , Sedlacek Petr , Pichler Herbert , Svec Peter , Gabriel Melissa , Güngör Tayfun , Bilic Ernest , Buechner Jochen , Renard Marleen , Vettenranta Kim , Ifversen Marianne , Diaz-de-Heredia Cristina , Stein Jerry , Toporski Jacek , Bierings Marc , Peters Christina , Ansari Marc , Locatelli Franco
Published: November 2024

The superiority of total body irradiation (TBI)–based vs chemotherapy conditioning for allogeneic hematopoietic stem cell transplantation (allo-HSCT) in children with acute lymphoblastic leukemia (ALL) has been established in the international, prospective phase-3 FORUM study, randomizing 417 patients aged 4-18 years in complete remission (CR), who received allo-HSCT from HLA-matched sibling or unrelated donors. Because of the unavailability of TBI in some regions and to accommodate individual contraindications, this study reports the prespecified comparison of outcomes of patients receiving busulfan (BU)– or treosulfan (TREO)–based regimens from 2013 to 2018. Overall, 180 and 128 patients received BU/thiotepa (THIO)/fludarabine (FLU) or TREO/THIO/FLU, respectively. Data were analyzed as of February 2023, with a median follow-up of 4.2 years (range, 0.3-9.1). 3-year overall survival was 0.71 (BU, 95% confidence interval [0.64-0.77]) and 0.72 (TREO, [0.63-0.79]) and 3-year event-free survival was 0.60 (BU, [0.53-0.67]) and 0.55 (TREO, [0.46-0.63]). The 3-year cumulative incidence of relapse (BU, 0.31 [0.25-0.38]; TREO, 0.36 [0.27-0.44]); and nonrelapse mortality (BU, 0.08 [0.05-0.13]; TREO, 0.09 [0.05-0.15]) were comparable. One case of fatal veno-occlusive disease occurred in each group. No significant differences in acute and chronic graft-versus-host disease (GVHD) or 3-year GVHD-free and relapse-free survival (BU, 0.48 [0.41-0.55]; TREO, 0.45 [0.37-0.54]) were recorded. Outcomes for patients in first and second CR were similar irrespective of the regimen. In conclusion, BU/THIO/FLU or TREO/THIO/FLU regimens can be an alternative to TBI for patients with ALL aged >4 years with contraindications or lack of access to TBI. This trial was registered at www.ClinicalTrials.gov as #NCT01949129.
Prognostic relevance of exercise pulmonary hypertension: results of the multicentre PEX-NET Clinical Research Collaboration
Authors: Kovacs Gabor , Humbert Marc , Avian Alexander , Lewis Gregory D. , Ulrich Silvia , Vonk Noordegraaf Anton , Souza Rogerio , Galiè Nazzareno , Malhotra Rajeev , Saxer Stephanie , Grünig Ekkehard , Egenlauf Benjamin , Ewert Ralf , Heine Alexander , Tedford Ryan J. , Houston Brian A. , Kasperowicz Krzysztof , Kurzyna Marcin , Rosenkranz Stephan , Herkenrath Simon , Barbera Joan Albert , Blanco Isabel , Oliveira Rudolf K.F. , Andersen Mads , Savale Laurent , Systrom David , Maron Bradley A. , Tello Khodr , Condliffe Robin , Mak Susanna , Baratto Claudia , Hsu Steven , D'Alto Michele , McCabe Colm , Herve Philippe , Olschewski Horst
Published: November 2024

Background

Exercise pulmonary hypertension (PH) was defined by a mean pulmonary arterial pressure (mPAP)/cardiac output (CO) slope >3 mmHg·min·L−1between rest and exercise in the 2022 European Society of Cardiology/European Respiratory Society PH guidelines. However, large, multicentre studies on the prognostic relevance of exercise haemodynamics and its added value to resting haemodynamics are missing.

Patients and methods

The PEX-NET (Pulmonary Haemodynamics during Exercise Network) registry enrolled patients who underwent clinically indicated right heart catheterisations both at rest and ergometer exercise from 23 PH centres worldwide. In this retrospective analysis we included subjects with resting mPAP <25 mmHg and complete haemodynamic data at rest and exercise in the same body position. Mixed effects Cox proportional hazard models with random effect centre were applied to identify independent markers of prognosis among the haemodynamic parameters.

Results

We included 764 patients (64% females; median (interquartile range) age 59 (46–69) years and mPAP 17 (14–20) mmHg). Median (range) observation time was 6.8 (0.1–15.9) years and 87 patients (11%) died during follow-up. After adjustment for age, sex, haemoglobin level and resting haemodynamics, CO (hazard ratio (HR) 0.85, 95% CI 0.77–0.93; p=0.001) and transpulmonary gradient (HR 1.04, 95% CI 1.00–1.08; p=0.044) at peak exercise and the mPAP/CO slope (HR 1.12, 95% CI 1.06–1.18; p<0.001) were the only independent predictors of prognosis. Patients with a mPAP/CO slope >3 mmHg·min·L−1had significantly worse survival compared to those with a mPAP/CO slope ≤3 mmHg·min·L−1(HR 2.04, 95% CI 1.16–3.58; p=0.013).

Conclusion

The mPAP/CO slope is a robust and independent predictor of prognosis in patients with normal or mildly elevated resting PAP that provides prognostic information beyond resting haemodynamics and appears suitable to define exercise PH.
Development of an open-source tool for risk assessment in pulmonary endarterectomy
Authors: Liley James , Bunclark Katherine , Newnham Michael , Cannon John , Sheares Karen , Taboada Dolores , Ng Choo , Screaton Nicholas , Jenkins David , Pepke-Zaba Joanna , Toshner Mark
Published: November 2024

Background

Risk prediction tools are routinely utilised in cardiothoracic surgery but have not been developed for pulmonary endarterectomy (PEA). There is no data on whether patients undergoing PEA may benefit from a tailored risk modelling approach. We develop and validate a clinically-usable tool to predict PEA 90-day mortality (90 DM) with the secondary aim of informing factors that may influence five-year mortality (5 YM) and improvement in patient-reported outcomes (PROchange) using common clinical assessment parameters. Derived model predictions were compared to those of the currently most widely implemented cardiothoracic surgery risk tool, EuroSCORE II.

Methods

Consecutive patients undergoing PEA for chronic thromboembolic pulmonary hypertension (CTEPH) between 2007 and 2018 (n=1334) were included in a discovery dataset. Outcome predictors included an intentionally broad array of variables, incorporating demographic, functional and physiological measures. Three statistical models (linear regression, penalised linear regression and random forest) were considered per outcome, each calibrated, fitted and assessed using cross-validation, ensuring internal consistency. The best predictive models were incorporated into an open-source PEA risk tool and validated using a separate prospective PEA cohort from 2019 to 2021 (n=443) at the same institution.

Results

Random forest models had the greatest predictive accuracy for all three outcomes. Novel risk models had acceptable discriminatory ability for outcome 90 DM (AUROC 0.82) outperforming that of EuroSCORE II (AUROC 0.65). CTEPH related factors were important for outcome 90 DM but 5 YM was driven by non-CTEPH factors, dominated by generic cardiovascular risk. We were unable to accurately predict a positive improvement in PRO status (AUROC 0.47).

Conclusions

Operative mortality from PEA can be predicted pre-operatively to a potentially clinically useful degree. Our validated models enable individualised risk stratification at clinician point-of-care to better inform shared decision making.
Outpatient Management of Cancer-Associated Pulmonary Embolism: A Systematic Review and Meta-Analysis
Authors: Delluc Aurélien , Pradier Michelle , Siegal Deborah M. , Le Gal Grégoire , Carrier Marc , Wang Tzu-Fei
Published: November 2024

Introduction

Outpatient management of pulmonary embolism (PE) remains controversial in patients with cancer due to their higher risks of mortality, recurrent venous thromboembolism (VTE) and bleeding complications. This systematic review and meta-analysis aimed to evaluate the safety and feasibility of outpatient management of cancer-associated PE.

Methods

We searched MEDLINE, Embase, Cochrane Central, and Scopus databases from inception to May 30, 2024, for studies on outpatient management of cancer-associated PE. Eligible studies included randomized controlled trials, cohort studies, and case-control studies with ≥10 patients. The primary outcome was 30-day-all-cause mortality; secondary outcomes included VTE-related mortality, major bleeding and recurrent VTE at 30 days. Meta-analysis was performed using random effects models, and heterogeneity was assessed with the I2statistic.

Results

Nineteen studies (13 full-article, 6 abstract-only) with a total of 1589 patients managed as outpatients were identified. Criteria for outpatient management of cancer-associated PE were reported in 14 studies. The pooled 30-day all-cause mortality rate was 1.74% (95% CI: 0.99–3.03; I2=0%, 691 patients, 6 full-article). The 30-day major bleeding pooled rate was 2.71% (95% CI: 1.51–4.83; I2=0%; 406 patients, 6 full-article), and the 30-day recurrent VTE pooled rate was 1.26% (95% CI: 0.53–3.00; I2=0%; 396 patients, 5 full-article).

Conclusion

Selected patients with cancer-associated PE managed as outpatients appear to have low short-term rates of mortality, major bleeding and recurrent VTE suggesting this may be a safe strategy. Further research with larger, prospective studies is needed to confirm these findings and refine risk stratification protocols.
Reporting of pre-existing multiple long-term conditions in physical rehabilitation for long COVID: a scoping review
Authors: Gardiner Lucy , Young Hannah M.L. , Drover Holly , Morgan-Selvaratnam Emily , Natt Michael , Smith Nikki , Daynes Enya , Orme Mark W. , Taylor Rod S. , Singh Sally J. , Evans Rachael A.
Published: November 2024

Background

Physical rehabilitation may improve health and wellbeing outcomes for some adults living with long COVID. However, individuals living with pre-existing multiple long-term conditions (MLTCs) and long COVID may have additional rehabilitation challenges. This scoping review aims to identify the available evidence describing physical rehabilitation interventions for adults living with long COVID, to systematically map the reporting of pre-existing MLTCs, and to describe the characteristics of physical rehabilitation interventions used in adults with both pre-existing long-term conditions (LTCs) and long COVID.

Methods

MEDLINE, CINAHL, Scopus, APA PsycInfo, medRxiv, OpenGrey and MedNar were searched from January 2020 to July 2023. Eligibility criteria included adults with long COVID, rehabilitation interventions including a physical component in any setting and any study design investigating interventions or intervention content except case series/reports.

Results

Of 5326 unique records, 50 articles met the inclusion criteria, of which 25 (50%) made reference to pre-existing LTCs. These articles included four protocols and one consensus statement. Four of the remaining 20 studies (20%) reported the number of pre-existing LTCs, enabling the differentiation of individuals with MLTCs. One study reported outcomes of individuals with MLTCs separately to those without. The interventions described (k=24) typically consisted of combined aerobic and strength exercises (k=17 (71%)) in an outpatient setting (k=13 (54%)).

Conclusions

There is limited and inconsistent reporting of the presence of MLTCs in studies of physical rehabilitation for adults with long COVID. Clarity and consistency of reporting of MLTCs is required to enable evaluation and adaptation of interventions to improve health and wellbeing for this population.
The impact of body mass index on mortality in COPD: an updated dose–response meta-analysis
Authors: Tenda Eric Daniel , Henrina Joshua , Setiadharma Andry , Felix Immanuel , Yulianti Mira , Pitoyo Ceva Wicaksono , Kho Sze Shyang , Tay Melvin Chee Kiang , Purnamasari Dyah S. , Soejono Czeresna Heriawan , Setiati Siti
Published: November 2024

Background and objective

The obesity paradox is a well-established clinical conundrum in COPD patients. This study aimed to provide an updated analysis of the relationship between body mass index (BMI) and mortality in this population.

Methods

A systematic search was conducted through Embase, PubMed, and Web of Science. International BMI cut-offs were employed to define underweight, overweight and obesity. The primary outcome was all-cause mortality, and the secondary outcome was respiratory and cardiovascular mortality.

Results

120 studies encompassed a total of 1 053 272 patients. Underweight status was associated with an increased risk of mortality, while overweight and obesity were linked to a reduced risk of mortality. A nonlinear U-shaped relationship was observed between BMI and all-cause mortality, respiratory mortality and cardiovascular mortality. Notably, an inflection point was identified at BMI 28.75 kg·m−2(relative risk 0.83, 95% CI 0.80–0.86), 30.25 kg·m−2(relative risk 0.51, 95% CI 0.40–0.65) and 27.5 kg·m−2(relative risk 0.76, 95% CI 0.64–0.91) for all-cause, respiratory and cardiovascular mortality, respectively, and beyond which the protective effect began to diminish.

Conclusion

This study augments the existing body of evidence by confirming a U-shaped relationship between BMI and mortality in COPD patients. It underscores the heightened influence of BMI on respiratory and cardiovascular mortality compared to all-cause mortality. The protective effect of BMI was lost when BMI values exceeded 35.25 kg·m−2, 35 kg·m−2and 31 kg·m−2for all-cause, respiratory and cardiovascular mortality, respectively.
Polycomb protein RYBP facilitates super-enhancer activity
Authors: Hong Yu , Dai Ranran , Li Xinlan , Xu He , Wei Chao
Published: November 2024

Background

Polycomb proteins are conventionally known as global repressors in cell fate determination. However, recent observations have shown their involvement in transcriptional activation, the mechanisms of which need further investigation.

Methods

Herein, multiple data from ChIP-seq, RNA-seq and HiChIP before or after RYBP depletion in embryonic stem cell (ESC), epidermal progenitor (EPC) and mesodermal cell (MEC) were analyzed.

Results

We found that Polycomb protein RYBP occupies super-enhancer (SE) in ESCs, where core Polycomb group (PcG) components such as RING1B and EZH2 are minimally enriched. Depletion of RYBP results in impaired deposition of H3K27ac, decreased expression of SE-associated genes, and reducing the transcription of enhancer RNA at SE regions (seRNA). Regarding the mechanism of seRNA transcription, the Trithorax group (TrxG) component WDR5 co-localizes with RYBP at SEs, and is required for seRNA expression. RYBP depletion reduces WDR5 deposition at SE regions. In addition, TrxG-associated H3K4me3 tends to be enriched at SEs with high levels of seRNA transcription, and RYBP deficiency impairs the deposition of H3K4me3 at SEs. Structurally, RYBP is involved in both intra- and inter-SE interactions. Finally, RYBP generally localizes at SEs in both in vitro cell lines and in vivo tissue-derived cells, dysfunction of RYBP is associated with various cancers and developmental diseases.

Conclusion

RYBP cooperates with TrxG component to regulate SE activity. Dysfunction of RYBP relates to various diseases. The findings provide new insights into the transcriptionally active function of Polycomb protein in cell fate determination.
KPNB1-ATF4 induces BNIP3-dependent mitophagy to drive odontoblastic differentiation in dental pulp stem cells
Authors: Zhang Zeying , Yang Di , Yan Xiaoyuan , Qiu Qiujing , Guo Jiajie , Qiu Lihong
Published: November 2024

Background

Differentiating dental pulp stem cells (DPSCs) into odontoblasts is a critical process for tooth self-repair and dentine‒pulp engineering strategies in the clinic. However, the mechanism underlying the regulation of DPSC odontoblastic differentiation remains largely unknown. Here, we demonstrated that BCL-2 interacting protein 3 (BNIP3)-dependent mitophagy is associated with importin subunit beta-1 (KPNB1)-activating transcription factor 4 (ATF4), which promotes DPSC odontoblastic differentiation.

Methods

The key genes involved in DPSC odontogenic differentiation were identified via bioinformatics. Stable silencing or overexpression of BNIP3 was performed to investigate its impact on DPSC differentiation in vitro (n ≥ 3). To explore the role of BNIP3 in vivo, tooth root fragments loaded with the hydrogel-transfected DPSC complex were implanted into nude mice (n ≥ 6). Dual-luciferase reporter assays and chromatin immunoprecipitation (ChIP) polymerase chain reaction (PCR) were conducted to explore the binding site of ATF4 to the BNIP3 promoter (n ≥ 3). Mitochondrial function experiments were performed to investigate the impact of ATF4-BNIP3 on mitochondria (n ≥ 3). Immunoprecipitation (IP) mass spectrometry (MS) was used to investigate the interaction between ATF4 and its binding protein, KPNB1. Plasmids containing wild-type (WT)/mutant (MUT)-nuclear localization signal (NLS) forms of ATF4 were constructed to determine the specific amino acid residues recognized by KPNB1 and their effects on DPSC odontoblastic differentiation (n ≥ 3).

Results

Compared with those in the control group, the levels of autophagy and mitophagy, especially BNIP3-dependent mitophagy, were greater in the DPSC odontoblastic differentiation group (P < 0.05). Genetic silencing or overexpression of BNIP3 demonstrated that BNIP3 expression was positively correlated with the transition of DPSCs into odontoblasts both in vitro and in vivo (P < 0.05). ATF4 regulates the expression of BNIP3 by directly binding to approximately −1292 to −1279 bp and approximately −1185 to −1172 bp within the BNIP3 promoter region, which is associated with mitophagy and mitochondrial reactive oxygen species (mtROS) levels (P < 0.05). Moreover, ATF4 increased mitophagy, mitochondrial function, and cell differentiation potential via BNIP3 (P < 0.05). Mechanistically, KPNB1 is a novel interacting protein of ATF4 that specifically recognizes amino acids (aa) 280–299 within ATF4 to control its translocation into the nucleus and subsequent transcription and differentiation processes (P < 0.05).

Conclusions

We reported that the critical role of KPNB1/ATF4/BNIP3 axis-dependent mitophagy could provide new cues for the regeneration of the dental pulp‒dentin complex in DPSCs.

Graphical Abstract
Single-step genomic BLUP (ssGBLUP) effectively models small cattle populations: lessons from the Israeli-Holstein Herdbook
Authors: Curzon Arie Yehuda , Ezra Ephraim , Weller Joel Ira , Seroussi Eyal , Börner Vinzent , Gershoni Moran
Published: November 2024

Background

Routine genomic-estimated breeding values (gEBVs) are computed for the Israeli dairy cattle population by a two-step methodology in combination with the much larger Dutch population. Only sire genotypes are included. This work evaluated the contribution of cow genotypes obtained from the Israeli Holstein population to enhance gEBVs predictions via single-step genomic best-linear unbiased prediction (ssGBLUP). The gEBV values of 141 bulls with daughter information and high reliabilities for 305-day lactation yield of milk, fat, and protein were compared with the bulls’ predicted ssGBLUP-gEBVs using a truncated dataset omitting production data of the last five years. We investigated how these sire gEBVs were affected by varying polygenic weights in the genomic relationship matrices and by deleting old phenotypic or genotypic records.

Results

The correlations of the predicted gEBVs for milk, fat and protein computed from the truncated data with the current gEBVs based also on daughter records of the last five years were 0.64, 0.57, and 0.56, respectively, for a polygenic weight of 0.5, similar to the values achieved by the current two-step methodology. The regressions of the current gEBVs on the predicted values were 0.9 for milk and 0.7 for fat and protein. Genotyping of 1.8-5 cows had the approximate statistical power of one additional bull depending on the trait. Omitting phenotype records earlier than 2000 resulted in similar gEBV values. Omitting genotypes before 1995 improved the regression coefficients. For all experiments, varying the polygenic weights over the range of 0.1 to 0.9 resulted in a trade-off between correlations and overestimation of gEBVs for young bulls.

Conclusions

The model suffers from overestimation of the predicted values for young bulls. The time interval used for inclusion of genotypic and phenotypic records and adjustment of the polygenic weight can improve gEBV predictions and should be tuned to fit the tested population. For relatively small populations, genotyping of cows can significantly increase the reliability of gEBVs computed by single-step methodology. By extrapolation of our results, records of ~ 13,000 genotyped cows should provide a sufficiently large training population to obtain reliable estimates of gEBVs using ssGBLUP.
Anesthetic technique and incidence of delirium after total knee or hip arthroplasty: a nationwide cohort study
Authors: Choi Hey-ran , Kim Saeyeon , Song In-Ae , Oh Tak Kyu
Published: November 2024

Background

The optimal type of anesthesia for reducing postoperative delirium remains undetermined. This study aimed to assess the relationship between type of anesthesia and postoperative delirium.

Methods

This retrospective national cohort study used data collected between 2016 and 2021 from the National Health Insurance Service of South Korea. Adult patients who underwent primary total hip or total knee arthroplasty under general or regional anesthesia were included. Patients with postoperative delirium were identified after arthroplasty according to the International Classification of Diseases 10th revision code for delirium (F05). The patients were divided into two groups: regional anesthesia (RA group) and general anesthesia (GA group). The primary endpoint was the incidence of postoperative delirium during hospitalization after total hip or knee arthroplasty.

Results

Our study sample consisted of 664,598 patients: 474,932 in the RA group and 189,666 in the GA group. After propensity score (PS) matching, 276,582 patients (138,291 in each group) were included in the final analysis. In the PS-matched cohort, the incidence of delirium following total knee or total hip arthroplasty was 2.8% (3,842/138,291) in the GA group and 2.3% (3,147/138,291) in the RA group. In logistic regression, the RA group was associated with 18% (odds ratio: 0.82, 95% confidence interval: 0.78, 0.86; P < 0.001) lower postoperative incidence than the GA group.

Conclusion

Compared to general anesthesia, regional anesthesia was associated with a decreased incidence of postoperative delirium in patients who underwent total hip or total knee arthroplasty. Our findings indicate that avoiding general anesthesia may prevent delirium after lower limb surgery.
Are socio-economic inequalities related to cardiovascular disease risk? A systematic review and meta-analysis of prospective studies
Authors: Baruwa Ololade J. , Alberti Federica , Onagbiye Sunday , Guddemi Annalisa , Odone Anna , Ricci Hannah , Gaeta Maddalena , Daniela Schmid , Ricci Cristian
Published: November 2024

Purpose

The aim of this research was to investigate the relationship between socio-economic inequalities and fatal and non-fatal cardiovascular events.

Methods

A systematic review of recently published cohort studies and a meta-analysis of relative risk (RR) of low compared with high socio-economic status (SES) in relation to cardiovascular incidence and mortality was conducted. Supplementary evaluations were conducted considering different proxies of SES in relation to different types of cardiovascular disease (CVD).

Results

We identified 17 studies including approximately 26.5 million of participants with more than 900,000 CVD events. We estimated a 50% increased CVD risk for low SES with respect to high SES (RR = 1.49 [95% confidence interval: 1.26, 1.78]). For sex-specific risk, we estimated a 79% increased CVD risk for women of low SES (RR = 1.79 [1.30, 2.46]). In men, the same investigation found a 45% increased CVD risk (RR = 1.45 [1.09, 1.92]). We reported that low education (RR = 1.56 [1.27, 1.91]), increased CVD risk the most, more than low income (RR = 1.38 [1.12, 1.70]).

Conclusion

Although not statistically significant, women of low SES were at higher CVD risk than men. CVD risk was more relevant to educational inequality than economic inequality.
The use of misoprostol before hysteroscopy in Nulliparous women: a systematic review and meta-analysis of randomized controlled trials
Authors: Salah Noha , Maged Ahmed Mohamed , Mahmoud Safaa I. , Bassiouny Nehal , Mohsen Reham A. , AbdelAziz Suzi , Ragab Wael S.
Published: November 2024

Objectives

To assess the value of misoprostol intake before hysteroscopy in nulliparous women.

Search strategy

Databases screening was done from inception to July 2023 using “Misoprostol” AND “Hysteroscopy” AND “Nullipara” and their MeSH terms as keywords.

Selection criteria

Thirteen studies were included in our analysis. Seven studies compared misoprostol to placebo, 3 studies compared it to dinoglandin, 1 study compared it to diclofenac and 4 studies compared different misoprostol doses and routes. These studies were conducted on 1528 participants,958 of them received misoprostol, 221 received dinoglandin, 51 received diclofenac and 308 received placebo.

Data collection and analysis

Extracted data included study place, participants number, inclusion and exclusion criteria, intervention details as dose, route, timing and comparotor, and hysteroscopy details.

Main Results

Ease of cervical dilatation was reported in 3 studies (309 participants) and revealed an effect estimate mean difference (MD) of -0.57 [-1.72, 0.58] and a P value of 0.33. The time needed for cervical dilatation was reported in 6 studies (512 participants) and revealed a MD of -22.96 [-43.29, -2.62] and a P value of 0.03. The preoperative cervical width was reported in 4 studies (263 participants) and revealed MD of 1.69 [-0.09, 3.46] and a P value of 0.06. The number of women with failure of cervical dilatation or who needed further dilatation was reported in 4 studies (372 participants) and revealed a MD of 0.40 with [0.13, 1.17] 95% CI and a P value of 0.09. The preoperative pain was reported in 3 studies (351 participants) and revealed a MD of -0.56 [-2.30, 1.18] and a P value of 0.53. Total number of cases who experienced side effects and procedure complications were reported in 2 and 3 studies (249 and 252 participants) respectively and revealed an effect estimate Odd Ratio of 1.99 and 0.42 with [0.27, 14.67] and [0.14,1.32] 95% CI and a P value of 0.50 and 0.14 respectively. In the 3 studies comparing misoprostol to dinoglandin, The ease of cervical dilatation, time needed for cervical dilatation and preoperative cervical width were evaluated in 1,3 and 2 studies with 60, 436 and 376 participants respectively. The estimated MD were not estimated, 0.17 and 0.01; 95% CI were not estimated, [-4.70, 5.05], and [-0.78, 0.79]; P values of 0.94, 0.98 and 0.99 and I2 of 96%,95% and 74% respectively.

Conclusion

Misoprostol improved the time needed for cervical dilatation without affecting the rate of complications or drug side effects when compared to placebo but has similar outcomes to dinoglandin with higher side effects.

Registration number

CRD42023438432.
Combined effects of nutrition, inflammatory status, and sleep quality on mortality in cancer survivors
Authors: Zhao Tingyu , Zhao Hui , Zhang Xiao , Jiang Xingyu , Liang Qi , Ni Siqi , Jiao Yi , Yu Jiamei , Dai Jianghong , Du Mulong , Liu Lingxiang
Published: November 2024

Background

Cancer survivors face many challenges in long-term health management, including malnutrition, systemic inflammation, and sleep issues, which significantly affect their survival and quality of life.

Methods

A prospective cohort study was derived from the National Health and Nutrition Examination Survey from 2005–2018 harboring 1,908 cancer survivors (weighted population, 11,453,293), of whom 688 deaths (220 from cancer mortality, 468 from non-cancer mortality). The Advanced Lung Cancer Inflammation Index (ALI) was used as a measure of nutritional status and systemic inflammation in cancer patients. Weighted multivariable Cox proportional hazards regression models were utilized to explore the independent and combined effects of ALI and sleep quality on mortality outcomes.

Results

The participants with a high ALI were more likely to be female, aged 40 to 64 years, non-Hispanic white, and have a higher BMI. We observed that elevated ALI levels were associated with decreased risks of all-cause mortality (Hazard ratio [HR] = 0.601, 95% Confidence interval [CI] = 0.521–0.695, P < 0.001), cancer-specific mortality (HR = 0.659, 95% CI = 0.497–0.870, P = 3.34 × 10–3) and non-cancer-specific mortality (HR = 0.579, 95% CI = 0.478–0.701, P < 0.001). Similarly, better sleep quality (e.g., without sleep troubles) was associated with lower risks of all-cause mortality (HR = 0.761, 95% CI = 0.620–0.933, P = 8.79 × 10–3) and non-cancer-specific mortality (HR = 0.713, 95% CI = 0.572–0.890, P = 2.80 × 10–3). Notably, the joint analysis showed that cancer survivors with higher ALI levels and better sleep quality (e.g., standard sleep duration) had the lowest risks of all-cause (HR = 0.468, 95% CI = 0.352–0.622, P < 0.001), cancer-specific mortality (HR = 0.631, 95% CI = 0.333–0.672, P = 7.59 × 10–3) and non-cancer-specific mortality (HR = 0.440, 95% CI = 0.315–0.615, P < 0.001).

Conclusions

This study suggests that better nutritional and inflammatory status, combined with good sleep quality, may contribute to improved survival among cancer survivors. These results underscore the potential clinical importance of integrating nutritional and sleep quality assessments into the long-term care of cancer survivors to enhance their overall prognosis.
Exploring the connectivity of dorsolateral prefrontal cortex and the modulatory impact of transcranial magnetic stimulation in adolescents with depression: a focus on pain-related cognitive processing
Authors: Qiao Dan , Li Yiran , Zhang Xiaoyu , Wen Yujiao , Zhang Xuemin , Ma Lu , Li Gaizhi , Yang Chunxia , Liu Zhifen
Published: November 2024

Background

Abnormal cognitive response to pain is consistently associated with deleterious outcomes among adolescents with depression. Highly relevant to both pain and cognition, dorsolateral prefrontal cortex (DLPFC) is important to understanding pain cognition. Our study aimed to characterize the circuit of DLPFC and the efficacy of transcranial magnetic stimulation (TMS) over DLPFC on pain cognition in adolescents with depression.

Methods

Using neuroimaging data, we first compared functional connectivity (FC) of DLPFC between 60 adolescents with depression and 65 controls. The patients were then divided into add-on TMS group (N = 30) and Sertraline group (N = 30). Clinical outcome was determined using Pain Vigilance and Awareness Questionnaire (PVAQ) and Pain Catastrophizing Scale (PCS). Finally, we conducted regression analysis to assess the effect that FC of DLPFC contributes to in predicting clinical outcome.

Results

FC analysis showed that compared to controls, patients displayed hyperconnection of left DLPFC - left triangular part of inferior frontal gyrus (IFG), which was significantly correlated with higher PCS total-, magnification- and helplessness-scores. Patients also showed hyperconnection of right DLPFC - right supramarginal gyrus (SMG), which was correlated with lower PCS total- and rumination- scores. After intervention, the add-on TMS group displayed significantly decreased score on PVAQ, PCS total and rumination. FC of left DLPFC - bilateral triangular part of IFG, - right SMG, as well as right DLPFC - left putamen, could predict the improvement of pain vigilance and magnification.

Conclusion

Our results point to a key role of DLPFC acting as a connection linking cognitive control and pain processing in adolescents with depression.

Trial registration

The study is registered in https://www.chictr.org.cn/ with a registration number ChiCTR2000039503 (date: 10.30.2020).
Body mass index and penile cancer incidence: results from a Norwegian cohort study of 829,081 men
Authors: Aune Dagfinn , Nordsletten Marie , Myklebust Tor Åge , Robsahm Trude Eid , Skålhegg Bjørn Steen , Mala Tom , Yaqub Sheraz , Saeed Usman
Published: November 2024

Background

A few previous studies have suggested a possible association between adiposity and increased risk of penile cancer, however, the evidence is to date limited for this rare cancer. We investigated the association between body mass index (BMI) and penile cancer risk in a large Norwegian cohort.

Methods

The analyses included 829,081 men aged 16–75 years at baseline in 1963–1975. Multivariable Cox regression analyses were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between BMI and penile cancer incidence.

Results

A total of 725 incident penile cancer cases occurred during 25.6 million person-years of follow-up. Compared to men with BMI 18.5-<25, the HRs (95% CIs) of those with a BMI of 15-<18.5, 25-<30, and ≥ 30 were 0.45 (0.15–1.41), 1.14 (0.97–1.33) and 1.63 (1.20–2.22), respectively, and the HR was 1.26 (1.12–1.42) per 5 kg/m2 increase in BMI. When the obese category was further subdivided in grade 1 (BMI 30-<35) and grade 2 obesity (≥ 35), the respective HRs were 1.52 (1.10–2.10) and 3.28 (1.46–7.35, ptrend<0.001). The positive association persisted in sensitivity analyses excluding the first 5 years of follow-up. The association between BMI in early adulthood and penile cancer risk was less precise (1.23, 0.91–1.65 per 5 kg/m2, n = 143 cases) and for BMI and early-onset penile cancer was null (1.03, 0.51–2.06 per 5 kg/m2, n = 27 cases).

Conclusion

High BMI is associated with increased risk of penile cancer. Further studies are needed to investigate the potential underlying mechanisms.
Comparing paper-based and mobile application for rank-based peer assessment in interprofessional education: before, during, and after the COVID-19 pandemic
Authors: Widyandana Doni , Utomo Prattama Santoso , Setiawan Ide Pustaka , Kurniawati Yustina Tyas , Dandekar Sucheta
Published: November 2024

Background

Education was affected during the COVID-19 pandemic, and there was a need to adapt the learning approaches to the situation. At the University of Gadjah Mada, many essential soft skills of healthcare professionals are taught using the interprofessional education (IPE) approach on-site. Our university responded to this crisis by offering online classes and similar types of training. Post-administration of the course, a peer-assessment was conducted, and it was used to provide feedback on the work or performance of peers among students. Peer assessment was done using paper-based and a mobile application during COVID-19. This study aimed to share a best practice for the implementation of a rank-based peer-assessment application for longitudinal interprofessional education in the community setting and to compare the score distribution of a rank-based peer-assessment before and after using mobile application.

Methods

Quantitative research design was used by processing secondary data on student peer assessment scores from 3 bachelor programs (medicine, nursing, nutritionist) Community and Family Health Care with Interprofessional Education (CFHC-IPE) in Faculty of Medicine, Nursing, and Public Health, Universitas Gadjah Mada. 4,790 students from 2018 to 2022 (5 years) were tracked before, during, and after the COVID-19 pandemic. The assessments carried out were offline, online, and blended learning, respectively. The assessment was carried out using a paper-based method before and during the pandemic, online-based with a mobile application was used. Thus, the peer-assessment was conducted manually or using paper-based method using a 5-rank scoring system. In 2019, the peer assessment was carried out using a mobile application and applied a 10-rank scoring system.

Results

The rank-based peer assessment can be well implemented to make students assess their friends more objectively, with an average score 82.02 ± 8.68. The rightward shift in the distribution of scores indicates that the average score has improved after using the mobile application compared to before its use. (82.02 ± 8.68 vs. 62.39 ± 11.13, p < 0.05).

Conclusion

The implementation of rank-based peer-assessment using a mobile application was well received during and after the pandemic by interprofessional undergraduate students. The online system made the assessment more objective and the average grades were seen to be better.
Prevalence of imposter syndrome and its association with depression, stress, and anxiety among nursing students: a multi-center cross-sectional study
Authors: El-Ashry Ayman Mohamed , Taha Samah Mohamed , Elhay Eman Sameh Abd , Hammad Heba Abdel-Hamid , Khedr Mahmoud Abdelwahab , El-Sayed Mona Metwally
Published: November 2024

Objective

To examine the prevalence of imposter syndrome among nursing students and its association with depression, stress, and anxiety.

Methods

A multi-center cross-sectional survey was conducted with 1572 nursing students randomly selected from three universities across Egypt. The study was conducted over 3 months, from the beginning of January to the end of March, during the academic year 2023/2024. Clance Imposter Phenomenon Scale and Depression Anxiety Stress Scale-21 were used for data collection.

Results

A significant proportion of nursing students experience moderate to highly severe levels of depression, anxiety, and stress. Around a quarter of students had moderate depression, 22.6% had moderate anxiety, and 14.9% had severe anxiety. Additionally, 13.3% of participants experienced severe stress, with only 3.8% experiencing highly severe stress. The study also found that 46.3% of students experienced moderate imposter syndrome, with 33% having frequent imposter levels and 6.2% scoring intense imposter on the scale. Furthermore, imposter syndrome was positively correlated with depression, anxiety, and stress, and the total score of the Depression Anxiety Stress Scale (r = 0.639, p < 0.001). The stepwise linear regression analysis explained that 45.0% of the variance in students' depression, anxiety, and stress was due to imposter syndrome and other sociodemographic covariates.

Conclusion

This study highlighted the relationship between imposter syndrome, depression, anxiety, and stress among nursing students. Specifically, female students in higher academic years, with lower grade point averages, living in urban areas, with lower family incomes, and not participating in hobbies are more prone to depression, anxiety, and stress.

Nursing implications

These findings underscore the need for a holistic approach to managing the complex nature of mental health among nursing students. Incorporating education and resources on self-care and stress management techniques into nursing training programs is imperative for addressing the implications of imposter syndrome in nursing practice. Equipping nursing students with these essential skills can enhance their resilience, foster a healthier work environment, and ultimately improve patient care outcomes.
Two cases of type I sialidosis and a literature review
Authors: Ding Yuan , Cheng Ming , Gong Chunxiu
Published: November 2024

Objective

This study aims to compare the clinical and electrophysiological characteristics of two cases of type I sialidosis in Chinese children with those reported in prior literature. The goal is to elucidate the clinical and genetic features of type I sialidosis.

Methods

Clinical investigations and genetic analyses were conducted on an 11-year-old girl, primarily presenting with short stature, who was admitted in June 2020, and a 10-year-old boy, admitted in July 2023, exhibiting rapid weight gain and accompanying visual impairment as primary manifestations. A literature review was performed by summarizing data from 31 published articles encompassing 69 genetically confirmed cases of type I sialidosis up to 2023 for comparative analysis.

Results

Patient 1 exhibited short stature, self-reported poor night vision, a history of occasional febrile seizures, mild scoliosis, bilateral cherry-red spots in the fundus, and prolonged P100 latency in both eyes as observed in visual evoked potentials (VEP). Genetic analysis revealed that she carried compound-heterozygous variants c.239 C > T (p.P80L) and c.880 C > T (p.R294C) in the NEU1 gene, inherited from her parents. Patient 2 presented with rapid weight gain and visual impairment, bilateral cherry-red spots in the fundus, abnormal neuroepithelial layer reflexes in both macular areas, approximately normal P100 latency but severely reduced amplitude in VEP after pupillary dilation, and severe bilateral optic nerve conduction block with relatively normal retinal cell function. Compound-heterozygous variants c.239 C > T (p.P80L) and c.803 A > G (p.T268C) were identified in the NEU1 gene of the Patient 2, inherited from his parents. By combining the cases reported in 31 literature articles with the 2 cases in our study, a total of 71 type I sialidosis patients were analyzed. The most common symptoms observed were muscle spasms (91.5%), followed by ataxia (75%) and seizures (63.6%). Intellectual impairment and abnormal electroencephalograms were more prevalent in Caucasian patients. Additionally, abnormal somatosensory evoked potentials, large cortical waves, and prolonged latency of VEP were more frequently observed in both Asian and Caucasian patients, serving as alternative indicators for early diagnosis.

Conclusion

NEU1 gene analysis provides essential guidance for genetic counseling and prenatal diagnosis. The exon 2 variant c.239 C > T (p.P80L) in the NEU1 gene may represent a mutation hotspot among Chinese patients.
I can’t feel your face: callous-unemotional traits, social anxiety, and approach-avoidance behaviour in conduct disorder
Authors: Derks Laura M. , Becker Eni S. , Rinck Mike , Holtmann Martin , Legenbauer Tanja , Lange Wolf-Gero
Published: November 2024

Background and objectives

Conduct disorders are associated with deficits in interpersonal behaviour. Both, callous-unemotional traits and social anxiety are often elevated in patients with conduct disorder and are associated with aggressive approach or disproportional avoidance. Previous studies have focused mainly on questionnaire reports of interpersonal behaviour, whereas direct explicit and implicit interpersonal behaviour in social contexts has not been considered sufficiently. Therefore, explicit and implicit interpersonal behaviour were investigated in children and adolescents with conduct disorder in the current study.

Methods

Forty male adolescent inpatients with conduct disorder and 30 typically developing controls (Mage = 12.5, SD = 1.39) took part in a virtual reality task in which they approached virtual agemates, displaying different facial expressions under the pretext of a cover story while interpersonal distance and walking speed were assessed (indirect condition). In addition, they were asked to move to a comfortable distance for conversation toward the agent (direct condition). Callous-unemotional traits and social anxiety were assessed via questionnaires.

Results

In the indirect condition, no differences between the groups emerged. In the direct condition, typically developing children adjusted their interpersonal distance to the respective expression that the virtual classmate displayed. They showed significantly greater interpersonal distances to angry classmates than to happy classmates. In contrast, conduct disorder patients’ interpersonal distance, did not differ between emotions. Interpersonal distance preferences were also associated with social anxiety and callous-unemotional traits.

Conclusion

The findings suggest that conduct disorder patients fail to adjust their interpersonal behaviour to the facial expression of social interaction partners and that this is associated with social anxiety and callous-unemotional traits. A lack of adjustment to social cues might contribute to and maintain problems with peers in individuals with conduct disorder.
Psychometric properties of the American version of the Chronic Uncertainty scale: long and short version (CU-40; CU-20)
Authors: Ghassabei Shiwa , Afifi Walid A. , Afifi Tamara , Petrowski Katja
Published: November 2024

Background

Uncertainty is a widespread phenomenon experienced worldwide. The bulk of existing research to date has focused on transitory or acute experiences of uncertainty, often in the particular context of illness. The current study evaluated the psychometric properties of the cross-contextual 40-item (long) and 20-item (short) Chronic Uncertainty scale (CU-40; CU-20).

Methods

A U.S. sample of 1083 participants (55% female) was recruited via Mechanical Turk (MTurk). Exploratory factor analysis revealed a six-factor model.

Results

Results of the Confirmatory factor analysis showed good model fit for the original and a slightly better model fit for the modified version of the CU-40 and CU-20. Slightly different item-to-factor attributions were suggested for the questionnaires. Internal consistencies were good for both models.

Conclusion

The evidence suggests that the CU scale offers psychometrically sound assessments of chronic uncertainty across a range of dimensions. Further assessments and implementations of the CU in different contexts using diverse samples are encouraged to test the efficacy of the CU measures as screening tools of general aspects of chronic uncertainty.