bluuebunny/crossref_metadata_2025 huggingface dataset:
Emergent Design and Unanticipated Ideas in Asynchronous Online Focus Groups: Finding an Unexpected Silver Lining in Apparent Methodological Compromise
Authors: Buddle Emily A. , Ankeny Rachel A. , Paxton Rebecca , Harms Rebekah J. , Bray Heather J.
Published: October 2024

This article explores methodological advantages and limitations of using asynchronous online focus groups (AOFGs) as an approach to investigating community attitudes and values relating to biotechnology in food production. We describe our experiences using AOFGs during the COVID-19 pandemic as a form of emergent design. We highlight the methodological advantages and limitations of such research approaches, particularly to explore unanticipated ideas relating to community attitudes and values associated with biotechnology in food production. Although AOFGs are not a direct substitute for traditional methodologies, there are clear advantages that can outweigh typical concerns, depending on the research questions and goals, particularly when research aims to involve participants from diverse demographic groups and engage in more emergent methods allowing unanticipated ideas to be explored. As a result of having to pivot our methods to produce the required analyses during the COVID-19 pandemic, this paper provides valuable insights into the use of AOFGs to capture qualitative data when use of traditional methods is restricted or may be less desirable.
Peter’s Mice
Authors: Unnikrishnan Deepak
Published: October 2024

A true story about the role of mice in the Peter Goodrich classroom.
Variations in treatment approaches for patients with scapula alata – A national survey across public hospitals in Denmark
Authors: Hvidberg Kirstine Lyngsøe , Budtz Cecilie Rud , Aalkjær Grethe , Villumsen Søren , Elmengaard Brian , Christiansen David Høyrup , Østergaard Helle Kvistgaard
Published: October 2024

Introduction

Scapula alata (SA) is a condition characterized by medial winging and reduced upward rotation of the scapula during arm elevation, leading to impaired shoulder function. This study aimed to assess diagnostic and treatment approaches for SA in public hospitals in Denmark.

Materials and Methods

A cross-sectional survey was undertaken using a self-administered questionnaire to healthcare professionals across departments in public hospitals in Denmark. The survey investigated diagnostic practices, including referral to electroneurography (ENG), ICD-10 coding and local treatment practices.

Results

A total of 20 hospital departments completed the questionnaire. Six hospitals use ENG as part of their diagnostic practice. Six different ICD-10 codes were reported for SA. Annual patient numbers ranged from 0 to 20, with four hospitals accounting for most of the patients. Doctors and physiotherapists are the primary healthcare providers involved in the diagnostic and treatment process. Only four hospitals reported written local guidelines for SA treatment. Treatment approaches included exercise therapy, brace treatment, surgery, and in some cases, a waiting approach.

Conclusion

The survey revealed significant variations in diagnostic and treatment practices for SA across Denmark. This emphasizes the need for further research and national and international consensus, including standardized guidelines for diagnostics and treatment practices.
The Impact of International Baccalaureate (IB) Courses: Experience and Outcome Differences for Full IB Diploma Earners Versus Nondiploma Earners in an Urban School in the United States
Authors: Jennens Christopher , Guler Nilufer
Published: October 2024

This study examines differences in educational experiences and outcomes for high school (HS) students who participated in the International Baccalaureate (IB) Diploma Program and earned full diplomas compared to those who participated in the IB Diploma Program but did not earn the diploma. ACT scores, after-HS placement, and HS graduation rates of 256 participants were collected. One hundred and twenty two participants completed an online survey, and 12 participated in interviews. The results revealed that the educational outcomes and experiences for diploma and nondiploma earners were vastly similar. Diploma earners had significantly higher ACT scores, but their college entrance and other academic outcomes were similar to nondiploma earners. However, students who participated in the IB program had significantly higher academic success than other students. Even students who did not earn the full IB diploma had higher graduation rates and high average ACT scores than students at this school, state, and even at the federal level.
Catheter-associated urinary tract infections in critically Ill patients with COVID-19: a retrospective cohort study
Authors: Dąbrowska Paulina , Bartoszewicz Mateusz , Bartoszewicz Klaudia , Kosel Juliusz , Stróż Samuel , Ładny Jerzy Robert , Czaban Sławomir Lech
Published: October 2024

Background:

Catheter-associated urinary tract infections (CA-UTIs) pose a significant challenge in intensive care unit (ICU) patients with COVID-19.

Objective:

The study aims to assess the prevalence of CA-UTIs, identify the causative pathogens and their resistance profiles, and determine the risk factors and outcomes associated with CA-UTIs in ICU patients with COVID-19.

Design:

Single-center, retrospective cohort study.

Methods:

The study included 201 adult ICU patients diagnosed with COVID-19 between March 2020 and July 2021. Patients were categorized into CA-UTI ( n = 56) and non-CA-UTI ( n = 145) groups. Data on demographic characteristics, clinical course, treatment, and outcomes were collected. Logistic regression analysis was used to identify risk factors for CA-UTI.

Results:

CA-UTIs developed in 28% of patients ( n = 56). Incidence density of 15.8 episodes per 1000 catheter days. The average onset occurrence is 7.2 days after ICU admission. Patients with CA-UTI had longer ICU stays (18.8 days vs 10.5 days, p < 0.001) and more elevated mortality rates (75.0% vs 54.5%, p = 0.010), higher mechanical ventilation (MV) usage (98.2% vs 88.3%, p = 0.027), a longer average duration of MV (16.6 days vs 9.1 days, p < 0.001). Longer ICU and hospital stays were significant risk factors for CA-UTI. Other factors, such as the use of corticosteroids, chronic organ insufficiency or immunocompromized status, female sex, age, diabetes mellitus, and the duration of urinary catheterization, did not show significant associations with CA-UTI risk in this cohort. Gram-negative bacteria, particularly Klebsiella pneumoniae (28 cases), was the most common pathogen, with a high prevalence of multidrug resistance (38.8%) with type ESBL, MBL, NDM, and OXA-48. The occurrence of multidrug resistant (MDR) organisms was 68.8%.

Conclusion:

The findings of this study underscore the prevalence of CA-UTIs in ICU patients with COVID-19, significantly impacting patient outcomes. Effective infection control and targeted antimicrobial therapy are crucial to managing these infections.
Exploring the relationship between neurologists and older persons with multiple sclerosis through the lens of social support theory
Authors: Stanikić Mina , Gille Felix , Schlomberg Jonas , Daniore Paola , Kägi Susanne , Chan Andrew , Kamm Christian P , Zecca Chiara , Calabrese Pasquale , Roth Patrick , Baum Claudia , Rapold Irene , Puhan Milo A , von Wyl Viktor
Published: October 2024

Background

Although healthcare practitioners (HCPs) are a valuable source of social support, research on support provided by neurologists to older persons with multiple sclerosis (pwMS) remains limited.

Objectives

To explore expectations of pwMS aged 55 years or older regarding MS care and to identify support types, met and unmet needs within their relationship with neurologists.

Methods

Utilizing a mixed-methods approach, we analyzed survey data from Swiss Multiple Sclerosis Registry participants. Quantitative data included Likert scales gauging the importance of various aspects of MS care for pwMS both in and out of neurological care. Qualitative data were derived from three open-ended questions, focusing on neurologist-provided support for pwMS in neurological care. Data underwent descriptive and deductive thematic analysis, using Cutrona and Suhr framework for coding social support.

Results

Among the 286 participants (median age 61.0 years, interquartile range (IQR) 57.0–66.0; median disease duration 23.5 years, IQR 15.0–31.0), 84.6% ( N = 244) were under neurological care. Quantitative findings highlighted the significance of HCP expertise and consultation time. Qualitative analysis identified all social support domains in the neurologist–pwMS relationship, with informational support being most prevalent, followed by emotional support. Neurologists’ expertise, availability, comprehensive advising, listening, and validation emerged as key themes. Unmet needs were relatively infrequent and concerned insufficient information on complementary medicine, empathy, and understanding of symptoms like fatigue.

Conclusions

Older pwMS see neurologists as adequate providers of comprehensive support and particularly value neurologists’ sufficient availability, informational and emotional support. Areas for improvement include attention to complementary medicine and empathy.
Differences in Player Performance and Longevity After Achilles Tendon Rupture Between Professional Basketball Players in the NBA and WNBA
Authors: Momtaz David A. , Ghali Abdullah , Ahmad Farhan , Gonuguntla Rishi , Wang Rebecca J. , Yanney Reid , Lao Ashley , Bora Varun , Shybut Theodore B.
Published: October 2024

Background:

Prior studies in the National Basketball Association (NBA) and Women's National Basketball Association (WNBA) reported worse player performance after Achilles tendon rupture (ATR).

Purpose/Hypothesis:

The purpose of this study was to compare time to return to play (RTP) and performance after ATR between NBA and WNBA athletes. It was hypothesized that there would be no relative difference between the NBA and WNBA players.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

ATRs in the NBA between 1987 and 2017 and WNBA between 2006 and 2017 were identified through a rigorous online search of articles. Included athletes had no prior leg injuries and had played ≥3 seasons before and after ATR. Sex, age, position, body mass index, height, years of experience, time to RTP, and player efficiency rating (PER) were recorded. Relative performance was measured by matching injured athletes to uninjured controls in the same league in a 1:2 ratio. Relative differences were compared between leagues, with adjustment for baseline features. Multiple regression analysis was employed to identify variables correlating with RTP and PER.

Results:

Included were 102 professional basketball players, of whom 34 sustained ATR (21 male, 13 female). Sex/league correlated with differences in RTP ( P < .001). There was a significant difference between the WNBA and NBA in PER when comparing 1 year pre- and 1 year postinjury (1.49 ± 0.25 vs 3.87 ± 0.43, respectively; mean ± SD P < .001). Compared with intraleague controls, the relative difference in PER postinjury was 0.81 ± 0.11 (WNBA) and 3.9 ± 0.89 (NBA) ( P < .001). Multiple regression analysis indicated that when controlling for years of experience, player position, and age, NBA players took 126 days longer than WNBA players to RTP ( P < .001) and NBA players had 9.96 times increased odds of taking >200 days to RTP compared with WNBA players ( P = .006).

Conclusion:

Sex/league was a significant predictor of RTP after ATR. When compared with their respective controls, NBA players saw a greater decrease in postinjury performance than WNBA players. NBA players took longer to RTP than WNBA players. ATRs appear to more negatively affect NBA players than WNBA players.
Severe Hemophilic Arthropathy of the Knee: MRI Has Its Place
Authors: Kessi Eric Michel Charlemagne Junior , Maslouhi Kaoutar , Guelzim Yousra , Belkouchi Lina , Allali Nazik , Chat Latifa , El Haddad Siham
Published: October 2024

Hemophilia is a congenital coagulopathy characterized by a deficiency of coagulation factors and the development of haematomas and haemarthrosis, either spontaneously or after minor trauma. Recurrent joint hemorrhage in hemophilia patients leads to progressive and degenerative arthropathy, which affects around 90% of patients with severe disease and contributes significantly to disease morbidity. Positive diagnosis is based on biology. Imaging, particularly MRI, plays an essential role in assessing the evolution and complications, especially osteoarticular complications. We report 2 cases of severe hemophilia A, who presented with almost identical clinical and radiological symptoms. The patients developed severe arthropathy with a course marked by recurrences of haemarthrosis.
Strategic Autonomy and India’s Hedging Policies in the Indo-Pacific
Authors: Vinodan C. , Kurian Anju Lis
Published: October 2024

Hedging is a collection of tactics that includes bandwagoning, limited resistance and involvement. Put another way, it is an insurance position between the two simple tactics of balancing and bandwagoning. Many states, including India, have adopted hedging as a favoured approach since the end of the Cold War. In light of the US–China rivalry and shifting great power dynamics in the Indo-Pacific, India continues to pursue a ‘hedging the bets’ strategy, despite the country and the United States enjoying stronger strategic ties—particularly through the Quadrilateral Security Dialogue. This article argues that as a rising power with its own ambitions to carve out a strategic space, India’s foreign policy in the Indo-Pacific seeks to retain a free, open and inclusive regional order. In the short and medium terms, this means forming soft-balancing coalitions and limited hard-balancing relationships with the United States. Strategic hedging still dominates Indian strategy in a broad sense. Forming an alliance with Washington will alienate China and Russia, the two great powers India is attempting not to dissociate completely. India’s somewhat neutral position on the Russian war on Ukraine and reluctance to join active military alliances in the Indo-Pacific indicates that hedging has value for maintaining India’s strategic autonomy and aspirations for great power status in the twenty-first century. India’s continued engagement through institutions such as BRICS, Shanghai Cooperation Organisation and G20 as well as increased trade with China and Russia suggest the pursuit of a hedging strategy in its relations with other great powers.
Duration of Marriage Exacerbates the Likelihood of Spousal Violence among Involuntarily Childless Women in Nigeria: Evidence from a National Survey
Authors: Okunlola David Aduragbemi , Adeleye Khadijat , Ogundele Oluranti M.
Published: October 2024

Given the roles of patriarchy and pronatalist culture and the high prevalence of spousal violence against partnered women in Nigeria, the authors estimate and visualize the moderating effect of years of marriage on the probability of experiencing spousal violence (ESV) among involuntarily childless women (ICW) (vs. non-childless women [NCW]). Using multiple binary logistic regression, the authors analyze the 2018 Nigeria Demographic and Health Survey among married women (15–49 years of age). The authors define ICW as nulliparous women who have never used contraception and have never experienced pregnancy termination, while NCW are the comparison group. The graphical result suggests that despite the lower probability of ESV among ICW (vs. NCW), the probability of ESV is higher among ICW as years of marriage increase.
Stakeholder Value and Firm Performance: Empirical Study of State-owned Enterprises in Indonesia
Authors: Sulastri  , Isnurhadi  , Muizuddin
Published: October 2024

The consistent distribution of economic value from state-owned companies in Indonesia to both external and internal stakeholders over the long term is crucial as an indicator of company growth. This research aims to demonstrate the influence of stakeholder value on the performance of state-owned enterprises in Indonesia. Using panel data to measure predictor consistency over the long term, the study finds that the data is stationary and cointegration occurs in the long term. The findings are: (a) Government Value positively influences return on equity (ROE) and sustainable growth rate (SGR) but has no effect on return on assets (ROA); (b) Customer Value positively influences ROA but has no effect on ROE and SGR; (c) Social Value has no significant impact on ROA, ROE and SGR; (d) Debt-holder Value negatively influences ROA, ROE and SGR; (e) Supplier Value positively influences ROA, ROE and SGR; (f) Employee Value positively influences ROE but has no effect on ROA and SGR; and (g) Shareholder Value positively influences ROE but has no effect on ROA and SGR. These findings indicate inconsistencies in the impact of stakeholder value on company performance.
Unveiling multifaceted resilience: A heterogeneous graph neural network approach for analyzing locale recovery patterns
Authors: Du Jiaxin , Ye Xinyue , Huang Xiao , Qiang Yi , Zhu Chunwu
Published: October 2024

Resilience, denoting the capacity to swiftly recover to a state of normalcy subsequent to the occurrence of a disaster, constitutes a multifaceted phenomenon necessitating in-depth investigation. This study undertakes the quantification of resilience pertaining to specific locales through the utilization of heterogeneous data encompassing visitation patterns, demographic particulars, and points of interest (POI). A heterogeneous graph neural network is applied to model the resilience of these locales in Galveston, TX, USA. Our model outperforms regression models and other homogeneous baseline methodologies. Subsequent analysis unveils discernible resilience patterns intertwined with metrics such as visitation frequencies, visitors’ travel behaviors, and geographical attributes. In comparison to resilience investigations solely predicated upon visitation counts, our approach captures a more extensive array of information, thereby yielding a comprehensive understanding of the locale’s resilience.
Persuasion Strategies of the Major Powers on Social Media: An Analysis of the Metadiscourse from the Chinese and American Spokespersons' Tweets
Authors: Feng Jie , Tang Jiajun , Xiao Yalong , Zhu Chengzhang
Published: October 2024

Despite the significant progress in studies on metadiscourse, scarce attention has been paid to it in the digital context. Social media platforms including Twitter have become arenas for the current Sino-U.S. discourse competition. In this regard, Twitter can be used to observe the diverse usage of metadiscourse by different political figures and uncover the underlying mechanisms. Combining computer-aided metadiscourse extraction and critical discourse analysis, the paper explores metadiscourse markers from the Chinese and American spokespersons’ tweets to reveal their rhetoric and social functions based on Foucault's “power discourse theory.” The results show that the American spokespersons are more inclined to use emotional persuasion and define some specific objects, which is part of the division & rejection system. In contrast, utterances of the Chinese spokespersons constitute a semantic terrain to distinguish truth from falsehood, utilizing the opposition system to eliminate their inferior discourse power status.
Safety and efficacy of standard-of-care ciltacabtagene autoleucel for relapsed/refractory multiple myeloma
Authors: Sidana Surbhi , Patel Krina K. , Peres Lauren C. , Bansal Radhika , Kocoglu Mehmet H. , Shune Leyla , Atrash Shebli , Smith Kinaya , Midha Shonali , Ferreri Christopher , Dhakal Binod , Dima Danai , Costello Patrick , Wagner Charlotte , Reshef Ran , Hosoya Hitomi , Mikkilineni Lekha , Atanackovic Djordje , Chhabra Saurabh , Parrondo Ricardo , Nadeem Omar , Mann Hashim , Kalariya Nilesh , Hovanky Vanna , De Avila Gabriel , Freeman Ciara L. , Locke Frederick L. , Alsina Melissa , Wong Sandy , Herr Megan , Htut Myo , McGuirk Joseph , Sborov Douglas W. , Khouri Jack , Martin Thomas , Janakiram Murali , Lin Yi , Hansen Doris K.
Published: October 2024

Ciltacabtagene autoleucel (cilta-cel) was approved in 2022 for patients with relapsed/refractory multiple myeloma (RRMM). We report outcomes with cilta-cel in the standard-of-care setting. Patients with RRMM who underwent leukapheresis for cilta-cel manufacturing between 1 March 2022 and 31 December 2022 at 16 US academic medical centers were included. Overall, 255 patients underwent leukapheresis and 236 (92.5%) received cilta-cel, of which 54% would not have met CARTITUDE-1 eligibility criteria. In treated patients (N = 236), cytokine release syndrome was seen in 75% (grade ≥3, 5%), immune effector cell–associated neurotoxicity syndrome in 14% (grade ≥3, 4%), and delayed neurotoxicity in 10%. Overall and complete response rates were as follows: all patients who received cilta-cel (N = 236), 89% and 70%; patients receiving conforming cilta-cel (n = 191), 94% and 74%; and conforming cilta-cel with fludarabine/cyclophosphamide lymphodepletion (n = 152), 95% and 76%, respectively. Nonrelapse mortality was 10%, most commonly from infection. After a median follow-up of 13 months from cilta-cel, the median progression-free survival (PFS) was not reached, with 12-month estimate being 68% (95% confidence interval, 62-74). High ferritin levels, high-risk cytogenetics, and extramedullary disease were independently associated with inferior PFS, with a signal for prior B-cell maturation antigen–targeted therapy (P = .08). Second primary malignancies excluding nonmelanoma skin cancers were seen in 5.5% and myeloid malignancies/acute leukemia in 1.7%. We observed a favorable efficacy profile of standard-of-care cilta-cel in RRMM, despite more than half the patients not meeting the CARTITUDE-1 eligibility criteria.
Systemic pro-inflammatory response following bronchoscopic lung volume reduction using endobronchial valves
Authors: Hartman Jorine E. , van der Molen Marieke C. , Jonker Marnix R. , Posthuma Rein , Vanfleteren Lowie E.G.W. , Slebos Dirk-Jan , Pouwels Simon D.
Published: October 2024

Rationale

Bronchoscopic lung volume reduction treatment using endobronchial valves (EBV) is an effective treatment for severe COPD patients by improving lung function and quality of life. However, little is known about its effects on systemic inflammation. Therefore, the aim of our study was to investigate whether EBV treatment impacts the inflammatory cytokine profile.

Methods

This study was a predefined substudy of the SoLVE trial (NCT03474471) that investigated the combination of EBV treatment with pulmonary rehabilitation (PR). The substudy included the collection of blood samples with assessment of 10 inflammatory markers prior to EBV treatment and 6 months after EBV or EBV+PR treatment.

Results

In 66 patients, six months after treatment a pro-inflammatory cytokine profile was observed, with an increase in all pro-inflammatory markers and a decrease in the anti-inflammatory cytokine IL-10. The changes in plasma cytokine profile were not associated with changes in clinical outcomes such as lung function or exercise capacity.

Discussion

In conclusion, our study demonstrated an elevation in systemic pro-inflammatory cytokine levels following successful EBV-treatment, which was not associated with adverse clinical outcomes. It would be interesting to further explore, whether this increase is attributed to a foreign body response or if other factors contribute to this phenomenon.
The association between endothelial dysfunction and subclinical myocardial injury in male obstructive sleep apnoea patients
Authors: Cao Wenhao , Luo Jinmei , Hui Xinjie , Xiao Yi , Huang Rong
Published: October 2024

Background

Endothelial dysfunction was shown to contribute significantly to the elevated cardiovascular risk observed in the general population. However, the relationship between endothelial dysfunction and subclinical myocardial injury in obstructive sleep apnoea (OSA) patients remains unclear.

Methods

This cross-sectional study recruited 165 consecutive male patients diagnosed with OSA. All participants underwent overnight polysomnography to confirm the diagnosis and assess the severity of OSA. Subclinical myocardial injury was evaluated using high-sensitivity cardiac troponin I (hs-cTnI) measurements, while endothelial dysfunction was assessed through the peripheral arterial tonometry.

Results

Endothelial dysfunction was present in 80 (48.5%) of the subjects and hs-cTnI was detectable in 147 (89.1%) of the participants. When compared with OSA patients without endothelial dysfunction, those with endothelial dysfunction exhibited significantly lower percentages of hypertension (23.8%versus43.5%, p=0.007) and abdominal obesity (76.3%versus88.2%, p=0.043). Patients with endothelial dysfunction frequently manifest a lower apnoea–hypopnoea index and oxygen desaturation index. Despite comparable median hs-cTnI levels, a higher proportion of subjects with detectable hs-cTnI levels was observed among those with endothelial dysfunction (95%versus83.5%, p=0.018). Logistic regression analysis indicated that endothelial dysfunction was significantly associated with a detectable level of hs-cTnI after adjustment for multiple confounders.

Conclusions

In male OSA patients, endothelial dysfunction appears to be potentially correlated with an increased risk of subclinical myocardial injury, as evidenced by the higher prevalence of detectable hs-cTnI levels. Further investigations are warranted to elucidate the role of endothelial dysfunction in predicting future cardiovascular mortality in this population.
Evaluating digital adherence support in asthma: The ADITION non-interventional study
Authors: Woehrle Holger , Driemert Jens , Jerrentrup Lukas , Schiefer Conrad , Bushart Gregor , Sauerbeck Inessa Schwab
Published: October 2024

Introduction

Poor adherence to asthma maintenance therapy is associated with worse outcomes. A solution could be digital adherence support. This study evaluated asthma control and adherence in patients using mometasone furoate/indacaterol/glycopyrronium (MF/IND/GLY) with a digital support system, or using any inhaled corticosteroid/long-acting β2-agonist/long-acting muscarinic antagonist combination (ICS/LABA/LAMA) without support.

Methods

This prospective, non-interventional, multicentre, open-label study enrolled adults with asthma in Germany. Prior to inclusion, treatment was initiated with MF/IND/GLY with digital support, or with any ICS/LABA/LAMA without digital support. The primary endpoint was change in Asthma Control Test (ACT) at 6 months.

Results

Of 222 and 203 patients in the MF/IND/GLY plus digital support and ICS/LABA/LAMA groups, respectively, 76.1% and 74.9% completed follow-up. Baseline mean ACT total scores were 17.0 and 14.7, with mean changes from baseline at 6 months of 3.0 and 4.1; following propensity matching (N=92/group), mean (95% CI) changes were similar in the two groups, with overlapping CIs (2.9 [1.9, 3.9] and 4.0 [3.0, 5.1]). At enrolment, patients were overall moderately adherent to maintenance therapy, with limited changes over the study. The overall incidence of adverse events was similar in the two groups (29.5% and 27.3% patients).

Conclusions

Patients using MF/IND/GLY with digital support had similar improvements in asthma control to those receiving ICS/LABA/LAMA alone, with minimal changes in adherence. These results illustrate the challenges in evaluating asthma control and adherence in non-interventional studies. Further studies are required to evaluate the value of digital support systems, and how they can be used to optimise inhaler adherence.
Establishing a rabbit model with massive supraspinatus tendon defect for investigating scaffold-assisted tendon repair
Authors: Huang Shuting , Tam Ming Yik , Ho Wai Hon Caleb , Wong Hong Ki , Zhou Meng , Zeng Chun , Xie Denghui , Elmer Ker Dai Fei , Ling Samuel KK. , Tuan Rocky S. , Wang Dan Michelle
Published: October 2024

Background

Shoulder pain and disability from rotator cuff tears remain challenging clinical problem despite advancements in surgical techniques and materials. To advance our understanding of injury progression and develop effective therapeutics using tissue engineering and regenerative medicine approaches, it is crucial to develop and utilize animal models that closely resemble the anatomy and display the pathophysiology of the human rotator cuff. Among various animal models, the rabbit shoulder defect model is particularly favored due to its similarity to human rotator cuff pathology. However, a standardized protocol for creating a massive rotator cuff defect in the rabbits is not well defined. Therefore, the objective of our study was to establish a robust and reproducible model of a rotator cuff defect to evaluate the regenerative efficacy of scaffolds.

Results

In our study, we successfully developed a rabbit model with a massive supraspinatus tendon defect that closely resembles the common rotator cuff injuries observed in humans. This defect involved a complete transection of the tendon, spanning 10 mm in length and encompassing its full thickness and width. To ensure stable scaffolding, we employed an innovative bridging suture technique that utilized a modified Mason-Allen suture as a structural support. Moreover, to assess the therapeutic effectiveness of the model, we utilized different scaffolds, including a bovine tendon extracellular matrix (ECM) scaffold and a commercial acellular dermal matrix (ADM) scaffold. Throughout the observation period, no scaffold damage was observed. Notably, comprehensive histological analysis demonstrated that the regenerative tissue in the tendon ECM scaffold group exhibited an organized and aligned fiber structure, indicating tendon-like tissue regeneration while the tissue in the ADM group showed comparatively less organization.

Conclusions

This study presents a comprehensive description of the implemented procedures for the development of a highly reproducible animal model that induces massive segmental defects in rotator cuff tendons. This protocol can be universally implemented with alternative scaffolds to investigate extensive tendon defects and evaluate the efficacy of regenerative treatments. The application of our animal model offers a standardized and reproducible platform, enabling researchers to systematically evaluate, compare, and optimize scaffold designs. This approach holds significant importance in advancing the development of tissue engineering strategies for effectively repairing extensive tendon defects.
Prevalence and factors associated with gestational diabetes mellitus in Malaysia: a population-based study comparing 2016 and 2022
Authors: Zulkiply Siti Hafizah , Ratnam Kishwen Kanna Yoga , Liew Siaw Hun
Published: October 2024

Background

Gestational diabetes mellitus (GDM) poses substantial health risks to both mothers and infants. Malaysia exhibits a heightened prevalence of GDM.

Objective

This study aims to examine the changes in the prevalence of GDM between 2016 and 2022 and its determining factors.

Methods

The data analysed in this study were derived from the National Health and Morbidity Survey (NHMS) 2016 and 2022, a nationwide study employing a two-stage stratified random sampling design in Malaysia. Changes in the prevalence were compared between data from NHMS 2016 and 2022, while factors were evaluated based on data from NHMS 2022. Descriptive statistics and multiple logistic regression analyses were performed using IBM SPSS version 27.

Results

The prevalence of GDM increased from 12.5% in 2016 to 27.1% in 2022. In both years, the prevalence was highest among those aged 44–49 years, those of Indian ethnicity, those in higher income groups and those with higher education levels. Advanced maternal age, high body mass index (BMI) and hypertension were associated with a greater risk of GDM.

Conclusion

The prevalence of GDM among the Malaysian population doubled from 2016 to 2022. The findings underscore the importance of implementing targeted programs for expectant mothers in high-risk groups to mitigate the incidence of GDM and its associated morbidities.
External validation of an artificial intelligence multi-label deep learning model capable of ankle fracture classification
Authors: Olczak Jakub , Prijs Jasper , IJpma Frank , Wallin Fredrik , Akbarian Ehsan , Doornberg Job , Gordon Max
Published: October 2024

Background

Advances in medical imaging have made it possible to classify ankle fractures using Artificial Intelligence (AI). Recent studies have demonstrated good internal validity for machine learning algorithms using the AO/OTA 2018 classification. This study aimed to externally validate one such model for ankle fracture classification and ways to improve external validity.

Methods

In this retrospective observation study, we trained a deep-learning neural network (7,500 ankle studies) to classify traumatic malleolar fractures according to the AO/OTA classification. Our internal validation dataset (IVD) contained 409 studies collected from Danderyd Hospital in Stockholm, Sweden, between 2002 and 2016. The external validation dataset (EVD) contained 399 studies collected from Flinders Medical Centre, Adelaide, Australia, between 2016 and 2020. Our primary outcome measures were the area under the receiver operating characteristic (AUC) and the area under the precision-recall curve (AUPR) for fracture classification of AO/OTA malleolar (44) fractures. Secondary outcomes were performance on other fractures visible on ankle radiographs and inter-observer reliability of reviewers.

Results

Compared to the weighted mean AUC (wAUC) 0.86 (95%CI 0.82–0.89) for fracture detection in the EVD, the network attained wAUC 0.95 (95%CI 0.94–0.97) for the IVD. The area under the precision-recall curve (AUPR) was 0.93 vs. 0.96. The wAUC for individual outcomes (type 44A-C, group 44A1-C3, and subgroup 44A1.1-C3.3) was 0.82 for the EVD and 0.93 for the IVD. The weighted mean AUPR (wAUPR) was 0.59 vs 0.63. Throughout, the performance was superior to that of a random classifier for the EVD.

Conclusion

Although the two datasets had considerable differences, the model transferred well to the EVD and the alternative clinical scenario it represents. The direct clinical implications of this study are that algorithms developed elsewhere need local validation and that discrepancies can be rectified using targeted training. In a wider sense, we believe this opens up possibilities for building advanced treatment recommendations based on exact fracture types that are more objective than current clinical decisions, often influenced by who is present during rounds.
Taurolidine-containing solution for reducing cardiac implantable electronic device infection-early report from the European TauroPace™ registry
Authors: Vonthein Reinhard , Baldauf Benito , Borov Stefan , Lau Ernest W. , Giaccardi Marzia , Assadian Ojan , Haddad Christelle , Chévalier Philippe , Bode Kerstin , Foley Paul , Thomas Honey , Campbell Niall G. , Fichtner Stephanie , Donazzan Luca , Pescoller Felix , Oberhollenzer Rainer , Cemin Roberto , Bonnemeier Hendrik
Published: October 2024

Introduction

Infection is a significant complication of cardiac implantable electronic device (CIED) therapy. The European TauroPace™ Registry investigates the safety and efficacy of TauroPace™ (TP), an antimicrobial solution containing taurolidine, designed to prevent CIED infections.

Methods

This multicenter study included patients undergoing CIED procedures at participating centers where TP was used as a disinfectant for external hardware surfaces and an antiseptic for irrigating surgical sites. All patients eligible for CIED placement with adjunctive TP as the standard of care were included. Other aspects of CIED procedures adhered to current guidelines. Data on CIED-related infective endocarditis, CIED pocket infection, device and procedure-related complications, adverse events, and all-cause mortality were prospectively collected for 12 months. In cases of revision, the previous procedure was censored, and a new procedure was created. Binomial and Kaplan–Meier statistics were employed to analyze event rates.

Results

From January 2020 to November 2022, TP was used in 822 out of 1170 CIED procedures. Among patients who completed the 3-month follow-up, no CIED pocket infections were observed, and one case of CIED-related infective endocarditis was reported. In the 12-month follow-up cohort, two additional local pocket CIED infections were observed, resulting in a total of three major CIED infections within 1 year after the CIED placement procedure. The 3-month and 12-month major CIED infection rates were 0.125% and 0.51%, respectively. During the observation a complication rate of 4.4% was reported. No adverse events related to TP were observed.

Conclusions

TP appears to be effective and safe in preventing CIED infections.

ClinicalTrials.gov Identifier: NCT04735666.
NAT10/ac4C/JunB facilitates TNBC malignant progression and immunosuppression by driving glycolysis addiction
Authors: Li Guozheng , Ma Xin , Sui Shiyao , Chen Yihai , Li Hui , Liu Lei , Zhang Xin , Zhang Lei , Hao Yi , Yang Zihan , Yang Shuai , He Xu , Wang Qin , Tao Weiyang , Xu Shouping
Published: October 2024

Background

N4-Acetylcytidine (ac4C), a highly conserved post-transcriptional mechanism, plays a pivotal role in RNA modification and tumor progression. However, the molecular mechanism by which ac4C modification mediates tumor immunosuppression remains elusive in triple-negative breast cancer (TNBC).

Methods

NAT10 expression was analyzed in TNBC samples in the level of mRNA and protein, and compared with the corresponding normal tissues. ac4C modification levels also measured in the TNBC samples. The effects of NAT10 on immune microenvironment and tumor metabolism were investigated. NAT10-mediated ac4C and its downstream regulatory mechanisms were determined in vitro and in vivo. The combination therapy of targeting NAT10 in TNBC was further explored.

Results

The results revealed that the loss of NAT10 inhibited TNBC development and promoted T cell activation. Mechanistically, NAT10 upregulated JunB expression by increasing ac4C modification levels on its mRNA. Moreover, JunB further up-regulated LDHA expression and facilitated glycolysis. By deeply digging, remodelin, a NAT10 inhibitor, elevated the surface expression of CTLA-4 on T cells. The combination of remodelin and CTLA-4 mAb can further activate T cells and inhibite tumor progression.

Conclusion

Taken together, our study demonstrated that the NAT10-ac4C-JunB-LDHA pathway increases glycolysis levels and creates an immunosuppressive tumor microenvironment (TME). Consequently, targeting this pathway may assist in the identification of novel therapeutic strategies to improve the efficacy of cancer immunotherapy.
Negotiating pricing and payment terms for insurance covered mHealth apps: a qualitative content analysis and taxonomy development based on a German experience
Authors: Freitag Bettina , Fehring Leonard , Uncovska Marie , Olsacher Alexandra , Meister Sven
Published: October 2024

Background

Germany was the first country worldwide to offer mobile digital health applications (mHealth apps, “DiGA”) on prescription with full cost coverage by statutory health insurances. Especially statutory health insurances criticize the current pricing and payment regulations in Germany due to “free and non-transparent” pricing in the first year and lack of cost use evidence. The study consists of two parts: The first part evaluates interests of digital health application providers and statutory health insurances in Germany to identify overlaps and divergences of interests. The second part includes the development of a comprehensive pricing and payment taxonomy for reimbursable mHealth apps in general.

Methods

Both parts of the study used the input from 16 expert interviews with representatives of digital health application providers and statutory health insurances in Germany. In part one the authors conducted a qualitative content analysis and in part two they followed the taxonomy development process according to Nickerson et al. (2013).

Results

A value based care model is expected to bring the greatest benefit for patients while statutory health insurances welcome the idea of usage based pricing. The final pricing and payment taxonomy consists of four design and negotiation steps (price finding, payment prerequisites, payment modalities, composition of negotiation board).

Conclusions

As healthcare resources are scarce and thus need to be optimally allocated, it is important to implement pricing and payment terms for reimbursable mHealth apps that result in the greatest benefit for patients. To the best of the authors’ knowledge, there has been no structured study yet that examines alternative pricing strategies for reimbursable mHealth apps.The developed pricing and payment taxonomy for reimbursable mHealth apps serves as planning and decision basis for developers, health policy makers and payers internationally.
Reasons for not seeking alcohol treatment among a sample of Florida adults with HIV who perceived the need for treatment
Authors: Parisi Christina E. , Siuluta Nanyangwe D. , Canidate Shantrel S. , Cook Robert L. , Wang Yan , Widmeyer Maya , Somboonwit Charurut , Dévieux Jessy G. , Chichetto Natalie
Published: October 2024

Background

A minority of people who need alcohol treatment receive it. Unhealthy alcohol use is common among people with HIV (PWH) and can lead to negative health outcomes. The aims of this multi-methods study are to (1) quantitatively describe the prevalence, psychosocial characteristics, and demographic traits of a sample of PWH currently receiving HIV care in Florida who had a self-reported need for alcohol treatment but did not seek care and (2) qualitatively explore reasons why PWH did not seek treatment.

Methods

PWH enrolled in the Florida Cohort Study between October 2020 and February 2023 who had drinking history (N = 487) completed a cross-sectional survey that asked if there was a time when they recognized they needed help for their drinking but did not seek it. If yes, they were asked an open-ended follow-up question about reasons why they did not seek care. Demographic and behavioral differences between those who did and did not endorse a time when they needed alcohol treatment were determined using multivariable logistic regression, while qualitative data were analyzed with thematic analysis based in the Social-Ecological Model to assess reasons for not seeking care at the individual, social, and systems levels.

Results

A quarter of PWH (n = 129) with lifetime drinking indicated a time they needed care but did not seek it. Patients who endorsed a time where they perceived the need for treatment but did not seek it were more likely to endorse current at-risk drinking and a history of ever trying to reduce their drinking or formally seek professional alcohol treatment. The most common reasons participants did not seek care were individual level factors and included shame, denial, fear, wanting to do it on their own, not feeling ready, and not wanting to seek care.

Conclusions

PWH experienced barriers largely at the individual level that prevented them from seeking alcohol treatment despite a recognized need, though many eventually sought care. Providers and public health professionals should consider helping to address various barriers, particularly internal barriers, when designing interventions to help PWH seek care.
The impact of preoperative stroke on 1-year mortality and days at home alive after major surgery: an observational cohort study
Authors: Widaeus Matilda , Cedermark Alva , Bell Max
Published: October 2024

Objective

The lifetime risk of stroke is one in four people. As the population aged over 60 constantly expands, the impact of stroke on perioperative care is of increasing concern. This study investigates the effect of preoperative stroke on short- and long-term outcomes, hypothesizing that it decreases both 1-year mortality and days alive and at home up to 30 days after surgery (DAH30).

Methods

This cohort study investigated 290,306 adult patients with (7214) and without (283,092) preoperative stroke undergoing major non-cardiovascular, non-ambulatory surgery at 23 hospitals in Sweden between 2007 and 2014. Data were pre- and postoperatively matched with quality registers. Using logistic regression, significant independent risk factors influencing the risk of 1-year mortality and impeded DAH30 were identified with adjusted odds ratios calculated.

Results

Preoperative stroke was associated with higher 1-year mortality and lower DAH30, even after full adjustment for other co-morbid and surgical factors.

Conclusions

This large cohort showed preoperative stroke to impact both the patient-centered short-term outcome DAH30 and 1-year mortality. These findings should be considered in perioperative planning.
AXL as immune regulator and therapeutic target in Acute Myeloid Leukemia: from current progress to novel strategies
Authors: Vandewalle Niels , De Beule Nathan , De Becker Ann , De Bruyne Elke , Menu Eline , Vanderkerken Karin , Breckpot Karine , Devoogdt Nick , De Veirman Kim
Published: October 2024

Until recently, treatment options for patients diagnosed with Acute Myeloid Leukemia (AML) were limited and predominantly relied on various combinations, dosages, or schedules of traditional chemotherapeutic agents. Patients with advanced age, relapsed/refractory disease or comorbidities were often left without effective treatment options. Novel advances in the understanding of leukemogenesis at the molecular and genetic levels, alongside recent progress in drug development, have resulted in the emergence of novel therapeutic agents and strategies for AML patients. Among these innovations, the receptor tyrosine kinase AXL has been established as a promising therapeutic target for AML. AXL is a key regulator of several cellular functions, including epithelial-to-mesenchymal transition in tumor cells, immune regulation, apoptosis, angiogenesis and the development of chemoresistance. Clinical studies of AXL inhibitors, as single agents and in combination therapy, have demonstrated promising efficacy in treating AML. Additionally, novel AXL-targeted therapies, such as AXL-specific antibodies or antibody fragments, present potential solutions to overcome the limitations associated with traditional small-molecule AXL inhibitors or multikinase inhibitors. This review provides a comprehensive overview of the structure and biological functions of AXL under normal physiological conditions, including its role in immune regulation. We also summarize AXL’s involvement in cancer, with a specific emphasis on its role in the pathogenesis of AML, its contribution to immune evasion and drug resistance. Moreover, we discuss the AXL inhibitors currently undergoing (pre)clinical evaluation for the treatment of AML.