bluuebunny/crossref_metadata_2025 huggingface dataset:
Renal Autotransplantation for Uncontrolled Hypertension in Nonatherosclerotic Renal Artery Stenosis—2 Case Reports and a Brief Review of the Literature
Authors: Goodman James , Kulkarni Spoorthy , Selvarajah Viknesh , Hilliard Nicholas , Russell Neil , Wilkinson Ian B.
Published: March 2024

Fibromuscular dysplasia is the most common cause of renovascular hypertension in young adults under 40 years old. It is potentially amenable to renal artery angioplasty, which frequently normalizes blood pressure. However, limited options exist if angioplasty is not technically possible, or restenosis occurs. Here, we describe 2 patients who presented with hypertension secondary to renal artery stenosis. In the first case, a young adult with hypertension secondary to renal artery stenosis (fibromuscular dysplasia), developed restenosis 11 weeks after an initially successful renal artery angioplasty. In the second case, a patient with neurofibromatosis type 1 was diagnosed with hypertension secondary to renal artery stenosis. Angioplasty was not possible due to multiple branch occlusions. Both individuals went on to have successful renal autotransplantations, which ultimately cured their hypertension. In this article, we review the background, indications, and blood pressure outcomes in relation to renal autotransplantation in nonatherosclerotic renal artery stenosis.
Treatment of Sleep Apnea and Reduction in Blood Pressure: The Role of Heart Rate Response and Hypoxic Burden
Authors: Messineo Ludovico , Sands Scott A. , Schmickl Christopher , Labarca Gonzalo , Hu Wen-Hsin , Esmaeili Neda , Vena Daniel , Gell Laura , Calianese Nicole , Malhotra Atul , Gottlieb Daniel J. , Wellman Andrew , Redline Susan , Azarbarzin Ali
Published: March 2024

BACKGROUND:

Obstructive sleep apnea is associated with increased blood pressure (BP). Obstructive sleep apnea treatment reduces BP with substantial variability, not explained by the apnea-hypopnea index, partly due to inadequate characterization of obstructive sleep apnea’s physiological consequences, such as oxygen desaturation, cardiac autonomic response, and suboptimal treatment efficacy. We sought to examine whether a high baseline heart rate response (ΔHR), a marker of high cardiovascular risk in obstructive sleep apnea, predicts a larger reduction in post-treatment systolic BP (SBP). Furthermore, we aimed to assess the extent to which a reduction in SBP is explained by a treatment-related reduction in hypoxic burden (HB).

METHODS:

ΔHR and HB were measured from pretreatment and posttreatment polygraphy, followed by a 24-hour BP assessment in 168 participants treated with continuous positive airway pressure or nocturnal supplemental oxygen from the HeartBEAT study (Heart Biomarker Evaluation in Apnea Treatment). Multiple linear regression models assessed whether high versus mid (reference) ΔHR predicted a larger reduction in SBP (primary outcome) and whether there was an association between treatment-related reductions in SBP and HB.

RESULTS:

A high versus mid ΔHR predicted improvement in SBP (adjusted estimate, 5.8 [95% CI, 1.0–10.5] mm Hg). Independently, a greater treatment-related reduction in HB was significantly associated with larger reductions in SBP (4.2 [95% CI, 0.9–7.5] mm Hg per 2 SD treatment-related reduction in HB). Participants with substantial versus minimal treatment-related reductions in HB had a 6.5 (95% CI, 2.5–10.4) mm Hg drop in SBP.

CONCLUSIONS:

A high ΔHR predicted a more favorable BP response to therapy. Furthermore, the magnitude of the reduction in BP was partly explained by a greater reduction in HB.
Prognostic Relevance of Short-Term Blood Pressure Variability. The Spanish ABPM Registry
Authors: de la Sierra Alejandro , Williams Bryan , Bursztyn Michael , Parati Gianfranco , Stergiou George S. , Vinyoles Ernest , Segura Julián , Gorostidi Manuel , Ruilope Luis M.
Published: March 2024

BACKGROUND:

The prognostic relevance of short-term blood pressure (BP) variability in hypertension is not clearly established. We aimed to evaluate the association of short-term BP variability, with all-cause and cardiovascular mortality in a large cohort of patients with hypertension.

METHODS:

We selected 59 124 patients from the Spanish Ambulatory Blood Pressure Monitoring Registry from 2004 to 2014 (median follow-up: 9.7 years). Systolic and diastolic BP SD and coefficient of variation from daytime and nighttime, weighted SD, weighted coefficient of variation, average real variability (mean of differences between consecutive readings), and BP variability ratio (ratio between systolic and diastolic 24-hour SD) were calculated through baseline 24-hour ambulatory BP monitoring. Association with all-cause and cardiovascular mortality were assessed by Cox regression models adjusted for clinical confounders and BP.

RESULTS:

Patients who died during follow-up had higher values of BP variability compared with those remaining alive. In adjusted models systolic and diastolic daytime and weighted SD and coefficient of variation, average real variability, as well as systolic nighttime SD and BP variability ratio were all significantly associated with all-cause and cardiovascular mortality. Hazard ratios for 1-SD increase in the systolic components ranged from 1.05 to 1.12 for all-cause mortality and from 1.07 to 1.17 for cardiovascular mortality. A daytime SD≥13 mm Hg, a nighttime and a weighted SD≥12 mm Hg, and an average real variability ≥10 mm Hg, all systolic, were independently associated with mortality.

CONCLUSIONS:

Short-term blood pressure variability shows a relatively weak but significant association with all-cause and cardiovascular mortality in patients with hypertension.
The Perennial Solidarity of the East
Authors: Gori Olesen Mattias
Published: March 2024

While the intertwinement of Indian anti-colonial politics and Theosophy is well-known, the entanglement of esotericism and anti-colonial endeavors in the modern Arab world remains understudied. The article contributes to this area of research by demonstrating how certain strands of “Western” and “Eastern” esotericisms found resonance among early twentieth-century Arab intelligentsia and provided a useful global ideational backdrop for anti-colonial politics. Focusing on “Easternist” Egyptian intellectuals and their engagement with the French esotericist René Guénon, Theosophy, Sufism and Vedanta, the article shows how these esotericisms—and René Guénon’s in particular—provided valuable ammunition to the anti-colonial Easternist construction of a perennially united East. In doing so, the article proposes to nuance the existing interpretation of Guénon (living in Cairo from 1930) as “on the margins” of the Egyptian scene and, on a general level, to reevaluate the position of global esotericism in modern Arab thought.
A splinter of charred oleaceous wood from late early Eocene volcanoclastic deposits of Germany
Authors: Haag Volker , Wilde Volker
Published: March 2024

A splinter of charred wood was recovered from late Early Eocene volcanoclastic deposits underlying the lacustrine succession of the Messel-pit near Darmstadt (Hesse, Germany). Well-preserved anatomical details due to charring allow for an attribution of the splinter to the Oleaceae family. Within Oleaceae, the wood shows good agreement with the anatomical structure of recent members of the genera Olea, Chionanthus and Noronhia. However, due to the high variability of structural features within this group of genera, a reliable taxonomic placement is restricted to the monophyletic drupaceous subtribe Oleinae. The Splinter was cut loose from a tree of the local vegetation and charred by effects of the respective phreatomagmatic eruption, even under a low-fire regime. The specimen represents a rare example of a Pre-Quarternary wood that can be related directly to a radiometric age of 48.27–48.11 Ma (±0.22 Ma).
Routine Climate Monitoring in the State of Hawai‘i: Establishment of State Climate Divisions
Authors: Luo Xiao , Frazier Abby G. , Diaz Henry F. , Longman Ryan , Giambelluca Thomas W.
Published: March 2024

The Hawaiian Islands have some of the most spatially diverse rainfall patterns on Earth, affected by prevailing trade winds, midlatitude disturbances, tropical cyclones, and complex island topography. However, it is the only state in the United States that does not have assigned climate divisions (boundaries defining climatically homogeneous areas), which excludes it from many national climate analyses. This study establishes, for the first time, official climate divisions for the state of Hawai‘i using cluster analysis applied to monthly gridded rainfall data from 1990 to 2019. Twelve climate divisions have been identified: two divisions were found each for the islands of Kaua‘i (Leeward Kaua‘i and Windward Kaua‘i), O‘ahu (Waianae and Ko‘olau), and Maui County (Leeward Maui Nui and Windward Maui Nui), and six divisions were identified for Hawai‘i Island (Leeward Kohala, Windward Kohala, Kona, Hawai‘i Mauka, Ka‘u, and Hilo). The climate divisions were validated using a statewide area-weighted division-average rainfall index which successfully captured the annual cycle and interannual rainfall variations in the statewide average rainfall series. Distinct rainfall seasonality features and interannual/decadal variability are found among the different divisions; Leeward Maui Nui, Leeward Kaua‘i, Kona, and Hawai‘i Mauka displayed the most significant rainfall seasonality. The western Hawai‘i Island divisions show the most significant long-term decreasing trends in annual rainfall during the past 100 years (ranging from −2.5% to −5.0% per decade). With these climate divisions now available, Hawai‘i will have access to numerous operational climate analyses that will greatly improve climatic research, monitoring, education, and outreach, as well as forecasting applications.
Effect of Age and Body Mass Index on Time to Advanced Imaging and Surgery in Young Athletes With Anterior Cruciate Ligament Injury
Authors: Sliepka Joseph M. , Gatto Jonathon , Iyer Ananth , Saper Michael , Schmale Gregory , Gee Albert , Kweon Christopher , Chin Kenneth , Hagen Mia
Published: March 2024

Background:

In young athletes with anterior cruciate ligament (ACL) injury, increased times from injury to magnetic resonance imaging (MRI) and injury to surgery can lead to the accrual of new injuries over time.

Purpose:

To determine the patient characteristics associated with differences in timing between injury, MRI, and surgery in young athletes with ACL tears.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

We reviewed the electronic medical records of patients aged 13 to 25 years who underwent isolated primary ACL reconstruction between January 2017 and June 2020 at a single orthopaedic surgery department. The times from injury to MRI, MRI to surgery, and injury to surgery were documented. Patient demographic data (age, sex, body mass index [BMI], race and ethnicity, and insurance type) were recorded. Multivariable analysis was used to determine if any patient characteristic had a significant association with increased time to MRI or surgery.

Results:

A total of 369 patients (mean age, 18.0 years; 56% female) were included. Both age and BMI were found to be significantly associated with timing of care while holding all other predictors constant. For every 1-year increase in patient age, time from injury to MRI increased by 9.6 days (95% CI, 1.8-17.4 days; P = .02), time from MRI to surgery increased by 7.4 days (95% CI, 4.4-10.5 days; P < .001), and time from injury to surgery increased by 17.0 days (95% CI, 8.4-25.6 days; P < .001). Compared with patients with normal BMI, overweight patients (BMI range, 25-29.9 kg/m2) had an MRI-to-surgery time that was on average 37.2 days (95% CI, 11.7-62.7 days; P < .004) longer and an injury to surgery time that was on average 71.8 days (95% CI, 0.5-143.0 days; P = .048) longer. Obese patients (BMI ≥30 kg/m2) did not demonstrate a significant relationship with the studied time intervals.

Conclusion:

Increasing age and elevated BMI were found to be associated with increased time to MRI and surgical care in young athletes with ACL injuries.
Primary renal leiomyosarcoma in adult patients: a systematic review and individual patient data analysis
Authors: Periasamy Kannan , Dey Treshita , Goyal Shikha , Madan Renu , Kumar Santosh , Devana Sudheer Kumar , Elumalai Thiraviyam , Giridhar Prashanth , Ghoshal Sushmita , Kapoor Rakesh , Das Chandan K.
Published: March 2024

Purpose

The optimal management of primary renal leiomyosarcomas is unknown owing to its rarity and minimal available information about their primary, adjuvant treatment and clinical outcomes. This study systematically reviews treatment evidence and effects in terms of survival for leiomyosarcomas arising primarily from kidney, renal pelvis and renal vessels.

Method

PubMed and Embase databases were searched from inception to March 2023, with manual searches of reference lists. Two investigators independently reviewed the studies reporting management and survival outcomes of renal leiomyosarcomas.

Results

A total of 85 publications met inclusion criteria, reporting on 188 cases. The median age was 55.5 years, predominantly female [52.7%]. Pain was the most common presenting symptom [41.5%], and most tumors were high grade [45.8%]. Complete surgical resection with negative margins forms definitive treatment. The median disease-free survival and overall survival (OS) for all reviewed patients were 24 months [95%CI 4.1–43.9] and 42 months [95%CI 32.5–51.4], respectively. The OS of 1 year, 2 year, 3 year and 5 year was 78.8%, 64.4%, 53.8% and 38.9%, respectively. On univariate analysis, favorable factors for OS included tumor size ≤ 5 cm, low-grade histology, tumors of renal vascular origin and non-metastatic disease at presentation. Neoadjuvant or adjuvant treatment with either radiotherapy or chemotherapy has been shown to improve OS (NR vs. 36 months, p < 0.001), especially for high-grade tumors > 5 cm in size.

Conclusion

Radical nephrectomy with en bloc tumor resection with negative margins forms the mainstay of treatment for renal leiomyosarcomas. Adjuvant radiotherapy or chemotherapy appears to improve OS. To validate this treatment strategy, prospective multicentric efforts are required to acquire reliable data from randomized trials.
Deciphering the possible role of RNA-helicase genes mechanism in response to abiotic stresses in rapeseed (Brassica napus L.)
Authors: Fatahi Bahareh , Sorkheh Karim , Sofo Adriano
Published: March 2024

Background

Plants mediate several defense mechanisms to withstand abiotic stresses. Several gene families respond to stress as well as multiple transcription factors to minimize abiotic stresses without minimizing their effects on performance potential. RNA helicase (RH) is one of the foremost critical gene families that can play an influential role in tolerating abiotic stresses in plants. However, little knowledge is present about this protein family in rapeseed (canola). Here, we performed a comprehensive survey analysis of the RH protein family in rapeseed (Brassica napus L.).

Results

A total of 133 BnRHs genes have been discovered in this study. By phylogenetic analysis, RHs genes were divided into one main group and a subgroup. Examination of the chromosomal position of the identified genes showed that most of the genes (27%) were located on chromosome 3. All 133 identified sequences contained the main DEXDC domain, the HELICC domain, and a number of sub-domains. The results of biological process studies showed that about 17% of the proteins acted as RHs, 22% as ATP binding, and 14% as mRNA binding. Each part of the conserved motifs, communication network, and three-dimensional structure of the proteins were examined separately. The results showed that the RWC in leaf tissue decreased with higher levels of drought stress and in both root and leaf tissues sodium concentration was increased upon increased levels of salt stress treatments. The proline content were found to be increased in leaf and root with the increased level of stress treatment. Finally, the expression patterns of eight selected RHs genes that have been exposed to drought, salinity, cold, heat and cadmium stresses were investigated by qPCR. The results showed the effect of genes under stress. Examination of gene expression in the Hayola #4815 cultivar showed that all primers except primer #79 had less expression in both leaves and roots than the control level.

Conclusions

New finding from the study have been presented new insights for better understanding the function and possible mechanism of RH in response to abiotic stress in rapeseed.
Promoting meaningful activities by occupational therapy in elderly care in Belgium: the ProMOTE intervention
Authors: De Coninck Leen , Declercq Anja , Bouckaert Leen , Döpp Carola , Graff Maud J.L. , Aertgeerts Bert
Published: March 2024

Background

Older people want to age in place. Despite advancing functional limitations and their desire of aging in place, they are not always faithful to therapy that maintains independence and promotes safety. Occupational therapists can facilitate aging in place. Occupational therapy is defined as the therapeutic use of everyday life occupations with persons, groups, or populations for the purpose of enhancing or enabling participation.

Aim

To describe the content a high-adherence-to-therapy and evidence-based occupational therapy intervention to optimize functional performance and social participation of home-based physically frail older adults and wellbeing of their informal caregiver, and the research activities undertaken to design this intervention.

Methods

A roadmap was created to develop the occupational therapy intervention. This roadmap is based on the Medical Research Council (MRC) framework and is supplemented with elements of the Intervention Mapping approach. The TIDieR checklist is applied to describe the intervention in detail. A systematic review and two qualitative studies substantiated the content of the intervention scientifically.

Results

The application of the first two phases of the MRC framework resulted in the ProMOTE intervention (Promoting Meaningful activities by Occupational Therapy in Elderly). The ProMOTE intervention is a high-adherence-to-therapy occupational therapy intervention that consists of six steps and describes in detail the evidence-based components that are required to obtain an operational intervention for occupational therapy practice.

Conclusion

This study transparently reflects on the process of a high-quality occupational therapy intervention to optimize the functional performance and social participation of the home-based physically frail older adult and describes the ProMOTE intervention in detail. The ProMOTE intervention contributes to safely aging in place and to maintaining social participation. The designed intervention goes beyond a description of the ‘what’. The added value lies in the interweaving of the ‘why’ and ‘how’. By describing the ‘how’, our study makes the concept of ‘therapeutic use-of-self’ operational throughout the six steps of the occupational therapy intervention. A further rigorous study of the effect of the ProMOTE intervention on adherence, functional performance and social participation is recommended based to facilitate the implementation of this intervention on a national level in Belgium.
The role of supervision and motivation during exercise on physical and mental health in older adults: a study protocol for a randomized controlled trial (PRO-Training project)
Authors: Gómez-Redondo Paola , Valenzuela Pedro L. , Martínez-de-Quel Óscar , Sánchez-Martín Coral , Cerezo-Arroyo Mónica , Moreno-Manzanaro David , Alegre Luis M. , Guadalupe-Grau Amelia , Ara Ignacio , Mañas Asier
Published: March 2024

Background

Although supervised exercise is frequently recommended for older adults, its superiority over unsupervised exercise remains uncertain. Furthermore, whether motivational techniques could help to enhance the effectiveness of the latter remains to be elucidated. The present randomized controlled trial aims to determine the role of supervision and motivational strategies on the safety, adherence, efficacy, and cost-effectiveness of different exercise programs for improving physical and mental health in older adults.

Methods

Participants (n = 120, aged 60–75 years) will be randomly allocated into five groups: 1-Control (CON), 2-Supervised exercise without motivational intervention (SUP), 3- Supervised exercise with motivational intervention (SUP +), 4- Unsupervised exercise without motivational intervention (UNSUP) and 5- Unsupervised exercise with motivational intervention (UNSUP +). Over 24 weeks, all exercise groups will participate in a multicomponent exercise program three times/week (performed in group classes at a center for SUP and SUP + , or home without supervision but with the help of a mobile app for UNSUP and UNSUP +), while the CON group will maintain their usual lifestyle. The motivational intervention (for SUP + and UNSUP + groups) will be based on the self-determination theory, including strategies such as phone calls, interactive workshops, motivational messages, informative infographics and videos. Primary outcomes will include safety, adherence, costs, and lower-body muscular function using a leg press machine. Secondary outcomes will include upper-body muscular function, physical and cardiorespiratory function, blood pressure and heart rate, body composition, health-related quality of life, cognitive performance, anxiety, depression, physical activity levels, sleep and sedentarism, biochemical markers, motivators and barriers to exercise. Assessments will be conducted at baseline, mid-intervention (i.e.,week 13), at the end of the intervention (i.e.,week 25), and 24 weeks later (i.e.,week 49).

Discussion

The findings of this trial might provide valuable insights into the role of supervision and motivational strategies on the effectiveness of exercise programs for older adults. Additionally, the study could contribute to developing cost-effective interventions, supporting the design of future public policies for healthy aging.

Trial registration

NCT05619250. Registered 16 November 2022.
Association between trough serum vancomycin concentration and vancomycin-associated acute kidney injury and 30-day mortality in critically ill elderly adults
Authors: Chen Jialong , Lin Jing , Weng Jianzhen , Ju Yang , Li Yanming
Published: March 2024

Background

Vancomycin-associated acute kidney injury (VA-AKI) is the most clinically relevant side effect of vancomycin. The objective of this study was to investigate the association between VTC and VA-AKI as well as 30-day mortality in critically ill elderly adults.

Method

Elderly patients with trough serum vancomycin concentration records(VTC) in the Medical Information Mart-IV (MIMIC-IV) and eICU databases were retrospectively studied.

Results

A total of 3,146 critically ill elderly adults were finally enrolled. The incidence of VA-AKI in the elderly population was 76.5%. Logistic regression analysis revealed significant relationships between VA-AKI and various factors, including VTC, comorbidities, and laboratory indicators, and SOFA, and GCS score. For each mg/L increase, the OR for VA-AKI increased by 2.5%. The association between VTC and 30-day mortality was found to be statistically significant (odds ratio (OR): 1.021, 95% CI: 1.010–1.031), P < 0.001). The Restricted cubic splines (RCS) curves revealed that VTC ranged of 19.67 to 35.72 mg/l for AKI and 19.17 to 42.86 mg/l for 30-day mortality exhibit OR with 95% CI above 1, indicating statistically significant associations with an increased risk of AKI and 30-day mortality, respectively. In the subgroup analysis, VTC was identified as a risk factor for VA-AKI in specific patient groups, including white individuals, female patients, those with shock, patients with SOFA > 6, patients with baseline creatinine > 1.2 mg/dl and patients with or without exposed to other nephrotoxic medications.

Conclusion

This study found the significant association between VTC and the incidence of VA-AKI and 30-day mortality in critically ill elderly adults. The RCS curves indicated concentration ranges for AKI (19.67–35.72 mg/L) and 30-day mortality (19.17–42.86 mg/L), signifying increased risk.
Prevalence and factors associated with hepatitis b vaccination uptake and completion among communities targeted for mass vaccination in gulu: a cross-sectional study
Authors: Kimera Andrew , Atuyambe Lynn , Mutyaba Huzaifa , Nantongo Claire , Namagembe Agnes , Nalumansi Anna Maria , Basenero Andrew , Auma Prisca , Mukiza Nelson , Mutyoba Joan
Published: March 2024

Background

Hepatitis B virus (HBV) is associated with several acute and long-term complications and vaccination is the cornerstone of prevention. A recent outbreak in Gulu, Uganda, one of the districts covered by a mass vaccination campaign, suggests low uptake of HBV vaccination. This study aims to determine the uptake and completion of HBV vaccination and associated factors among residents of Gulu, Uganda.

Methods

A mixed methods cross-sectional study was conducted in Gulu, Northern Uganda, among 434 adult residents. A pretested questionnaire was used to collect data on socio-demographics, perceptions, and knowledge of HBV vaccination. Modified Poisson regression analysis was used in STATA 14 software to obtain prevalence ratios for the association between the independent and dependent variables. For qualitative data, 9 key informant interviews were conducted and thematic analysis was done using Quirkos software.

Results

Out of the 434 respondents, 41.9% had received at least one dose of the hepatitis B vaccine, 32.5% had received at least 2 doses, and only 20% had completed all 3 doses, with an overall completion rate of 47.8% for participants who had been initiated on the vaccine. Gender, residence, risk perception of Hepatitis B infection, perceived safety of the vaccine, and awareness of mass vaccination were associated with uptake of Hepatitis B vaccination. Residence, knowledge, and perception of being at risk of acquiring Hepatitis B were associated with completion. Qualitative results revealed that the levels of uptake and completion could have been affected by access to vaccination sites; inadequate knowledge about the disease; myths about the vaccine and inadequate community engagement.

Conclusion

Low Hepatitis B vaccine uptake and completion rates were observed in Gulu. To enhance vaccination coverage, future initiatives should prioritize awareness, education, and dispelling of vaccination myths. Additionally, increased government investment in training health workers can serve as a valuable strategy to improve information dissemination and awareness among the population.
Exploring the causal relationship between immune cells and idiopathic pulmonary fibrosis: a bi-directional Mendelian randomization study
Authors: He Zhao , Wang Ruixin , Song Chenghu , Liu Jiwei , Chen Ruo , Zheng Mingfeng , Liu Weici , Jiang Guanyu , Mao Wenjun
Published: March 2024

Background

The potential pathogenic mechanism of idiopathic pulmonary fibrosis is widely recognized to involve immune dysregulation. However, the current pool of studies has yet to establish a unanimous agreement regarding the correlation between various types of immune cells and IPF.

Methods

By conducting a two-sample Mendelian randomization analysis using publicly available genetic data, the study examined the causal relationship between IPF and 731 immune cells. To ensure the reliability of the results, combined sensitivity analyses and inverse Mendelian analyses were conducted. Moreover, within subgroups, multivariate Mendelian randomization analyses were utilized to investigate the autonomous causal connection between immune cell characteristics and IPF.

Results

After adjusting for false discovery rate, it was discovered that 20 immunophenotypes exhibited a significant association with IPF. After subgrouping for multivariate Mendelian randomization analysis, there were six immunophenotypes that remained significantly associated with IPF. These included CD33 + HLA DR + CD14dim (OR = 0.96, 95% CI 0.93–0.99, P = 0.033), HLA DR + NK (OR = 0.92, 95% CI 0.85–0.98, P = 0.017), CD39 + CD8 + T cell %T cell (OR = 0.93, 95% CI 0.88–0.99, P = 0.024), CD3 on activated & secreting Treg (OR = 0.91, 95% CI 0.84–0.98, P = 0.026), PDL-1 on CD14- CD16 + monocyte (OR = 0.89, 95% CI 0.84–0.95, P = 8 × 10–4), and CD45 on CD33 + HLA DR + CD14- (OR = 1.08, 95% CI 1.01–1.15, P = 0.011).

Conclusion

Our study reveals a noteworthy association between IPF and various immune cells, providing valuable insights for clinical research and aiding the advancement of immunologically-based therapeutic strategies.
Determining the clinicopathological significance of the VI-RADS ≧4 group: a retrospective study
Authors: Ikuma Shunsuke , Akatsuka Jun , Takeda Hayato , Endo Yuki , Kiriyama Tomonari , Hamasaki Tsutomu , Kimura Go , Kondo Yukihiro
Published: March 2024

Background

The Vesical Imaging Reporting and Data System (VI-RADS) is widely used for predicting muscle-invasive bladder cancer (MIBC). This study aimed to determine the clinicopathological significance of the VI-RADS ≧4 (VI≧4) group.

Methods

Patients who underwent transurethral resections of bladder tumors during the study period and preoperative magnetic resonance imaging were considered. The patients were pathologically diagnosed with urothelial carcinoma (UC). We first compared the results of patients with VI-RADS scores of 3 and 4 to determine the cut-off score for MIBC; thereafter, the patients were divided into the VI≧4 and VI-RADS ≦3 (VI≦3) groups using VI-RADS. The clinicopathological significance of the VI≧4 group was examined retrospectively by comparing the characteristics of each group.

Results

In total, 121 cases were examined, of which 28 were pathologically diagnosed with MIBC. Of the 28 MIBC cases, three (10.7%) had a VI-RADS score of ≦3, and 25 (89.3%) had a VI-RADS score of ≧4. Of the 93 NMIBC cases, 86 (92.5%) had a VI-RADS score of ≦3, and seven (7.5%) had a VI-RADS score of ≧4. The diagnostic performance of the VI-RADS with a cut-off score of 4 was 89.3% for sensitivity, 92.5% for specificity, and an area under the curve (AUC) of 0.91. Contrastingly, for a cut-off score of 3, the sensitivity was 89.3%, specificity was 62.0%, and AUC was 0.72. A VI-RADS score of ≥ 4 could predict MIBC. In the VI≧4 group, 30 of 32 (93.8%) patients had high-grade tumors. The VI≧4 group had significantly more high-grade bladder cancers than the VI≦3 group (p < 0.001 OR = 31.77 95%CI:8.47–1119.07). In addition, the VI≧4 group had more tumor necrosis (VI≧4 vs VI≦3, p < 0.001 OR = 7.46 95%CI:2.61–21.34) and more UC variant cases (VI≧4 vs VI≦3, p = 0.034 OR = 3.28 95%CI:1.05–10.25) than the VI≦3 group.

Conclusions

This study suggests that VI-RADS has a high diagnostic performance in predicting MIBC and that VI-RADS could diagnose high-grade tumors, necrosis, and UC variants.
Immediate postpartum anemia and associated factors at shewarobit health facilities, Amhara, Ethiopia, 2022: a cross sectional study
Authors: Eshete Nigus Amime , Mittiku Yohannes Moges , Mekonnen Alemayehu Gonie , Welu Tesfay Hailu , Haile Teklehaimanot Gereziher
Published: March 2024

Background

Immediate postpartum anemia occurs when the amount of red blood cell count is reduced or hemoglobin concentration is below 10 g/dl in the immediate postpartum. It occurs primarily due to inadequate iron intake before and during pregnancy and blood loss during delivery. The aim of this study is to assess the proportion of immediate postpartum anemia and associated factors among mothers who gave birth at Shewarobit health facilities; in Amhara, Ethiopia.

Methods

Institutional-based cross-sectional study was conducted from June to September 2022. A systematic random sampling method was employed to select the study participants. The data were collected through interviewer-assisted questions. Data were entered into Epi Data software version 4.6.0.4 and exported to SPSS 21 for analysis, and descriptive statistics were computed. Logistic regression was applied, and P-values less than 0.05 were considered statistically significant.

Results

This study was conducted among 307 study participants and, the proportion of immediate postpartum anemia was 41.4% [95% CI: 36.7–46.6]. Having postpartum hemorrhage [AOR = 4.76, 95% CI: 2.44–9.28], not taking iron and folic acid supplementation [AOR = 6.19, 95% CI: 2.69, 14.22], having a prolonged second stage of labor [AOR = 2.52, 95% CI: 1.16–5.44], and mid-upper arm circumference < 23 cm [AOR = 2.02, 95% CI: 1.11–3.68] were factors significantly associated with immediate postpartum anemia.

Conclusions

The proportion of immediate postpartum anemia was public problem in Shewarobit health facilities. Following the progress of labor using a partograph, closely monitoring and immediate intervention of PPH, and prevent undernutrition during antenatal care is recommended.
Gene variants and clinical characteristics of children with sitosterolemia
Authors: Gu Rui , Wang Hui , Wang Chun-Lin , Lu Mei , Miao Miao , Huang Meng-Na , Chen Yi , Dai Yang-Li , Zhu Ming-Qiang , Zhou Qiong , Zou Chao-Chun
Published: March 2024

Objective

To enhance the detection, management and monitoring of Chinese children afflicted with sitosterolemia by examining the physical characteristics and genetic makeup of pediatric patients.

Methods

In this group, 26 children were diagnosed with sitosterolemia, 24 of whom underwent genetic analysis. Patient family medical history, physical symptoms, tests for liver function, lipid levels, standard blood tests, phytosterol levels, cardiac/carotid artery ultrasounds, fundus examinations, and treatment were collected.

Results

The majority (19, 73.1%) of the 26 patients exhibited xanthomas as the most prevalent manifestation. The second most common symptoms were joint pain (7, 26.9%) and stunted growth (4, 15.4%). Among the 24 (92.3%) patients whose genetics were analyzed, 16 (66.7%) harboredABCG5variants (type 2 sitosterolemia), and nearly one-third (8, 33.3%) harboredABCG8variants (type 1 sitosterolemia). Additionally, the most common pathogenicABCG5 variant was c.1166G > A (p.Arg389His), which was found in 10 patients (66.7%). Further analysis did not indicate any significant differences in pathological traits among those carryingABCG5 andABCG8 variations (P > 0.05). Interestingly, there was a greater abundance of nonsense variations inABCG5 than inABCG8 (P = 0.09), and a greater frequency of splicing variations inABCG8 thanABCG5 (P = 0.01). Following a change in diet or a combination of ezetimibe, the levels of cholesterol and low-density lipoprotein were markedly decreased compared to the levels reported before treatment.

Conclusion

Sitosterolemia should be considered for individuals presenting with xanthomas and increased cholesterol levels. Phytosterol testing and genetic analysis are important for early detection. Managing one’s diet and taking ezetimibe can well control blood lipids.
Automatic IMRT treatment planning through fluence prediction and plan fine-tuning for nasopharyngeal carcinoma
Authors: Cai Wenwen , Ding Shouliang , Li Huali , Zhou Xuanru , Dou Wen , Zhou Linghong , Song Ting , Li Yongbao
Published: March 2024

Background

At present, the implementation of intensity-modulated radiation therapy (IMRT) treatment planning for geometrically complex nasopharyngeal carcinoma (NPC) through manual trial-and-error fashion presents challenges to the improvement of planning efficiency and the obtaining of high-consistency plan quality. This paper aims to propose an automatic IMRT plan generation method through fluence prediction and further plan fine-tuning for patients with NPC and evaluates the planning efficiency and plan quality.

Methods

A total of 38 patients with NPC treated with nine-beam IMRT were enrolled in this study and automatically re-planned with the proposed method. A trained deep learning model was employed to generate static field fluence maps for each patient with 3D computed tomography images and structure contours as input. Automatic IMRT treatment planning was achieved by using its generated dose with slight tightening for further plan fine-tuning. Lastly, the plan quality was compared between automatic plans and clinical plans.

Results

The average time for automatic plan generation was less than 4 min, including fluence maps prediction with a python script and automated plan tuning with a C# script. Compared with clinical plans, automatic plans showed better conformity and homogeneity for planning target volumes (PTVs) except for the conformity of PTV-1. Meanwhile, the dosimetric metrics for most organs at risk (OARs) were ameliorated in the automatic plan, especially Dmax of the brainstem and spinal cord, and Dmean of the left and right parotid glands significantly decreased (P < 0.05).

Conclusion

We have successfully implemented an automatic IMRT plan generation method for patients with NPC. This method shows high planning efficiency and comparable or superior plan quality than clinical plans. The qualitative results before and after the plan fine-tuning indicates that further optimization using dose objectives generated by predicted fluence maps is crucial to obtain high-quality automatic plans.
Ethnic variations in metabolic syndrome components and their associations with the gut microbiota: the HELIUS study
Authors: Balvers Manon , de Goffau Marcus , van Riel Natal , van den Born Bert-Jan , Galenkamp Henrike , Zwinderman Koos , Nieuwdorp Max , Levin Evgeni
Published: March 2024

Background

The occurrence of metabolic syndrome (MetS) and the gut microbiota composition are known to differ across ethnicities yet how these three factors are interwoven is unknown. Also, it is unknown what the relative contribution of the gut microbiota composition is to each MetS component and whether this differs between ethnicities. We therefore determined the occurrence of MetS and its components in the multi-ethnic HELIUS cohort and tested the overall and ethnic-specific associations with the gut microbiota composition.

Methods

We included 16,209 treatment naïve participants of the HELIUS study, which were of Dutch, African Surinamese, South-Asian Surinamese, Ghanaian, Turkish, and Moroccan descent to analyze MetS and its components across ethnicities. In a subset (n = 3443), the gut microbiota composition (16S) was associated with MetS outcomes using linear and logistic regression models.

Results

A differential, often sex-dependent, prevalence of MetS components and their combinations were observed across ethnicities. Increased blood pressure was commonly seen especially in Ghanaians, while South-Asian Surinamese and Turkish had higher MetS rates in general and were characterized by worse lipid-related measures. Regarding the gut microbiota, when ethnic-independent associations were assumed, a higher α-diversity, higher abundance of several ASVs (mostly for waist and triglyceride-related outcomes) and a trophic network of ASVs ofRuminococcaceae,Christensenellaceae, andMethanobrevibacter(RCM) bacteria were associated with better MetS outcomes. Statistically significant ethnic-specific associations were however noticed for α-diversity and the RCM trophic network. Associations were significant in the Dutch but not always in all other ethnicities. In Ghanaians, a higher α-diversity and RCM network abundance showed an aberrant positive association with high blood pressure measures compared to the other ethnicities. Even though adjustment for socioeconomic status-, lifestyle-, and diet-related variables often attenuated the effect size and/or the statistical significance of the ethnic-specific associations, an overall similar pattern across outcomes and ethnicities remained.

Conclusions

The occurrence of MetS characteristics among ethnicities is heterogeneous. Both ethnic-independent and ethnic-specific associations were identified between the gut microbiota and MetS outcomes. Across multiple ethnicities, a one-size-fits-all approach may thus be reconsidered in regard to both the definition and/or treatment of MetS and its relation to the gut microbiota.
An integrated SDN framework for early detection of DDoS attacks in cloud computing
Authors: Songa Asha Varma , Karri Ganesh Reddy
Published: March 2024

Cloud computing is a rapidly advancing technology with numerous benefits, such as increased availability, scalability, and flexibility. Relocating computing infrastructure to a network simplifies hardware and software resource monitoring in the cloud. Software-Defined Networking (SDN)-based cloud networking improves cloud infrastructure efficiency by dynamically allocating and utilizing network resources. While SDN cloud networks offer numerous advantages, they are vulnerable to Distributed Denial-of-Service (DDoS) attacks. DDoS attacks try to stop genuine users from using services and drain network resources to reduce performance or shut down services. However, early-stage detection of DDoS attack patterns in cloud environments remains challenging. Current methods detect DDoS at the SDN controller level, which is often time-consuming. We recommend focusing on SDN switches for early detection. Due to the large volume of data from diverse sources, we recommend traffic clustering and traffic anomalies prediction which is of DDoS attacks at each switch. Furthermore, to consolidate the data from multiple clusters, event correlation is performed to understand network behavior and detect coordinated attack activities. Many existing techniques stay behind for early detection and integration of multiple techniques to detect DDoS attack patterns. In this paper, we introduce a more efficient and effectively integrated SDN framework that addresses a gap in previous DDoS solutions. Our framework enables early and accurate detection of DDoS traffic patterns within SDN-based cloud environments. In this framework, we use Recursive Feature Elimination (RFE), Density Based Spatial Clustering (DBSCAN), time series techniques like Auto Regressive Integrated Moving Average (ARIMA), Lyapunov exponent, exponential smoothing filter, dynamic threshold, and lastly, Rule-based classifier. We have evaluated the proposed RDAER model on the CICDDoS 2019 dataset, that achieved an accuracy level of 99.92% and a fast detection time of 20 s, outperforming existing methods.
Antibiotic exposure during pregnancy increases risk for childhood atopic diseases: a nationwide cohort study
Authors: Tai Sheng-Kang , Lin Yi-Hsuan , Lin Ching-Heng , Lin Ming-Chih
Published: March 2024

Purpose

The prevalence of atopic diseases has increased in recent decades. A possible link between antibiotic use during pregnancy and childhood atopic disease has been proposed. The aim of this study is to explore the association of antibiotic exposure during pregnancy with childhood atopic diseases from a nationwide, population-based perspective.

Methods

This was a nationwide population-based cohort study. Taiwan’s National Health Insurance Research Database was the main source of data. The pairing of mothers and children was achieved by linking the NHIRD with the Taiwan Maternal and Child Health Database. This study enrolled the first-time pregnancies from 2004 to 2010. Infants of multiple delivery, preterm delivery, and death before 5 years old were excluded. All participants were followed up at least for 5 years. Antenatal antibiotics prescribed to mothers during the pregnancy period were reviewed. Children with more than two outpatient visits, or one admission, with a main diagnosis of asthma, allergic rhinitis, or atopic dermatitis were regarded as having an atopic disease.

Results

A total of 900,584 children were enrolled in this study. The adjusted hazard ratios of antibiotic exposure during pregnancy to childhood atopic diseases were 1.12 for atopic dermatitis, 1.06 for asthma, and 1.08 for allergic rhinitis, all of which reached statistical significance. The trimester effect was not significant. There was a trend showing the higher the number of times a child was prenatally exposed to antibiotics, the higher the hazard ratio was for childhood atopic diseases.

Conclusions

Prenatal antibiotic exposure might increase the risk of childhood atopic diseases in a dose-dependent manner.
β1 integrins play a critical role maintaining vascular integrity in the hypoxic spinal cord, particularly in white matter
Authors: Halder Sebok K. , Sapkota Arjun , Milner Richard
Published: March 2024

Interactions between extracellular matrix (ECM) proteins and β1 integrins play an essential role maintaining vascular integrity in the brain, particularly under vascular remodeling conditions. As blood vessels in the spinal cord are reported to have distinct properties from those in the brain, here we examined the impact of β1 integrin inhibition on spinal cord vascular integrity, both under normoxic conditions, when blood vessels are stable, and during exposure to chronic mild hypoxia (CMH), when extensive vascular remodeling occurs. We found that a function-blocking β1 integrin antibody triggered a small degree of vascular disruption in the spinal cord under normoxic conditions, but under hypoxic conditions, it greatly enhanced (20-fold) vascular disruption, preferentially in spinal cord white matter (WM). This resulted in elevated microglial activation as well as marked loss of myelin integrity and reduced density of oligodendroglial cells. To understand why vascular breakdown is localized to WM, we compared expression levels of major BBB components of WM and grey matter (GM) blood vessels, but this revealed no obvious differences. Interestingly however, hypoxyprobe staining demonstrated that the most severe levels of spinal cord hypoxia induced by CMH occurred in the WM. Analysis of brain tissue revealed a similar preferential vulnerability of WM tracts to show vascular disruption under these conditions. Taken together, these findings demonstrate an essential role for β1 integrins in maintaining vascular integrity in the spinal cord, and unexpectedly, reveal a novel and fundamental difference between WM and GM blood vessels in their dependence on β1 integrin function during hypoxic exposure. Our data support the concept that the preferential WM vulnerability described may be less a result of intrinsic differences in vascular barrier properties between WM and GM, and more a consequence of differences in vascular density and architecture.
Navigating uncertain waters: 12 tips for medical department social media engagement under shifting platform landscapes
Authors: Van Roy Zachary , Cawcutt Kelly A. , Marcelin Jasmine R.
Published: March 2024

Social media has revolutionized how society receives and transmits information in the digital age, including healthcare. While the future of social media platforms remains uncertain, the benefits of social media for healthcare organizations, departments, and divisions are clear when compared to traditional communication methods, including improved recruitment efforts, increased promotion of faculty work, rapid dissemination of information and education innovations, and accelerated professional networking. Consequently, preferred platforms may shift but the benefits of social media likely cement it, in one form or another, in medical education and society at large. The strategic development of a social media presence at the department level can be opaque and overwhelming amidst varying mediums, yet the benefits of use have never been more important. Here, we present 12 tips for developing a successful social media presence as a healthcare department, addressing the creation of a purposeful social media strategy and crucial considerations for any platform, current or future, at all levels of development.