bluuebunny/crossref_metadata_2025 huggingface dataset:
Increasing angiotensin-converting enzyme concentrations and absent angiotensin-converting enzyme activity are associated with adverse kidney outcomes in pediatric septic shock
Authors: Pode-Shakked Naomi , Ceschia Giovanni , Rose James E. , Goldstein Stuart L. , Stanski Natalja L. ,   the Genomics of Pediatric Septic Shock Investigators
Published: June 2023

Background

Sepsis-induced endothelial dysfunction is proposed to cause angiotensin-converting enzyme (ACE) dysfunction and renin–angiotensin–aldosterone system (RAAS) derangement, exacerbating vasodilatory shock and acute kidney injury (AKI). Few studies test this hypothesis directly, including none in children. We measured serum ACE concentrations and activity, and assessed their association with adverse kidney outcomes in pediatric septic shock.

Methods

A pilot study of 72 subjects aged 1 week–18 years from an existing multicenter, observational study. Serum ACE concentrations and activity were measured on Day 1; renin + prorenin concentrations were available from a previous study. The associations between individual RAAS components and a composite outcome (Day 1–7 severe persistent AKI, kidney replacement therapy use, or mortality) were assessed.

Results

50/72 subjects (69%) had undetectable ACE activity (< 2.41 U/L) on Day 1 and 27/72 (38%) developed the composite outcome. Subjects with undetectable ACE activity had higher Day 1 renin + prorenin compared to those with activity (4533 vs. 2227 pg/ml, p = 0.017); ACE concentrations were no different between groups. Children with the composite outcome more commonly had undetectable ACE activity (85% vs. 65%, p = 0.025), and had higher Day 1 renin + prorenin (16,774 pg/ml vs. 3037 pg/ml, p < 0.001) and ACE concentrations (149 vs. 96 pg/ml, p = 0.019). On multivariable regression, increasing ACE concentrations (aOR 1.01, 95%CI 1.002–1.03, p = 0.015) and undetectable ACE activity (aOR 6.6, 95%CI 1.2–36.1, p = 0.031) retained associations with the composite outcome.

Conclusions

ACE activity is diminished in pediatric septic shock, appears uncoupled from ACE concentrations, and is associated with adverse kidney outcomes. Further study is needed to validate these findings in larger cohorts.
Clinical effectiveness of pulsed electromagnetic field therapy as an adjunct treatment to eccentric exercise for Achilles tendinopathy: a randomised controlled trial
Authors: Ko Violet Man-Chi , He Xin , Fu Sai-Chuen , Yung Patrick Shu-Hang , Ling Samuel Ka-Kin
Published: June 2023

Background

The Achilles tendon is the largest and strongest tendon in the human body. Achilles tendinopathy (AT) is a common clinical problem with Achilles overuse. Eccentric exercise is often used as an initial treatment for these patients. Most patients with AT experienced moderate to severe pain, limiting the incentive to perform eccentric exercise. It is difficult for them to complete eccentric exercise for 3 months consecutively to obtain significant improvements. Using PEMF as an adjunct, there could be immediate pain relief and improved response to eccentric exercise by modulating the mechanical properties of the Achilles tendon. Participants may experience less pain while performing eccentric exercises to increase compliance with the rehabilitation programme.

Methods

This prospective randomised double-blinded, placebo-controlled trial aims to investigate the treatment effects of PEMF for participants with AT. All participants are randomised into two groups: the intervention group (n = 20; active PEMF treatment and eccentric exercise) and the control group (n = 20; sham treatment and eccentric exercise). Researchers perform self-reported, functional and ultrasonographic outcomes during baseline assessment, 4 weeks, 8 weeks follow-ups, and 3 and 6 months follow-ups after the commencement of the PEMF treatment.

Discussion

AT is a common clinical condition affecting athletes and sedentary populations. It is essential to investigate treatment adjuncts to improve rehabilitation outcomes for these patients. This trial may demonstrate the effectiveness of PEMF in relieving pain, improving function, and restoring mechanical changes of the tendon in participants with AT.

Trial registration

ClinicalTrials.gov NCT05316961. Registered on 7th April 2022.
Late diagnosis of congenital diaphragmatic hernia: a case report
Authors: Mwamanenge Naomi A. , Mussa Fatima , Nyamuryekung’e Masawa K. , Mkony Martha , Abdallah Yaser , Manji Karim
Published: June 2023

Background

Congenital diaphragmatic hernia beyond the neonatal period is not uncommon. Its diagnosis in infancy and early childhood poses a challenge owing to different clinical presentation ranging from gastrointestinal to respiratory symptoms. These neonates are usually misdiagnosed as having pneumonia until radiological imaging picks up the defect during routine scan for worsening respiratory symptoms. In high-income countries, the survival rate for these patients has been reported to be high, while in Sub-Saharan Africa the survival rate is still low due to delayed diagnosis, delayed referral, and hence delayed management.

Case report

We present an African male baby from non-consanguineous parents, 6 weeks old, diagnosed with congenital diaphragmatic hernia at 6 weeks of age after failure to respond to antibiotics for suspected pneumonia. Despite attempts at management, he died at 5 weeks post surgery.

Conclusion

Our case emphasizes the importance of early clinical suspicion and early detection for a differential diagnosis of congenital diaphragmatic hernia in infants who present with respiratory symptoms not responding to antibiotics or recurrent pneumonia, and improving the availability of imaging in primary care facilities to diagnose such defects early and manage them accordingly.
The effect of restrictive vs. liberal fluid protocols on ocular parameters in patients undergoing prone spine surgery: a randomized controlled trial
Authors: Yang Xiao-Yu , Wei Miao-Miao , Tan Hong , Wang Hai-Lian , Luo Meng-Qiang , Xu Ming , Wang Ying-Wei
Published: June 2023

Background

Elevated intraocular pressure (IOP) and optic nerve edema occurring during prone surgeries may cause ocular and optic nerve ischaemia injury. We hypothesized that a liberal fluid protocol might further increase IOP and optic nerve sheath diameter (ONSD) than a restrictive fluid protocol for patients in the prone position.

Methods

A single-centre, prospective and randomized trial was conducted. Patients were randomly allocated into 2 groups: the liberal fluid infusion group, in which repeated bolus doses of Ringer’s lactate solution were given to maintain pulse pressure variation (PPV) within 6~9%, and the restrictive fluid infusion group, where PPV was maintained within 13–16%. IOP and ONSD were measured in both eyes at 10min after the anaesthesia induction in the supine position, 10min after the prone position placement, and 1h and 2h since the prone position was placed, at the conclusion of surgery, and returned to the supine position.

Results

A total of 97 patients were recruited and completed the study. IOP increased significantly from 12±3mmHg in the supine position to 31±5 mmHg (p<0.001) at the end of surgery in the liberal fluid infusion group and from 12±2 to 28±4 mmHg (p<0.001) in the restrictive fluid infusion group. There was a statistically significant difference in the change of IOP over time between the two groups (p=0.019). ONSD increased significantly from 5.3±0.3mm in the supine position to 5.5±0.3mm (p<0.001) at the end of surgery in both groups (both p<0.001). There was no statistically significant difference in the change of ONSD over time between the two groups (p>0.05).

Conclusions

Compared to the restrictive fluid protocol, the liberal fluid protocol increased IOP but not ONSD in patients undergoing prone spine surgery.

Trial registration

The study was registered in ClinicalTrials.gov (https://clinicaltrials.gov) prior to patient enrollment, ID: NCT03890510, on March 26, 2019. The principal investigator was Xiao-Yu Yang.
Mental Health, Discourse and Stigma
Authors: Zayts-Spence Olga , Edmonds David , Fortune Zoe
Published: June 2023

In this editorial to the special collection “Mental Health, Discourse and Stigma” we outline the concepts of mental, health, discourse and stigma as they are examined through sociolinguistic lenses. We examine the sociolinguistic approach to mental health and stigma and discuss the different theoretical frameworks and methodological approaches that have been applied in such contexts. Sociolinguistics views mental health and stigma as discursively constructed and constituted, i.e. they are both manifest, negotiated, reinforced or contested in the language that people use. We highlight existing gaps in sociolinguistic research and outline how it could enrich research in psychology and psychiatry and contribute to professional practice. Specifically, sociolinguistics provides well-established methodological tools to research the ‘voices’ of people with a history of mental ill health, their family, carers and mental health professionals in both online and off-line contexts. This is vital to develop targeted interventions and to contribute to de-stigmatization of mental health. To conclude, we highlight the importance of transdisciplinary research that brings together expertise in psychology, psychiatry and sociolinguistics.
Procedure-related pain during CT-guided percutaneous transthoracic needle biopsies of lung lesions: a prospective study
Authors: Yang Shou-Xin , Chen Mai-Lin , Xie Lei , Zhu Hai-Bin , Liu Yu-Liang , Sun Rui-Jia , Zhao Bo , Deng Xu-Bo , Li Xiao-Ting , Sun Ying-Shi
Published: June 2023

Background

The existing data on the degree of pain in patients during CT-guided percutaneous transthoracic needle biopsy (PTNB) of lung lesions are limited and the factors related to pain are unclear. In this study, we aimed to evaluate the prevalence and severity of pain reported during PTNB and to identify factors associated with increased reported pain.

Methods

Patients who underwent PTNB from April 2022 to November 2022 were prospectively evaluated using the numeric rating scale, which assesses subjective pain based on a 0–10 scoring system (0 = no pain; 10 = the worst pain imaginable). The scale divides the scores into three categories: mild pain (1–3 points), moderate pain (4–6 points), and severe pain (7–10 points). Pain scores from 4 to 10 were considered significant pain. Demographic data of patients, lesion characteristics, biopsy variables, complications, the patient’s subjective feelings, and pathological result data were analyzed by multivariable logistic regression analysis to identify variables associated with significant pain.

Results

We enrolled 215 participants who underwent 215 biopsy procedures (mean age: 64.5 ± 9.3 years, 123 were men). The mean procedure-related pain score was 2 ± 2. Overall, 20% (43/215) of participants reported no pain (score of 0), 67.9% (146/215) reported pain scores of 1–3, 11.2% (24/215) reported scores of 4–6, and 0.9% (2/215) reported scores of 7 or higher. Furthermore, non-significant pain (scores of 0–3) was reported during 87.9% (189/215) of the procedures. In the adjusted model, significant pain was positively associated with lesions ≥ 34 mm (p = 0.001, odds ratio [OR] = 6.90; 95% confidence interval [CI]: 2.18, 21.85), a needle-pleural angle ≥ 77° (p = 0.047, OR = 2.44; 95% CI: 1.01, 5.89), and a procedure time ≥ 26.5 min (p = 0.031, OR = 3.11; 95% CI: 1.11, 8.73).

Conclusions

Most participants reported no pain or mild pain from CT-guided percutaneous transthoracic needle biopsies of lung lesions. However, those with a larger lesion, a greater needle-pleural angle, and a longer procedure time reported greater pain.
Acupuncture regulates the apoptosis of ovarian granulosa cells in polycystic ovarian syndrome-related abnormal follicular development through LncMEG3-mediated inhibition of miR-21-3p
Authors: Chen Xiaohong , He Hengzhen , Long Bingcai , Wei Binli , Yang Peng , Huang Xiaoying , Wang Qian , Lin Jing , Tang Hongliang
Published: June 2023

Background

The main features of polycystic ovary syndrome (PCOS) are abnormal follicular development and ovulatory dysfunction, which are caused by excessive apoptosis of ovarian granulosa cells. Acupuncture has been shown to improve follicular development abnormalities in patients with PCOS, but its mechanism is unknown. This study hypothesized that the mechanism of acupuncture on follicular development abnormalities in PCOS patients is the inhibition of granulosa cell apoptosis through LncMEG3-mediated regulation of miR-21-3p.

Methods

A PCOS-like rat model was established using subcutaneous injection of dehydroepiandrosterone (DHEA). Acupuncture was performed on rats for 15 d (CV-4, RN-3, CV-6, SP-6 and EX-CA 1). Ovarian morphology was observed by HE staining, and sex hormone and AMH levels were detected by ELISA. Primary granulosa cells were isolated from each group of rats to assess the association of acupuncture treatment, LncMEG3, miR-21-3p, and granulosa cell apoptosis in rats with PCOS.

Results

LncMEG3 and miR-21-3p were highly expressed in the ovarian granulosa cells of rats with PCOS, and LncMEG3-mediated regulation of miR-21-3p was involved in the development of PCOS in rats. Silencing of MEG3 attenuated sex hormone dysregulation and ovarian histopathological changes in PCOS rats and promoted follicle cell development and maturation. In addition, silencing MEG3 increased the viability and number of granulosa cells. In addition, silencing MEG3 further inhibited early and late apoptosis of ovarian granulosa cells in PCOS rats. Acupuncture improved polycystic ovarian morphology and sex hormone levels in PCOS rats. Acupuncture intervention increased the viability and number of granulosa cells. Acupuncture intervention inhibited early and late apoptosis of ovarian granulosa cells in PCOS rats by targeting miR-21-3p via LncMEG3.

Conclusion

These results suggest that acupuncture can downregulate LncMEG3, thereby targeting and regulating miR-21-3p to suppress early and late granulosa cell apoptosis and normalize their proliferation. These factors ultimately compensate for abnormal follicular development. These findings shed light on the clinical potential of acupuncture as a safe treatment for follicular developmental abnormalities in PCOS.
Reflections on patient engagement by patient partners: how it can go wrong
Authors: Richards Dawn P. , Poirier Sabrina , Mohabir Vina , Proulx Laurie , Robins Sue , Smith Jeffery
Published: June 2023

As six patient partners in Canada, we aim to contribute to learning and to provide an opportunity to reflect on patient engagement (PE) in research and healthcare environments. Patient engagement refers to “meaningful and active collaboration in governance, priority setting, conducting research and knowledge translation” with patient partners as members of teams, rather than participants in research or clinical care. While much has been written about the benefits of patient engagement, it is important to accurately document and share what we term ‘patient engagement gone wrong.’ These examples have been anonymized and presented as four statements: patient partners as a check mark, unconscious bias towards patient partners, lack of support to fully include patient partners, and lack of recognizing the vulnerability of patient partners. The examples provided are intended to demonstrate that patient engagement gone wrong is more common than discussed openly, and to simply bring this to light. This article is not intending to lay blame, rather to evolve and improve patient engagement initiatives. We ask those who interact with patient partners to reflect so we can all work towards improving patient engagement. Lean into the discomfort with these conversations as that is the only way to change these all too recognizable examples, and which will lead to better project outcomes and experiences for all team members.
Sub-lethal toxicity of indigo dye (Indigofera tinctoria) on Oreochromis niloticus juveniles
Authors: Ayebidun Omotola Victoria , Ajibare Adefemi Olatayo
Published: June 2023

Background

Textile dyes which are eliminated as unfixed dyes through the effluent from textile industry cause deleterious effect on the fresh water fish. Thus, toxicity tests were conducted using indigo dye on Oreochromis niloticus juveniles (mean weight 30.00 ± 0.73 g) as a test fish under bioassay system. Varying concentration of 0.00 (control), 0.5, 1.0, 1.5, 2.0, and 2.5 mg/l containing graded levels of Indigofera were applied in experimental tanks to determine the lethal concentration. The LC50 of dye at 96 h was 1.3 mg/l of water. The histopathology (heart, gills, kidney and spleen) and water quality parameters (Dissolved oxygen, pH and temperature) were determined using standard methods and behavioural responses were observed.

Results

Histopathology of heart, gills, kidney and spleen revealed degeneration of cells, space formation, slight cellular changes and vacuolation among the treatments especially in the higher concentration of 1.5 mg/l, 2.0 mg/l, and 2.5 mg/l of the dye solution used except in the control. The pH and DO of control were significantly different from the experimental units while there was no significant variation in the temperature of the control and all the experimental units. Effects of indigo dye on water parameters were significant (P < 0.05) throughout the experiment. Behavioural responses exhibited by the experimental fish include irregular swimming, hyperventilation, rapid opercula movement, and restlessness. The dye concentration and exposure period both boosted these behaviours.

Conclusions

The findings of this study indicated that indigo dye solution is toxic to fish, and that fish opercula movement and mortality were influenced by the dosage of each concentration and the duration of exposure.
Development of HPV16 mouse and dog models for more accurate prediction of human vaccine efficacy
Authors: Totain Emmanuelle , Lindner Loïc , Martin Nicolas , Misseri Yolande , Iché Alexandra , Birling Marie-Christine , Sorg Tania , Herault Yann , Bousquet-Melou Alain , Bouillé Pascale , Duthoit Christine , Pavlovic Guillaume , Boullier Severine
Published: June 2023

Background

Animal models are essential to understand the physiopathology of human diseases but also to evaluate new therapies. However, for several diseases there is no appropriate animal model, which complicates the development of effective therapies. HPV infections, responsible for carcinoma cancers, are among these. So far, the lack of relevant animal models has hampered the development of therapeutic vaccines. In this study, we used a candidate therapeutic vaccine named C216, similar to the ProCervix candidate therapeutic vaccine, to validate new mouse and dog HPV preclinical models. ProCervix has shown promising results with classical subcutaneous murine TC-1 cell tumor isografts but has failed in a phase II study.

Results

We first generated E7/HPV16 syngeneic transgenic mice in which the expression of the E7 antigen could be switched on through the use of Cre–lox recombination. Non-integrative LentiFlash® viral particles were used to locally deliver Cre mRNA, resulting in E7/HPV16 expression and GFP reporter fluorescence. The expression of E7/HPV16 was monitored by in vivo fluorescence using Cellvizio imaging and by local mRNA expression quantification. In the experimental conditions used, we observed no differences in E7 expression between C216 vaccinated and control groups. To mimic the MHC diversity of humans, E7/HPV16 transgenes were locally delivered by injection of lentiviral particles in the muscle of dogs. Vaccination with C216, tested with two different adjuvants, induced a strong immune response in dogs. However, we detected no relationship between the level of cellular response against E7/HPV16 and the elimination of E7-expressing cells, either by fluorescence or by RT-ddPCR analysis.

Conclusions

In this study, we have developed two animal models, with a genetic design that is easily transposable to different antigens, to validate the efficacy of candidate vaccines. Our results indicate that, despite being immunogenic, the C216 candidate vaccine did not induce a sufficiently strong immune response to eliminate infected cells. Our results are in line with the failure of the ProCervix vaccine that was observed at the end of the phase II clinical trial, reinforcing the relevance of appropriate animal models.
Potential molecular mechanism underlying cardiac fibrosis in diabetes mellitus: a narrative review
Authors: Ridwan Muhammad , Dimiati Herlina , Syukri Maimun , Lesmana Ronny
Published: June 2023

Background

Diabetes mellitus (DM) is among the most common risk factors for cardiovascular disease in the world with prevalence of more than 500 million population in 2021. Cardiac fibrosis with its complex process has been hypothesized as one of the mechanisms explaining development of heart failure in diabetic patients. Recently, the biomolecular mechanism of cardiac fibrosis in the hyperglycemia setting has been focusing around transforming growth factor β-1 (TGFβ-1) as a major factor. However, there is interplay role of several factors including microRNAs (miRNAs) which acts as a potential regulator of cardiac fibrosis connected with TGFβ-1. In this review, we explored interplay role of several factors including microRNAs which acts as a potential regulator of cardiac fibrosis connected with TGFβ-1 in diabetes mellitus. This narrative review included articles from the PubMed and Science Direct databases published in the last 10 years (2012–2022).

Main text

In diabetic patients, excessive activation of myofibroblasts occurs and triggers pro-collagen to convert into mature collagen to fill the cardiac interstitial space resulting in a pathological process of extracellular matrix remodeling. The balance between matrix metalloproteinase (MMP) and its inhibitor (tissue inhibitor of metalloproteinase, TIMP) is crucial in degradation of the extracellular matrix. Diabetes-related cardiac fibrosis is modulated by increasing level of TGF-β1 mediated by cellular components, including cardiomyocyte and non-cardiomyocyte cells involving fibroblasts, vascular pericytes smooth muscle cells, endothelial cells, mast cells, macrophages, and dendritic cells. Several miRNAs such as miR-21, miR-9, miR-29, miR-30d, miR-144, miR-34a, miR-150, miR-320, and miR-378 are upregulated in diabetic cardiomyopathy. TGF-β1, together with inflammatory cytokines, oxidative stress, combined sma and the mothers against decapentaplegic (smad) protein, mitogen-activated protein kinase (MAPK), and microRNAs, is interconnectedly involved in extracellular matrix production and fibrotic response. In this review, we explored interplay role of several factors including microRNAs which acts as a potential regulator of cardiac fibrosis connected with TGFβ-1 in diabetes mellitus.

Conclusions

Long-term hyperglycemia activates cardiac fibroblast via complex processes involving TGF-β1, miRNA, inflammatory chemokines, oxidative stress, smad, or MAPK pathways. There is increasing evidence of miRNA’s roles lately in modulating cardiac fibrosis.
Role of preoperative SPECT/CT standardized uptake values in medication-related osteonecrosis of the jaw: a preliminary study of SPECT/CT in relation to cone-beam CT and histopathological findings of the resected bone of mandibulectomy
Authors: Kobayashi Eizaburo , Tezuka Yasuhito , Ono Junya , Okada Yasuo , Ogura Ichiro
Published: June 2023

Background

SPECT/CT has been applied for preoperative planning of MRONJ. Furthermore, the SUV using bone SPECT/CT has enabled quantitative analysis of jaw lesions. This study aimed to evaluate the role of preoperative SPECT/CT SUVs in MRONJ, especially SPECT/CT in relation to CBCT and histopathological findings of the resected bone of mandibulectomy. The preliminary study was conducted on five MRONJ patients who underwent mandibulectomy after SPECT/CT.

Results

The SUVmax and SUVmean of MRONJ in all cases (19.5 ± 5.6 and 5.5 ± 0.8) were significantly higher than those of right side of the MRONJ (8.5 ± 2.0 and 2.7 ± 0.5) and left side of the MRONJ (7.2 ± 1.6 and 2.7 ± 0.4), respectively. The CBCT of all cases showed osteolytic and sclerotic internal texture and sequestrum. The histopathological characteristics of all cases showed necrotic bone and granulation tissue with the bone circumference surrounded by inflammatory cells.

Conclusions

The preliminary results indicated a difference between MRONJ and right and left sides of the MRONJ in SPECT/CT SUVs. The SUVs has enabled quantitative analysis for surgical planning of MRONJ.
New Opportunities for Minimizing Toxicity in Rectal Cancer Management
Authors: Couwenberg Alice M. , Varvoglis Dimitrios N. , Grieb Brian C. , Marijnen Corrie A.M. , Ciombor Kristen K. , Guillem Jose G.
Published: June 2023

Advances in multimodal management of locally advanced rectal cancer (LARC), consisting of preoperative chemotherapy and/or radiotherapy followed by surgery with or without adjuvant chemotherapy, have improved local disease control and patient survival but are associated with significant risk for acute and long-term morbidity. Recently published trials, evaluating treatment dose intensification via the addition of preoperative induction or consolidation chemotherapy (total neoadjuvant therapy [TNT]), have demonstrated improved tumor response rates while maintaining acceptable toxicity. In addition, TNT has led to an increased number of patients achieving a clinical complete response and thus eligible to pursue a nonoperative, organ-preserving, watch and wait approach, thereby avoiding toxicities associated with surgery, such as bowel dysfunction and stoma-related complications. Ongoing trials using immune checkpoint inhibitors in patients with mismatch repair-deficient tumors suggest that this subgroup of patients with LARC could potentially be treated with immunotherapy alone, sparing them the toxicity associated with preoperative treatment and surgery. However, the majority of rectal cancers are mismatch repair-proficient and less responsive to immune checkpoint inhibitors and require multimodal management. The synergy noted in preclinical studies between immunotherapy and radiotherapy on immunogenic tumor cell death has led to the design of ongoing clinical trials that explore the benefit of combining radiotherapy, chemotherapy, and immunotherapy (mainly of immune checkpoint inhibitors) and aim to increase the number of patients eligible for organ preservation.
Cardiac Substructure Radiation Dose and Risk of Late Cardiac Disease in Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study
Authors: Bates James E. , Shrestha Suman , Liu Qi , Smith Susan A. , Mulrooney Daniel A. , Leisenring Wendy , Gibson Todd , Robison Leslie L. , Chow Eric J. , Oeffinger Kevin C. , Armstrong Gregory T. , Constine Louis S. , Hoppe Bradford S. , Lee Choonsik , Yasui Yutaka , Howell Rebecca M.
Published: June 2023

PURPOSE

Radiation-associated cardiac disease is a major cause of morbidity/mortality among childhood cancer survivors. Radiation dose-response relationships for cardiac substructures and cardiac diseases remain unestablished.

METHODS

Using the 25,481 5-year survivors of childhood cancer treated from 1970 to 1999 in the Childhood Cancer Survivor Study, we evaluated coronary artery disease (CAD), heart failure (HF), valvular disease (VD), and arrhythmia. We reconstructed radiation doses for each survivor to the coronary arteries, chambers, valves, and whole heart. Excess relative rate (ERR) models and piecewise exponential models evaluated dose-response relationships.

RESULTS

The cumulative incidence 35 years from diagnosis was 3.9% (95% CI, 3.4 to 4.3) for CAD, 3.8% (95% CI, 3.4 to 4.2) for HF, 1.2% (95% CI, 1.0 to 1.5) for VD, and 1.4% (95% CI, 1.1 to 1.6) for arrhythmia. A total of 12,288 survivors (48.2%) were exposed to radiotherapy. Quadratic ERR models improved fit compared with linear ERR models for the dose-response relationship between mean whole heart and CAD, HF, and arrhythmia, suggesting a potential threshold dose; however, such departure from linearity was not observed for most cardiac substructure end point dose-response relationships. Mean doses of 5-9.9 Gy to the whole heart did not increase the risk of any cardiac diseases. Mean doses of 5-9.9 Gy to the right coronary artery (rate ratio [RR], 2.6 [95% CI, 1.6 to 4.1]) and left ventricle (RR, 2.2 [95% CI, 1.3 to 3.7]) increased risk of CAD, and to the tricuspid valve (RR, 5.5 [95% CI, 2.0 to 15.1]) and right ventricle (RR, 8.4 [95% CI, 3.7 to 19.0]) increased risk of VD.

CONCLUSION

Among children with cancer, there may be no threshold dose below which radiation to the cardiac substructures does not increase the risk of cardiac diseases. This emphasizes their importance in modern treatment planning.
Adapting to Change: A Thoracic Oncology Team's Perspective
Authors: Crawford Jeffrey , Blackwell Susan , Barbour Sally Yowell
Published: June 2023

With targeted therapies, outcomes for patients with NSCLC are improving, but better monitoring for AEs is needed
A Visual Diagnosis: Lipodystrophy
Authors: Bhat Salman Zahoor , Brown Rebecca J , Banerjee Ronadip R
Published: June 2023

Lipodystrophy syndromes are rare metabolic disorders characterized by local or generalized loss of adipose tissue, resulting in insulin resistance, dyslipidemia, and cosmetic disfiguration. The lipodystrophic phenotype is highly variable, with partial lipodystrophy often missed or misdiagnosed as other diseases from a lack of a proper physical examination and low physician awareness. Correct diagnosis is important for optimal treatment and follow-up strategies in these patients. The use of GLP-1 analogs has not been systematically evaluated in lipodystrophy and could be a potential precision medicine therapy. We aim to make the reader, particularly generalists or endocrinologists outside of tertiary referral centers, aware of the presentation and clinical features of partial lipodystrophy, emphasize the role of a full physical examination in diagnosis, and discuss therapeutic options, including GLP-1–based glycemic management illustrated by our clinical case.
A Point-Based Risk Calculator for Mortality After Hepatectomy
Authors: Luu Tiffany , Curran Brian P. , Macias Alvaro A. , Mehdipour Soraya , Simpson Sierra , Gabriel Rodney A.
Published: June 2023

BACKGROUND:

Preoperative risk stratification for hepatectomy patients can aid clinical decision making. The objective of this retrospective cohort study was to determine postoperative mortality risk factors and develop a score-based risk calculator using a limited number of preoperative predictors to estimate mortality risk in patients undergoing hepatectomy.

METHODS:

Data were collected from patients that underwent hepatectomy from the National Surgical Quality Improvement Program dataset from 2014 to 2020. Baseline characteristics were compared between survival and 30-day mortality cohorts using the χ2 test. Next, the data were split into a training set to build the model and a test set to validate the model. A multivariable logistic regression model modeling 30-day postoperative mortality was trained on the training set using all available features. Next, a risk calculator using preoperative features was developed for 30-day mortality. The results of this model were converted into a score-based risk calculator. A point-based risk calculator was developed that predicted 30-day postoperative mortality in patients who underwent hepatectomy surgery.

RESULTS:

The final dataset included 38,561 patients who underwent hepatectomy. The data were then split into a training set from 2014 to 2018 (n = 26,397) and test set from 2019 to 2020 (n = 12,164). Nine independent variables associated with postoperative mortality were identified and included age, diabetes, sex, sodium, albumin, bilirubin, serum glutamic-oxaloacetic transaminase (SGOT), international normalized ratio, and American Society of Anesthesiologists classification score. Each of these features were then assigned points for a risk calculator based on their odds ratio. A univariate logistic regression model using total points as independent variables were trained on the training set and then validated on the test set. The area under the receiver operating characteristics curve on the test set was 0.719 (95% confidence interval, 0.681–0.757).

CONCLUSIONS:

Development of risk calculators may potentially allow surgical and anesthesia providers to provide a more transparent plan to support patients planned for hepatectomy.
Dexmedetomidine Prevents Chronic Incisional Pain After Brain Tumor Resection: A Secondary Analysis of the Randomized Control Trial
Authors: Zeng Min , Xu Xin , Li Ruowen , Zhang Xingyue , Ma Tingting , Cui Qianyu , Wang Juan , Li Shu , Peng Yuming
Published: June 2023

BACKGROUND:

Dexmedetomidine was reported to reduce postoperative acute pain after neurosurgery. However, the efficacy of dexmedetomidine for preventing chronic incisional pain is uncertain.

METHODS:

This article is a secondary analysis of a randomized, double-blind, placebo-controlled trial. Eligible patients were randomly allocated to either the dexmedetomidine group or the placebo group. Patients assigned to the dexmedetomidine group were given a 0.6 μg kg−1 dexmedetomidine bolus followed by a 0.4 μg kg−1 h−1 maintenance dose until dural closure; placebo patients were given comparable amounts of normal saline. The primary end point was the incidence of incisional pain at 3 months after craniotomy evaluated by numerical rating scale scores and defined as any score >0. The secondary end points were postoperative acute pain scores, sleep quality, and Short-Form McGill Pain Questionnaire (SF-MPQ-2) at 3 months after craniotomy.

RESULTS:

From January 2021 to December 2021, a total of 252 patients were included in the final analysis: the dexmedetomidine group (n = 128) and the placebo group (n = 124). The incidence of chronic incisional pain was 23.4% (30 of 128) in the dexmedetomidine group versus 42.7% (53 of 124) in the placebo group (risk ratio, 0.55; 95% confidence interval, 0.38–0.80; P = .001). The overall severity of chronic incisional pain was mild in both groups. Patients in the dexmedetomidine group had lower acute pain severity on movement than those in the placebo group for the first 3 days after surgery (all adjusted P < .01). Sleep quality did not differ between groups. However, the SF-MPQ-2 total sensory (P = .01) and neuropathic pain descriptor (P = .023) scores in the dexmedetomidine group were lower than those in the placebo group.

CONCLUSIONS:

Prophylactic intraoperative dexmedetomidine infusion reduces the incidence of chronic incisional pain as well as acute pain score after elective brain tumor resections.
The Class Dynamics of Antiracism inGo Set a Watchman
Authors: Dolan Neal
Published: June 2023

Because it portrayed Atticus Finch as a racist and a segregationist, when Harper Lee’s Go Set a Watchman was published it caused much public dismay. But the book’s classism has not yet aroused such dismay. This essay argues that the antiracism of its main character—an adult Jean Louise Finch—is articulated in part by snobbish opposition to what she deems to be “white trash” attitudes. In this way Lee’s critique of a steeply stratified southern society is compromised by her transferring the symbolic rhetoric of defilement from a racial “other” to a class “other” assumed to be racist. Studying the classist premise of Watchman, then, helps attune us to its operation in To Kill a Mockingbird.
Totality in a Box
Authors: Menozzi Filippo
Published: June 2023

This essay proposes a reading of the American photographer Allan Sekula’s 1995 essay “Dismal Science” alongside The Forgotten Space, an essay film he directed with Noël Burch in 2010. These works are still resonant today because they suggest the possibility of picturing the totality of capitalist modernity. Sekula’s representations of the shipping container and the subsequent shifts in maritime economy recuperate the prospect of a panoramic, totalizing view in an era marked by a prevalence of detail and data over meaningful grand narrative. The totality the container embodies and represents, however, is not the whole of a frictionless and seamless accumulation of capital but a nonsynchronous, polemical, and critical totality of struggle and antagonism. Sekula turns the shipping container from a stand-in for a system of commodity circulation to an allegorical sign of the continuing fight between labor and capital. Rather than envisioning this totality of struggle as a merely thematic concern, Sekula’s compositions eschew commodification on the level of form by delving into the constitutive tensions of realism and reintroducing a living context of militancy and resistance into the matter of representation itself.
From Fetish to Totality
Authors: Mansoor Jaleh
Published: June 2023

This essay argues that the artwork’s opacity and purposively purposeless quality are a tacit refusal of the compulsory division between intellectual and manual labor, which afford the artwork a unique capacity to access an otherwise occluded totality. By analyzing conceptual work by the artist duo Claire Fontaine—who deploy Alfred Sohn-Rethel’s notion of market exchangism in their work—in relation to twentieth-century intellectual debates around representation, abstraction, and social synthesis, the essay develops a model of totality in a descriptive rather than prescriptive register. At issue is the artwork’s potential for dereification, whereby a given work of art may provide perceptual experience of the transactional logic that underpins and structures the social field.
Performance of ChatGPT, GPT-4, and Google Bard on a Neurosurgery Oral Boards Preparation Question Bank
Authors: Ali Rohaid , Tang Oliver Y. , Connolly Ian D. , Fridley Jared S. , Shin John H. , Zadnik Sullivan Patricia L. , Cielo Deus , Oyelese Adetokunbo A. , Doberstein Curtis E. , Telfeian Albert E. , Gokaslan Ziya L. , Asaad Wael F.
Published: June 2023

BACKGROUND AND OBJECTIVES:

General large language models (LLMs), such as ChatGPT (GPT-3.5), have demonstrated the capability to pass multiple-choice medical board examinations. However, comparative accuracy of different LLMs and LLM performance on assessments of predominantly higher-order management questions is poorly understood. We aimed to assess the performance of 3 LLMs (GPT-3.5, GPT-4, and Google Bard) on a question bank designed specifically for neurosurgery oral boards examination preparation.

METHODS:

The 149-question Self-Assessment Neurosurgery Examination Indications Examination was used to query LLM accuracy. Questions were inputted in a single best answer, multiple-choice format. χ2, Fisher exact, and univariable logistic regression tests assessed differences in performance by question characteristics.

RESULTS:

On a question bank with predominantly higher-order questions (85.2%), ChatGPT (GPT-3.5) and GPT-4 answered 62.4% (95% CI: 54.1%-70.1%) and 82.6% (95% CI: 75.2%-88.1%) of questions correctly, respectively. By contrast, Bard scored 44.2% (66/149, 95% CI: 36.2%-52.6%). GPT-3.5 and GPT-4 demonstrated significantly higher scores than Bard (bothP< .01), and GPT-4 outperformed GPT-3.5 (P= .023). Among 6 subspecialties, GPT-4 had significantly higher accuracy in the Spine category relative to GPT-3.5 and in 4 categories relative to Bard (allP< .01). Incorporation of higher-order problem solving was associated with lower question accuracy for GPT-3.5 (odds ratio [OR] = 0.80,P= .042) and Bard (OR = 0.76,P= .014), but not GPT-4 (OR = 0.86,P= .085). GPT-4's performance on imaging-related questions surpassed GPT-3.5's (68.6% vs 47.1%,P= .044) and was comparable with Bard's (68.6% vs 66.7%,P= 1.000). However, GPT-4 demonstrated significantly lower rates of “hallucination” on imaging-related questions than both GPT-3.5 (2.3% vs 57.1%,P< .001) and Bard (2.3% vs 27.3%,P= .002). Lack of question text description for questions predicted significantly higher odds of hallucination for GPT-3.5 (OR = 1.45,P= .012) and Bard (OR = 2.09,P< .001).

CONCLUSION:

On a question bank of predominantly higher-order management case scenarios for neurosurgery oral boards preparation, GPT-4 achieved a score of 82.6%, outperforming ChatGPT and Google Bard.
Surgery Decreases Nonunion, Myelopathy, and Mortality for Patients With Traumatic Odontoid Fractures: A Propensity Score Matched Analysis
Authors: Cloney Michael , Thirunavu Vineeth , Roumeliotis Anastasios , Azad Hooman , Shlobin Nathan A. , Swong Kevin , El Tecle Najib , Dahdaleh Nader S.
Published: June 2023

BACKGROUND:

Existing literature suggests that surgical intervention for odontoid fractures is beneficial but often does not control for known confounding factors.

OBJECTIVE:

To examine the effect of surgical fixation on myelopathy, fracture nonunion, and mortality after traumatic odontoid fractures.

METHODS:

We analyzed all traumatic odontoid fractures managed at our institution between 2010 and 2020. Ordinal multivariable logistic regression was used to identify factors associated with myelopathy severity at follow-up. Propensity score analysis was used to test the treatment effect of surgery on nonunion and mortality.

RESULTS:

Three hundred and three patients with traumatic odontoid fracture were identified, of whom 21.6% underwent surgical stabilization. After propensity score matching, populations were well balanced across all analyses (Rubin's B < 25.0, 0.5 < Rubin's R < 2.0). Controlling for age and fracture angulation, type, comminution, and displacement, the overall rate of nonunion was lower in the surgical group (39.7% vs 57.3%, average treatment effect [ATE] = −0.153 [−0.279, −0.028], P = .017). Controlling for age, sex, Nurick score, Charlson Comorbidity Index, Injury Severity Score, and selection for intensive care unit admission, the mortality rate was lower for the surgical group at 30 days (1.7% vs 13.8%, ATE = −0.101 [−0.172, −0.030], P = .005) and at 1 year was 7.0% vs 23.7%, ATE = −0.099 [−0.181, −0.017], P = .018. Cox proportional hazards analysis also demonstrated a mortality benefit for surgery (hazard ratio = 0.587 [0.426, 0.799], P = .0009). Patients who underwent surgery were less likely to have worse myelopathy scores at follow-up (odds ratio = 0.48 [0.25, 0.93], P = .029).

CONCLUSION:

Surgical stabilization is associated with better myelopathy scores at follow-up and causes lower rates of fracture nonunion, 30-day mortality, and 1-year mortality.
Η απεικόνιση του δομημένου δημόσιου χώρου στην αττική αγγειογραφία της αρχαϊκής και κλασικής εποχής
Authors: Μπακανδρίτσου Ανδριανή
Published: June 2023

Στην παρούσα διδακτορική διατριβή εξετάζεται ο τρόπος, με τον οποίο απεικονίζεται ο δομημένος δημόσιος χώρος στην αττική αγγειογραφία της αρχαϊκής και κλασικής εποχής. Συγκεκριμένα, η διατριβή εστιάζει στα κτήρια δημόσιου χαρακτήρα που απεικονίζονται συχνότερα στην αττική αγγειογραφία, δηλαδή στις κρήνες, στους ναούς και σε άλλα κτήρια που σχετίζονται με τη λατρεία, καθώς και στα τείχη. Μέσα από τη μελέτη 210 συνολικά παραστάσεων και ακολουθώντας μεθοδολογικά κυρίως την εικονογραφική/εικονολογική προσέγγιση επιχειρείται μία ενδελεχής συνθετική επισκόπηση του τρόπου απόδοσης των προαναφερόμενων τύπων κτηρίων στα αττικά μελανόμορφα, ερυθρόμορφα και λευκού βάθους αγγεία της αρχαϊκής και κλασικής περιόδου. Οι παραστάσεις κατανέμονται σε εικονογραφικές ομάδες/κατηγορίες ανάλογα με τον τρόπο απόδοσης και την αρχιτεκτονική μορφή των εικονιζόμενων κτηρίων, ενώ στο πλαίσιο κάθε κατηγορίας γίνονται περαιτέρω διαχωρισμοί ανάλογα με τα θέματα των παραστάσεων. Με βάση τις προαναφερόμενες κατηγοριοποιήσεις, στο κυρίως σώμα της διατριβής γίνεται η ανάλυση της αρχιτεκτονικής μορφής των εικονιζόμενων δημόσιων κτηρίων σε συνδυασμό με τη λεπτομερή παρουσίαση του θεματικού πλαισίου, εντός του οποίου αυτά απεικονίζονται, δεδομένου ότι το τελευταίο πολύ συχνά συμβάλλει καθοριστικά στην ερμηνεία των πρώτων. Η διατριβή στοχεύει στην εξαγωγή συμπερασμάτων που αφορούν στους τρόπους προσέγγισης και απόδοσης των παραπάνω τύπων κτηρίων από τους αττικούς αγγειογράφους, στη σχέση με την πραγματική αρχιτεκτονική και στον σημαντικό ρόλο που παίζει το ‘χέρι’ του αγγειογράφου, λαμβάνοντας εξαρχής υπ’ όψιν τις παραδοχές ότι οι αγγειογραφίες δεν είναι φωτογραφίες και ότι καθορίζονται πάντα από δεσμεύσεις που σχετίζονται με το υλικό κατασκευής, το σχήμα, τη χρήση και την τεχνική διακόσμησης των αντικειμένων που τις φέρουν, δηλαδή των αγγείων. Το κυρίως σώμα της διατριβής ξεκινά με την εισαγωγή, στη συνέχεια χωρίζεται σε τρία μέρη, καθένα από τα οποία είναι αφιερωμένο στην εξέταση καθενός από τους τρεις τύπους κτηρίων, και ολοκληρώνεται με το κεφάλαιο των γενικών συμπερασμάτων.
Η μετάφραση ως φορέας θεματικών και ιδεολογίας στο πρωτότυπο λογοτεχνικό έργο του Κωνσταντίνου Θεοτόκη
Authors: Κορνηλίου Άννα
Published: June 2023

Στόχοι της παρούσας διατριβής είναι οι εξής: Πρώτο, να μελετηθεί και να αξιολογηθεί με επιστημονικούς όρους το σύνολο της μεταφραστικής εργασίας του Θεοτόκη, κάτι που ως τώρα έχει γίνει μόνο σποραδικά και μόνο για μεμονωμένα μεταφράσματα. Δεύτερο, να τοποθετηθεί η μεταφραστική εργασία του Θεοτόκη στο ιστορικό της πλαίσιο και να αναδειχθεί η συνάφειά της με το μεταφραστικό πρόγραμμα του σολωμικού κύκλου και των συνεχιστών του. Τρίτο, να γίνει διαχρονική μελέτη σύνολου του έργου του Θεοτόκη, μεταφραστικού και πρωτότυπου, ώστε να αναδειχθούν οι επιρροές του από όλα τα λογοτεχνικά και ιδεολογικά ρεύματα. Τέταρτο, να μελετηθούν συστηματικά οι διακειμενικές σχέσεις μεταξύ πρωτότυπου και μεταφραστικού έργου του Θεοτόκη, με σκοπό να αναδειχθεί η σημαντική συμβολή της λογοτεχνικής μετάφρασης στη δημιουργία πρωτότυπης λογοτεχνίας. Όλα τα παραπάνω έχουν ως τελικό σκοπό τη σύνθεση μιας ολοκληρωμένης εικόνας της συγγραφικής ταυτότητας του Θεοτόκη, θεωρώντας ως αναπόσπαστο κομμάτι της την ιδιότητα του μεταφραστή.
Human Resources Management Analytics in Private Healthcare Unit
Authors: Kavvadas Yiannis , Kirkos Efstathios
Published: June 2023

Private Greek healthcare sector consists mainly of medium and small size entities. These entities, especially small ones, rely completely on their Human Resources.  However, it seems that they do not avail themselves of new technological methods and tools for assessing their human resources.

The aim of the present study was to create a methodology that will help these entities to evaluate their employees properly and to prove that the empirical knowledge of managers and heads can be enhanced by employing Data Mining methods, in order to create a successful evaluation model.

In the present study, a healthcare unit consisted of 287 employees was selected. Twelve interviews were conducted with 12 managers and heads. A Graphic Rating Scale Τable, built by eight qualitative attributes, was given to the interviewees. Those 8 qualitative attributes were combined with 18 quantitative attributes in order for a new model to be created. Data were collected from the Human Resources department. To perform the analysis, Machine Learning methods were used.

This model proved to be functional and capable of giving valid information to management for employees’ evaluation. Data Mining methods are quite useful for the HR department and the Administration of the unit.

The above methodology provides low-costs and usable tools, for appropriate employees’ evaluation.

 

EL Classifications: J24, M12, M54, C38.

Key words: Human Resources, Management, Healthcare Unit, Data Mining