bluuebunny/crossref_metadata_2025 huggingface dataset:
Organizational attributes that contribute to the learning & improvement capabilities of healthcare organizations: a scoping review
Authors: de Kok Kees , van der Scheer Wilma , Ketelaars Corry , Leistikow Ian
Published: June 2023

Background

This study aims to explore and identify the organizational attributes that contribute to learning and improvement capabilities (L&IC) in healthcare organizations. The authors define learning as a structured update of system properties based on new information, and improvement as a closer correspondence between actual and desired standards. They highlight the importance of learning and improvement capabilities in maintaining high-quality care, and emphasize the need for empirical research on organizational attributes that contribute to these capabilities. The study has implications for healthcare organizations, professionals, and regulators in understanding how to assess and enhance learning and improvement capabilities.

Methods

A systematic search of peer-reviewed articles published between January 2010 and April 2020 was carried out in the PubMed, Embase, CINAHL, and APA PsycINFO databases. Two reviewers independently screened the titles and abstracts and conducted a full-text review of potentially relevant articles, eventually adding five more studies identified through reference scanning. Finally, a total of 32 articles were included in this review. We extracted the data about organizational attributes that contribute to learning and improvement, categorized them and grouped the findings step-by-step into higher, more general-level categories using an interpretive approach until categories emerged that were sufficiently different from each other while also being internally consistent. This synthesis has been discussed by the authors.

Results

We identified five attributes that contribute to the L&IC of healthcare organizations: perceived leadership commitment, open culture, room for team development, initiating and monitoring change, and strategic client focus, each consisting of multiple facilitating aspects. We also found some hindering aspects.

Conclusions

We have identified five attributes that contribute to L&IC, mainly related to organizational software elements. Only a few are identified as organizational hardware elements. The use of qualitative methods seems most appropriate to understand or assess these organizational attributes. We feel it is also important for healthcare organisations to look more closely at how clients can be involved in L&IC.

Trial registration

Not applicable.
Nurses’ discursive construction of older adult immigrant patients in hospitals
Authors: Vestgarden Lisbeth Alnes , Dahlborg Elisabeth , Strunck Jeanne , Aasen Elin Margrethe
Published: June 2023

Background

The immigrant population across Europe is ageing rapidly. Nurses will likely encounter an increasing number of patients who are older adult immigrants. Moreover, access to and equal provision of healthcare is a key issue for several European countries. The relationship between nurses and patients is asymmetrical with unequal power relations; however, the way nurses construct the patient through language and discourse can help maintain or change the balance of power. Unequal power relations can affect access and be a hindrance to equal healthcare delivery. Hence, the aim of this study is to explore how older adult immigrants are discursively constructed as patients by nurses.

Methods

An exploratory qualitative design was used. Data were collected through in-depth interviews with a purposive sample of eight nurses from two hospitals. The nurses’ narratives were analysed using critical discourse analysis (CDA) as described by Fairclough.

Results

The analysis identified an overarching, stable, and dominant discursive practice; ‘The discourse of the other’, with three interdiscursive practices: (1) ‘The discourse on the immigrant patient versus an ideal patient’; (2) ‘The expert discourse’; and (3) ‘The discourse of adaption’. Older immigrant adults were constructed as ‘othered’ patients, they were different, alienated, and ‘they’ were not like ‘us’.

Conclusion

The way nurses construct older adult immigrants as patients can be an obstacle to equitable health care. The discursive practice indicates a social practice in which paternalism overrides the patient’s autonomy and generalization is more prevalent than a person-centred approach. Furthermore, the discursive practice points to a social practice wherein the nurses’ norms form the basis for normal; normality is presumed and desirable. Older adult immigrants do not conform to these norms; hence, they are constructed as ‘othered’, have limited agency, and may be considered rather powerless as patients. However, there are some examples of negotiated power relations where more power is transferred to the patient. The discourse of adaptation refers to a social practice in which nurses challenge their own existing norms to best adapt a caring relationship to the patient’s wishes.
Sex and age do not modify the association between glucocorticoids and bone mineral density in patients with rheumatoid arthritis: a cross-sectional study
Authors: Palmowski Andriko , Boyadzhieva Zhivana , Nielsen Sabrina M. , Muche Burkhard , Hermann Sandra , Boers Maarten , Bliddal Henning , Christensen Robin , Wiebe Edgar , Buttgereit Frank
Published: June 2023

Background

It is unclear whether sex or age modify the association of glucocorticoid (GC) use with reduced bone mineral density (BMD) in patients with rheumatoid arthritis (RA).

Methods

We studied cross-sectional data of RA patients with current or previous GC treatment in a single center cohort study (Rh-GIOP cohort). Our primary outcome was the minimum T-score (measured by DXA) of either lumbar spine, total femur, or femoral neck. Current GC dose was the main exposure; cumulative GC dose and cumulative duration of GC use were also assessed. Following a predefined statistical analysis plan, linear regression analyses with adjustment for confounders assessed whether the association of GC use with BMD was modified by sex (men versus women) or age (≥ 65 versus < 65 years).

Results

Four hundred eighty-three patients with RA (mean age 64 ± 12 years, 80% women) were included. 33% were not currently taking GCs, 32% were treated with a dose of 5 mg/d prednisone equivalent and 11% with more than 7.5 mg/d. 23% of patients had osteoporosis by DXA (minimum T-score ≤ -2.5). The slope, i.e., the association between changes in minimum T-scores with 1 mg/d change in current GC dose, was similar in men and women (-0.07 and -0.04, respectively; difference -0.03 [-0.11 to 0.04]; p for interaction = 0.41). Slopes were also similar for elderly and non-elderly patients (-0.03 and -0.04, respectively; difference -0.01 [-0.06 to 0.05]; p for interaction = 0.77). Using cumulative dose and duration of use as exposures did not lead to substantial changes of these results.

Conclusions

In our sample, the association of GC use with reduced BMD in RA was not modified by sex or age.
Efficacy and safety evaluation of SGLT2i on blood pressure control in patients with type 2 diabetes and hypertension: a new meta-analysis
Authors: Zhang Qin , Zhou Siyuan , Liu Lijun
Published: June 2023

Background

The clinical efficacy and safety of SGLT2i in treating patients with type 2 diabetes mellitus and hypertension lack immense data support.

Objective

To systematically evaluate the clinical efficacy and safety of SGLT2i in patients with type 2 diabetes mellitus and hypertension by collecting the previously published randomized controlled trials on SGLT2i to provide data support for SGLT2i as an adjuvant in the first-line antihypertensive regimen in patients with type 2 diabetes mellitus and hypertension.

Methods

Randomized controlled trials comparing SGLT2i with a placebo in treating type 2 diabetes with hypertension were screened strictly according to inclusion and exclusion criteria. The primary efficacy endpoints included 24H systolic blood pressure, 24H diastolic blood pressure, office systolic blood pressure, and office diastolic blood pressure. The secondary efficacy endpoints included HbA1c. The safety indicators were hypoglycemia, urinary tract infection, genital infection, and renal impairment.MD was the combined effect size for continuous variables, and RR was the combined effect size for dichotomous variables.

Results

10 RCTs with 9913 participants (6293 in the SGLT2i group and 3620 in the control group) were included for analysis.SGLT2i is effective in reducing blood pressure compared with placebo in patients with type 2 diabetes and hypertension, 24HSBP (− 5.06 mmHg, 95% CI [− 7.10, − 3.01], t = − 6.19, P < 0.05), 24HDBP (− 2.39 mmHg, 95% CI [− 4.11, − 0.67], t = − 4.15, P = 0.004), Office SBP (− 4.53 mmHg, 95% CI [− 5.66, − 3.40], t = − 9.50, P < 0.05), Office DBP (− 2.12 mmHg, 95% CI [− 3.42, − 0.82], t = − 4.88, P = 0.001). HbA1c decreased significantly (− 0.57%, 95% CI [− 0.60, − 0.54], z = 37.02, p < 0.01). SGLT2i did not increase hypoglycemia compared to placebo (RR = 1.22, 95% CI [0.916, 1.621], z = 1.36 p = 0.174), urinary tract infection (RR = 1.56, 95% CI [0.96, 2.52], z = 1.79 p = 0.073), risk of renal injury (RR = 0.78, 95% CI [0.54, 1.13], Z = 1.31, P = 0.19), but the risk of genital tract infection increased by 2.32 times (RR = 2.32, 95% CI [1.57, 3.42], Z = 4.23, P = 0.00).

Conclusion

SGLT2i can effectively control blood pressure and blood glucose and generally has high safety. For patients with type 2 diabetes mellitus and hypertension with a low risk of genital infection, SGLT2i should be considered as an adjuvant drug for a first-line antihypertensive regimen.
Preoperative imaging accuracy in size determination of prostate cancer in men undergoing radical prostatectomy for clinically localised disease
Authors: Ageeli Wael , Soha Nabi , Zhang Xinyu , Szewcyk-Bieda Magdalena , Wilson Jennifer , Li Chunhui , Nabi Ghulam
Published: June 2023

Objectives

To compare the accuracy of pre-surgical prostate size measurements using mpMRI and USWE with imaging-based 3D-printed patient-specific whole-mount moulds facilitated histopathology, and to assess whether size assessment varies between clinically significant and non-significant cancerous lesions including their locations in different zones of the prostate.

Methods

The study population included 202 men with clinically localised prostate cancer opting for radical surgery derived from two prospective studies. Protocol-based imaging data was used for measurement of size of prostate cancer in clinically localised disease using MRI (N = 106; USWE (N = 96). Forty-eight men overlapped between two studies and formed the validation cohort. The primary outcome of this study was to assess the accuracy of pre-surgical prostate cancerous size measurements using mpMRI and USWE with imaging-based 3D-printed patient-specific whole-mount moulds facilitated histopathology as a reference standard. Independent-samples T-tests were used for the continuous variables and a nonparametric Mann–Whitney U test for independent samples was applied to examine the distribution and median differences between mpMRI and USWE groups.

Results

A significant number of men had underestimation of prostate cancer using both mpMRI (82.1%; 87/106) and USWE (64.6%; 62/96). On average, tumour size was underestimated by a median size of 7 mm in mpMRI, and 1 mm in USWE. There were 327 cancerous lesions (153 with mpMRI and 174 for USWE). mpMRI and USWE underestimated the majority of cancerous lesions (108/153; 70.6%) and (88/174; 50.6%), respectively. Validation cohort data confirmed these findings MRI had a nearly 20% higher underestimation rate than USWE (χ2 (1, N = 327) = 13.580, p = 0.001); especially in the mid and apical level of the gland. Clinically non-significant cancers were underestimated in significantly higher numbers in comparison to clinically significant cancers.

Conclusions

Size measurement of prostate cancers on preoperative imaging utilising maximum linear extent technique, underestimated the extent of cancer. Further research is needed to confirm our observations using different sequences, methods and approaches for cancer size measurement.
Colonic atresia and hirschsprung disease: a case report and review of the literature
Authors: Ladan Amirhossein , Mahdian Jouybari Reza , Zareh Akbari Mahnaz , Moharrami Yeganeh Pegah
Published: June 2023

Background

Colon atresia is one of the rarest congenital anomalies of the gastrointestinal tract, with an incident range of between 1 in 10,000 and 66,000 live births. Type I colonic atresia affects only the mucosal layer of the intestine and spares the intestinal wall and mesentery. Hirschsprung Disease is a rare association of Colon atresia and is usually diagnosed as a complication of atresia treatment.

Case presentation

This study reports a 14-h term white middle-eastern female infant with type I transverse colonic atresia complicated by the association of Hirschsprung disease and provides a brief literature review of the topic. She presented with poor feeding, weakness, and failure to pass meconium, and her abdominal X-ray showed complete distal bowel obstruction. The presence of Hirschsprung disease was realized after complications of atresia surgery. The infant underwent a total of three surgeries involving an end-to-end anastomosis of the atresia, colostomy formation following anastomosis leakage, and Hirschsprung surgery. The patient ultimately expired.

Conclusions

The association between colonic atresia and Hirschsprung disease poses a diagnostic and therapeutic challenge. Considering Hirschsprung disease as a possible association in colon atresia patients can facilitate proper decision-making in the course of treating colon atresia cases and achieving better outcomes.
Significant improvement of bone marrow-derived MSC expansion from MDS patients by defined xeno-free medium
Authors: Altrock Eva , Sens-Albert Carla , Hofmann Franziska , Riabov Vladimir , Schmitt Nanni , Xu Qingyu , Jann Johann-Christoph , Rapp Felicitas , Steiner Laurenz , Streuer Alexander , Nowak Verena , Obländer Julia , Weimer Nadine , Palme Iris , Göl Melda , Darwich Ali , Wuchter Patrick , Metzgeroth Georgia , Jawhar Mohamad , Hofmann Wolf-Karsten , Nowak Daniel
Published: June 2023

Background

Robust and reliable in vitro and in vivo models of primary cells are necessary to study the pathomechanisms of Myelodysplastic Neoplasms (MDS) and identify novel therapeutic strategies. MDS-derived hematopoietic stem and progenitor cells (HSPCs) are reliant on the support of bone marrow (BM) derived mesenchymal stroma cells (MSCs). Therefore, isolation and expansion of MCSs are essential for successfully modeling this disease. For the clinical use of healthy MSCs isolated from human BM, umbilical cord blood or adipose tissue, several studies showed that xeno-free (XF) culture conditions resulted in superior growth kinetics compared to MSCs cultured in the presence of fetal bovine serum (FBS). In this present study, we investigate, whether the replacement of a commercially available MSC expansion medium containing FBS with a XF medium is beneficial for the expansion of MSCs derived from BM of MDS patients which are often difficult to cultivate.

Methods

MSCs isolated from BM of MDS patients were cultured and expanded in MSC expansion medium with FBS or XF supplement. Subsequently, the impact of culture media on growth kinetics, morphology, immunophenotype, clonogenic potential, differentiation capacity, gene expression profiles and ability to engraft in immunodeficient mouse models was evaluated.

Results

Significant higher cell numbers with an increase in clonogenic potential were observed during culture of MDS MSCs with XF medium compared to medium containing FBS. Differential gene expression showed an increase in transcripts associated with MSC stemness after expansion with XF. Furthermore, immunophenotypes of the MSCs and their ability to differentiate into osteoblasts, adipocytes or chondroblasts remained stable. MSCs expanded with XF media were similarly supportive for creating MDS xenografts in vivo as MSCs expanded with FBS.

Conclusion

Our data indicate that with XF media, higher cell numbers of MDS MSCs can be obtained with overall improved characteristics in in vitro and in vivo experimental models.
The effects of novel macrocyclic chelates on the targeting properties of the 68Ga-labeled Gastrin releasing peptide receptor antagonist RM2
Authors: Wang Yinwen , Yuan Hongmei , Tang Sufan , Liu Yang , Cai Ping , Liu Nan , Chen Yue , Zhou Zhijun
Published: June 2023

Background

The gastrin-releasing peptide receptor (GRPr) is a molecular target for the visualization of prostate cancer. Bombesin (BN) analogs are short peptides with a high affinity for GRPr. RM2 is a bombesin-based antagonist. It has been demonstrated that RM2 have superior in vivo biodistribution and targeting properties than high-affinity receptor agonists. This study developed new RM2-like antagonists by introducing the novel bifunctional chelators AAZTA5 and DATA5m to RM2.

Results

The effects of different macrocyclic chelating groups on drug targeting properties and the possibility of preparing 68Ga-radiopharmaceuticals in a kit-based protocol were investigated using 68Ga-labeled entities. Both new RM2 variants were labelled with 68Ga3+ resulting in high yields, stability, and low molarity of the ligand. DATA5m-RM2 and AAZTA5-RM2 incorporated 68Ga3+ nearly quantitatively at room temperature within 3–5 min, and the labelling yield for 68Ga-DOTA-RM2 was approximately 10% under the same conditions. 68Ga-AAZTA5-RM2 showed stronger hydrophilicity according to partition coefficient. Although the maximal cellular uptake values of the three compounds were similar, 68Ga-AAZTA5-RM2 and 68Ga-DATA5m-RM2 peaked more rapidly. Biodistribution studies showed high and specific tumor uptake, with a maximum of 9.12 ± 0.81 percentage injected activity per gram of tissue (%ID/g) for 68Ga-DATA5m-RM2 and 7.82 ± 0.61%ID/g for 68Ga-AAZTA5-RM2 at 30 min after injection.

Conclusions

The conditions for complexation of DATA5m-RM2 and AAZTA5-RM2 with gallium-68 are milder, faster and require less amount of precursors than DOTA-RM2. Chelators had an evident influence on the pharmacokinetics and targeting properties of 68Ga-X-RM2 derivatives. Positively charged 68Ga-DATA5m-RM2 provided a high tumor uptake, high image contrast and good capability of targeting GRPr.
Economic evaluation of pharmacogenomic-guided antiplatelet treatment in Spanish patients suffering from acute coronary syndrome participating in the U-PGx PREPARE study
Authors: Koufaki Margarita-Ioanna , Fragoulakis Vasileios , Díaz-Villamarín Xando , Karamperis Kariofyllis , Vozikis Athanassios , Swen Jesse J. , Dávila-Fajardo Cristina L. , Vasileiou Konstantinos Z. , Patrinos George P. , Mitropoulou Christina
Published: June 2023

Background

Cardiovascular diseases and especially Acute Coronary Syndrome (ACS) constitute a major health issue impacting millions of patients worldwide. Being a leading cause of death and hospital admissions in many European countries including Spain, it accounts for enormous amounts of healthcare expenditures for its management. Clopidogrel is one of the oldest antiplatelet medications used as standard of care in ACS.

Methods

In this study, we performed an economic evaluation study to estimate whether a genome-guided clopidogrel treatment is cost-effective compared to conventional one in a large cohort of 243 individuals of Spanish origin suffering from ACS and treated with clopidogrel. Data were derived from the U-PGx PREPARE clinical trial. Effectiveness was measured as survival of individuals while study data on safety and efficacy, as well as on resource utilization associated with each adverse drug reaction were used to measure costs to treat these adverse drug reactions. A generalized linear regression model was used to estimate cost differences for both study groups.

Results

Based on our findings, PGx-guided treatment group is cost-effective. PGx-guided treatment demonstrated to have 50% less hospital admissions, reduced emergency visits and almost 13% less ADRs compared to the non-PGx approach with mean QALY 1.07 (95% CI, 1.04–1.10) versus 1.06 (95% CI, 1.03–1.09) for the control group, while life years for both groups were 1.24 (95% CI, 1.20–1.26) and 1.23 (95% CI, 1.19–1.26), respectively. The mean total cost of PGx-guided treatment was 50% less expensive than conventional therapy with clopidogrel [€883 (95% UI, €316–€1582), compared to €1,755 (95% UI, €765–€2949)].

Conclusion

These findings suggest that PGx-guided clopidogrel treatment represents a cost-effective option for patients suffering from ACS in the Spanish healthcare setting.
Validation of the adolescent binge eating disorder measure (ADO-BED) among transgender youth and young adults
Authors: Linsenmeyer Whitney , Stiles Dana , Garwood Sarah , Giedinghagen Andrea , Lewis Christopher , Strand Gretta
Published: June 2023

Background

Transgender youth and young adults are at increased risk for eating disorders, including binge eating disorder, yet few measures have been validated for screening purposes with the transgender population.

Methods

The purpose of this study was to provide initial evidence for the internal consistency and convergent validity of the Adolescent Binge Eating Disorder questionnaire (ADO-BED) in a sample of transgender youth and young adults. 208 participants completed the ADO-BED as part of a routine nutrition screening protocol at a gender center. Exploratory factor analysis and confirmatory factor analysis was used to establish the factor structure of the ADO-BED. Relationships between the ADO-BED, Sick, Control, One Stone, Fat, Food (SCOFF), Nine Item Avoidant/restrictive Intake Disorder (NIAS), Patient Health Questionnaire 9 (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7), and demographic characteristics were explored.

Results

Analyses revealed a one-factor structure of the ADO-BED with good fit to the data in the present sample. The ADO-BED was shown to be significantly related to all convergent validity variables, except the NIAS.

Conclusions

The ADO-BED is a valid measure to screen for BED among transgender youth and young adults. Healthcare professionals can screen all transgender patients for BED, regardless of body size, in order to effectively identify and manage binge eating concerns.
Review immune response of targeting CD39 in cancer
Authors: Liu Yao , Li Zhongliang , Zhao Xiaoguang , Xiao Jing , Bi Jiacheng , Li Xian-Yang , Chen Guokai , Lu Ligong
Published: June 2023

The ATP-adenosine pathway has emerged as a promising target for cancer therapy, but challenges remain in achieving effective tumor control. Early research focused on blocking the adenosine generating enzyme CD73 and the adenosine receptors A2AR or A2BR in cancer. However, recent studies have shown that targeting CD39, the rate-limiting ecto-enzyme of the ATP-adenosine pathway, can provide more profound anti-tumor efficacy by reducing immune-suppressive adenosine accumulation and increasing pro-inflammatory ATP levels. In addition, combining CD39 blocking antibody with PD-1 immune checkpoint therapy may have synergistic anti-tumor effects and improve patient survival. This review will discuss the immune components that respond to CD39 targeting in the tumor microenvironment. Targeting CD39 in cancer has been shown to not only decrease adenosine levels in the tumor microenvironment (TME), but also increase ATP levels. Additionally, targeting CD39 can limit the function of Treg cells, which are known to express high levels of CD39. With phase I clinical trials of CD39 targeting currently underway, further understanding and rational design of this approach for cancer therapy are expected.
Linking changes in individual specialization and population niche of space use across seasons in the great evening bat (Ia io)
Authors: Wang Zhiqiang , Gong Lixin , Huang Zhenglanyi , Geng Yang , Zhang Wenjun , Si Man , Wu Hui , Feng Jiang , Jiang Tinglei
Published: June 2023

Background

The niche breadth of an animal population comprises both within-individual and between-individual variation (individual specialization). Both components can be used to explain changes in population niche breadth, and this has been extensively investigated in dietary niche dimension studies. However, little is known about how changes in food resources or environmental factors across seasons affect changes in individual and population space use within the same population.

Methods

In this study, we used micro-GPS loggers to capture the space use of individuals and of a population of the great evening bat (Ia io) in summer and autumn. We used I. io as a model to investigate how individual spatial niche breadth and spatial individual specialization affect changes in population niche breadth (home range and core area sizes) across seasons. Additionally, we explored the drivers of individual spatial specialization.

Results

We found that the population home range and the core area of I. io did not increase in autumn when insect resources were reduced. Moreover, I. io showed different specialization strategies in the two seasons: higher spatial individual specialization in summer and lower individual specialization but broader individual niche breadth in autumn. This trade-off may maintain the dynamic stability of the population spatial niche breadth across seasons and facilitate the population response to changes in food resources and environmental factors.

Conclusions

Like diet, spatial niche breadth of a population also may be determined by a combination of individual niche breadth and individual specialization. Our work provides new insights into the evolution of niche breadth from the spatial dimension.
Characterizing ancient jade by on-site analysis in Sanxingdui, China
Authors: Lu Hao , Fu Wanlu , Xu Shiyu , Chai Jun , Ran Honglin , Lei Yu , Zhao Hao
Published: June 2023

Characterized by various materials, types and patterns, ancient jade is a unique symbol of Chinese civilization. However, crucial information can be jeopardized by the sudden exposure during excavations, and abundant jade artefacts were stored without scientific identification in the archaeological context. Sanxingdui site was an essential center of a complex society in the Chengdu Plain in Bronze Age China. During the new excavation in Sanxingdui sacrificial area (pit K3–K8) since 2019, cabins have been used for better site conservation, providing ideal conditions for on-site study. Employing portable devices, on-site non-destructive analysis were conducted inside pit K8. The results of Raman and XRF show that the raw material is nephrite, indicating the consistency of jade material preference with the majority of Sanxingdui jade from pit K1–K2 and the majority of prehistoric jade as well. Evidence of mineral thermal phase transition from tremolite to diopside was found on the zao chisel and proved the existence of jade burning related to the sacrificial activities. The Fe content in the surrounding soil led to the red and orange colors on the jade surfaces and the neutral environment helped retaining of the original texture and natural luster of the nephrite. Based on the geometric morphometric database, the jade zhang forked blade was quantitatively recognized as the most typical zhang type only found in Sanxingdui. It is demonstrated that the non-destructive analysis is efficient to characterize the ancient jade and makes it possible to construct the database of all the jade artefacts on site, providing the basis of solving larger-scale archaeological problems that are not necessarily bounded by geographical regions or time periods.
Imaging features based on CT and MRI for predicting prognosis of patients with intrahepatic cholangiocarcinoma: a single-center study and meta-analysis
Authors: Sun Dongwei , XU Zhenggang , Cao Shuya , Wu Huaiyu , LU Ming , Xu Qing , Wang Ke , Ji Guwei
Published: June 2023

Background

To evaluate the prognostic role of imaging features based on CT and MRI in intrahepatic cholangiocarcinoma (ICC).

Methods

Two hundred and four patients from a single-center database who underwent radical ICC surgery from 2010 to 2019 were enrolled in the study. Cox proportional hazard model was used for survival analysis of imaging features. A meta-analysis was performed to determine imaging features that predict overall survival (OS) and event-free survival (EFS) in ICC.

Results

In the CT group of the retrospective cohort, tumor multiplicity, infiltrative tumor margin, lymph node metastasis, enhancement pattern in hepatic arterial phase and tumor necrosis correlated with poorer EFS and OS; moreover, enhancing capsules, high carcinoembryonic antigen levels contributed to poor OS. In the MRI group, tumor multiplicity and enhancement pattern were prognostic factors for OS; tumor multiplicity and enhancement pattern resulted in poor EFS. A total of 13 articles containing 1822 patients with ICC were enrolled in the adjusted hazard ratios meta-analysis. The results showed that enhancement pattern and infiltrative tumor margin were predictors of OS and EFS, whereas bile duct invasion was a predictor of OS.

Conclusions

Arterial enhancement patterns and tumor margin status were associated with both OS and EFS of ICC patients following resection.
Electrical analysis of logical complexity: an exploratory eeg study of logically valid/invalid deducive inference
Authors: Salto Francisco , Requena Carmen , Alvarez-Merino Paula , Rodríguez Víctor , Poza Jesús , Hornero Roberto
Published: June 2023

Introduction

Logically valid deductive arguments are clear examples of abstract recursive computational procedures on propositions or on probabilities. However, it is not known if the cortical time-consuming inferential processes in which logical arguments are eventually realized in the brain are in fact physically different from other kinds of inferential processes.

Methods

In order to determine whether an electrical EEG discernible pattern of logical deduction exists or not, a new experimental paradigm is proposed contrasting logically valid and invalid inferences with exactly the same content (same premises and same relational variables) and distinct logical complexity (propositional truth-functional operators). Electroencephalographic signals from 19 subjects (24.2 ± 3.3 years) were acquired in a two-condition paradigm (100 trials for each condition). After the initial general analysis, a trial-by-trial approach in beta-2 band allowed to uncover not only evoked but also phase asynchronous activity between trials.

Results

showed that (i) deductive inferences with the same content evoked the same response pattern in logically valid and invalid conditions, (ii) mean response time in logically valid inferences is 61.54% higher, (iii) logically valid inferences are subjected to an early (400 ms) and a late reprocessing (600 ms) verified by two distinct beta-2 activations (p-value < 0,01, Wilcoxon signed rank test).

Conclusion

We found evidence of a subtle but measurable electrical trait of logical validity. Results put forward the hypothesis that some logically valid deductions are recursive or computational cortical events.
Laparoscopically assisted percutaneous endoscopic gastrostomy performed for remnant stomach in patient with amyotrophic lateral sclerosis: a case report
Authors: Ohgaki Yutaro , Ishibashi Yuji , Hatao Fumihiko , Furuta Ryuichiro , Saito Noriyuki , Inayoshi Rie , Morita Yasuhiro
Published: June 2023

Background

Although percutaneous endoscopic gastrostomy (PEG) offers better access to the gastrointestinal system, in patients with previous abdominal surgery, PEG can be unsuccessful. Laparoscopically assisted percutaneous endoscopic gastrostomy (LAPEG) is indicated for such patients. However, patients with amyotrophic lateral sclerosis (ALS) may be more susceptible to anesthesia-related complications than other patients, requiring the indications for LAPEG, along with perioperative management, to be considered carefully.

Case presentation

A 70-year-old, male patient with ALS was referred to our hospital for a gastrostomy for progressive dysphagia. He had undergone an open distal gastrectomy for gastric ulcer perforation in his twenties. Upper gastrointestinal endoscopy denied the transillumination sign and focal finger invagination. Because the risk of respiratory complications caused by general anesthesia was not considered serious, the decision was made to perform a LAPEG. Under careful, intraoperative airway management and neuromuscular monitoring, adhesiolysis was performed to increase mobility of the remnant stomach. A gastrostomy tube was inserted through the abdominal wall and into the remnant stomach under laparoscopic and endoscopic guidance. The patient was discharged in stable condition on postoperative day 3 without any respiratory complications.

Conclusions

LAPEG was able to be performed in a patient with ALS with a previous gastrectomy. A perioperative team comprised of neurologists, endoscopists, surgeons, anesthesiologists, and nurses who are fully conversant with ALS must be assembled to deal with potentially complex medical issues related to the procedure and anesthetic and perioperative management.
The impacts of ocean acidification, warming and their interactive effects on coral prokaryotic symbionts
Authors: Li Jinlong , Chai Guangjun , Xiao Yilin , Li Zhiyong
Published: June 2023

Background

Reef-building corals, the foundation of tropical coral reefs, are vulnerable to climate change e.g. ocean acidification and elevated seawater temperature. Coral microbiome plays a key role in host acclimatization and maintenance of the coral holobiont’s homeostasis under different environmental conditions, however, the response patterns of coral prokaryotic symbionts to ocean acidification and/or warming are rarely known at the metatranscriptional level, particularly the knowledge of interactive and persistent effects is limited. Using branching Acropora valida and massive Galaxea fascicularis as models in a lab system simulating extreme ocean acidification (pH 7.7) and/or warming (32 °C) in the future, we investigated the changes of in situ active prokaryotic symbionts community and gene expression of corals under/after (6/9 d) acidification (A), warming (H) and acidification–warming (AH) by metatranscriptome analysis with pH8.1, 26 °C as the control.

Results

A, H and AH increased the relative abundance of in situ active pathogenic bacteria. Differentially expressed genes (DEGs) involved in virulence, stress resistance, and heat shock proteins were up-regulated. Many DEGs involved in photosynthesis, carbon dioxide fixation, amino acids, cofactors and vitamins, auxin synthesis were down-regulated. A broad array of new DEGs involved in carbohydrate metabolism and energy production emerged after the stress treatment. Different response patterns of prokaryotic symbionts of massive G. fascicularis and branching A. valida were suggested, as well as the interactive effects of combined AH and persistent effects.

Conclusions

The metatranscriptome-based study indicates that acidification and/or warming might change coral’s in situ active prokaryotic microbial diversity and functional gene expression towards more pathogenic and destabilized coral-microbes symbioses, particularly combined acidification and warming show interactive effects. These findings will aid in comprehension of the coral holobiont’s ability for acclimatization under future climate change.
Medico legal aspects of medical malpractice dead cases in Cairo and Giza governorates from 2014–2015
Authors: Nagieb MM , El-Gallad GA , Ghaleb SS , Saleh AR
Published: June 2023

Background

In Egypt, as elsewhere around the world, there are more medical malpractice claims and lawsuits being brought against doctors and hospitals. The present study attempts to identify the medico-legal aspects of medical malpractice cases, determine the most frequent causes of medical errors, and the most medical specialities facing this problem and their qualifications. Find out the positive cases from the negative ones, and determine the causes of their death.

Methods

This study is a retrospective descriptive observational study of medical malpractice dead cases in Cairo and Giza governorates from the available records and reports of the Forensic Medical Authority from the 1st of January 2014- to the 1st of January 2015 which included 112 cases with alleged medical malpractice dead cases. The outcomes of forensic autopsies were used to distinguish between positive and negative cases.

Results

According to the socio-demographic data of the claimed cases, the female cases (53.6%) dominated the male cases (46.4%). The majority of accusations of medical errors were submitted due to negligence (73.68%), followed by complications within surgical therapy (15.79%). In the study, claims against obstetricians were the highest (24.1%), followed by those against anesthesiologists (20.5%), and general surgeons (17%). university hospitals have the highest percentage of positive cases (75%), followed by insurance hospitals (25%), private hospitals (15.6%), and public hospitals (11.1%).

Conclusions

The majority of the studied cases were female. Obstetricians had the most accusations in the study and the most positive cases. The most frequent medical error in the study is negligence. All of the study's cases of obstructed labour are positive, but none of the cardiac arrhythmia or heart failure cases are. The majority of cases at university hospitals were positive and the majority of cases at public hospitals were negative.
Interactive assistance via eHealth for small- and medium-sized enterprises’ employer and health care manager teams on tobacco control (eSMART-TC): protocol for a cluster randomized hybrid type II trial (N-EQUITY2101/J-SUPPORT2102)
Authors: Saito Junko , Odawara Miyuki , Fujimori Maiko , Kuchiba Aya , Oyamada Shunsuke , Swe Khin Thet , Saito Eiko , Fukai Kota , Tatemichi Masayuki , Nakamura Masakazu , Uchitomi Yosuke , Shimazu Taichi
Published: June 2023

Background

Tobacco control should be a higher public health priority in Japan. Some workplaces provide smoking cessation support and connect employees to effective smoking cessation treatments such as outpatient clinics. However, tobacco control measures have not been sufficiently implemented in Japan, especially in small- and medium-sized enterprises (SMEs), where resources are limited. Organizational commitment and consistent leadership are crucial to facilitate implementation, but research on whether supporting organizational leaders leads to health behavior changes among employees is limited.

Methods

This hybrid type II cluster randomized effectiveness implementation trial (eSMART-TC) aims to examine the effects of interactive assistance for SME management on health and implementation outcomes. We will provide interactive assistance to employers and health managers for 6 months, aiming to promote the utilization of reimbursed smoking cessation treatments by public health insurance and to implement smoke-free workplaces. The intervention will consist of three strategies: supporting employees through campaigns, tailored ongoing facilitation, and ensuring executive engagement and support. The primary health and implementation outcomes will be salivary cotinine-validated 7-day point-prevalence abstinence rate, and the adoption of two recommended measures (promoting utilization of smoking cessation treatment and implementing smoke-free workplaces) 6 months after the initial session, respectively. Other outcomes for implementation (e.g., penetration of smoking cessation clinic visits), health (e.g., salivary cotinine-validated 7-day point-prevalence abstinence rate at 12 months), and process (e.g., adherence and potential moderating factors) will be collected via questionnaires, interviews, logbooks, and interventionists’ notes at 6 and 12 months. An economic analysis will be undertaken to assess the cost-effectiveness of the implementation interventions at 12 months.

Discussion

This will be the first cluster randomized controlled trial to evaluate the effectiveness of an implementation intervention with interactive assistance for employers and health managers in SMEs on smoking cessation and implementation of evidence-based tobacco control measures in SMEs. The findings of this trial targeting management in SMEs have the potential to accelerate the implementation of evidence-based smoking cessation methods as well as abstinence rates among employees in SMEs across Japan.

Trial registration

The study protocol has been registered in the UMIN Clinical Trials Registry (UMIN-CTR; ID: UMIN000044526). Registered on 06/14/2021.
Preliminary results from a phase II study comparing sunitinib alone or with stereotactic body radiotherapy (SBRT) for newly diagnosed oligometastatic renal cell carcinoma.
Authors: Liu Yang , Wei Wensu , Zhang Zhiling , Liu Ruiqi , Gao Jianming , Guo Shengjie , Han Hui , Dong Pei , He Liru , Zhou Fangjian
Published: June 2023

4533

Background: Although SBRT has become an option for oligometastatic renal cell carcinoma (oligoRCC), current trials supporting SBRT haven’t been adequately persuasive given their single-arm, non-first-line design. Our study aimed to explore if SBRT improves oncologic outcomes compared with standard first-line systemic therapy in oligoRCC. Methods: This an open-label, double-arm phase II controlled trial enrolling treatment naïve oligoRCC patients (pts), defined as ≤ 5 metastatic lesions (ChiCTR1800017136). No liver or brain metastasis was allowed. Nephrectomy was mandatory before enrollment. Pts were allocated 1:1 to receive either sunitinib alone (control arm) or sunitinib plus SBRT (SBRT arm). Sunitinib was started as 50 mg daily for 4 weeks, followed by 2 weeks off treatment. SBRT was delivered to all metastatic sites within 2 months after sunitinib initiation, with 35-50Gy in 5 fractions. Primary endpoint was objective response rate (ORR); secondary endpoints were disease control rate (DCR), progression-free survival (PFS), overall survival (OS) and safety. Data from pts with ≥ 1 year of follow-up were reported this time. Results: Starting in 2018, the trial has currently completed its accrual, with 48 pts enrolled. Forty-two pts had ≥ 1 year of follow-up and were evaluable for the present analysis. Pt characteristics for SBRT and control arms: median age 51 vs 59 years (p=0.094); synchronous metastasis 31.8% vs 10.0% (p=0.179); clear cell carcinoma 77.3% vs 80.0% (p=1.000); IMDC low or intermediate risk 86.4% vs 80.0% (p=1.000); solitary metastasis 45.5% vs 25.0% (p=0.167). Thirty-four sites received SBRT, most frequently to bone (61.8%) and soft tissue (17.6%) metastasis. The 1-year local control rate after SBRT was 93.8%. ORR (81.8% vs. 25.0%, p=0.000) and DCR (90.9% vs. 60.0%, p=0.047) were significantly higher in SBRT arm than those in control arm. The 1y-PFS was 72.7% for SBRT arm and 35.0% for control arm (HR 0.33, 95% CI 0.16-0.69, p= 0.003). And the 1y-OS was 95.5% for SBRT arm and 80.0% for control arm (HR 1.06, 95% CI 0.31-3.67, p=0.923). Grade 3-4 treatment-related AEs occurred in 66.7% and 62.5% pts in SBRT arm and control arm (p=0.763), respectively. SBRT-related Grade 3-4 toxicity included radiation enteritis (n=1, grade 3) and radiation pneumonitis (n=1, grade 3). Conclusions: Our results showed promising efficacy and acceptable toxicity of SBRT plus sunitinib when compared with sunitinib alone for oligoRCC. Complete results are awaited in 2023 after follow-up completion of the entire cohort. Clinical trial information: ChiCTR1800017136.
Preliminary results from a phase I/II study of IMM0306, a CD47 and CD20 bispecific monoclonal antibody-trap, in patients with relapsed or refractory CD20-positive B-cell non-Hodgkin's lymphoma.
Authors: Yang Jianliang , Song Yongping , Li Zhiming , Zhang Mingzhi , Zhou Keshu , Wang Zhen , Jing Hongmei , Yu Li , Ma Huizi , Zhao Xiwen , Li Wei , Meng Wei , Tian Wenzhi , Shi Yuankai
Published: June 2023

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Background: IMM0306 is a fusion protein of CD20 monoclonal antibody with the CD47 binding domain of SIRPα on both heavy chains. It has a higher affinity for CD20 than for CD47, thus enabling its preferential and simultaneous binding to CD20 and CD47 on malignant B cells rather than to CD47-postive normal tissues. Here, we report the safety, pharmacokinetics (PK), pharmacodynamics (PD), and efficacy results of the dose escalation stage in a phase I/II study in patients (pts) with relapsed or refractory CD20-positive B-cell non-Hodgkin's lymphoma. Methods: This is a first-in-human, open-label, phase I/II study of IMM0306. The ongoing Phase I part (0.04, 0.1, 0.25, 0.5, 0.8, 1.2, 1.6, 2.0 mg/kg, IV) followed an accelerated titration and standard 3+3 design. IMM0306 was administered once per week after a 2-week single-dose period, until disease progression or intolerable toxicity. Dose-limiting toxicity (DLT) was evaluated in the first 28 days. Safety was evaluated per CTCAE 5.0, tumor assessments performed once every 8 weeks, PK and PD were also assessed. Results: As of the data cut-off date on Dec 15th, 2022, 42 pts were enrolled. 18 (43%) pts received 3 or more prior lines of therapy, all pts received prior anti-CD20 therapy. No DLTs were observed up to 2.0 mg/kg. The most frequent treatment related adverse events (TRAEs) were lymphocyte decreased (61.9%), white blood cell (WBC) decreased (61.9%), anemia (59.5%), neutrophil (ANC) decreased (40.5%), platelet (PLT) decreased (40.5%), infusion-related reactions (31.0%). Grade ≥ 3 TRAEs occurred in 30 (71.4%) pts, the most frequent grade ≥ 3 TRAEs were lymphocyte decreased (59.5%), WBC decreased (16.7%), ANC decreased (11.9%). Three treatment related SAEs were PLT decreased (grade 4), chest pain (grade 2) and diarrhea (grade 3). In 38 response evaluable pts, 2 follicular lymphoma (FL) pts achieved CR, 1 marginal zone lymphoma (MZL) pt and 2 FL pts achieved PR and 13 pts showed SD. 26 pts were treated at doses ≥ 0.8 mg/kg, among whom 11 were FL pts. Of these 11 FL pts, 4 (36%) responded including 2 CR both at 1.2 mg/kg and 2 PR at 1.2 and 1.6 mg/kg respectively. IMM0306 exhibited approximate dose-proportional increase in PK exposure from 0.5 to 2.0 mg/kg and no obvious accumulation was observed after repeated dosing. B-cell counts depleted rapidly at doses ≥ 0.8 mg/kg. Elevated cytokines levels were observed after first dosing of IMM0306, but multiple dosing did not stimulate further cytokine activation. Conclusions: IMM0306 was well-tolerated and with a robust preliminary anti-tumor activity especially in pts with R/R FL and MZL. The phase I/II study is ongoing. Clinical trial information: CTR20192612 .