bluuebunny/crossref_metadata_2025 huggingface dataset:
A systematic review and meta-analysis of glucocorticoids treatment in severe COVID-19: methylprednisolone versus dexamethasone
Authors: Hong Shukun , Wang Hongye , Li Shuyuan , Liu Jian , Qiao Lujun
Published: May 2023

Objective

The preferred agent of glucocorticoids in the treatment of patients with severe COVID-19 is still controversial. This study aimed to compare the efficacy and safety of methylprednisolone and dexamethasone in the treatment of patients with severe COVID-19.

Methods

By searching the electronic literature database including PubMed, Cochrane Central Register of Controlled Trials, and Web of Science, the clinical studies comparing methylprednisolone and dexamethasone in the treatment of severe COVID-19 were selected according to the inclusion criteria and exclusion criteria. Relevant data were extracted and literature quality was assessed. The primary outcome was short-term mortality. The secondary outcomes were the rates of ICU admission and mechanical ventilation, PaO2/FiO2 ratio, plasma levels of C-reactive protein (CRP), ferritin, and neutrophil/lymphocyte ratio, hospital stay, and the incidence of severe adverse events. Statistical pooling applied the fixed or random effects model and reported as risk ratio (RR) or mean difference (MD) with the corresponding 95% confidence interval (CI). Meta-analysis was performed using Review Manager 5.1.0.

Results

Twelve clinical studies were eligible, including three randomized controlled trials (RCTs) and nine non-RCTs. A total of 2506 patients with COVID-19 were analyzed, of which 1242 (49.6%) received methylprednisolone and 1264 (50.4%) received dexamethasone treatment. In general, the heterogeneity across studies was significant, and the equivalent doses of methylprednisolone were higher than that of dexamethasone. Our meta-analysis showed that methylprednisolone treatment in severe COVID-19 patients was related to significantly reduced plasma ferritin and neutrophil/lymphocyte ratio compared with dexamethasone, and that no significant difference in other clinical outcomes between the two groups was found. However, subgroup analyses of RCTs demonstrated that methylprednisolone treatment was associated with reduced short-term mortality, and decreased CRP level compared with dexamethasone. Moreover, subgroup analyses observed that severe COVID-19 patients treated with a moderate dose (2 mg/kg/day) of methylprednisolone were related to a better prognosis than those treated with dexamethasone.

Conclusions

This study showed that compared with dexamethasone, methylprednisolone could reduce the systemic inflammatory response in severe COVID-19, and its effect was equivalent to that of dexamethasone on other clinical outcomes. It should be noted that the equivalent dose of methylprednisolone used was higher. Based on the evidence of subgroup analyses of RCTs, methylprednisolone, preferably at a moderate dose, has an advantage over dexamethasone in the treatment of patients with severe COVID-19.
Association between hyperuricemia and acute kidney injury in critically ill patients with sepsis
Authors: Jiang Yuan-Xia , Gong Chun-Lei , Tang Yan , Yi Yang , Liu Fu-Gang , Zhou Jing-Wen , Shi Ying-Long , Zhou Hong-Wei , Xie Kai-Qing
Published: May 2023

Background

Sepsis-related AKI is related to short-term mortality and poor long-term prognoses, such as chronic renal insufficiency, late development of end-stage renal disease, and long-term mortality. In this study, we aimed to investigate the association of hyperuricemia with acute kidney injury (AKI) in patients with sepsis.

Methods

The retrospective cohort study included 634 adult sepsis patients hospitalized in the intensive care unit (ICU) of the First Affiliated Hospital of Guangxi Medical University from March 2014 to June 2020 and the ICU of the Second Affiliated Hospital of Guangxi Medical University from January 2017 to June 2020. Based on the first serum uric acid level within 24 h of admission to the ICU, patients were divided into groups with or without hyperuricemia, and the incidence of AKI within seven days of ICU admission was compared between the two groups. The univariate analysis analyzed the effect of hyperuricemia on sepsis-related AKI, and the multivariable logistic regression model analysis was used.

Results

Among the 634 patients with sepsis, 163 (25.7%) developed hyperuricemia, and 324 (51.5%) developed AKI. The incidence of AKI in the groups with and without hyperuricemia was 76.7% and 42.3%, respectively, with statistically significant differences (2 = 57.469, P < 0.001). After adjusting for genders, comorbidities (coronary artery disease), organ failure assessment (SOFA) score on the day of admission, basal renal function, serum lactate, calcitonin, and mean arterial pressure, hyperuricemia was showed to be an independent risk factor for AKI in patients with sepsis (OR = 4.415, 95%CI 2.793 ~ 6.980, P < 0.001). For every 1 mg/dL increase in serum uric acid in patients with sepsis, the risk of AKI increased by 31.7% ( OR = 1.317, 95%CI 1.223 ~ 1.418, P < 0.001).

Conclusion

AKI is a common complication in septic patients hospitalized in the ICU, and hyperuricemia is an independent risk factor for AKI in septic patients.
Risk of cervical intraepithelial neoplasia grade 2 or worse in women aged ≥ 69 referred to colposcopy due to an HPV-positive screening test
Authors: Booth Berit B. , Tranberg Mette , Gustafson Line W. , Christiansen Anne G. , Lapirtis Helle , Krogh Lisa M. , Hjorth Ina Marie D. , Hammer Anne
Published: May 2023

Background

Cervical cancer incidence and mortality rates are high in older women in many developed countries, including Denmark. Therefore, Danish women aged 69 and older were invited for one additional human papilloma virus (HPV) based screening test in 2017. Here, we describe the clinical management and detection rate of cervical intraepithelial neoplasia grade 2 or worse (CIN2 +) in screen-positive women referred for colposcopy.

Methods

We conducted an observational study in public gynecology departments in Central Denmark Region, Denmark. Women were eligible for enrolment if they were aged 69 + in 2017, HPV positive on a screening test taken between April 20th, 2017, and December 31st, 2017, and had been referred for direct colposcopy. Data on participants’ characteristics, colposcopic findings, and histological outcomes were collected from medical records and the Danish Pathology Databank. We estimated the proportion of women with CIN2 + at the first colposcopy visit and at end of follow up including 95% confidence intervals (CIs).

Results

A total of 191 women were included with a median age of 74 years (IQR: 71—78). Most women (74.9%) did not have a fully visible transformation zone at colposcopy. At the first visit 170 women (89.0%) had a histological sample collected, 34 of whom (20.0%, 95% CI 14.3–26.8%) had CIN2 + diagnosed, 19 had CIN3 + , and two had cervical cancer). During follow-up additional CIN2 + were detected resulting in a total of 42 women (24.4%, 95% CI: 18.2–31.5%) being diagnosed with CIN2 + , 25 with CIN3 + , and three with cervical cancer. When restricting to women with paired histologic results (i.e., biopsies and a loop electrosurgical excision procedure (LEEP) specimen), we found that CIN2 + was missed in 17.9% (95% CI 8.9–30.4%) of biopsies compared to the LEEP.

Conclusion

Our findings suggest a potential risk of underdiagnosis in older postmenopausal women referred to colposcopy. Future studies should explore potential risk-markers for discrimination of women at increased risk of CIN2 + from those at low risk, as this would reduce risk of underdiagnosis and overtreatment.
Neonatal mortality in small for gestational age infants based on reference local newborn curve at secondary and tertiary hospitals in Indonesia
Authors: Haksari Ekawaty L. , Hakimi Mohammad , Ismail Djauhar
Published: May 2023

Background

Small for gestational (SGA) infants during the neonatal period have risks of mortality and sequelae for survival. Two - third of neonatal mortality occurs in the first weeks of life. Prevalence of SGA depends on the newbon curve used. Objectives of the study were to know the conditions that posed the risk of early neonatal and neonatal mortality, to identify preterm/full-term and SGA/appropriate gestational age (AGA) infants with cumulative mortality incident (CMI), to compare 5- year-period of early and neonatal mortality, and to investigate CMI on neonatal mortality of four categories during 5-year-period.

Methods

A retrospective cohort study on all live births, during 1998–2017, was conducted in Sleman and Sardjito hospitals, Yogyakarta, Indonesia. Based on the reference local curve, the eligible subjects were categorized into SGA and AGA infants. The analyses were based on preterm/full-term and SGA/AGA, thus resulting in 4 categories: preterm-SGA, preterm-AGA, full-term-SGA and full-term-AGA. Analysis was made with Unadjusted Hazard Ratio (HR) by Simple Cox Regression and Adjusted HR was calculated by Multiple Cox Regression, survival analysis to calculate CMI, and analysis mortality for 5-year period ( 1998–2002, 2003–2007, 2008–2012, 2013–2017).

Result

There were 35,649 live births eligible for the study. Respiratory distress was the highest risk with HR 9,46, followed by asphyxia with HR 5,08, mother’s death with HR 227, extra-health facility with HR 1,97, symmetrical SGA with HR 1,97, preterm-AGA with HR 1,75, low birth weight (LBW) with HR 1,64, primary health facility with HR 1,33, and boys with HR 1,16 consecutively. Early neonatal mortality in 4 categories by survival analysis revealed the highest CMI in preterm SGA. Similar result was found in neonatal mortality. Analysis of 5-year period unveiled the highest CMI during 1998–2002. The highest CMI based on the four categories, however, was found in preterm-SGA.

Conclusion

Respiratory distress posed the highest HR in early and neonatal mortality. Survival analysis showing the highest CMI on early and neonatal mortality was identified in preterm-SGA. The 5 - year - period of neonatal mortality showed the highest CMI during 1998–2002 period, whereas based on 4 SGA categories, preterm-SGA demonstrated the highest CMI.
Molecular genetic screening of full-term small for gestational age
Authors: Zhang Shuman , Zhou Lingna , Zhang Lin , Wang Yu , Wang Huaiyan
Published: May 2023

Objective

To examine the clinical application of genomic screening in newborns small for gestational age (SGA), hoping to provide an efficient technique for early discovery of neonatal diseases, which is necessary to elevate survival rates and the quality of life in infants.

Methods

Totally 93 full-term SGA newborns were assessed. Dried blood spot (DBS) samples were obtained at 72 h after birth, and tandem mass spectrometry (TMS) and Angel Care genomic screening (GS, using Targeted next generation sequencing) were carried out.

Results

All 93 subjects were examined by Angel Care GS and TMS. No children showing inborn errors of metabolism (IEM) were detected by TMS, while 2 pediatric cases (2.15%, 2/93) were confirmed as thyroid dyshormonogenesis 6 (TDH6) by Angel Care GS. Additionally, 45 pediatric cases (48.4%) had one or more variants conferring a carrier status for recessive childhood-onset disorders, with 31 genes and 42 variants associated with 26 diseases. The top three gene-related diseases with carrier status were autosomal recessive deafness (DFNB), abnormal thyroid hormone and Krabbe disease.

Conclusions

SGA is tightly associated with genetic variation. Molecular Genetic Screening allows early detection of congenital hypothyroidism and may be a potent genomic sequencing technique for screening newborns.
Predicting polypharmacy in half a million adults in the Iranian population: comparison of machine learning algorithms
Authors: Seyedtabib Maryam , Kamyari Naser
Published: May 2023

Background

Polypharmacy (PP) is increasingly common in Iran, and contributes to the substantial burden of drug-related morbidity, increasing the potential for drug interactions and potentially inappropriate medications. Machine learning algorithms (ML) can be employed as an alternative solution for the prediction of PP. Therefore, our study aimed to compare several ML algorithms to predict the PP using the health insurance claims data and choose the best-performing algorithm as a predictive tool for decision-making.

Methods

This population-based cross-sectional study was performed between April 2021 and March 2022. After feature selection, information about 550 thousand patients were obtained from National Center for Health Insurance Research (NCHIR). Afterwards, several ML algorithms were trained to predict PP. Finally, to assess the models’ performance, the metrics derived from the confusion matrix were calculated.

Results

The study sample comprised 554 133 adults with a median (IQR) age of 51 years (40 – 62) that nested in 27 cities within the Khuzestan province of Iran. Most of the patients were female (62.5%), married (63.5%), and employed (83.2%) during the last year. The prevalence of PP in all populations was about 36.0%. After performing the feature selection, out of 23 features, the number of prescriptions, Insurance coverage for prescription drugs, and hypertension were found as the top three predictors. Experimental results showed that Random Forest (RF) performed better than other ML algorithms with recall, specificity, accuracy, precision and F1-score of 63.92%, 89.92%, 79.99%, 63.92% and 63.92% respectively.

Conclusion

It was found that ML provides a reasonable level of accuracy in predicting polypharmacy. Therefore, the prediction models based on ML, especially the RF algorithm, performed better than other methods for predicting PP in Iranian people in terms of the performance criteria.
Distribution of nursing workforce in the world using Gini coefficient
Authors: Kharazmi Erfan , Bordbar Najmeh , Bordbar Shima
Published: May 2023

Introduction

Unequal Access to human resources for health, reduces access to healthcare services, worsens the quality of services and reduces health outcomes. This study aims to investigate the distribution of the nursing workforce around the world.

Methods

This is a descriptive-analytical study, which was conducted in 2021. The number of nurses and world populations was gathered from World Health Organization (WHO) and The United Nations (UN) databases. The UN has divided world countries based on the Human Development Index (HDI) into four categories of very high, high, medium and low HDI. To investigate the distribution of the nurses around the world, we used the nurse population ratio (per 10,000 population), Gini coefficient, Lorenz curve and Pareto curve.

Findings

On average, there were 38.6 nurses for every 10,000 people in the world. Nations with the very high HDI, had the highest nurse/population ratio (95/10,000), while the low HDI nations had the lowest nurse/population ratio (7/10,000). Most nurses around the world were females (76.91%) who were in the age group of 35–44 (29.1%). The Gini coefficient of nations in the each four HDI categories varied from 0.217 to 0.283. The Gini coefficient of the nations between the four HDI categories was 0.467, and the Gini coefficient of the whole world was 0.667.

Conclusion

There were inequalities between countries all over the world. Policymakers should focus on the equitable distribution of the nursing workforce across all local, national and regional levels.
Task shifting roles, interventions and outcomes for kidney and cardiovascular health service delivery among African populations: a scoping review
Authors: Okpechi Ikechi G. , Chukwuonye Ijezie I. , Ekrikpo Udeme , Noubiap Jean Jacques , Raji Yemi R. , Adeshina Yusuf , Ajayi Samuel , Barday Zunaid , Chetty Malini , Davidson Bianca , Effa Emmanuel , Fagbemi Stephen , George Cindy , Kengne Andre P. , Jones Erika S. W. , Liman Hamidu , Makusidi Mohammad , Muhammad Hadiza , Mbah Ikechukwu , Ndlovu Kwazi , Ngaruiya Grace , Okwuonu Chimezie , Samuel-Okpechi Ugochi , Tannor Elliot K. , Ulasi Ifeoma , Umar Zulkifilu , Wearne Nicola , Bello Aminu K.
Published: May 2023

Background

Human resources for health (HRH) shortages are a major limitation to equitable access to healthcare. African countries have the most severe shortage of HRH in the world despite rising communicable and non-communicable disease (NCD) burden. Task shifting provides an opportunity to fill the gaps in HRH shortage in Africa. The aim of this scoping review is to evaluate task shifting roles, interventions and outcomes for addressing kidney and cardiovascular (CV) health problems in African populations.

Methods

We conducted this scoping review to answer the question: “what are the roles, interventions and outcomes of task shifting strategies for CV and kidney health in Africa?” Eligible studies were selected after searching MEDLINE (Ovid), Embase (Ovid), CINAHL, ISI Web of Science, and Africa journal online (AJOL). We analyzed the data descriptively.

Results

Thirty-three studies, conducted in 10 African countries (South Africa, Nigeria, Ghana, Kenya, Cameroon, Democratic Republic of Congo, Ethiopia, Malawi, Rwanda, and Uganda) were eligible for inclusion. There were few randomized controlled trials (n = 6; 18.2%), and tasks were mostly shifted for hypertension (n = 27; 81.8%) than for diabetes (n = 16; 48.5%). More tasks were shifted to nurses (n = 19; 57.6%) than pharmacists (n = 6; 18.2%) or community health workers (n = 5; 15.2%). Across all studies, the most common role played by HRH in task shifting was for treatment and adherence (n = 28; 84.9%) followed by screening and detection (n = 24; 72.7%), education and counselling (n = 24; 72.7%), and triage (n = 13; 39.4%). Improved blood pressure levels were reported in 78.6%, 66.7%, and 80.0% for hypertension-related task shifting roles to nurses, pharmacists, and CHWs, respectively. Improved glycaemic indices were reported as 66.7%, 50.0%, and 66.7% for diabetes-related task shifting roles to nurses, pharmacists, and CHWs, respectively.

Conclusion

Despite the numerus HRH challenges that are present in Africa for CV and kidney health, this study suggests that task shifting initiatives can improve process of care measures (access and efficiency) as well as identification, awareness and treatment of CV and kidney disease in the region. The impact of task shifting on long-term outcomes of kidney and CV diseases and the sustainability of NCD programs based on task shifting remains to be determined.
Lobeglitazone, a novel thiazolidinedione, for secondary prevention in patients with ischemic stroke: a nationwide nested case-control study
Authors: Yoo Joonsang , Jeon Jimin , Baik Minyoul , Kim Jinkwon
Published: May 2023

Introduction

Ischemic stroke patients with diabetes are at high risk for recurrent stroke and cardiovascular complications. Pioglitazone, a type of thiazolidinedione, has been shown to reduce cardiovascular complications in patients with ischemic stroke and type 2 diabetes (T2D) or insulin resistance. Lobeglitazone is a novel thiazolidinedione agent that improves insulin resistance and has similar glycemic efficacy to pioglitazone. Using population-based health claims data, we evaluated whether lobeglitazone has secondary cardiovascular preventive effects in patients with ischemic stroke and T2D.

Methods

This study has a nested case-control design. From nationwide health claims data in Korea, we identified patients with T2D admitted for acute ischemic stroke in 2014–2018. Cases were defined who suffered the primary outcome (a composite of recurrent stroke, myocardial infarction, and all-cause death) before December 2020. Three controls were selected by incidence density sampling for each case from those who were at risk at the time of their case occurrence with exact matching on sex, age, the presence of comorbidities, and medications. As a safety outcome, we also evaluated the risk of heart failure (HF) according to the use of lobeglitazone.

Results

From the cohort of 70,897 T2D patients with acute ischemic stroke, 20,869 cases and 62,607 controls were selected. In the multivariable conditional logistic regression, treatment with lobeglitazone (adjusted OR 0.74; 95% CI 0.61–0.90; p = 0.002) and pioglitazone (adjusted OR 0.71; 95% CI 0.64–0.78; p < 0.001) were significantly associated with a lower risk for the primary outcome. In a safety outcome analysis for HF, treatment with lobeglitazone did not increase the risk of HF (adjusted OR 0.90; 95% CI 0.66–1.22; p = 0.492).

Conclusions

In T2D patients with ischemic stroke, lobeglitazone reduced the risk of cardiovascular complications similar to that of pioglitazone without an increased risk of HF. There is a need for further studies on the cardioprotective role of lobeglitazone, a novel thiazolidinedione.
A giant orbital solitary fibrous tumor treated by surgical excision: a case report and literature review
Authors: Zhou Qi , Liu Yuting , Wang Fang , Cao Yang , Lv Hongbin , Zhang Xibo
Published: May 2023

Background

Spindle cell tumors, called solitary fibrous tumors (SFTs), are of mesenchymal origin, and can develop in the orbit. As ‘intermediate malignancy’ tumors, only a small percentage show malignant behavior, such as invasion of surrounding tissue.

Case presentation

A 57-year-old woman presented with a 19-year history of a giant right orbital mass. Orbital computed tomography (CT) revealed an inhomogeneously-enhancing mass compressing and engulfing the eyeball and optic nerve. She underwent lid-sparing orbital exenteration. Microscopic characteristics and immunohistochemistry (IHC) tests were indicative of a benign SFT. No recurrence was observed at the 4-year follow-up.

Conclusion

Early and complete tumor resection is recommended.
Close orthopedic surgery skin incision with combination of barbed sutures and running subcuticular suturing technique for less dermal tension concentration: a finite element analysis
Authors: Li Li , Shao Qin , He Wenbin , Wang Tao , Wang Fang
Published: May 2023

Background

Mechanical forces have an important role in the initiation and progression of orthopedic surgical incisions complications. To avoid incision complications with the reduction of dermal tension, surgeons may choose a buried continuous suture technique other than the traditional interrupted vertical mattress suture. Absorbable barbed sutures are widely used in orthopedics due to their convenience and reducing wound tension. The aim of this research is to compare and explain the advantages of running subcuticular suturing technique with absorbable barbed sutures for orthopedic surgical incisions closure.

Methods

Finite element models of layered skin and two different suture techniques, running subcuticular suture and intradermal buried vertical mattress suture, ware constructed. The mechanical property difference between standard sutures and barbed sutures was modelled using different contact friction coefficient. Pulling the skin wound was simulated, and the sutures’ pressure on the skin tissue was determined.

Results

Compared with traditional smooth sutures, the barbed sutures effectively increased the contact force for subepidermal layers, which led the less force variation between different layers. The results also suggested that subcuticular suture caused less stress concentration compared with intradermal buried vertical mattress suture.

Conclusions

In conclusion, our study indicated that running subcuticular suturing technique with absorbable barbed sutures for orthopedic surgical incisions closure results in more uniform stress distribution in the dermis. We recommend this combination as the preferred method of skin closure in orthopedic surgery unless contraindicated.
Anatomical study of the technique of the axis laminar screws and development of guide
Authors: Sun Maji , Chu Fuchao , Gao Chunjiu , Yang Shuo , Long Chen , Li Zhongwei , Li Gen , Wu Jibin , Yuan Feng
Published: May 2023

Purpose

To develop a bidirectional slide guide to assist screw placement in the axial lamina and to preliminarily discuss the accuracy and feasibility of auxiliary screw placement.

Methods

CT data from 40 randomly selected patients were imported into the software for modelling, and cross-pinning was used to simulate pinning. According to the different crossing methods of the upper and lower laminar screws, they are divided into two groups. In the software, the position of the needlepoint of each screw is accurately measured, and the needle point is kept unchanged to simulate the movable range of the screw tail under the condition that the body does not penetrate the cortical bone. The data were compared by grouping and gender. Finally, the guide was designed by combining the screw exit point and fine adjustment angle data of all patients with the centripetal principle of the slide rail.

Results

The needle exit data L1/L2/L3/L4 were 6.44 ± 0.52 mm, 7.05 ± 0.48 mm, 3.55 ± 0.75 mm and 5.09 ± 0.74 mm, respectively, and the fine adjustment angle of the slide rail was 10.51° ± 0.87°. There was no significant difference between the two groups or between men and women (p > 0.05).

Conclusion

In this experiment, using the data obtained from the simulation of screw insertion, a two-way slide guide was designed to assist the insertion of axial laminar screws. The guide locks the screw outlet point to position and guides the screw inlet point, which improves the accuracy and safety of screw placement.
Optimizing enteral nutrition delivery by implementing volume-based feeding protocol for critically ill patients: an updated meta-analysis and systematic review
Authors: Wang Lu , Wang Yu , Li Hua-Xin , Zhang Rui-peng , Chang Li , Zeng Jun , Jiang Hua
Published: May 2023

Background

This study aims to provide an updated assessment of the efficacy of optimized enteral nutrition (EN) delivery by implementing the volume-based feeding (VBF) protocol in critically ill patients.

Methods

We updated our previous literature retrieval with no language restrictions. The inclusion criteria were:1) Participants: Critically ill patients (Patients who was admitted in ICU; 2) Intervention: The VBF protocol was adopted for EN administration; 3) Comparison: The rate-based feeding (RBF) protocol was adopted for EN administration; 4) Major outcomes: EN nutrition delivery. The exclusion criteria included participants aged < 18 years, duplicated literature, animal and cellular experiments, and studies lacking any of the outcomes mentioned in the inclusion criteria. The databases included MEDLINE (through PubMed), Web of Science, Cochrane Library, Chinese Biomedical Literature Service System (SinoMed), Wanfang Data Knowledge Service Platform, and China National Knowledge Infrastructure.

Result

Sixteen studies involving a total of 2896 critically ill patients are included in the updated meta-analysis. Compared with the previous meta-analysis, nine new studies were added that included 2205 more patients. The VBF protocol significantly improved energy (MD = 15.41%, 95% CI: [10.68, 20.14], p < 0.00001) and protein (MD = 22.05%, 95% CI: [10.89, 33.22], p = 0.0001) delivery. The patients in the VBF group stayed in the ICU for a shorter time (MD = 0.78, 95% CI: [0.01, 1.56], p = 0.05). The VBF protocol did not increase the risk of death (RR = 1.03, 95% CI: [0.85, 1.24], p = 0.76) or prolong the mechanical ventilation duration (MD = 0.81, 95% CI: [-0.30,1.92], p = 0.15). In addition, the VBF protocol did not affect EN complications, such as diarrhea (RR = 0.91, 95% CI: [0.73, 1.15], p = 0.43), emesis (RR = 1.23, 95% CI: [0.76, 1.99], p = 0.41), feeding intolerance (RR = 1.14, 95% CI: [0.63, 2.09], p = 0.66), and gastric retention (RR = 0.45, 95% CI: [0.16, 1.30], p = 0.14).

Conclusion

Our study revealed that the VBF protocol significantly improved calorie and protein delivery in critically ill patients with no additional risk.
Vangl-dependent Wnt/planar cell polarity signaling mediates collective breast carcinoma motility and distant metastasis
Authors: VanderVorst Kacey , Dreyer Courtney A. , Hatakeyama Jason , Bell George R. R. , Learn Julie A. , Berg Anastasia L. , Hernandez Maria , Lee Hyun , Collins Sean R. , Carraway Kermit L.
Published: May 2023

Background

In light of the growing appreciation for the role of collective cell motility in metastasis, a deeper understanding of the underlying signaling pathways will be critical to translating these observations to the treatment of advanced cancers. Here, we examine the contribution of Wnt/planar cell polarity (Wnt/PCP), one of the non-canonical Wnt signaling pathways and defined by the involvement of the tetraspanin-like proteins Vangl1 and Vangl2, to breast tumor cell motility, collective cell invasiveness and mammary tumor metastasis.

Methods

Vangl1 and Vangl2 knockdown and overexpression and Wnt5a stimulation were employed to manipulate Wnt/PCP signaling in a battery of breast cancer cell lines representing all breast cancer subtypes, and in tumor organoids from MMTV-PyMT mice. Cell migration was assessed by scratch and organoid invasion assays, Vangl protein subcellular localization was assessed by confocal fluorescence microscopy, and RhoA activation was assessed in real time by fluorescence imaging with an advanced FRET biosensor. The impact of Wnt/PCP suppression on mammary tumor growth and metastasis was assessed by determining the effect of conditional Vangl2 knockout on the MMTV-NDL mouse mammary tumor model.

Results

We observed that Vangl2 knockdown suppresses the motility of all breast cancer cell lines examined, and overexpression drives the invasiveness of collectively migrating MMTV-PyMT organoids. Vangl2-dependent RhoA activity is localized in real time to a subpopulation of motile leader cells displaying a hyper-protrusive leading edge, Vangl protein is localized to leader cell protrusions within leader cells, and actin cytoskeletal regulator RhoA is preferentially activated in the leader cells of a migrating collective. Mammary gland-specific knockout of Vangl2 results in a striking decrease in lung metastases in MMTV-NDL mice, but does not impact primary tumor growth characteristics.

Conclusions

We conclude that Vangl-dependent Wnt/PCP signaling promotes breast cancer collective cell migration independent of breast tumor subtype and facilitates distant metastasis in a genetically engineered mouse model of breast cancer. Our observations are consistent with a model whereby Vangl proteins localized at the leading edge of leader cells in a migrating collective act through RhoA to mediate the cytoskeletal rearrangements required for pro-migratory protrusion formation.
Association between air pollutants and initiation of biological therapy in patients with ankylosing spondylitis: a nationwide, population-based, nested case–control study
Authors: Kao Chung-Mao , Chen Yi-Ming , Huang Wen-Nan , Chen Yi-Hsing , Chen Hsin-Hua
Published: May 2023

Background

Outdoor air pollution has been found to trigger systemic inflammatory responses and aggravate the activity of certain rheumatic diseases. However, few studies have explored the influence of air pollution on the activity of ankylosing spondylitis (AS). As patients with active AS in Taiwan can be reimbursed through the National Health Insurance programme for biological therapy, we investigated the association between air pollutants and the initiation of reimbursed biologics for active AS.

Methods

Since 2011, hourly concentrations of ambient air pollutants, including PM2.5, PM10, NO2, CO, SO2, and O3, have been estimated in Taiwan. Using Taiwanese National Health Insurance Research Database, we identified patients with newly diagnosed AS from 2003 to 2013. We selected 584 patients initiating biologics from 2012 to 2013 and 2336 gender-, age at biologic initiation-, year of AS diagnosis- and disease duration-matched controls. We examined the associations of biologics initiation with air pollutants exposure within 1 year prior to biologic use whilst adjusting for potential confounders, including disease duration, urbanisation level, monthly income, Charlson comorbidity index (CCI), uveitis, psoriasis and the use of medications for AS. Results are shown as adjusted odds ratio (aOR) with 95% confidence intervals (CIs).

Results

The initiation of biologics was associated with exposure to CO (per 1 ppm) (aOR, 8.57; 95% CI, 2.02–36.32) and NO2 (per 10 ppb) (aOR, 0.23; 95% CI, 0.11–0.50). Other independent predictors included disease duration (incremental year, aOR, 8.95), CCI (aOR, 1.31), psoriasis (aOR, 25.19), use of non-steroidal anti-inflammatory drugs (aOR, 23.66), methotrexate use (aOR, 4.50; 95% CI, 2.93–7.00), sulfasalazine use (aOR, 12.16; 95% CI, 8.98–15.45) and prednisolone equivalent dosages (mg/day, aOR, 1.12).

Conclusions

This nationwide, population-based study revealed the initiation of reimbursed biologics was positively associated with CO levels, but negatively associated with NO2 levels. Major limitations included lack of information on individual smoking status and multicollinearity amongst air pollutants.
Hypoglossal nerve trunk stimulation: electromyography findings during drug-induced sleep endoscopy: a case report
Authors: Thuler E. R. , Rabelo F. A. W. , Santos Junior Vanier , Kayamori F. , Bianchini E. M. G.
Published: May 2023

Background

Literature has demonstrated hypoglossal nerve stimulation to be a safe and effective treatment for patients with obstructive sleep apnea nonadherent to positive airway pressure therapy. However, the recommended criteria for patient selection are still unable to identify all the unresponsive patients, highlighting the need for improved understanding about hypoglossal nerve stimulation for obstructive sleep apnea.

Case presentation

A 48-year-old Caucasian male patient with obstructive sleep apnea had been successfully treated with electrical stimulation of the hypoglossal nerve trunk, documented by level 1 polysomnography data. However, due to snoring complaints, he underwent postoperation drug-induced sleep endoscopy for evaluation of electrode activation during upper airway collapse, aiming to improve electrostimulation parameters. Concurrent surface electromyography of the suprahyoid muscles and masseter was obtained. Activation of electrodes 2, 3, and 6 promoted upper airway opening most strongly at the velopharynx and tongue base during drug-induced sleep endoscopy. The same channels also significantly increased the electrical activity on suprahyoid muscles bilaterally, but predominantly on the stimulated side (right). The masseters also presented a considerable asymmetry in electrical potential on the right side (> 55%).

Conclusion

Beyond the genioglossus muscle, our findings demonstrate recruitment of other muscles during hypoglossal nerve stimulation, which may be attributed to the electrical stimulation of the nerve trunk. This data provides new insights on how stimulation of the hypoglossal nerve trunk may contribute to obstructive sleep apnea treatment.
Isolated gastric involvement of recurrent Hodgkin lymphoma: a case report and review of the literature
Authors: Kohansal Soroush , Ashouri Mohammad , Mohammadzadeh Narjes
Published: May 2023

Background

Although the gastrointestinal tract is one of the most common sites for extranodal lymphoma, gastrointestinal lymphoma is a rare disease that is almost exclusively non-Hodgkin lymphoma.

Case presentation

We present a rare condition of Hodgkin lymphoma relapse after 12 years as isolated gastric involvement caused massive gastrointestinal bleeding in a 34-year-old Iranian woman. According to the result of the upper endoscopy, laparotomy was performed, and a large mass in the upper part of the fundus, alongside the esophagogastric junction, was seen, so gastrectomy was performed.

Conclusion

All symptoms and paraclinical findings for gastrointestinal Hodgkin lymphoma are nonspecific. Therefore, the preoperative diagnosis is challenging. It seems that surgery is a suitable diagnostic and therapeutic method in this field.
MUSIB: musical score inpainting benchmark
Authors: Araneda-Hernandez Mauricio , Bravo-Marquez Felipe , Parra Denis , Cádiz Rodrigo F.
Published: May 2023

Music inpainting is a sub-task of automated music generation that aims to infill incomplete musical pieces to help musicians in their musical composition process. Many methods have been developed for this task. However, we observe a tendency for each method to be evaluated using different datasets and metrics in the papers where they are presented. This lack of standardization hinders an adequate comparison of these approaches. To tackle these problems, we present MUSIB, a new benchmark for musical score inpainting with standardized conditions for evaluation and reproducibility. MUSIB evaluates four models: Variable Length Piano Infilling (VLI), Music InpaintNet, Music SketchNet, and AnticipationRNN, and over two commonly used datasets: JSB Chorales and IrishFolkSong. We also compile, extend, and propose metrics to adequately quantify note attributes such as pitch and rhythm with Note Metrics, but also higher-level musical properties with the introduction of Divergence Metrics, which operate by comparing the distance between distributions of musical features. Our evaluation shows that VLI, a model based on Transformer architecture, is the best performer on a larger dataset, while VAE-based models surpass this Transformer-based model on a relatively small dataset. With MUSIB, we aim at inspiring the community towards better reproducibility in music generation research, setting an example for strongly founded comparisons among SOTA methods.
The comparative impacts of portfolio-based assessment, self-assessment, and scaffolded peer assessment on reading comprehension, vocabulary learning, and grammatical accuracy: insights from working memory capacity
Authors: Hammad Al-Rashidi Anwar , Vadivel Balachandran , Ramadan Khalil Nawroz , Basim Nirvana
Published: May 2023

This research was carried out to comparatively study the impacts of portfolio-based assessment, self-assessment, and scaffolded peer assessment on reading comprehension, vocabulary learning, and grammatical accuracy of Afghan English as a foreign language learners. To accomplish this, 172 learners enrolled at a language institute, through an Oxford Quick Placement Test (OQPT), 120 lower-intermediate learners and 5 higher-intermediate learners were selected. These selected participants were assigned into four groups: portfolio group (N = 30), self-assessment group (N = 30), scaffolded peer assessment group (N = 35), and control group (N = 30). The five higher-intermediate learners were injected into the scaffolded peer assessment group to function as the mediators, hence more participants in the group. After selecting the participants, through a reading-span test developed by Shahnazari (2013), learners’ working memory (WM) span was determined. It was discovered that 16 subjects in the portfolio condition, 14 self-assessment learners, 18 participants in the peer assessment group, and 13 participants in the control condition had high WM, while the rest of the participants had low WM. Thereafter, through validated instructor-made tests, subjects’ reading comprehension, knowledge of targeted lexical items, and grammatical accuracy at baseline were determined. Then, a ten-session treatment began. After the treatment, a follow-up post-test was administered. The results of three two-way between-group MANOVA disclosed that all three experimental conditions outstripped the comparison group on the second occasion and that high WM learners outstripped low WM learners (with a large effect size on reading comprehension test (partial eta squared = .365), a moderate effect size on the same test among high vs. low WM learners (partial eta squared = .095), a large effect size on vocabulary post-test (partial eta squared = .465), a moderate effect size on the same test among high vs. low WM learners (partial eta squared = .083), a large effect size on grammar test (partial eta squared = .500), and a moderate effect size on the same test among high vs. low WM learners (partial eta squared = .072)). The results further revealed that subjects in the scaffolded peer assessment group outstripped subjects in other experimental conditions, but the difference was non-significant. Additionally, the difference between the portfolio assessment and self-assessment group was not statistically significant. The implications of the study are reported.
Premature farrowing and stillbirths in two organic sow farms due to riboflavin deficiency
Authors: Torreggiani Camilla , Maes Dominiek , Franchi Luigi , Raffi Valeria , Borri Elena , Prosperi Alice , Chiapponi Chiara , Luppi Andrea
Published: May 2023

Background

Riboflavin deficiency can lead to premature farrowing, stillborn piglets, weak-born piglets and neonatal death. Riboflavin (vitamin B2) is considered essential for reproductive function. The longer the period on riboflavin-deficient diets, the more severe the clinical signs become. Litter size as well as body size of piglets can also be considered risk factors that may contribute to the problem.

Case presentation

This case report involved two organic farms of 320 (farm A) and 250 sows (farm B). Between 2019 and 2020, premature farrowing with weak-born or stillborn piglets and severe intra-litter mortality, ranging from 60 to 100% were observed. Investigations for infectious causes of reproductive disease, drinking water quality and general feed composition were performed, but showed no significant results. Feed composition was subsequently evaluated more in detail. Riboflavin levels were very low specifically 1.25 mg/kg of diet (3.75 mg/kg of diet is the NRC minimum recommended level). Riboflavin as a vitamin complex supplement (B complex) was administered to sows one month before the farrowing date and this led to a rapid improvement of the problem such that no stillbirth or intra-litter mortality was observed.

Conclusions

The clinical presentation, the low riboflavin levels in the feed below the recommended levels for gestating sows and the effectiveness of the riboflavin supplementation, led to an ex juvantibus diagnosis of this deficiency condition. This case report highlights that riboflavin deficiency during gestation should be considered in case of premature parturition and stillborn litters.
Membrane-based microfluidic solvent extraction of Ga-68 from aqueous Zn solutions: towards an automated cyclotron production loop
Authors: Trapp Svenja , Lammers Tom , Engudar Gokce , Hoehr Cornelia , Denkova Antonia G. , Paulssen Elisabeth , de Kruijff Robin M.
Published: May 2023

Background

The radionuclide Ga-68 is commonly used in nuclear medicine, specifically in positron emission tomography (PET). Recently, the interest in producing Ga-68 by cyclotron irradiation of [68Zn]Zn nitrate liquid targets is increasing. However, current purification methods of Ga-68 from the target solution consist of multi-step procedures, thus, leading to a significant loss of activity through natural decay. Additionally, several processing steps are needed to recycle the costly, enriched target material.

Results

To eventually allow switching from batch to continuous production, conventional batch extraction and membrane-based microfluidic extraction were compared. In both approaches, Ga-68 was extracted using N-benzoyl-N-phenylhydroxylamine in chloroform as the organic extracting phase. Extraction efficiencies of up to 99.5% ± 0.6% were achieved within 10 min, using the batch approach. Back-extraction of Ga-68 into 2 M HCl was accomplished within 1 min with efficiencies of up to 94.5% ± 0.6%. Membrane-based microfluidic extraction achieved 99.2% ± 0.3% extraction efficiency and 95.8% ± 0.8% back-extraction efficiency into 6 M HCl. When executed on a solution irradiated with a 13 MeV cyclotron at TRIUMF, Canada, comparable efficiencies of 97.0% ± 0.4% were achieved. Zn contamination in the back-extracted Ga-68 solution was found to be below 3 ppm.

Conclusions

Microfluidic solvent extraction is a promising method in the production of Ga-68 achieving high efficiencies in a short amount of time, potentially allowing for direct target recycling.

Graphical Abstract
Metabolite changes in the posterior cingulate cortex could be a signature for early detection of Alzheimer’s disease: a systematic review and meta-analysis study based on 1H-NMR
Authors: Rahim Fakher , Khalafi Mohammad , Davoodi Mohammad , Shirbandi Kiarash
Published: May 2023

Background

Posterior cingulate cortex (PCC) is a paralimbic cortical structure with a fundamental role in integrative functions of the default mode network (DMN). PCC activation and deactivation of interconnected structures within the medial temporal lobe is essential in memory recall.

Aim

Assessing the metabolomics content changes in PCC of the patients with Alzheimer’s disease (AD) compared to healthy controls (HC) to find a new method for early AD detection was the primary goal of this study.

Methods

We performed a comprehensive search through eight international indexing databases. Searches were done using the medical subject headings (Mesh) keywords. Outcome measures included Population (HC/AD), Age (y), Gender (Male/Female), MRI equipment, Tesla (T), MMSE (mean ± SD), absolute and ratio absolutes metabolites in the PCC. All meta-analyses were performed using STATA V.14 tools to provide pooled figures.

Results

Studies published from 1980 to 2019 using the 1H-NMR technique of 3,067 screened studies, 18 studies comprising 1647 people (658 males and 941 females, 921 HC and 678 AD cases) were included. The results revealed a significant increase in mI content and a substantial decrease in NAA, Glu, and Glx levels of the PCC in AD patients compared to HC.

Conclusions

Our meta-analysis showed that microstructural disruptions in the PCC could be used as a marker for early AD detection. Although NAA, mI, Glu, and (NAA, Cho, and mI)/Cr biomarkers are substantial metabolites for diagnosis and are most sensitive for diagnosis.

Trial registration PROSPERO Registration: CRD42018099325.