bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of in-hospital appendiceal perforation in patients with non- perforated acute appendicitis with appendicolithiasis at presentation
Authors: Sohail Amir H. , Hakmi Hazim , Cohen Koral , Hurwitz Joshua C. , Brite Jasmine , Cimaroli Sawyer , Tsou Harry , Khalife Michael , Maurer James , Symer Matthew
Published: October 2023

Introduction

Appendicolithiasis is a risk factor for perforated acute appendicitis. There is limited inpatient data on predictors of progression in appendicolithiasis-associated non-perforated acute appendicitis.

Methods

We identified adults presenting with appendicolithiasis-associated non-perforated acute appendicitis (on computed tomography) who underwent appendectomy. Logistic regression was used to investigate predictors of in-hospital perforation (on histopathology).

Results

296 patients with appendicolithiasis-associated non-perforated acute appendicitis were identified; 48 (16.2%) had perforation on histopathology. Mean (standard deviation [SD]) age was 39 (14.9) years. The mean (SD) length of stay (LOS) was 1.5 (1.8) days. LOS was significantly longer with perforated (mean [SD]: 3.0 [3.1] days) vs. non-perforated (mean [SD]: 1.2 [1.2] days) appendicitis (p < 0.001). On multivariate analysis, in-hospital perforation was associated with age > 65 years (OR 5.4, 95% CI: 1.4- 22.2; p = 0.015), BMI > 30 kg/m2 (OR 3.5, 95% CI: 1.3–8.9; p = 0.011), hyponatremia (OR 3.6, 95% CI: 1.3–9.8; p = 0.012). There was no significant association with age 25–65 years, gender, race, steroids, time-to- surgery, neutrophil percentage, or leukocyte count.

Conclusion

Geriatric age, obesity, and hyponatremia are associated with progression to perforation in appendicolithiasis-associated non-perforated acute appendicitis.
Lipid profile in girls with precocious puberty: a systematic review and meta-analysis
Authors: Jiang Mei , Gao Ying , Wang Kai , Huang Ling
Published: October 2023

Objective

Many studies have investigated the impact of precocious puberty on cardiovascular disease (CVD) outcomes and the association between lipid profile levels and precocious puberty. However, the results have been inconsistent. The aim of this meta-analysis was to evaluate whether triglyceride (TG), total cholesterol (TC), high density lipoprotein (HDL)and low density lipoprotein (LDL) levels were altered in girls with precocious puberty compared with healthy controls.

Methods

References published before June 2022 in the EMBASE, Cochrane Library, PubMed and Web of Science databases were searched to identify eligible studies. A DerSimonian-Laird random-effects model was used to evaluate the overall standard mean difference (SMD) between precocious puberty and healthy controls. Subgroup analyses and sensitivity analyses were preformed, and publication bias was assessed.

Results

A total of 14 studies featuring 1023 girls with precocious puberty and 806 healthy girls were selected for analysis. The meta-analysis showed that TG (SMD: 0.28; 95% CI: 0.01 to 0.55; P = 0.04), TC (SMD: 0.30; 95% CI: 0.01 to 0.59; P = 0.04), LDL (SMD: 0.45; 95% CI: 0.07 to 0.84; P = 0.02)levels were significantly elevated in girls with precocious puberty. HDL levels did not change significantly (SMD: -0.06; 95% CI: -0.12 to 0.61; P = 0.62). Subgroup analyses revealed that the heterogeneity in the association between lipid profile and precocious puberty in this meta-analysis may arise from disease type, region, sample size, chronological age, body mass index difference and drug usage.

Conclusion

Lipid profile levels altered in girls with precocious puberty compared with healthy controls. In order to minimize the risk of CVD morbidity and mortality, early interventions were needed to prevent obesity in children and adolescents, especially those with precocious puberty.
Bifidobacterium infantis supplementation versus placebo in early life to improve immunity in infants exposed to HIV: a protocol for a randomized trial
Authors: Happel Anna-Ursula , Rametse Lerato , Perumaul Brandon , Diener Christian , Gibbons Sean M. , Nyangahu Donald D. , Donald Kirsten A. , Gray Clive , Jaspan Heather B.
Published: October 2023

Introduction

Infants who are born from mothers with HIV (infants who are HIV exposed but uninfected; iHEU) are at higher risk of morbidity and display multiple immune alterations compared to infants who are HIV-unexposed (iHU). Easily implementable strategies to improve immunity of iHEU, and possibly subsequent clinical health outcomes, are needed. iHEU have altered gut microbiome composition and bifidobacterial depletion, and relative abundance of Bifidobacterium infantis has been associated with immune ontogeny, including humoral and cellular vaccine responses. Therefore, we will assess microbiological and immunological phenotypes and clinical outcomes in a randomized, double-blinded trial of B. infantis Rosell®-33 versus placebo given during the first month of life in South African iHEU.

Methods

This is a parallel, randomised, controlled trial. Two-hundred breastfed iHEU will be enrolled from the Khayelitsha Site B Midwife Obstetric Unit in Cape Town, South Africa and 1:1 randomised to receive 8 × 109 CFU B. infantis Rosell®-33 daily or placebo for the first 4 weeks of life, starting on day 1–3 of life. Infants will be followed over 36 weeks with extensive collection of meta-data and samples. Primary outcomes include gut microbiome composition and diversity, intestinal inflammation and microbial translocation and cellular vaccine responses. Additional outcomes include biological (e.g. gut metabolome and T cell phenotypes) and clinical (e.g. growth and morbidity) outcome measures.

Discussion

The results of this trial will provide evidence whether B. infantis supplementation during early life could improve health outcomes for iHEU.

Ethics and dissemination

Approval for this study has been obtained from the ethics committees at the University of Cape Town (HREC Ref 697/2022) and Seattle Children’s Research Institute (STUDY00003679).

Trial registration

Pan African Clinical Trials Registry Identifier: PACTR202301748714019. Clinical.trials.gov: NCT05923333.

Protocol Version: Version 1.8, dated 18 July 2023.
An adapted algorithm for patient engagement in care for young people living with perinatal HIV in England
Authors: Le Prevost Marthe , Ford Deborah , Crichton Siobhan , Foster Caroline , Bamford Alasdair , Judd Ali ,   Adolescents and Adults Living with Perinatal HIV (AALPHI) Steering Committee
Published: October 2023

Background

Evidence suggests that engagement in care (EIC) may be worse in young people living with perinatal HIV (YPLPHIV) compared to adults or children living with HIV. We took a published EIC algorithm for adults with HIV, which takes patients’ clinical scenarios into account, and adapted it for use in YPLPHIV in England, to measure their EIC.

Methods

The adult algorithm predicts when in the next 6 months the next clinic visit should be scheduled, based on routinely collected clinical indicators at the current visit. We updated the algorithm based on the latest adult guidelines at the time, and modified it for young people in paediatric care using the latest European paediatric guidelines. Paediatric/adolescent HIV consultants from the UK reviewed and adapted the resulting flowcharts. The adapted algorithm was applied to the Adolescent and Adults Living with Perinatal HIV (AALPHI) cohort in England. Data for 12 months following entry into AALPHI were used to predicted visits which were then compared to appointment attendances, to measure whether young people were in care in each month. Proxy markers (e.g. dates of CD4 counts, viral loads (VL)) were used to indicate appointment attendance.

Results

Three hundred sixteen patients were in AALPHI, of whom 41% were male, 82% of black African ethnicity and 58% born abroad. At baseline (time of AALPHI interview) median [IQR] age was 17 [15–18] years, median CD4 was 597 [427, 791] cells/µL and 69% had VL ≤50c/mL. 10 patients were dropped due to missing data. 306 YPLPHIV contributed 3,585 person months of follow up across the 12 month study in which a clinic visit was recorded for 1,204 months (38/1204 dropped due to missing data). The remaining 1,166 months were classified into 3 groups: Group-A: on ART, VL ≤ 50c/mL—63%(734/1,166) visit months, Group-B: on ART, VL > 50c/mL—27%(320/1,166) Group-C: not on ART-10%(112/1,166). Most patients were engaged in care with 87% (3,126/3,585) of months fulfilling the definition of engaged in care.

Conclusions

The adapted algorithm allowed the varying clinical scenarios of YPLPHIV to be taken into account when measuring EIC. However availability of good quality surveillance data is crucial to ensure that EIC can be measured well.
Invasive stratified mucin-producing carcinoma of the colorectum: expanding the morphologic spectrum of large bowel cancer
Authors: Auld Finn Morgan , Moyana Terence N.
Published: October 2023

Background

Invasive stratified mucin-producing carcinoma is a recently recognized adenocarcinoma with distinctive features. It was first described in the cervix but similar tumors have since been reported in the penis, anus and prostate. In the gastrointestinal tract, the phenomenon of epithelial stratification has an interesting embryologic morphogenesis. Gastrointestinal mucosa starts off as nascent columnar epithelium that is subsequently patterned to confer regional specific functions. However, in disease states, normal architectural patterning can be disrupted by aberrant differentiation. Given this background and the phenotypic plasticity of neoplastic cells, we were interested in ascertaining whether invasive stratified mucin-producing carcinoma occurs in the colorectum.

Methods

This was a retrospective study of all 584 cases of colorectal carcinoma accessioned at our institution over a 2-year period (January 2021- December 2022). Cases were analyzed to determine which fulfilled the criteria for invasive stratified mucin-producing carcinoma.

Results

There were 9 cases of colorectal invasive stratified mucin-producing carcinoma—one pure form and 8 mixed. They showed the classic colorectal (CK20 + , CDX2 + , CK7-) immunostaining profile but, based on various morphologic criteria, they could be distinguished from conventional adenocarcinoma NOS, mucinous, signet ring cell, medullary, goblet cell and undifferentiated carcinomas. About half the cases were MLH1/PMS2 deficient and BRAF &/or PIK3CA mutated, which aligns with the hypermutated phenotype.

Conclusions

Colorectal invasive stratified mucin-producing carcinoma appears to be a real entity, best recognized in its early stages. It appears to be a high-grade carcinoma. With tumor progression, it evolves into a mucinous adenocarcinoma with a proclivity towards signet ring cells. In summary, the study of this tumor, particularly in its early stages, provides useful clues to further understanding the biology and progression of large bowel cancer. Further studies are required to learn more about this tumor.
Health-related factors and dysregulation of epigenetic related genes in metabolic syndrome trigger finger patients and smoker trigger finger patients: preliminary analysis of patient-derived sample
Authors: Shayea Abdulaziz M. F. , Alshatti Amna A. , Alfadhli Danah H. , Ibrahim Almutairi Fatimah , Almutairi Mariam Kh. , Nadar Mohammed Sh.
Published: October 2023

Purpose

To investigate the health-related factors and analyze the expression of epigenetic related genes and inflammatory genes in metabolic syndrome Trigger Finger (TF) and smoker TF.

Methods

Samples from patients’ fingers with symptomatic TF were collected. There were seven groups: healthy control group, carpal tunnel syndrome (as a control for gene expression analysis), TF, diabetic TF, hypertensive TF, dyslipidemic TF and smoker TF. The expression levels of epigenetic related genes and inflammatory genes in metabolic syndrome TF and smoker TF were evaluated by the reverse transcription–polymerase chain reaction (RT-PCR) technique. The Perceived Stress Scale (PSS), Pittsburgh Sleep Quality Index (PSQI) questionnaires, disability of the arm, shoulder and hand (DASH) and numeric pain rating scale were given to the participants to fill out.

Results

There was a significant increase in hand dysfunction in the metabolic TF groups and smoker group compared to the TF group (p < 0.0001). The stress levels of the smoker TF group and TF with hypertension group were significantly increased compared with those in the TF group (p < 0.03) and (p < 0.021), respectively. On the other hand, there was a significant increase in the COL-I, COL-II and TNF-α gene expression of the metabolic TF groups and smoker group (p < 0.0001).

Conclusions

Health-related factors in the TF tendons was highly associated with the level of inflammation and genetic alteration in TF metabolic syndromes and smoker TF patients. Therefore, further investigation is required to examine the combination of occupational therapy, gene expression, and health-related factors as a promising method of managing TF.
Age in addition to RETTS triage priority substantially improves 3-day mortality prediction in emergency department patients: a multi-center cohort study
Authors: Malmer G. , Åhlberg R. , Svensson P. , af Ugglas B. , Westerlund E.
Published: October 2023

Background

Previous studies have shown varying results on the validity of the rapid emergency triage and treatment system (RETTS), but have concluded that patient age is not adequately considered as a risk factor for short term mortality. Little is known about the RETTS system’s performance between different chief complaints and on short term mortality. We therefore aimed to evaluate how well a model including both RETTS triage priority and patient age (TP and age model) predicts 3-day mortality compared to a univariate RETTS triage priority model (TP model). Secondarily, we aimed to evaluate the TP model compared to a univariate age model (age model) and whether these three models’ predictive performance regarding 3-day mortality varies between patients with different chief complaints in an unsorted emergency department patient population.

Methods

This study was a prospective historic observational cohort study, using logistic regression on a cohort of patients seeking emergency department care in Stockholm during 2012–2016. Patient visits were stratified into the 10 chief complaint categories (CCC) with the highest number of deceased patients within 3 days of arrival, and to “other chief complaints”. Patients with priority 1 were excluded.

Results

The studied cohort contained 1,690,981 visits by 788,046 different individuals. The TP and age model predicted 3-day mortality significantly and substantially better than both univariate models in the total population and in each studied CCC. The age model predicted 3-day mortality significantly and substantially better than the TP model in the total population and for all but three CCCs and was not inferior in any CCC. There were substantial differences between the studied CCCs in the predictive ability of each of the three models.

Conclusions

Adding patient age to the RETTS triage priority system significantly and substantially improves 3-day mortality prediction compared to RETTS priority alone. Age alone is a non-inferior predictor of 3-day mortality compared to RETTS priority. The impact on 3-day mortality prediction of adding patient age to RETTS priority varies between CCCs but is substantial for all CCCs and for the total population. Including age as a variable in future revisions of RETTS could substantially improve patient safety.
Dynamics of loops surrounding the active site architecture in GH5_2 subfamily TfCel5A for cellulose degradation
Authors: Wu Xiuyun , Zhao Sha , Tian Zhennan , Han Chao , Jiang Xukai , Wang Lushan
Published: October 2023

Background

Lignocellulose is the most abundant natural biomass resource for the production of biofuels and other chemicals. The efficient degradation of cellulose by cellulases is a critical step for the lignocellulose bioconversion. Understanding the structure-catalysis relationship is vital for rational design of more stable and highly active enzymes. Glycoside hydrolase (GH) family 5 is the largest and most functionally diverse group of cellulases, with a conserved TIM barrel structure. The important roles of the various loop regions of GH5 enzymes in catalysis, however, remain poorly understood.

Results

In the present study, we investigated the relationship between the loops surrounding active site architecture and its catalytic efficiency, taking TfCel5A, an enzyme from GH5_2 subfamily of Thermobifida fusca, as an example. Large-scale computational simulations and site-directed mutagenesis experiments revealed that three loops (loop 8, 3, and 7) around active cleft played diverse roles in substrate binding, intermediate formation, and product release, respectively. The highly flexible and charged residue triad of loop 8 was responsible for capturing the ligand into the active cleft. Severe fluctuation of loop 3 led to the distortion of sugar conformation at the − 1 subsite. The wobble of loop 7 might facilitate product release, and the enzyme activity of the mutant Y361W in loop 7 was increased by approximately 40%.

Conclusion

This study unraveled the vital roles of loops in active site architecture and provided new insights into the catalytic mechanism of the GH5_2 cellulases.
Prediction of organic compound aqueous solubility using machine learning: a comparison study of descriptor-based and fingerprints-based models
Authors: Tayyebi Arash , Alshami Ali S , Rabiei Zeinab , Yu Xue , Ismail Nadhem , Talukder Musabbir Jahan , Power Jason
Published: October 2023

A reliable and practical determination of a chemical species’ solubility in water continues to be examined using empirical observations and exhaustive experimental studies alone. Predictions of chemical solubility in water using data-driven algorithms can allow us to create a rationally designed, efficient, and cost-effective tool for next-generation materials and chemical formulations. We present results from two machine learning (ML) modeling studies to adequately predict various species’ solubility using data for over 8400 compounds. Molecular-descriptors, the most used method in previous studies, and Morgan fingerprint, a circular-based hash of the molecules' structures, were applied to produce water solubility estimates. We trained all models on 80% of the total datasets using the Random Forest (RFs) technique as the regressor and tested the prediction performance using the remaining 20%, resulting in coefficient of determination (R2) test values of 0.88 and 0.81 and root-mean-square deviation (RMSE) test values 0.64 and 0.80 for the descriptors and circular fingerprint methods, respectively. We interpreted the produced ML models and reported the most effective features for aqueous solubility measures using the Shapley Additive exPlanations (SHAP) and thermodynamic analysis. Low error, ability to investigate the molecular-level interactions, and compatibility with thermodynamic quantities made the fingerprint method a distinct model compared to other available computational tools. However, it is worth emphasizing that physicochemical descriptor model outperformed the fingerprint model in achieving better predictive accuracy for the given test set.
A deep learning-based load forecasting algorithm for energy consumption monitoring system using dimension expansion
Authors: Zhang Wei-guo , Zhu Qing , Gu Lin-Lin , Lin Hui-Jie
Published: October 2023

As a basic task in energy consumption monitoring system, load forecasting has great effects on system operation safety, generation costs and economic benefits. In this paper, a long-term load forecasting algorithm using data dimension expansion and deep feature extraction is proposed. First, the outliers of the meteorological measurements are removed by median filter method, and then the time information is encoded to form the fingerprint of the training data. Next, the full connected network (FCN) is used to expand the dimensions of the fingerprint, and the convolutional neural network (CNN) is used to extract the deep features which can obtain better feature representation. Finally, the FCN, the CNN and regression learning model are combined for jointly offline training. The optimal parameters of these network can be obtained under global solution. Experimental results show that the proposed algorithm has better load forecasting performance than existing methods.
Image embedding and user multi-preference modeling for data collection sampling
Authors: Tom Anju Jose , Toni Laura , Maugey Thomas
Published: October 2023

This work proposes an end-to-end user-centric sampling method aimed at selecting the images from an image collection that are able to maximize the information perceived by a given user. As main contributions, we first introduce novel metrics that assess the amount of perceived information retained by the user when experiencing a set of images. Given the actual information present in a set of images, which is the volume spanned by the set in the corresponding latent space, we show how to take into account the user’s preferences in such a volume calculation to build a user-centric metric for the perceived information. Finally, we propose a sampling strategy seeking the minimum set of images that maximize the information perceived by a given user. Experiments using the coco dataset show the ability of the proposed approach to accurately integrate user preference while keeping a reasonable diversity in the sampled image set.
Developing a framework for regular and sustainable qualitative assessment of antibiotic use in Korean medical institutions: a Delphi study
Authors: Park Se Yoon , Kim Yong Chan , Moon Song Mi , Kim Bongyoung , Lee Raeseok , Kim Hong Bin ,   Korea Study Group for Antimicrobial Stewardship (KOSGAP)
Published: October 2023

Background

We aimed to develop a roadmap for conducting regular, sustainable, and strategic qualitative assessments of antibiotic use in medical institutions within the Republic of Korea.

Methods

A literature review on the current state of qualitative antibiotic assessments was conducted, followed by one open round to collect ideas, two scoring rounds to establish consensus, and one panel meeting between them. The expert panel comprised 20 experts in infectious disease or antibiotic stewardship.

Results

The response rate for all three surveys was 95% (19/20), while the panel meeting attendance rate was 90% (18/20). The following long-term goals were defined to assess the annual use of antibacterial and antifungal agents in all medical institutions, including clinics. The panel agreed that random sampling of antibiotic prescriptions was the most suitable method of selecting antibiotics for qualitative assessment, with the additional possibility of evaluating specific antibiotics or infectious diseases that warrant closer evaluation for promoting appropriate antibiotic use. The plan for utilization of results from evaluation involves providing feedback while maintaining anonymity and disclosure. It includes a quantitative assessment of antibiotic prescriptions and resistance rates to compare against institutional benchmarks. Furthermore, it was agreed to link the evaluation findings to the national antibiotic stewardship programme, enabling policy and institutional approaches to address frequently misused items, identified during the evaluation.

Conclusion

This study provides a framework for establishing a qualitative assessment of antimicrobial use for medical institutions at a national level in the Republic of Korea.
ZnO, TiO2 and Fe3O4/Carbopol hybrid nanogels for the cleaner process of paper manuscripts from dust stains and soil remains
Authors: Hassan Rushdya Rabee Ali , Hassan Haidi M. , Mohamed Yassmine A. , Ismail Mai E. M. , Farid Yara , Mohamed Hager , Ismail Sameh H. , Salem Mohamed Z. M. , Abdel-Hamied Mostafa
Published: October 2023

There are many paper manuscripts at museums, stores, and libraries that have different stains. The dust stains and soil remains played an important role in the degradation of these manuscripts. Therefore, the cleaning process for these stains is important to process. Unfortunately, the removal of stains by some traditional techniques can be hazardous to the paper's fibers. Therefore, this study aims to evaluate innovative nanoparticle gels in the cleaning process of dust stains from paper manuscripts. The synthesized nanomaterials [Fe3O4, TiO2, and ZnO]/Carbopol hybrid nanogel were examined in order to investigate the surface morphology, determine the physio-chemical properties, for phase structure, using scanning electron microscope (SEM), transmission electron microscope (TEM), AFM, DLS, XRD, and Zeta potential. Some stained paper samples were prepared and exposed to accelerated thermal aging at 100 °C for 72 h. The evaluation of the cleaning by nanogel was performed by different analytical procedures containing investigation with a USB digital microscope, SEM, color change, mechanical properties, and ATR-FTIR analysis. The results of this study showed that ZnO/Carbopol hybrid nanogel at high viscosity gave the best results in the cleaning process of mud stains through the ability to dismantle mud particles and increase surface contact with the solvent. The aged treated sample with high viscosity form of ZnO NPs/carbopol hybrid nanogel gave the highest tensile strength value of (56.0 N). The treated samples with the high viscosity form of ZnO NPs/carbopol hybrid nanogel gave the highest value of elongation (1.398%) before aging. It also does not affect the chemical composition of the paper after cleaning it, but rather on the whole, it bites the hydration of the paper, which positively affects the properties of the treated paper.
Automated labeling of PDF mathematical exercises with word N-grams VSM classification
Authors: Yamauchi Taisei , Flanagan Brendan , Nakamoto Ryosuke , Dai Yiling , Takami Kyosuke , Ogata Hiroaki
Published: October 2023

In recent years, smart learning environments have become central to modern education and support students and instructors through tools based on prediction and recommendation models. These methods often use learning material metadata, such as the knowledge contained in an exercise which is usually labeled by domain experts and is costly and difficult to scale. It recognizes that automated labeling eases the workload on experts, as seen in previous studies using automatic classification algorithms for research papers and Japanese mathematical exercises. However, these studies didn’t delve into fine-grained labeling. In addition to that, as the use of materials in the system becomes more widespread, paper materials are transformed into PDF formats, which can lead to incomplete extraction. However, there is less emphasis on labeling incomplete mathematical sentences to tackle this problem in the previous research. This study aims to achieve precise automated classification even from incomplete text inputs. To tackle these challenges, we propose a mathematical exercise labeling algorithm that can handle detailed labels, even for incomplete sentences, using word n-grams, compared to the state-of-the-art word embedding method. The results of the experiment show that mono-gram features with Random Forest models achieved the best performance with a macro F-measure of 92.50%, 61.28% for 24-class labeling and 297-class labeling tasks, respectively. The contribution of this research is showing that the proposed method based on traditional simple n-grams has the ability to find context-independent similarities in incomplete sentences and outperforms state-of-the-art word embedding methods in specific tasks like classifying short and incomplete texts.
Demonstrating the learning and impact of embedding participant involvement in a pandemic research study: the experience of the SARS-CoV-2 immunity & reinfection evaluation (SIREN) study UK, 2020–2023
Authors: Howells Anna , Aquino Erika Neves , Bose Deepika , Kelly Martin Gerard , Molony-Oates Barbara , Syed Asmah Hassan , Tolley Kim , Neill Claire , Hopkins Susan , Hall Victoria , Islam Jasmin
Published: October 2023

Background

Participant involvement in research studies is not a new concept, yet barriers to implementation remain and application varies. This is particularly true for pandemic response research studies, where timeframes are condensed, pressure is high and the value and inclusion of participant involvement can be overlooked. The SIREN Participant Involvement Panel (PIP) provides a case study for participant involvement in pandemic research, working in partnership with people who the research is for and about.

Methods

SIREN and the British Society for Immunology (BSI) recruited and ran two phases of the PIP, involving 15 members in total over a 16-month period. Phase 1 ran between January and August 2022 and Phase 2 between October 2022 and March 2023. Activity figures including recruitment interest and PIP meeting attendance were recorded. To evaluate how the PIP has influenced SIREN, feedback was collected from (a) researchers presenting at the PIP and (b) PIP members themselves. Evaluation at the end of Phase 1 informed our approach to Phase 2. Thematic grouping was planned to identify key lessons learned.

Results

Applications increased from n = 30 to n = 485 between Phase 1 and Phase 2 of the PIP, a more than 15-fold increase. The SIREN PIP positively impacted the design, implementation and evaluation phases of the study and sub-studies. Feedback from PIP members themselves was positive, with members highlighting that they found the role rewarding and felt valued.

Learnings from the PIP have been condensed into five key themes for applying to future pandemic response research studies: the importance of dedicated resources; recruiting the right panel; understanding motivations for participant involvement; providing flexible options for involvement and enabling the early involvement of participants.

Conclusions

The SIREN PIP has demonstrated the value of actively involving people who research is for and about. The PIP has provided an active feedback mechanism for research and demonstrated a positive influence on both SIREN study researchers and PIP members themselves. This paper makes the case for participant involvement in future pandemic research studies. Future work should include improved training for researchers and we would support the development of a national PIP forum as part of future pandemic research preparedness.
Transcutaneous auricular vagus nerve stimulation attenuates inflammatory bowel disease in children: a proof-of-concept clinical trial
Authors: Sahn Benjamin , Pascuma Kristine , Kohn Nina , Tracey Kevin J. , Markowitz James F.
Published: October 2023

Background

Vagus nerve stimulation is an investigational anti-inflammatory therapy targeting the nervous system to modulate immune activity. This study evaluated the efficacy and safety of transcutaneous auricular VNS (ta-VNS) in patients with pediatric-onset Crohn’s disease (CD) or ulcerative colitis (UC).

Methods

Participants were 10–21 years of age with mild/moderate CD or UC and fecal calprotectin (FC) > 200 ug/g within 4 weeks of study entry. Subjects were randomized to receive either ta-VNS targeting the cymba conchae of the external left ear, or sham stimulation, of 5 min duration once daily for a 2-week period, followed by a cross over to the alternative stimulation for an additional 2 weeks. At week 4, all subjects received ta-VNS of 5 min duration twice daily until week 16. Primary study endpoints were clinical remission, and a ≥ 50% reduction in FC level from baseline to week 16. Heart rate variability measurements and patient-reported outcome questionnaires were completed during interval and week 16 assessments.

Results

Twenty-two subjects were enrolled and analyzed (10 CD, 12 UC). Six of 10 with CD had a wPCDAI > 12.5 and 6/12 with UC had a PUCAI > 10 at baseline, correlating to mild to moderate symptom activity. Among the 12 subjects with active symptomatic disease indices at baseline, clinical remission was achieved in 3/6 (50%) with CD and 2/6 (33%) with UC at week 16. Despite all subjects having FC levels ≥ 200 within 4 weeks of enrollment, five subjects (4 UC, 1 CD) had FC levels < 200 at the baseline visit and were excluded from the FC analysis. Of the remaining 17, median baseline FC was 907 µg/g (IQR 411–2,120). At week 16, 11/17 (64.7%) of those with baseline FC ≥ 200 had a ≥ 50% reduction in FC (95% CI 38.3—85.8). In the UC subjects, there was an 81% median reduction in FC vs baseline (833 µg/g; p = 0.03) while in the CD subjects, median reduction in FC at 16 weeks was 51% (357 µg/g; p = 0.09). There were no safety concerns.

Conclusion

Noninvasive ta-VNS attenuated signs and symptoms in a pediatric cohort with mild to moderate inflammatory bowel disease.

Trial Registration

NCT03863704—Date of registration 3/4/2019.
The use of high-sensitivity cardiac troponin I in assessing cardiac involvement and Disease prognosis in idiopathic inflammatory myopathy
Authors: Zhang Hao , Chi Huihui , Xie Liangzhe , Sun Yue , Liu Honglei , Cheng Xiaobing , Ye Junna , Shi Hui , Hu Qiongyi , Meng Jianfen , Zhou Zhuochao , Teng Jialin , Yang Chengde , Su Yutong
Published: October 2023

Objectives

Cardiac involvement is one of the most serious complications of idiopathic inflammatory myopathy (IIM) that indicates poor prognosis. However, there is a lack of effective biomarkers for the identification of cardiac involvement and the prediction of prognosis in IIM. Here, we aimed to explore the value of different cardiac biomarkers in IIM patients.

Methods

A total of 142 IIM patients in the Department of Rheumatology and Immunology, Ruijin Hospital from July 2019 to October 2022 were included in this study. The clinical characteristics, laboratory tests, treatments and prognosis were recorded. The disease activity was assessed according to the core set measures. The correlations of the serum cardiac biomarkers levels with disease activity were analyzed by the Spearman correlation test. Risk factors for cardiac involvement were evaluated by multivariate logistic regression analysis.

Results

Higher high-sensitivity cardiac troponin I (hs-cTnI) levels were associated with cardiac involvement (n = 41) in IIM patients [adjusted OR 7.810 (95% CI: 1.962–31.097); p = 0.004], independent of other serum cardiac biomarkers. The abnormal hs-cTnI had the highest AUC for distinguishing of cardiac involvement in IIM patients (AUC = 0.848, 95% CI: 0.772,0.924; p < 0.001). Besides, we found that high serum levels of hs-cTnI were significantly correlated with disease activity. Moreover, patients with higher serum levels of hs-cTnI tended to suffer from poor prognosis.

Conclusions

Serum hs-cTnI testing may play a role in screening for cardiac involvement in IIM patients. Abnormal levels of serum hs-cTnI were associated with increased disease activity and poor prognosis.
Diagnosis, management and prevention of Pediatric Acute Hemolytic Anemia: Egyptian adapted evidence-based clinical practice guidelines
Authors: Mokhtar Galila , Baky Ashraf Abdel , Youssry Ilham , Ragab Iman , Sherief Laila , Zakaria Marwa , Hesham Mervat , Salah Nouran , Abdel-Raouf Rasha , Makkeyah Sara , Shalaby Sherein , Habib Sonia Adolf , Omar Tarek , Amer Yasser , Salama Niveen M.
Published: October 2023

Background

Acute hemolytic anemia (AHA) is a common emergency in pediatric emergency departments, hence the need to adapt pre-existing high-quality practice guidelines for the diagnosis, management, and prevention of AHA to be available for national use.

Methods

The guideline panel used the adapted ADAPTE methodology. The panel prioritized the health questions and recommendations according to their importance for clinicians and patients. The procedure included searching for existing guidelines, quality appraisal, and adaptation of the recommendations to be used in low-resource countries.

Results

The guideline provided approach to a child with AHA: laboratory diagnosis of glucose-6-phosphate dehydrogenase (G6PD) deficiency, autoimmune hemolytic anemia (AIHA), and hemolytic uremic syndrome (HUS); treatment of AHA including indications for red cell transfusion, medical treatment, plasma exchange, and indications of antibiotic in HUS; how to avoid further episodes of hemolysis; and when to refer to a hematologist. Implementation tools included a checklist for history and examination, lists of differential diagnoses, flow charts for the diagnosis of AHA, and a list of medications and food to be avoided in patients with G6PD deficiency.

Conclusion

This adapted guideline will aid decision-making related to the diagnosis, management, and prevention of AHA.
Geospatial distribution of under-five mortality in Alexandria, Egypt: a cross-sectional survey
Authors: Abd ElHafeez Samar , Hassan Mahmoud A. , Hammouda Esraa Abdellatif , Omran Abdelrahman , Esmail Ola Fahmy , Mahboob Amira Saad , Tahoun Mohamed Mostafa , El Malawany Dina Hussein , Eldwiki Mohamed Kamal , El-Meligy Passent Ehab , Elrewany Ehab , Ali Shaimaa Gadelkarim Ebrahim , Elzayat Amira Mahmoud , Ramadan Ahmed , Elshabrawy Abdelhamid , Youssef Naglaa , Ghazy Ramy Mohamed
Published: October 2023

Background

Globally, infectious diseases, including pneumonia, diarrhea, and malaria, along with pre-term birth complications, birth asphyxia and trauma, and congenital anomalies remain the leading causes of death for under-five mortality (U5M). This study aimed to identify the geospatial pattern of U5M in Alexandria and its key determinants.

Methodology

We analyzed the geospatial distribution of 3064 deaths registered at 24 health offices reported from January 1, 2018 to June 30, 2019. We adopted two methods of analysis: geospatial analysis and the structural equation model (SEM).

Result

Neonates represented 58.7% of U5M, while post-neonates and children were 31.1%, 10.2%respectively. Male deaths were significantly higher compared to females (P = 0.036). The main leading causes of U5M were prematurity (28.32%), pneumonia (11.01%), cardiac arrest (10.57%), congenital malformation (9.95%), and childhood cardiovascular diseases (9.20%). The spatial distribution of U5M (including the most common three causes) tends to be clustered in western parts of Alexandria (El Hawaria, Bahig, Hamlis, and Ketaa Maryiut). SEM showed the total effects of exogenous and intermediate variables on U5M. The U5M proportionately increased by living in rural areas (8.48), followed by crowding rate (8.35), household size (1.36), population size (0.52), and illiteracy average (0.06). On the contrary, the U5M decreased with increasing access to sanitation (-0.17) and access to drinking water (-4.55).

Conclusion

Illiteracy, and poor locality characteristics (household size, population density, and access to water supply and sanitation) were statistically significant predictors of U5M.
A rare clinical presentation of lung cancer: two cases of solitary digital metastasis on Tc-99m MDP bone scan
Authors: Uslu Biner Inci , Akin Kabalak Pinar , Inal Cengiz Tuba , Yilmaz Ulkü , Kizilgoz Derya , Karaca Metehan , Canbay Fatma , Agackiran Yetkin , Tatci Ebru , Ozmen Ozlem
Published: October 2023

Background

Acrometastases are accounted for a very small proportion of bone metastases. Lung cancer is the most common acrometastasis origin, and it often has a poor prognosis. The aim of the present cases is to describe the probability of an acrometastasis in the differential diagnosis of finger lesions and to emphasize the importance of taking local views of extremity of complaint for proper interpretation in such patients.

Case presentation

Here we reported two patients with metastases to the fingers with occult primary lung carcinoma and a history of prior lung malignancy, respectively. First case was a 58-year-old man with history of pain and swelling in the fourth finger of his left hand. He underwent an amputation from the metacarpophalangeal level and the pathological diagnosis was metastatic NSCLC. The second case was a 65-year-old ex-smoker man with a history of prior lung cancer (adenocarcinoma) suffered from a swollen, erythematous, painful tip of the right third finger. Phalangectomy was performed and the histological examination of the amputated part revealed the presence of a metastatic differentiated carcinoma of pulmonary origin.

Conclusions

When assessing the masses located at fingers, possibility of a solitary metastatic lung lesion should be considered.
Scaphoid megalourethra associated with congenital urethrocutaneous fistula: a case report of a rare association
Authors: Chrun Lucas Rossato , Egger Paulo Acácio , Toda Lia Yoneka , Henrique Aquiles , Filho Orlando Ribeiro Prado , Costa Larissa Rossato Chrun , Nezo Victor Hugo Silva
Published: October 2023

Background

Congenital megalourethra is a rare male genital malformation, with less than 100 cases reported in literature. Urethrocutaneous fistula, in turn, has only 65 cases described, which what makes the association between these two anomalies an even rarer condition.

Case presentation

The patient was male and born at 37 weeks of gestational age. At birth, the testicles were impalpable, and he had a penile malformation compatible with scaphoid megalourethra associated with congenital urethrocutaneous fistula, with urine output exclusively through a small orifice in the ventral region of the penis. When the child completed 7 months and 22 days, underwent the first surgery, laparoscopically. The first Fowler-Stephens was performed, and the gonadal vessels were ligated, with reconstruction of the penis. Nine months later, the second Fowler-Stephens procedure was performed, with bilateral orchidopexy and penoplasty to improve penis aesthetics. The urethra region was not approached. The postoperative period of the second surgery progressed uneventfully. Nowadays, the patient presents adequate urinary stream.

Conclusion

The scaphoid megalourethra associated with congenital urethrocutaneous fistula is an extremely rare pathology, with very few cases reported in the literature to date. The obstetric USG is important to increasing the chances of early diagnosis and treatment.
The diagnostic role of C2PAC index in cases of sepsis-induced coagulopathy (SIC)
Authors: Mousa Mohamed Shaaban , Ahmed Salwa Hassan , Maksoud Fatma Abdel Wahab Abdel , Soliman Soliman Belal , Tantawy Ahmed A.
Published: October 2023

Background

To study the potential role of the C2PAC index (a ratio of soluble type C lectin-like receptor 2 level sCLEC-2 and platelet count) in sepsis-induced coagulopathy with the possibility of using this index as an early predictor in sepsis and sepsis-induced coagulopathy.

Methods

Our case–control study included a total of 86 participants divided into 2 groups: group I is the case group consisting of 56 patients of sepsis or septic shock and group II (control group) of 30 healthy persons: sex and age-matched healthy individuals. All patients were subjected to assessment of C lectin domain family 2 receptor (sCLEC2), by enzyme-linked immunosorbent assay ELIZA kit, then C2PAC index (a ratio of soluble type C lectin-like receptor 2 level sCLEC-2 and platelet count) was calculated using the platelet count.

Results

Our study demonstrated that sCLEC-2 levels and C2PAC in group I were higher than in group II (p value < 0.001), and Klebsiella was the most common organism detected in ICU septic patients; detected in 25 patients (44.6%), there is a statistical significance (p value 0.045) between sCLEC2 levels and streptococcal infections. It was detected also that the SIC group was 17 patients (30.4%) and the sepsis without coagulopathy group was 39 patients (69.6%). Compared with the sepsis without coagulopathy group, the SIC group was significantly older and had a significantly higher SOFA score, sCLEC-2 levels, and C2PAC index. Lastly, the strong potentiality of using C2PAC as a diagnostic and prognostic marker for sepsis-induced coagulopathy with high statistical significance < 0. 001.

Conclusions

C2PAC index can be validated as an accurate marker of sepsis-induced coagulopathy with higher sensitivity when using the C2PAC index (82.4%) than using sCLEC-2 (58.8%) and both have the same specificity (89.7%). The C2PAC index is a useful predictor of SIC progression.
Vascular calcification: from the perspective of crosstalk
Authors: Yang Shiqi , Zeng Zhaolin , Yuan Qing , Chen Qian , Wang Zuo , Xie Hui , Liu Jianghua
Published: October 2023

Vascular calcification (VC) is highly correlated with cardiovascular disease morbidity and mortality, but anti-VC treatment remains an area to be tackled due to the ill-defined molecular mechanisms. Regardless of the type of VC, it does not depend on a single cell but involves multi-cells/organs to form a complex cellular communication network through the vascular microenvironment to participate in the occurrence and development of VC. Therefore, focusing only on the direct effect of pathological factors on vascular smooth muscle cells (VSMCs) tends to overlook the combined effect of other cells and VSMCs, including VSMCs-VSMCs, ECs-VMSCs, Macrophages-VSMCs, etc. Extracellular vesicles (EVs) are a collective term for tiny vesicles with a membrane structure that are actively secreted by cells, and almost all cells secrete EVs. EVs docked on the surface of receptor cells can directly mediate signal transduction or transfer their contents into the cell to elicit a functional response from the receptor cells. They have been proven to participate in the VC process and have also shown attractive therapeutic prospects. Based on the advantages of EVs and the ability to be detected in body fluids, they may become a novel therapeutic agent, drug delivery vehicle, diagnostic and prognostic biomarker, and potential therapeutic target in the future. This review focuses on the new insight into VC molecular mechanisms from the perspective of crosstalk, summarizes how multi-cells/organs interactions communicate via EVs to regulate VC and the emerging potential of EVs as therapeutic methods in VC. We also summarize preclinical experiments on crosstalk-based and the current state of clinical studies on VC-related measures.
Influence of compliance to antithrombotic agents on perioperative morbidity and mortality
Authors: Duranteau Olivier , Hamriti Ayoub , Ickx Brigitte , Tuna Turgay
Published: October 2023

For patients on antithrombotic medication, the outcome of a planned surgery depends on the adjustment of their daily treatment. This study aimed to assess the impact of non-compliance to published recommendations about antithrombotic agents, specifically those provided by the Groupement d'Intérêt pour l'hémostase Peri-opératoire (GIHP), on patient morbidity and mortality.

A prospective cohort observational monocentric study was conducted over a 7-month period in 2019 in an academic hospital. The study included patients on antithrombotic agents scheduled for elective surgery, excluding cardiac surgery. The primary endpoints were morbidity and mortality at 1 month according to GIHP guidelines compliance. Blood loss during surgery and length of hospital stay were secondary endpoints.

Among the 589 patients included in the study, 87 complications were recorded, resulting in a morbidity rate of 14.8%. Thirty-six patients experienced hemorrhagic events, leading to 8 deaths, while 33 patients suffered from ischemic events, resulting in 3 deaths. Additionally, 18 patients died from causes unrelated to hemorrhage or ischemia. Compliance with GIHP guidelines was observed in 62% of patients. Statistical analysis did not reveal a significant association between adherence to guidelines and morbidity (p value = 0.923), nor between adherence and 1-month survival (p value = 0.698). Similarly, no statistically significant relationships were found between compliance and intraoperative bleeding volume (p value = 0.087), postoperative bleeding (p value = 0.460), or length of hospital stay (p value = 0.339).

This study did not identify any substantial associations between non-strict adherence to GIHP recommendations and patient outcomes, including morbidity, mortality, and bleeding. However, it is important to interpret these findings with caution, considering the study’s limitations and the need for further research in this area.