bluuebunny/crossref_metadata_2025 huggingface dataset:
Neutrophil-to-lymphocyte ratio for predicting postoperative recurrence in Crohn’s disease patients with isolated anastomotic lesions
Authors: Chen Rirong , Li Chao , Chao Kang , Tie Yizhe , Zheng Jieqi , Guo Huili , Zeng Zhirong , Li Li , Chen Minhu , Zhang Shenghong
Published: March 2023

Background:

Patients with isolated anastomotic lesions (iAL) are common in postoperative Crohn’s disease (CD) and have heterogeneous prognosis.

Objectives:

To investigate the prognostic value of neutrophil-to-lymphocyte ratio (NLR) in CD patients with iAL.

Design:

A bicenter retrospective cohort study.

Methods:

CD patients who received ileocolonic resection from 2013 and 2020 and had a modified Rutgeerts score of i2a were recruited. NLR was determined within 1 week around the initial endoscopy after ileocolectomy. The primary outcome was clinical recurrence. Kaplan–Meier method and Cox hazard regression analysis were utilized to assess the association between candidate variables and outcomes of interest.

Results:

In total, 411 postoperative CD patients were preliminarily reviewed and 83 patients were eligible. In total, 36 (48.6%) patients experienced clinical recurrence with a median follow-up time of 16.3 (interquartile range, 9.7–26.3) months. NLR > 2.45 and age at surgery >45 years had higher cumulative incidence of clinical recurrence in the Kaplan–Meier analysis. After adjusted for potential confounders, NLR > 2.45 was the only independent risk factor for clinical recurrence, with an adjusted hazard ratio (HR) of 2.88 [95% confidence interval (CI), 1.39–6.00; p = 0.005]. Furthermore, a risk score based on NLR and age at surgery were built to further stratify patients. Compared to those who scored 0, patients with a score of 1 and 2 had an adjusted HR of 2.48 (95% CI, 1.22–5.02) and 6.97 (95% CI, 2.19–22.16) for developing clinical recurrence, respectively.

Conclusions:

NLR is a promising prognostic biomarker for CD patients with iAL. The utilization of NLR and the risk score to stratify patients may facilitate the personalized management in patients with iAL.
Glycemic Risk Index Profiles and Predictors Among Diverse Adults With Type 1 Diabetes
Authors: Hoogendoorn Claire J. , Hernandez Raymond , Schneider Stefan , Harmel Mark , Pham Loree T. , Crespo-Ramos Gladys , Agarwal Shivani , Crandall Jill , Peters Anne L. , Spruijt-Metz Donna , Gonzalez Jeffrey S. , Pyatak Elizabeth A.
Published: March 2023

Background:

The Glycemia Risk Index (GRI) was introduced as a single value derived from the ambulatory glucose profile that identifies patients who need attention. This study describes participants in each of the five GRI zones and examines the percentage of variation in GRI scores that is explained by sociodemographic and clinical variables among diverse adults with type 1 diabetes.

Methods:

A total of 159 participants provided blinded continuous glucose monitoring (CGM) data over 14 days (mean age [SD] = 41.4 [14.5] years; female = 54.1%, Hispanic = 41.5%). Glycemia Risk Index zones were compared on CGM, sociodemographic, and clinical variables. Shapley value analysis examined the percentage of variation in GRI scores explained by different variables. Receiver operating characteristic curves examined GRI cutoffs for those more likely to have experienced ketoacidosis or severe hypoglycemia.

Results:

Mean glucose and variability, time in range, and percentage of time in high, and very high, glucose ranges differed across the five GRI zones ( P values < .001). Multiple sociodemographic indices also differed across zones, including education level, race/ethnicity, age, and insurance status. Sociodemographic and clinical variables collectively explained 62.2% of variance in GRI scores. A GRI score ≥84.5 reflected greater likelihood of ketoacidosis (area under the curve [AUC] = 0.848), and scores ≥58.2 reflected greater likelihood of severe hypoglycemia (AUC = 0.729) over the previous six months.

Conclusions:

Results support the use of the GRI, with GRI zones identifying those in need of clinical attention. Findings highlight the need to address health inequities. Treatment differences associated with the GRI also suggest behavioral and clinical interventions including starting individuals on CGM or automated insulin delivery systems.
Regeneration of articular cartilage defects: Therapeutic strategies and perspectives
Authors: Guo Xueqiang , Xi Lingling , Yu Mengyuan , Fan Zhenlin , Wang Weiyun , Ju Andong , Liang Zhuo , Zhou Guangdong , Ren Wenjie
Published: March 2023

Articular cartilage (AC), a bone-to-bone protective device made of up to 80% water and populated by only one cell type (i.e. chondrocyte), has limited capacity for regeneration and self-repair after being damaged because of its low cell density, alymphatic and avascular nature. Resulting repair of cartilage defects, such as osteoarthritis (OA), is highly challenging in clinical treatment. Fortunately, the development of tissue engineering provides a promising method for growing cells in cartilage regeneration and repair by using hydrogels or the porous scaffolds. In this paper, we review the therapeutic strategies for AC defects, including current treatment methods, engineering/regenerative strategies, recent advances in biomaterials, and present emphasize on the perspectives of gene regulation and therapy of noncoding RNAs (ncRNAs), such as circular RNA (circRNA) and microRNA (miRNA).
Assessment of microbial bioburden on portable medical equipment in a hospital setting
Authors: Chatterjee Piyali , Coppin John David , Martel Julie Ann , Williams Marjory D , Choi Hosoon , Stibich Mark , Simmons Sarah , Passey Deborah , Allton Yonhui , Jinadatha Chetan
Published: March 2023

Objectives:

Although routine disinfection of portable medical equipment is required in most hospitals, frontline staff may not be able to disinfect portable medical equipment at a rate that adequately maintains low bioburden on high-use equipment. This study quantified bioburden over an extended time period for two types of portable medical equipment, workstations on wheels and vitals machines, across three hospital wards.

Methods:

Bioburden was quantified via press plate samples taken from high touch surfaces on 10 workstations on wheels and 5 vitals machines on each of 3 medical surgical units. The samples were taken at three timepoints each day over a 4-week period, with random rotation of timepoints and portable medical equipment, such that frontline staff were not aware at which timepoint their portable medical equipment would be sampled. The mean bioburden from the different locations and portable medical equipment was estimated and compared with Bayesian multilevel negative binomial regression models.

Results:

Model estimated mean colony counts (95% credible interval) were 14.4 (7.7–26.7) for vitals machines and 29.2 (16.1–51.1) for workstations on wheels. For the workstations on wheel, colony counts were lower on the mouse, 0.22 (0.16–0.29), tray, 0.29 (0.22, 0.38), and keyboard, 0.43 (0.32–0.55), when compared to the arm, as assessed by incident rate ratios.

Conclusions:

Although routine disinfection is required, bioburden is still present across portable medical equipment on a variety of surfaces. The difference in bioburden levels among surfaces likely reflects differences in touch patterns for the different portable medical equipment and surfaces on the portable medical equipment. Although the association of portable medical equipment bioburden to healthcare-associated infection transmission was not assessed, this study provides evidence for the potential of portable medical equipment as a vector for healthcare-associated infection transmission despite hospital disinfection requirements.
The influence of health information attention and app usage frequency of older adults on persuasive strategies in mHealth education apps
Authors: Guo Yongyan , Wen Tingting , Yue Siyu , Zhao Xiaoran , Huang Keke
Published: March 2023

With the development of mobile communication technology, persuasive technology is widely used in mobile health. Using personalized persuasive strategies in mobile health education (MHE) apps can effectively improve users’ health literacy and health behaviors. The transtheoretical model explains the process of user behavior change. Different usage frequency of the app reflects changes in user behavior. However, few studies have examined how the perceived importance of persuasive strategies among older adults changes with increasing use frequency. In this study, we analyzed the sensitivity of 111 older adults in China to persuasive strategies in MHE apps. Thirteen persuasive strategies were selected for this study. A repeated measure analysis of variance (RM-ANOVA) was used to demonstrate the influence of gender, health information attention and frequency of use on the sensitivity of perceived persuasive strategies among older adults. The results revealed older adults with a high usage frequency of health apps were more receptive to persuasive strategies, especially in social comparison strategy. This result may help developers consider factors such as the frequency of use by older users when designing personalized persuasive strategies for MHE apps.
Financial Development and International R&D Spillovers Through Trade: Evidence From Developing Countries
Authors: Le Thanh , Vu Bich Ngoc , Mai Sau , Nguyen Ha , Bui Hung
Published: March 2023

This paper examines how financial development affects technological progress of 55 developing countries over the 2003 to 2016 period, with particular attention to the interaction between R&D spillovers and financial development. We find that financial development induces total factor productivity improvement in developing countries both directly and indirectly. While there has been a profound literature on the direct effect of financial development on total factor productivity improvement, the evidence of an indirect effect is relatively new. Specifically, the indirect effect takes place through international R&D spillovers from developed countries to developing countries. Between the two components of financial development, the financial institutional aspects exert a more significant effect on total factor productivity than that of their financial market counterparts. As this paper also re-examines the effectiveness of the North-South R&D spillovers, it conveys important implications for policymakers whose objectives are to promote technological development and economic performance.
Relationship Between Quadriceps Strength and Knee Joint Power During Jumping After ACLR
Authors: Graham Megan C. , Reeves Kelsey A. , Johnson Darren L. , Noehren Brian
Published: March 2023

Background:

Knee joint power is significantly impaired during the propulsive phase of jumping after anterior cruciate ligament reconstruction (ACLR); however, it is currently unknown how quadriceps strength influences knee joint power.

Purpose:

To (1) evaluate the relationship between quadriceps strength, joint power, and the percentage contribution of the hip, knee, and ankle joints to total limb power during the propulsive phase of jumping and (2) establish a quadriceps strength cutoff value for maximizing the likelihood of having knee joint power characteristics similar to healthy participants.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

A total of 75 participants were included in this study—40 patients who underwent ACLR 6 months before (18 females; mean age, 19.3 ± 5.7 years) and 35 healthy controls (HC) (20 females; mean age, 21.5 ± 4.5 years). Participants performed a drop vertical jump and underwent isometric quadriceps strength testing. The peak joint power was calculated as the product of the internal joint moment and joint angular velocity. Pearson product-moment correlations were used to assess the relationship between quadriceps strength and knee joint power. Paired samples t tests were used to quantify differences between limbs. Receiver operating characteristic (ROC) curve analysis was used to determine a quadriceps strength cutoff.

Results:

The involved limbs of the ACLR cohort (INV) had significantly lower peak knee joint power and percentage contribution from the knee joint during jumping compared with the uninvolved limbs (NON) and limbs of the controls (INV, 2.5 ± 1.2 W/kg; NON, 4.4 ± 1.5 W/kg; HC, 4.3 ± 1.7 W/kg [ P < .0001]). Quadriceps strength was associated with knee joint power in involved limbs and limbs of controls (INV, r = 0.50; HC, r = 0.60). A quadriceps strength cutoff value of 2.07 N·m/kg had an area under the ROC curve of 0.842, indicating good predictive accuracy.

Conclusion:

Athletes at 6 months after ACLR demonstrated knee-avoidant jumping mechanics and had significant reductions in knee joint power on the involved limb. A quadriceps strength cutoff value of 2.07 N·m/kg can help predict which athletes will display knee joint power characteristics similar to those of healthy controls.
Antenatal Care Dropout and Associated Factors in Ethiopia: A Systematic Review and Meta-Analysis
Authors: Sisay Gizaw , Mulat Tsion
Published: March 2023

Background

The prevalence and determinants of antenatal care (ANC) dropout in Ethiopia were studied. However, the results were inconsistent and showed considerable variation. Hence, this meta-analysis aimed at estimating the overall prevalence of ANC dropout and its predictors in Ethiopia.

Methods

A comprehensive search of published studies was done using different international databases such as such as PubMed, DOJA, Embase, Cochrane Library, Google Scholar, and the institutional repository of Ethiopian universities were used to search for relevant studies. Data were extracted using Microsoft Excel spreadsheet, and exported to STATA v17 for analysis. A random effect model was used to estimate the overall national prevalence of ANC dropout. Fixed effects model were used to compute the pooled adjusted odd ratios (AOR) with the corresponding 95% confidence intervals (CIs). I2 test was used to assess heterogeneity of the included studies. Egger's tests was used to check for the presence of publication bias.

Results

A total of 7 studies were included in this systematic review and meta-analysis with 11,839 study participants. The overall pooled prevalence of ANC in Ethiopia was found to be 41.37% (95% CI =35.04, 47.70). Distance from the health care facility (AOR = 2.93, 95% CI = 2.75, 3.11), pregnancy complication signs (AOR = 2.97, 95% CI = 2.77, 3.16), place of residence (AOR =  1.79, 95% CI = 1.31, 2.26), educational level (AOR = 1.79, 95%CI = 1.37, 2.21), and age group (30-49) (AOR = 0.61, 95% CI = 0.45, 0.78) were significantly associated with ANC dropout.

Conclusion

Based on this review and meta-analysis, 41% of Ethiopian women dropped out of ANC visits before the minimum recommended visit (4 times). Hence, to reduce the number of ANC dropouts, it is important to counsel and educate women during their first prenatal care. Issues of urban–rural disparities and noted hotspot areas for ANC dropout should be given further attention.
Stressors Among Healthcare Workers: A Summative Content Analysis
Authors: Rink Lesley C. , Oyesanya Tolu O. , Adair Kathryn C. , Humphreys Janice C. , Silva Susan G. , Sexton John Bryan
Published: March 2023

Healthcare workers are experiencing high stress and burnout, at rates up to 70%, hindering patient care. Studies often focus on stressors in a particular setting or within the context of the pandemic which limits understanding of a more comprehensive view of stressors experienced by healthcare workers. The purpose of this study was to assess healthcare workers’ self-reported major stressors. Between June 2018 and April 2019, U.S. healthcare workers ( N = 2,310) wrote answers to an open-ended question: “What are your biggest stressors as you look back over the last few weeks?” A summative content analysis was used to analyze the data. Healthcare workers described three types of stressors: work stressors (49% of total stressors), personal life stressors (32% of total stressors), and stressors that intersect work and personal life (19% of total stressors). Future research and clinical practice should consider the multi-faceted sources of stress.
The role of size effects in moderating the benefits of sustainable investing
Authors: Ferrat Yann , Daty Frédéric , Burlacu Radu
Published: March 2023

Using an extensive sample of environmental, social, and governance (ESG) ratings, we reexamine the corporate social responsibility (CSR) factor premium in the developed equity markets between 2007 and 2019 and show that its extent is contingent upon size effects. Consistent with the novel market equilibrium, we contend that the exponential growth of socially responsible investment (SRI) has rendered the risk-adjusted returns of large CSR-leading firms in line with or even below their lagging counterparts. In line with the neglected effect, greater market segmentation, lower market efficiency, and lower investor awareness of CSR enable us to observe the former market equilibrium in the smaller corporation partition, where CSR-lagging firms exhibit lower returns than leading ones. We thus theorize a two-stage CSP–CFP relationship, where size effects are considered a relevant moderator. This contention is robust to portfolio and panel regression settings. However, our partly contradicting results with the existent literature emphasize the divergence in ESG ratings across rating agencies.

JEL Classification M14; G11; G15
Effect of Training Program on Knowledge and Practice of Breast feeding Women During COVID-19
Authors: Harthi Amnah M. , Harthi Abeer M. , Hendy Abdelaziz
Published: March 2023

Aim

Evaluate the effect of the training program on knowledge and practice of breastfeeding women during coronavirus disease 2019 (COVID-19).

Methods

One-group pretest/post-test quasiexperimental research design was utilized to accomplish the aim of this study. The study was carried out at the primary health care units Ad Dar Al Baida 1, Ad Dar Al Baida 2, Al Aziziyah at Riyadh Province of Saudi Arabia. The study included a convenience sample of 100 breastfeeding women.

Tool

A structured interviewing questionnaire sheet was used for data collection that included three parts knowledge, reported practice, and demographic characteristics.

Results

More than one-quarter (30%) and (28%) of studied women had satisfactory knowledge-related causes, risk factor and signs, symptoms of COVID-19 at preintervention, while the majority 85% and 86% of them had satisfactory knowledge postintervention at p-value <.01**. In addition, less than one-fifth (17%) and (16%) of studied women had satisfactory knowledge about Breastfeeding guidelines during COVID-19 and care of breastfeeding women during COVID-19, compared with most of them (89%) and (92%) postintervention at p-value <.01**.

Conclusion

Based on our current study, it was concluded that the educational program effectively improves breastfeeding women's knowledge and practices. There was a highly statistically significant positive linear correlation between the breastfeeding women's knowledge and reported practices regarding COVID-19 infection before and after the implementation of the educational program at p < .0.
Typical Complications After Cartilage Repair of the Ankle Using Autologous Matrix-Induced Chondrogenesis (AMIC)
Authors: Waltenspül Manuel , Meisterhans Michel , Ackermann Jakob , Wirth Stephan
Published: March 2023

Background:

Autologous matrix-induced chondrogenesis (AMIC) for the treatment of osteochondral lesions of the talus (OLT) results in favorable clinical outcomes, yet high reoperation rates. The aim of this study was to report and analyze typical complications and their risk factors after AMIC for OLT.

Methods:

A total of 127 consecutive patients with 130 AMIC procedures for OLT were retrospectively assessed. All AMIC procedures were performed in an open fashion with 106 (81.5%) cases requiring a malleolar osteotomy (OT) to access the OLT. Seventy-one patients (54.6%) underwent subsequent surgery. These cases were evaluated at a mean follow-up of 3.1 years (±2.5) for complications reviewing postoperative imaging and intraoperative findings during revision surgery. Six patients (8.5%) were lost to follow-up. Regression model analysis was conducted to identify factors that were associated with AMIC-related complications.

Results:

Among the 65 (50%) patients who required revision surgery, 18 patients (28%) demonstrated AMIC-related complications with deep fissuring (83%) and thinning (17%) of the AMIC graft. Conversely, 47 patients (72%) underwent subsequent surgery due to AMIC-unrelated reasons including isolated removal of symptomatic hardware (n = 17) and surgery addressing concomitant pathologies with (n = 25) and without hardware removal (n = 5). Previous prior cartilage repair surgery was significantly associated with AMIC graft-associated complications in patients undergoing revision surgery ( P = .0023). Among age, body mass index, defect size, smoking, and bone grafting, smoking was the only factor showing statistical significance with an odds ratio of 3.7 (95% CI 1.24, 10.9; P = .019) to undergo revision surgery due to graft-related complications, when adjusted for previous cartilage repair surgery.

Conclusion:

The majority of revision surgeries after AMIC for OLT are unrelated to the performed AMIC graft but frequently address symptomatic hardware and concomitant pathologies. Both smoking and previous cartilage repair surgery seem to significantly increase the risk of undergoing revision surgery due to AMIC-related complications.

Level of evidence:

Level IV, case series.
Research on cursive symbols and variants in Vietnamese manuscripts
Authors: Huang Ying
Published: March 2023

The complexity of variants is more prominent because of the greater randomness of manuscripts. Symbolization is one of the essential characteristics of the spread and variation of Chinese characters in Vietnam. There are many types of symbols in the configuration of Vietnamese variants, and most of them are derived from cursive handwriting in China. Based on the Vietnamese symbolic variants and from the angle of combining the handwriting in calligraphy with the symbol theory in philology, the present article analyzes eight kinds of common symbols in variants in Vietnamese manuscripts and probes into their sources, hoping to encourage a preliminary discussion regarding their symbolic features’?
The urgency of hope in a time of despair
Authors: Freeman Mark
Published: March 2023

Given the state of the world, it is perilously easy—for some, including, at times, the author—to fall prey to despair, including the supposition that the world is moving inexorably downward, perhaps even toward some cataclysmic end. Alluring though despair may sometimes be, and impertinent though hope may sometimes seem, it is precisely in a time of despair that hope becomes most urgent. To succumb to despair is not only fatalistic but problematically “safe.” Hope, predicated as it is on uncertainty about the future, is decidedly more risky. Difficult though it may be to fully embrace hope, it is imperative to hold on to it, for only then can a sense of the possible be sustained.
Genomic diversity of aquaporins across genus Oryza provides a rich genetic resource for development of climate resilient rice cultivars
Authors: Raza Qasim , Rashid Muhammad Abdul Rehman , Waqas Muhammad , Ali Zulfiqar , Rana Iqrar Ahmad , Khan Sultan Habibullah , Khan Iqrar Ahmad , Atif Rana Muhammad
Published: March 2023

Background

Plant aquaporins are critical genetic players performing multiple biological functions, especially climate resilience and water-use efficiency. Their genomic diversity across genus Oryza is yet to be explored.

Results

This study identified 369 aquaporin-encoding genes from 11 cultivated and wild rice species and further categorized these into four major subfamilies, among which small basic intrinsic proteins are speculated to be ancestral to all land plant aquaporins. Evolutionarily conserved motifs in peptides of aquaporins participate in transmembrane transport of materials and their relatively complex gene structures provide an evolutionary playground for regulation of genome structure and transcription. Duplication and evolution analyses revealed higher genetic conservation among Oryza aquaporins and strong purifying selections are assisting in conserving the climate resilience associated functions. Promoter analysis highlighted enrichment of gene upstream regions with cis-acting regulatory elements involved in diverse biological processes, whereas miRNA target site prediction analysis unveiled substantial involvement of osa-miR2102-3p, osa-miR2927 and osa-miR5075 in post-transcriptional regulation of gene expression patterns. Moreover, expression patterns of japonica aquaporins were significantly perturbed in response to different treatment levels of six phytohormones and four abiotic stresses, suggesting their multifarious roles in plants survival under stressed environments. Furthermore, superior haplotypes of seven conserved orthologous aquaporins for higher thousand-grain weight are reported from a gold mine of 3,010 sequenced rice pangenomes.

Conclusions

This study unveils the complete genomic atlas of aquaporins across genus Oryza and provides a comprehensive genetic resource for genomics-assisted development of climate-resilient rice cultivars.
Effect of fluvoxamine on preventing neuropsychiatric symptoms of post COVID syndrome in mild to moderate patients, a randomized placebo-controlled double-blind clinical trial
Authors: Farahani Ramin Hamidi , Ajam Ali , Naeini Alireza Ranjbar
Published: March 2023

Background

Shortly after the Coronavirus disease 2019 (COVID-19) pandemic, a considerable number of recovered patients reported persisting symptoms, especially neuropsychological manifestations, which were later named post-COVID syndrome (PCS). Immune dysregulation was suggested as one of the main mechanisms for PCS. Fluvoxamine, a selective serotonin reuptake inhibitor (SSRI) that is mostly used to treat depression, anxiety disorders, and obsessive–compulsive disorder, has been suggested as an anti-COVID drug due to its anti-inflammatory effects, mainly through the sigma-1 receptor. Therefore, we aimed to evaluate fluvoxamine's effect on PCS neuropsychiatric symptoms.

Method

In this double-blind randomized clinical trial, we included confirmed mild to moderate COVID-19 outpatients using polymerase chain reaction (PCR) by an infectious disease specialist. The presence of severe COVID-19 symptoms was evaluated by the infectious disease specialist and included dyspnea, SpO2 < 94% on room air, PaO2/FiO2 < 300 mm Hg, a respiratory rate > 30 breaths/min, and lung infiltrates > 50%. Then we performed permuted block randomization and assigned patients 1:1 into two groups to either receive fluvoxamine 100 mg tablet or a placebo daily for 10 days. Eligible patients were evaluated after 12 weeks for the presence of fatigue, as the primary, and other PCS symptoms as secondary outcomes.

Results

We screened a total of 486 patients from March to June 2022. After 12 weeks, 42 patients receiving fluvoxamine and 43 patients receiving Placebo were evaluated for PCS. Patients had a mean age of 38.5 ± 14.1 and 48% of them were women. Fatigue was significantly lower in the fluvoxamine group (p-value 0.026). No significant differences were observed in other symptoms.

Conclusion

We concluded that taking fluvoxamine during active COVID-19 can reduce the chance of fatigue but the advantage of fluvoxamine was not observed for other symptoms. Further studies are necessary to confirm these preliminary results.
An unusual form of kidney injury without glomerulonephritis in microscopic polyangiitis: a case report
Authors: Uysal Cihan , Yilmaz Tugba , Kocyigit Hafsa , Akgun Hulya , Sipahioglu Murat Hayri
Published: March 2023

Background

Microscopic polyangiitis (MPA), a kind of antineutrophil cytoplasmic autoantibody associated vasculitis (AAV), predominantly affects small-sized vessels. MPA is a significant cause of the pulmonary-renal syndrome. Pauci-immune necrotizing and crescentic glomerulonephritis is the typical renal histological feature of AAV. Tubulointerstitial lesions may occur and mostly form with inflammatory cell infiltration in the interstitium. However, a few cases reported only tubulointerstitial involvement without glomerular lesions in patients with MPA.

Case presentation

We present an MPA case, a 70-year-old male patient diagnosed with acute kidney injury accompanying the dialysis requirement. Only acute tubulointerstitial nephritis was revealed in kidney biopsy without evidence of glomerular injury. Also, interstitial pulmonary fibrosis was determined on computerized tomography, and myeloperoxidase antineutrophil cytoplasmic autoantibody was positive. Consequently, we have considered the main diagnosis as MPA. We did not prefer a standard tubulointerstitial nephritis treatment regimen due to the presence of life-threatening systemic vasculitis. Treatment was established like crescentic glomerulonephritis. Induction therapy consisted of pulse steroid, cyclophosphamide, and plasmapheresis. Unfortunately, severe SARS-CoV-2 infection caused death during induction therapy in this case.

Conclusions

The lack of glomerular injury and solely interstitial inflammation is atypical regarding AAV involvement in the kidney. This diversity might be initially considered as only a simple histological elaboration. However, it is a significant entity for guiding the treatment of AAV.
International rates of receipt of psychological therapy for psychosis and schizophrenia: systematic review and meta-analysis
Authors: Burgess-Barr Susanna , Nicholas Emily , Venus Bethany , Singh Niharika , Nethercott Abigail , Taylor Gemma , Jacobsen Pamela
Published: March 2023

Background

International clinical practice guidelines commonly recommend the provision of psychological therapies for psychosis and schizophrenia as an adjunct to medication. However, access to recommended therapies in routine clinical practice is limited. The aim of this review was to synthesise the available data on the provision of recommended psychological therapies for psychosis and schizophrenia across international mental health systems.

Methods

Electronic databases (PsychINFO, Pubmed and EMBASE) were searched for audits, service evaluation projects, or surveys, which reported data on rates of offer or receipt of any recommended psychological therapy or therapeutic intervention as part of routine clinical care.

Results

Twenty-two eligible studies from 9 countries were identified (N participants = 79,407). The most commonly recommended therapies in national guidelines were Cognitive-Behavioural Therapy for Psychosis (CBTp) and Family Interventions (FI). The overall pooled prevalence of rate of receipt of CBTp was 24% [95% CI 0.15–0.32] based on 15 studies (N = 42,494), with a higher rate of receipt of therapy found when pooling data from Early Intervention services only (41% [95% CI 0.21–0.60], 6 studies, N = 11,068). The overall pooled prevalence of rate of receipt of FI was 30% [95% CI 0.22–0.37] based on 14 studies (N = 13,863).

Conclusions

Overall rates of receipt of recommended psychological therapies for psychosis were low across the 9 countries data were available for in this review. However, there were high rates of heterogeneity across studies, meaning that pooled estimates should be interpreted with caution. Sources of heterogeneity included different service settings (e.g. early intervention vs. non-early intervention services), and varying methods used to collect the data (e.g. audit of electronic health records vs. self-report etc.). There were no available data from the continents of South America, Asia, or Africa, meaning that a truly global picture of provision of psychological therapies for psychosis and schizophrenia is currently lacking.
Diet prevents the expansion of segmented filamentous bacteria and ileo-colonic inflammation in a model of Crohn’s disease
Authors: Metwaly Amira , Jovic Jelena , Waldschmitt Nadine , Khaloian Sevana , Heimes Helena , Häcker Deborah , Ahmed Mohamed , Hammoudi Nassim , Le Bourhis Lionel , Mayorgas Aida , Siebert Kolja , Basic Marijana , Schwerd Tobias , Allez Matthieu , Panes Julian , Salas Azucena , Bleich André , Zeissig Sebastian , Schnupf Pamela , Cominelli Fabio , Haller Dirk
Published: March 2023

Background

Crohn’s disease (CD) is associated with changes in the microbiota, and murine models of CD-like ileo-colonic inflammation depend on the presence of microbial triggers. Increased abundance of unknown Clostridiales and the microscopic detection of filamentous structures close to the epithelium of TnfΔARE mice, a mouse model of CD-like ileitis pointed towards segmented filamentous bacteria (SFB), a commensal mucosal adherent bacterium involved in ileal inflammation.

Results

We show that the abundance of SFB strongly correlates with the severity of CD-like ileal inflammation in two mouse models of ileal inflammation, including TnfΔARE and SAMP/Yit mice. SFB mono-colonization of germ-free TnfΔARE mice confirmed the causal link and resulted in severe ileo-colonic inflammation, characterized by elevated tissue levels of Tnf and Il-17A, neutrophil infiltration and loss of Paneth and goblet cell function. Co-colonization of SFB in human-microbiota associated TnfΔARE mice confirmed that SFB presence is indispensable for disease development. Screening of 468 ileal and colonic mucosal biopsies from adult and pediatric IBD patients, using previously published and newly designed human SFB-specific primer sets, showed no presence of SFB in human tissue samples, suggesting a species-specific functionality of the pathobiont. Simulating the human relevant therapeutic effect of exclusive enteral nutrition (EEN), EEN-like purified diet antagonized SFB colonization and prevented disease development in TnfΔARE mice, providing functional evidence for the protective mechanism of diet in modulating microbiota-dependent inflammation in IBD.

Conclusions

We identified a novel pathogenic role of SFB in driving severe CD-like ileo-colonic inflammation characterized by loss of Paneth and goblet cell functions in TnfΔARE mice. A purified diet antagonized SFB colonization and prevented disease development in TnfΔARE mice in contrast to a fiber-containing chow diet, clearly demonstrating the important role of diet in modulating a novel IBD-relevant pathobiont and supporting a direct link between diet and microbial communities in mediating protective functions.
Finite-frequency sensitivity kernels and hierarchical traveltime and waveform inversion of direct and reflected waves from vertical seismic profile data
Authors: Ren Zhiming , Dai Xue , Bao Qianzong
Published: March 2023

Wave-equation-based traveltime or waveform inversion updates the velocity model along finite-frequency sensitivity kernels and exhibits higher accuracy than ray-based tomography. Owing to special geometry, the kernels for vertical seismic profile (VSP) data are different from those for surface seismic data. We have used the Born approximation to compute the traveltime and waveform kernels for direct and reflected waves from VSP data. Based on the property of sensitivity kernels for different information and arrivals, we develop a hierarchical inversion scheme: joint wave-equation traveltime inversion (JWETI) of direct and reflected waves, joint waveform inversion (JWI) of direct and reflected waves, and full-waveform inversion (FWI) of the reflected wave. The traveltime kernels, the waveform kernels, and the migration isochrones are used to retrieve the long-, intermediate-, and short-wavelength components of the velocity model, respectively. Numerical tests on synthetic and real walkway VSP data reveal that the JWETI stage obtains a plausible velocity macromodel, which can be treated as a starting model for subsequent JWI and FWI stages. The JWI stage is a transition between JWETI and FWI and helps to improve the structures of the deep layers of the model. The FWI stage offers some high-wavenumber contents to the inverted model. For the VSP survey, the transmitted direct waves can be used to reduce the dependence of FWI on the initial model. However, the conventional reflection-based wave-equation traveltime inversion and FWI still suffer from cycle skipping when the initial model is far away from the real model. In contrast, the hierarchical inversion scheme can yield reasonable inversion results around the borehole, even when large velocity errors are present in the starting model.
Noisy pursuit by a self-steering active particle in confinement
(a)
Authors: Gassner Marielle , Goh Segun , Gompper Gerhard , Winkler Roland G.
Published: March 2023

The properties of a cognitive, self-propelled, and self-steering particle in the presence of a stationary target are analyzed theoretically and by simulations. In particular, the effects of confinement in competition with activity and steering are addressed. The pursuer is described as an intelligent active Ornstein-Uhlenbeck particle (iAOUP), confined in a harmonic potential. For the free pursuer, we find universal scaling regimes for the pursuer-target distance in terms of the Péclet number and maneuverability. Steering results in a novel constant mean-distance regime, which broadens with increasing maneuverability. Confinement strongly affects the propulsion direction and leads to a scaling at large Péclet numbers similar to that in the absence of confinement, yet with a pronounced dependence on confinement strength.
Molecular Genetics of Diffuse Sclerosing Papillary Thyroid Cancer
Authors: Alswailem Meshael , Alghamdi Balgees , Alotaibi Anwar , Aljomiah Abeer , Al-Hindi Hindi , Murugan Avaniyapuram Kannan , Abouelhoda Mohamed , Shi Yufei , Alzahrani Ali S
Published: March 2023

Context

Diffuse sclerosing papillary thyroid cancer (DSPTC) is rare, with limited data on its molecular genetics.

Objective

We studied the molecular genetics of a cohort of DSPTC.

Methods

DNA was isolated from paraffin blocks of 22 patients with DSPTC (15 females, 7 males, median age 18 years, range 8-81). We performed polymerase chain reaction–based Sanger sequencing and a next-generation sequencing (NGS) gene panel to characterize the genomic landscape of these tumors. We classified genetic alterations to definitely or probably pathogenic. Definitely pathogenic are genetic alterations that are well known to be associated with PTC (e.g., BRAFV600E). Probably pathogenic are other alterations in genes that were reported in The Cancer Genome Atlas or the poorly differentiated and anaplastic thyroid cancer datasets.

Results

Three tumors were tested only by Sanger sequencing and were negative for BRAFV600E, HRAS, KRAS, NRAS, TERT promoter, PTEN, and PIK3CA mutations. The other 19 tumors tested by NGS showed definitely pathogenic alterations in 10 patients (52.6%): 2/19 (10.5%) BRAFV600E, 5/19 (26.3%) CCDC6-RET (RET/PTC1), 1/19 (5.3%) NCOA4-RET (RET/PTC3), 1/19 (5.3%) STRN-ALK fusion, and 2/19 (10.6%) TP53 mutations. Probably pathogenic alterations occurred in 13/19 tumors (68.4%) and included variants in POLE (31.6%), CDKN2A (26%), NF1 (21%), BRCA2 (15.8%), SETD2 (5.3%), ATM (5.3%), FLT3 (5.3%), and ROS1 (5.3%). In 1 patient, the gene panel showed no alterations. No mutations were found in the RAS, PTEN, PIK3CA, or TERT promoter in all patients. There was no clear genotype/phenotype correlation.

Conclusion

In DSPTC, fusion genes are common, BRAFV600E is rare, and other usual point mutations are absent. Pathogenic and likely pathogenic variants in POLE, NF1, CDKN2A, BRCA2, TP53, SETD2, ATM, FLT3, and ROS1 occur in about two-thirds of DTPTC.
Biochemical Assessment of Pheochromocytoma and Paraganglioma
Authors: Eisenhofer Graeme , Pamporaki Christina , Lenders Jacques W M
Published: March 2023

Pheochromocytoma and paraganglioma (PPGL) require prompt consideration and efficient diagnosis and treatment to minimize associated morbidity and mortality. Once considered, appropriate biochemical testing is key to diagnosis. Advances in understanding catecholamine metabolism have clarified why measurements of the O-methylated catecholamine metabolites rather than the catecholamines themselves are important for effective diagnosis. These metabolites, normetanephrine and metanephrine, produced respectively from norepinephrine and epinephrine, can be measured in plasma or urine, with choice according to available methods or presentation of patients. For patients with signs and symptoms of catecholamine excess, either test will invariably establish the diagnosis, whereas the plasma test provides higher sensitivity than urinary metanephrines for patients screened due to an incidentaloma or genetic predisposition, particularly for small tumors or in patients with an asymptomatic presentation. Additional measurements of plasma methoxytyramine can be important for some tumors, such as paragangliomas, and for surveillance of patients at risk of metastatic disease. Avoidance of false-positive test results is best achieved by plasma measurements with appropriate reference intervals and preanalytical precautions, including sampling blood in the fully supine position. Follow-up of positive results, including optimization of preanalytics for repeat tests or whether to proceed directly to anatomic imaging or confirmatory clonidine tests, depends on the test results, which can also suggest likely size, adrenal vs extra-adrenal location, underlying biology, or even metastatic involvement of a suspected tumor. Modern biochemical testing now makes diagnosis of PPGL relatively simple. Integration of artificial intelligence into the process should make it possible to fine-tune these advances.
The Effect of Population Aging on Economic Growth, the Labor Force, and Productivity
Authors: Maestas Nicole , Mullen Kathleen J. , Powell David
Published: March 2023

Population aging is expected to slow US economic growth. We use variation in the predetermined component of population aging across states to estimate the impact of aging on growth in GDP per capita for 1980–2010. We find that each 10 percent increase in the fraction of the population age 60+ decreased per capita GDP by 5.5 percent. One-third of the reduction arose from slower employment growth; two-thirds due to slower labor productivity growth. Labor compensation and wages also declined in response. Our estimate implies population aging reduced the growth rate in GDP per capita by 0.3 percentage points per year during 1980–2010. (JEL E23, E24, J11, J14, J31, O47)
Cross-Sectional Uncertainty and the Business Cycle: Evidence from 40 Years of Options Data
Authors: Dew-Becker Ian , Giglio Stefano
Published: March 2023

This paper presents a novel and unique measure of cross-sectional uncertainty constructed from stock options on individual firms. Cross-sectional uncertainty varied little between 1980 and 1995 and subsequently had three distinct peaks—during the tech boom, the financial crisis, and the coronavirus epidemic. Cross-sectional uncertainty has had a mixed relationship with overall economic activity, and aggregate uncertainty is much more powerful for forecasting aggregate growth. The data and moments can be used to calibrate and test structural models of the effects of uncertainty shocks. In international data, we find similar dynamics and a strong common factor in cross-sectional uncertainty. (JEL D21, D81, E23, E24, E32, G13, O34)
Bubbles, Crashes, and Economic Growth: Theory and Evidence
Authors: Guerron-Quintana Pablo A. , Hirano Tomohiro , Jinnai Ryo
Published: March 2023

We analyze the ups and downs in economic growth in recent decades by constructing a model with recurrent bubbles, crashes, and endogenous growth. Once realized, bubbles crowd in investment and stimulate economic growth, but expectation about future bubbles crowds out investment and reduces economic growth. We identify bubbly episodes by estimating the model using the US data. Counterfactual simulations suggest that the IT and housing bubbles not only caused economic booms but also lifted US GDP by almost 2 percentage points permanently, but the economy could have grown even faster if people had believed that asset bubbles would never arise. (JEL E22, E23, E32, E44, G14, R31)
Test–retest, inter- and intra-rater reproducibility of size measurements of focal bone marrow lesions in MRI in patients with multiple myeloma
Authors: Wennmann Markus , Grözinger Martin , Weru Vivienn , Hielscher Thomas , Rotkopf Lukas Thomas , Bauer Fabian , Gnirs Regula , Nonnenmacher Tobias , Sauer Sandra , Goldschmidt Hartmut , Weinhold Niels , Bonekamp David , Weber Tim Frederik , Schlemmer Heinz-Peter , Delorme Stefan
Published: March 2023

Objective:

To investigate the reproducibility of size measurements of focal bone marrow lesions (FL) in MRI in patients with monoclonal plasma cell disorders under variation of patient positioning and observer.

Methods:

A data set from a prospective test–retest study was used, in which 37 patients with a total of 140 FL had undergone 2 MRI scans with identical parameters after patient repositioning. Two readers measured long and short axis diameter on the initial scan in T  1 weighted, T  2 weighted short tau inversion recovery and diffusion-weighted imaging sequences. The first reader additionally measured FL on the retest-scan. The Bland–Altman method was used to assess limits of agreement (LoA), and the frequencies of absolute size changes were calculated.

Results:

In the simple test–retest experiment with one identical reader, a deviation of ≥1 mm / ≥2 mm / ≥3 mm for the long axis diameter in T  1 weighted images was observed in 66% / 25% / 8% of cases. When comparing measurements of one reader on the first scan to the measurement of the other reader on the retest scan, a change of ≥1 mm / ≥3 mm / ≥5 mm for the long axis diameter in T  1 weighted images was observed in 78% / 21% / 5% of cases.

Conclusion:

Small deviations in FL size are common and probably due to variation in patient positioning or inter-rater variability alone, without any actual biological change of the FL. Knowledge of the uncertainty associated with size measurements of FLs is critical for radiologists and oncologists when interpreting changes in FL size in clinical practice and in clinical trials.

Advances in knowledge:

According to the MY-RADs criteria, size measurements of focal lesions in MRI are now of relevance for response assessment in patients with monoclonal plasma cell disorders.

Size changes of 1 or 2 mm are frequently observed due to uncertainty of the measurement only, while the actual focal lesion has not undergone any biological change.

Size changes of at least 6 mm or more in T  1 weighted or T  2 weighted short tau inversion recovery sequences occur in only 5% or less of cases when the focal lesion has not undergone any biological change.
Η Βιοηθική διάσταση της καθημερινότητας των ατόμων με άνοια: από την αυτονομία αποφάσεων έως την φροντίδα για το μέλλον
Authors: Λυγνός Δημήτριος , Ρεθυμιωτάκη Ελένη
Published: March 2023

Η άνοια θέτει μια πρόκληση για την ορθή κρίση και την αυτονομία των ατόμων, ενώ υποσκάπτει την ποιότητα ζωής τους. Τα ηθικά ζητήματα αντιμετωπίζονται από τα ίδια τα άτομα με άνοια, τους φροντιστές τους και τους παρόχους υγειονομικής περίθαλψης σε καθημερινή βάση. Αυτά εκτείνονται σε ένα ευρύ φάσμα, το οποίο περιλαμβάνει όχι μόνο τα σοβαρά ζητήματα για τις αποφάσεις στο τέλος της ζωής, αλλά και τα απλά καθημερινά προβλήματα, όπως η οδήγηση. Η διεπιστημονική προσέγγιση των βιοηθικών ζητημάτων αναδεικνύει την άνοια ως σημαντικό και πολύπλευρο κοινωνικό φαινόμενο. Οι αλλαγές στις γνωστικές ικανότητες και τις καθημερινές δραστηριότητες επηρεάζουν τις διαπροσωπικές αλληλεπιδράσεις και τις οικογενειακές σχέσεις. Οι ασθενείς, το περιβάλλον τους και οι κλινικοί ιατροί καλούνται σε ένα νέο πλαίσιο να συνεργάζονται για να λάβουν αποφάσεις σχετικά με τη διαγνωστική διαδικασία, την καθημερινή διαβίωση, τον συντονισμό της φροντίδας, τον εκ των προτέρων προγραμματισμό της ή τις παρεμβάσεις στο τέλος της ζωής. Οι στενές σχέσεις μεταξύ ηθικής και δικαίου είναι διαχρονικές, καθιστώντας απαραίτητη την παράλληλη μελέτη των ηθικών ζητημάτων με τη νομοθεσία.