bluuebunny/crossref_metadata_2025 huggingface dataset:
Systemic and targeted steroids for the treatment of IgA nephropathy
Authors: Locatelli Francesco , Del Vecchio Lucia , Ponticelli Claudio
Published: December 2023

Immunoglobulin A nephropathy (IgAN) is a common glomerulonephritis partially correlated with mucosal immune system dysfunction. Progressive renal failure occurs in many patients, with about 30–50% of the patients with IgAN developing end-stage kidney disease (ESKD). Many treatments have been used for decades, despite uncertainty about their effectiveness and the ideal dose. Randomised controlled trials reported that systemic glucocorticoids can be an effective treatment for patients with persistent and significant proteinuria despite renin-angiotensin system inhibitors use possibly causing systemic side effects. The primary focus of IgAN management should be based on optimised supportive care, including renin-angiotensin system (RAS) blockade and now SGLT2 inhibitors. The novel targeted-release formulation (TRF) of budesonide has been tested to reduce the adverse events of systemic steroids by delivering the drug to the distal ileum. The local efficacy of TRF-budesonide may represent a novel and promising approach to treating IgAN. Two clinical trials showed that TRF-budesonide could significantly reduce proteinuria and haematuria and possibly preserve renal function while significantly reducing the side effects. However, the limited number of treated patients and the relatively short follow-up suggest caution before considering budesonide superior to the current six-months steroid pulses scheme. Long-term data on the efficacy and safety of TRF budesonide are awaited, together with the design of trials with a head-to-head comparison with systemic steroids before considering TRF-budesonide as the standard of care treatment for IgAN nephropathy.
Exploratory behavior is associated with the cognitive speed in male chestnut thrushes
Authors: Lou Yingqiang , Zou Yuqi , Fang Yun , Sun Yuehua
Published: December 2023

Intra-individual variation in cognitive abilities has been widely reported in animals. Recent studies have found that individual cognitive performance varies with personality traits in a wide range of animal taxa, with a speed-accuracy trade-off between cognition and personality traits. Few studies investigated whether these relationships change depending on different contexts. Here we investigate whether the personality trait (as measured by exploratory behavior in a novel environment) is associated with cognition (novel skill learning and spatial memory) in wild male chestnut thrushes Turdus rubrocanus. Using an experimental novel skill-learning task set-up, we found that fast-exploring individuals explored the experimental device (a cardboard with 8 opaque cups) sooner than slow-exploring individuals. Exploratory behavior was not associated with individual spatial memory performances or an individual’s capacity to learn the novel skill. Learning speed was positively associated with the difficulty of learning phases, and fast-exploring individuals used less trials to meet the learning criterion. In addition, fast-exploring individuals took less time to complete the 24-h spatial memory test, but the accuracy of the test was not significantly different between individuals who were more or less exploratory. We suggest that variation in personality traits associates with individual learning speed in cognitive tasks and that this relationship is context-dependent.
Serial troponin-I and long-term outcomes in subjects with suspected acute coronary syndrome
Authors: Pareek Manan , Kristensen Anna Meta Dyrvig , Vaduganathan Muthiah , Byrne Christina , Biering-Sørensen Tor , Højbjerg Lassen Mats Christian , Johansen Niklas Dyrby , Skaarup Kristoffer Grundtvig , Rosberg Victoria , Pallisgaard Jannik L , Mortensen Martin Bødtker , Maeng Michael , Polcwiartek Christoffer B , Frangeskos Julia , McCarthy Cian P , Bonde Anders Nissen , Lee Christina Ji-Young , Fosbøl Emil L , Køber Lars , Olsen Niels Thue , Gislason Gunnar H , Torp-Pedersen Christian , Bhatt Deepak L , Kragholm Kristian H
Published: December 2023

Aims

It is unclear how serial high-sensitivity troponin-I (hsTnI) concentrations affect long-term prognosis in individuals with suspected acute coronary syndrome (ACS).

Methods and results

Subjects who underwent two hsTnI measurements (Siemens TnI Flex® Reagent) separated by 1–7 h, during a first-time hospitalization for myocardial infarction, unstable angina, observation for suspected myocardial infarction, or chest pain from 2012 through 2019, were identified through Danish national registries. Individuals were stratified per their hsTnI concentration pattern (normal, rising, persistently elevated, or falling) and the magnitude of hsTnI concentration change (<20%, >20–50%, or >50% in either direction). We calculated absolute and relative mortality risks standardized to the distributions of risk factors for the entire study population. A total of 20 609 individuals were included of whom 2.3% had died at 30 days, and an additional 4.7% had died at 365 days. The standardized risk of death was highest among persons with a persistently elevated hsTnI concentration (0–30 days: 8.0%, 31–365 days: 11.1%) and lowest among those with two normal hsTnI concentrations (0–30 days: 0.5%, 31–365 days: 2.6%). In neither case did relative hsTnI concentration changes between measurements clearly affect mortality risk. Among persons with a rising hsTnI concentration pattern, 30-day mortality was higher in subjects with a >50% rise compared with those with a less pronounced rise (2.2% vs. <0.1%).

Conclusion

Among individuals with suspected ACS, those with a persistently elevated hsTnI concentration consistently had the highest risk of death. In subjects with two normal hsTnI concentrations, mortality was very low and not affected by the magnitude of change between measurements.
Biosimilars engage in low levels of direct-to-physician marketing relative to reference biologics
Authors: Hyland Megan F , Carey Colleen M
Published: December 2023

Biosimilars have the potential to greatly reduce US spending on biologic drugs, but uptake of these competitor products varies. We used Open Payments data from 2014 to 2022 to proxy for direct-to-physician marketing and compared levels of activity between biologic and biosimilar drug manufacturers. Our analysis focused on 6 reference biologics that recently faced competition in the years immediately before and after the launch of the first biosimilar. We used Medicare Part B dosage units to measure market penetration of biosimilars and its relationship with biosimilar marketing activity. Last, we conducted a sensitivity test, comparing payments for primarily office- or hospital-based physicians, using affiliations constructed from Medicare Carrier claims. Reference biologic manufacturers greatly reduced the amount of direct-to-physician marketing in the post-launch period. Biosimilar manufacturers generally engaged in low levels of activity relative to the historic performance of reference biologics. These trends were consistent across office- and hospital-based physicians. The intensity of biosimilars' direct-to-physician marketing also had no apparent relationship with achieved market penetration. Our findings demonstrate that persistently high market shares of reference biologics cannot be explained by ongoing direct-to-physician marketing activities. At the same time, while such activities could educate physicians or induce switching, biosimilar entrants engaged in little direct-to-physician marketing.
Making care primary: Medicare's latest attempt at value-based primary care
Authors: Kumar Wasan , Adashi Eli Y , Kocher Bob
Published: December 2023

On June 8th, 2023, the Centers for Medicare and Medicaid Innovation (CMMI) announced the Making Care Primary (MCP) model, its latest attempt to transform primary care delivery for a value-based care payment system. The MCP is a decade-long multi-payer partnership with a voluntary risk-adjusted payment model for primary care organizations. It provides financial support for organizations to develop and implement a value-based care infrastructure and prospective payments per beneficiary for the delivery of primary care. The MCP consists of 3 tracks, ranging from lump-sum infrastructure payments to a fully prospective payment model with 1-sided risk. In turn, physicians need to meet a set criteria, such as quality outcomes, health-related social needs screening and referral, and high-touch chronic care management (CMMI; https://innovation.cms.gov/innovation-models/making-care-primary). While MCP is a well-planned effort, it is likely to suffer from some of the same pitfalls as prior CMS attempts to revolutionize primary care and may therefore exert unintended effects on market consolidation.
Comparing image quality and trachoma detection across three camera types from a survey in Kongwa, Tanzania
Authors: Aguwa Ugochi T , Mkocha Harran , Munoz Beatriz , Wolle Meraf A , Brady Christopher J , West Sheila K
Published: December 2023

Background

There is an increasing demand for photography for trachoma prevalence surveys. In previous studies, digital single lens reflex (DSLR) images were superior to smartphone images, but newer-model smartphones and/or lens attachments may be able to bridge this gap. This study compares the image quality and ability to detect trachomatous inflammation – follicular (TF) of three camera types: a DSLR Nikon camera, an iPhone SE and an iPhone 13 Pro with a cell scope.

Methods

We surveyed 62 children ages 1–7 y from two Tanzanian communities. Upper tarsal conjunctiva images of both eyes were graded for TF by two standardized graders. The McNemar's test and a logistic regression model were used for analyses.

Results

The DSLR camera malfunctioned during the study, thus the iPhone SE and iPhone 13 Pro with cell scope were both more likely to take high-quality, gradable photographs (88% and 86%, respectively) compared with the DSLR camera (69%) (p<0.001 and p=0.02, respectively). TF was detected in gradable images from the iPhone SE (8.8%) and iPhone 13 Pro with cell scope (9.0%) at the same rate (p=1.0) as images from the DSLR camera (9.7%).

Conclusion

Smartphones with high-quality image capture, like the iPhone SE/13 Pro, have the potential for use in trachoma surveys if the proportion of gradable images can be improved.
Gender differences in the surgical management of trachomatous trichiasis: an exploratory analysis of global trachoma survey data, 2015–2019
Authors: Sullivan Kristin M , Harding-Esch Emma M , Batcho Wilfrid E , Issifou Amadou A Bio , Lopes Maria de Fátima Costa , Szwarcwald Celia Landmann , Vaz Ferreira Gomez Daniela , Bougouma Clarisse , Christophe Nassa , Kabore Martin , Bucumi Victor , Bella Assumpta L , Epee Emilienne , Yaya Georges , Trujillo-Trujillo Julian , Dejene Michael , Gebretsadik Fikre Seife , Gebru Genet , Kebede Fikreab , Mathewos Tsedeke , Cassama Eunice Texiera de Silva , Sanha Salimato , Barasa Ernest , Sultani Hadley Matendechero , Watitu Titus , Tekeraoi Rabebe , Kalua Khumbo M , Masika Michael P , Traoré Lamine , Minnih Abdallahi O , Abdala Mariamo , Massangaie Marília E , Win Ye , Apadinuwe Sue-Chen , Mishra Sailesh Kumar , Sharma Shekhar , Amza Abdou , Kadri Boubacar , Nassirou Beido , Mpyet Caleb D , Olobio Nicholas , Hussain Arif , Khan Asad Aslam , Jambi Garap , Ko Robert , Kello Amir B , Badiane Mouctar D , Sarr Boubacar , Dalmar Abdi , Elshafie Balgesa E , Kabona George E , Kaitaba Oscar , Mwingira Upendo , Simon Alistidia , Kanyi Sarjo , Awoussi Marcel S , Togbey Kwamy , Baayenda Gilbert , Francis Mugume , Tukahebwa Edridah M , Bakhtiari Ana , Keil Alexander P , Maselko Joanna , Westreich Daniel , Garae Mackline , Taleo Fasiah , Al-Khateeb Tawfik Q , Mwale Consity , Solomon Anthony W , Gower Emily W
Published: December 2023

Background

Trachomatous trichiasis (TT) is a painful, potentially blinding eye condition that can be managed through epilation or surgery. Women are affected by TT approximately twice as often as men and are believed to face gendered barriers to receiving surgical care to prevent vision loss.

Methods

We used data from 817 cross-sectional surveys conducted during 2015–2019 in 20 African countries to estimate the prevalence difference (PD) between female and male eyes for four outcomes potentially indicating gender-related differences in TT management: (1) received surgery and developed postoperative TT (PTT), (2) never offered surgery, (3) offered surgery but declined it, and (4) offered epilation but never offered surgery.

Results

The prevalence was modestly elevated among female eyes compared with male eyes for having PTT (PD:1.8 [95% confidence limits (CL): 0.6, 3.0]) and having declined surgery for the eye (PD: 6.2 [95% CL: 1.8, 10.7]). The proportion offered epilation was similar by gender (PD:0.5 [95% CL: −0.4, 1.3]), while never having been offered surgery was somewhat more prevalent among male eyes (PD: −2.1 [95% CL: −3.5, −0.7]).

Conclusions

Our results suggest potential gender differences in TT management. More research is needed to determine the causes and implications of the observed differences.
Treatment coverage of mass administration of azithromycin among children aged 1–11 months in 21 districts of Kebbi state, Nigeria
Authors: Wamyil-Mshelia Teyil , Madaki Suzie , Isiyaku Sunday , Shu'aibu Joy , Olobio Nicholas P , Aliero Attahiru A , Abdulsalam Muhammad , Taiwo Joshua , McDickoh Victor J
Published: December 2023

Background

The WHO recommends mass drug administration (MDA) as a strategy to deliver safe and cost-effective medicines to prevent and treat diseases. The antibiotic, azithromycin, has been used during MDA for the treatment and prevention of trachoma in Nigeria. Azithromycin has recently been shown to reduce infant mortality in communities receiving it for trachoma-elimination purposes in sub-Saharan Africa. This article reports on the implementation strategies for the safety and antimicrobial resistance of mass administration of azithromycin to children aged 1–11 mo using the trachoma programme platform in Kebbi state.

Methods

The mass administration of azithromycin among 1–11-mo-olds in Kebbi was implemented in three phases: (i) the preimplementation phase, during which specific activities were conducted to achieve government and community buy-in, ownership and capacity building; (ii) the implementation phase, which included the mass administration of azithromycin carried out by community volunteers (also known as community-directed distributors [CDDs]), monitoring (by health workers and independent monitors) and reporting of the distribution by all personnel; and (iii) the postimplementation phase, which included the validation of community data, where each item of community summary data is verified and checked for completeness and accuracy before uploading to the District Health Information System platform, where data are visualised, analysed and stored.

Results

In total, 97% of the target population received treatment; the remaining 3% were not treated due to signs of ill health, history of allergy to antibiotics, parental refusal or absence at the time of MDA. Children aged 1–11 mo accounted for 17% of the under-5 population, with females constituting 56% of the target population. In communities that were monitored, reports showed that only 5% lacked distribution materials (scales, slings or registers), >80% correctly entered data into community registers and 5% of children were not treated due to inadequate azithromycin provided to the CDDs for distribution.

Conclusion

The implementation of azithromycin MDA for children aged 1–11 mo in Kebbi, utilising the trachoma platform, exhibited commendable coverage due to existing programme platform, healthcare and community structures, intensive advocacy and social mobilisation, real-time monitoring and progress-tracking strategies. It also demonstrated that the trachoma platform is suitable for implementing public health interventions, even after the elimination of trachoma in previously endemic districts.
Beyond working hours: the association between long working hours, the use of work-related communication devices outside regular working hours, and anxiety symptoms
Authors: Kim Shinhyeong , Ham Seunghon , Kang Seong-Kyu , Choi Won-Jun , Lee Wanhyung
Published: December 2023

Objectives: The present study aimed to identify and compare the associations between long working hours and use of work-related communication devices outside regular working hours and anxiety symptoms, thereby providing insight into redefining working hours.

Methods: Based on the cross-sectional data from the sixth Korean Working Conditions Survey (KWCS), specifically the responses from 46 055 workers, the use of work-related communication devices outside of regular working hours, long working hours, and anxiety symptoms were assessed. To investigate the associations between using work-related communication devices outside regular working hours or long working hours with anxiety symptoms, odds ratios (ORs) and 95% CIs were calculated using multiple logistic regression models.

Results: Among 46 055 participants, 25 659 (55.7%) used work-related communication devices outside working hours, 8145 (17.7%) worked long hours, and 2664 (5.8%) experienced anxiety symptoms. Compared with the reference group, those who used work-related communication devices outside regular working hours without working long hours, had higher OR of anxiety symptoms (OR: 2.18; 95% CI, 1.97-2.41) than those who worked long hours without using work-related communication devices during off-hours (OR: 1.32; 95% CI, 1.09-1.59). Furthermore, the group that both worked long hours and used work-related communication devices outside working hours exhibited the highest OR of anxiety symptoms (OR: 2.57; 95% CI, 2.24-2.97).

Conclusions: Using work-related communication devices outside regular working hours is associated with a higher risk of anxiety symptoms compared with long working hours. This result suggests that using work-related devices outside regular working hours, in addition to regular work time, should be considered when redefining working hours.
Association between health-related physical fitness indicators and working ability: a systematic review
Authors: Leso Veruscka , Scalfi Luca , Giordano Angela , Reppuccia Liberata , Guarino Davide , Fedele Mauro , Iavicoli Ivo
Published: December 2023

Objectives: Work ability (WA) reflects a balance between work demands and an individual’s ability to meet them. It is influenced by several occupational and health-related factors including the individual’s physical fitness (PF). Therefore, the aim of the present study was to provide an overview of the possible relationship between PF measures and the individual’s WA.

Methods: A systematic review of studies published up to December 1, 2022 and available in PubMed, Scopus, and ISI Web of Science databases, was performed. Results have been summarized according to the specific PF parameter explored.

Results: The 14 reviewed studies, enrolling 47 to 1005 workers, all showed a satisfactory methodological quality. Some positive evidence emerged for a possible association between changes in aerobic capacity, walking speed, balance, flexibility, muscle strength, and WA perception. However, the limited number of studies, their cross-sectional design, the different PF performance indicators, populations, and job tasks explored prevented definite conclusions.

Conclusions: Future longitudinal studies should be planned to confirm such positive results and identify PF indicators better predictive for changes in the WA of employees engaged in specific job tasks, particularly in physically demanding activities. This may be helpful to include PF performance tests in occupational health practice as an integrated part of risk assessment and management strategies as well as in health and well-being promotion plans.
Sexual function scores are associated with arterial stiffness in postmenopausal women
Authors: Armeni Anastasia , Armeni Eleni , Augoulea Areti , Delialis Dimitrios , Angelidakis Lasthenis , Papaioannou Maria , Kaparos George , Alexandrou Andreas , Georgopoulos Neoklis , Vlahos Nicolaos , Stamatelopoulos Kimon , Lambrinoudaki Irene
Published: December 2023

Background

Female sexual dysfunction (FSD) has been suggested to be correlated with the burden of cardiovascular risk factors.

Aim

We aimed to evaluate the possible association between functional indices of vascular function and FSD scores in apparently healthy postmenopausal women.

Methods

This cross-sectional study included 116 postmenopausal women who underwent assessment of endothelial function with measurement of flow-mediated dilation (FMD) of the branchial artery and arterial stiffness estimation with measurement of the carotid-femoral pulse wave velocity (PWV). We used the Greene Climacteric Scale to evaluate vasomotor symptomatology, the Female Sexual Function Index (FSFI) to evaluate FSD and the Beck Depression Inventory to evaluate mood disorder. Low sexual function was defined as an FSFI score <26.55.

Outcomes

These included FSFI and low sexual function scores as well as measures of PWV and FMD.

Results

Sexual function scores were associated with measures of blood pressure (normal vs low sexual function; systolic blood pressure: 120.2 ± 15.0 mm Hg vs 113.4 ± 14.6 mm Hg; analysis of covariance P = .026; diastolic blood pressure: 75.9 ± 10.5 mm Hg vs 70.3 ± 9.9 mm Hg; analysis of covariance P = .012; both adjusted for age, body mass index, current smoking, and PWV). Systolic blood pressure, but not diastolic blood pressure, was associated with FSFI (B = 0.249, P = .041) and PWV (B = 0.392, P < .001). PWV measures were associated with FSFI (B = −0.291, P = .047) and pulse pressure (B = 0.355, P = .017). FMD measures were also associated with FSFI (B = 0.427, P = .033). All models were adjusted for age, body mass index, current smoking, insulin resistance, vasomotor symptomatology, and Beck Depression Inventory.

Clinical implications

Our findings demonstrate that lower scores of sexual function are associated with deteriorated vascular function mainly manifested as arterial stiffening, further contributing to systolic blood pressure changes.

Strengths and limitations

The strength of this study is the carefully selected healthy sample of postmenopausal women, with simultaneous assessment of climacteric symptomatology and mood disorders. The limitations include the small sample size, the cross-sectional design, and the recruitment of consecutive outpatients of a university menopause clinic.

Conclusion

Longitudinal studies and interventions to improve FSD should further assess the clinical relevance of these findings.
The neutral hydrogen mass in galaxies estimated via optical spectroscopy
Authors: Bizyaev Dmitry
Published: December 2023

We propose to employ emission line luminosities obtained via optical spectroscopy to estimate the content of neutral hydrogen (H i) in galaxies. We use the optical spectroscopy data from the Mapping of Nearby Galaxies at APO (MaNGA) survey released in the frames of public DR17 of the Sloan Digital Sky Survey (SDSS). We compare the H i mass estimated by us for a large sample of SDSS/MaNGA galaxies with direct H i measurements from the Arecibo Legacy Fast ALFA survey and find a tight correlation between the masses with the correlation coefficient (CC) of 0.91 and the rms scatter of 0.15 dex for the logarithmic mass. The obtained relationship is verified via another sample of MaNGA galaxies with H i masses measured with the Green Bank Telescope. Despite the coarser angular resolution of the radio data, the relation between the estimated and measured directly H i mass is tight as well – in this case CC = 0.74 and the rms is 0.29 dex. The established relations allow us to estimate the total mass of neutral hydrogen as well as the spatial distribution of H i surface density in galaxies from optical spectroscopic observations only in a simple and efficient way.
Real-world safety and effectiveness of mepolizumab for patients with eosinophilic granulomatosis with polyangiitis in Japan: A 48-week interim analysis of the MARS study
Authors: Ishii Tomonori , Kunishige Hideaki , Kobayashi Tamami , Hayashi Etsuko , Komatsubara Masaki , Ishii Takeo , Alfonso-Cristancho Rafael , Tamaoki Jun , Howarth Peter
Published: December 2023

Objectives

The objective of the study is to assess real-world, long-term safety/effectiveness of mepolizumab for eosinophilic granulomatosis with polyangiitis (EGPA) in Japan.

Methods

The Mepolizumab long-term study to Assess Real-world Safety and effectiveness of EGPA in Japan (MARS) (GSK ID: 213684/NCT04551989) is an ongoing 96-week study of patients with EGPA who received four-weekly mepolizumab 300 mg subcutaneously for ≥96 weeks before study entry (baseline) and continued treatment. This interim analysis included safety from baseline to Week 48 (observation period) and clinical outcomes before mepolizumab and during the observation period.

Results

Of 118 patients enrolled, 29% (34/118) experienced adverse events (AEs), of which 13% (15/118) experienced serious AEs; none were considered mepolizumab related. The median oral corticosteroid (OCS) dose decreased from 6.9 (pre-mepolizumab) to 3.0 (baseline) and 2.0 mg/day (Weeks 45–48); the proportion of patients receiving no OCS increased from 8% to 32% and 38%, respectively. Patients experiencing clinical symptoms decreased from 94% (pre-mepolizumab) to 73% (baseline) and 67% (Week 48). During the observation period, 5% of patients experienced EGPA relapse; the rates of EGPA-related hospitalisations, EGPA-related emergency room/unscheduled visits, and asthma exacerbations were 0.05, 0.09, and 0.08 event/person-year, respectively.

Conclusions

The results of mepolizumab treatment for ≥144 weeks (before baseline plus observation) were consistent with the known safety profile and allowed OCS dose reduction while improving disease control versus pre-treatment among patients with EGPA.
The 5th Kidney Cancer Research Summit: Research Accelerating Cures for Renal Cell Carcinoma in 2023
Authors: Choueiri Toni K , Pal Sumanta K , Lewis Bryan , Poteat Susan , Pels Kevin , Hammers Hans
Published: December 2023

The 5th Kidney Cancer Research Summit was a hybrid event hosted in Boston, MA in July 2023. As in previous editions, the conference attracted a wide representation of global thought leaders in kidney cancer spanning all stages of clinical and laboratory research. Sessions covered tumor metabolism, novel immune pathways, advances in clinical trials and immunotherapy, and progress toward biomarkers. The abstract presentations were published as a supplement in The Oncologist (https://academic.oup.com/oncolo/issue/28/Supplement_1). Aiming to be more concise than comprehensive, this commentary summarizes the most important emerging areas of kidney cancer research discussed and debated among the stakeholders at the conference, with relevant updates that have occurred since.
High-pressure xenon gas time projection chamber with scalable design and its performance around the Q value of 136Xe double-beta decay
Authors: Yoshida Masashi , Nakamura Kazuhiro , Akiyama Shinichi , Ban Sei , Hikida Junya , Hirose Masanori , Ichikawa Atsuko K , Iwashita Yoshihisa , Kashino Yukimasa , Kikawa Tatsuya , Minamino Akihiro , Miuchi Kentaro , Nakajima Yasuhiro , Nakamura Kiseki D , Nakaya Tsuyoshi , Obara Shuhei , Sakashita Ken , Sekiya Hiroyuki , Shinagawa Hibiki , Sugashima Bungo , Urano Soki
Published: December 2023

We have been developing a high-pressure xenon gas time projection chamber (TPC) called AXEL (A Xenon ElectroLuminescence detector) to search for neutrinoless double-beta (0νββ) decay of 136Xe. The unique feature of this TPC is the electroluminescence light collection cell (ELCC), the part designed to detect ionization electrons. The ELCC is composed of multiple units, and one unit covers 48.5 cm2. A 180 L size prototype detector with 12 units, 672 channels, of the ELCC was constructed and operated with 7.6 bar natural xenon gas to evaluate the performance of the detector around a Q value of 136Xe 0νββ. The obtained FWHM energy resolution is $0.73 \pm 0.11\%$ at 1836 keV. This corresponds to $0.60 \pm 0.03\%$ to $0.70 \pm 0.21\%$ of the energy resolution at a Q value of 136Xe 0νββ. This result shows the scalability of the AXEL detector with the ELCC while maintaining a high energy resolution. Factors determining the energy resolution were quantitatively evaluated and the result indicates that further improvement is feasible. Reconstructed track images show distinctive structures at the endpoints of electron tracks, which will be an important feature in distinguishing 0νββ signals from gamma-ray backgrounds.
Risk of atrial fibrillation in patients with systemic sclerosis: a nationwide population-based study
Authors: Kwon Oh Chan , Han Kyungdo , Park Min-Chan
Published: December 2023

Objective

Atrial fibrillation (AF) is the most common arrhythmia in the general population, causing substantial economic burden, morbidity and mortality. The incidence rate and risk of AF in patients with SSc are unclear. We aimed to assess the incidence rate of AF in patients with SSc and the risk of incident AF in patients with SSc compared with the general population.

Methods

The Korean National Health Insurance Service database was used as the data source. Patients with claims data for SSc between 2010 and 2017 were extracted from the database along with 1:5 age- and sex-matched controls. The index date was the earliest date with claims data for SSc between 2010 and 2017. The follow-up duration was from the index date to 2019. Multivariable Cox proportional hazard models were used to estimate the hazard ratio (HR) and 95% CI for AF in patients with SSc.

Results

Overall, 2519 patients with SSc and 12 595 age- and sex-matched controls were included. Over a mean follow-up duration of 5.2 years (s.d. 2.6), the incidence rates of AF were 3.52 and 1.68 per 1000 person-years for patients with SSc and controls, respectively. Compared with controls, patients with SSc had a significantly higher risk of incident AF [adjusted HR 2.095 (95% CI 1.466, 2.994)].

Conclusion

Patients with SSc had a 2-fold higher risk of incident AF than controls. Given the significant economic burden, morbidity and mortality that AF poses, close monitoring for incident AF in patients with SSc is warranted.
Performance evaluation of stationary and mobile radiography systems in Indonesia
Authors: Lubis Lukmanda Evan , Satrio Michael Christian , Nasution Alimuddin , Suryanti Rini , Soejoko Djarwani Soeharso
Published: December 2023

An analysis and evaluation has been carried out on each test parameter contained in the compliance test of 1016 stationary and 480 mobile radiography devices compiled by the Indonesian Nuclear Energy Regulatory Agency (Badan Pengawas Tenaga Nuklir, BAPETEN) from 2019 to 2020. The data were categorised and analysed based on the devices’ age to observe the correlation of performance with the age of the X-ray machine. In addition, the implementation level of the Automatic Exposure Control (AEC) system test of the stationary radiography X-ray modality is also reviewed. The results of the evaluation showed that 89.9% of the stationary radiography devices unconditionally pass the test, 5.2% are in the status of ‘conditional pass’ and 4.9% fail the test. On the other hand, 84.8% of mobile radiography devices unconditionally pass the test, 2.1% are in the status of ‘conditional pass’ and 13.1% fail the test. From the evaluation conducted, there is no observable correlation between the age of the modality and the results of the compliance test. Overall, only 9.2% of stationary radiography X-ray compliance test reports have included the AEC test since it is not a mandatory requirement of the national protocol.
Mechanism of simulated lunar dust-induced lung injury in rats based on transcriptomics
Authors: Gu Chen , Sun Yan , Mao Meiqi , Liu Jinguo , Li Xiongyao , Zhang Xiaoping
Published: December 2023

Lunar dust particles are an environmental threat to lunar astronauts, and inhalation of lunar dust can cause lung damage. The current study explored the mechanism of lunar dust simulant (CLDS-i) inducing inflammatory pulmonary injury. Wistar rats were exposed to CLDS-i for 4 h/d and 7d/week for 4 weeks. Pathological results showed that a large number of inflammatory cells gathered and infiltrated in the lung tissues of the simulated lunar dust group, and the alveolar structures were destroyed. Transcriptome analysis confirmed that CLDS-i was mainly involved in the regulation of activation and differentiation of immune inflammatory cells, activated signaling pathways related to inflammatory diseases, and promoted the occurrence and development of inflammatory injury in the lung. Combined with metabolomics analysis, the results of joint analysis of omics were found that the genes Kmo, Kynu, Nos3, Arg1 and Adh7 were involved in the regulation of amino acid metabolism in rat lung tissues, and these genes might be the key targets for the treatment of amino acid metabolic diseases. In addition, the imbalance of amino acid metabolism might be related to the activation of nuclear factor kappaB (NF-κB) signaling pathway. The results of quantitative real-time polymerase chain reaction and Western blot further confirmed that CLDS-i may promote the occurrence and development of lung inflammation and lead to abnormal amino acid metabolism by activating the B cell activation factor (BAFF)/ B cell activation factor receptor (BAFFR)-mediated NF-κB signaling pathway.
Metabolic and Bariatric Surgery Utilization Trends in the United States: Evidence From 2012 to 2021 National Electronic Medical Records Network
Authors: Alsuhibani Abdulrahman , Thompson Jonathan R. , Wigle Patricia R. , Guo Jeff Jianfei , Lin Alex C. , Rao Marepalli B. , Hincapie Ana L.
Published: December 2023

Background:

Bariatric surgery has evolved over the past 2 decades yet assessing trends of bariatric surgery utilization in the growing eligible population is lacking.

Aim:

This study aimed to update the trends in bariatric surgery utilization, changes in types of procedures performed, and the characteristics of patients who underwent bariatric surgery in the United States, using real-world data.

Method:

This retrospective descriptive observational study was conducted using the TriNetX, a federated electronic medical records network from 2012 to 2021, for adult patients 18 years old or older who had bariatric surgery. Descriptive statistical analysis was conducted to assess patients’ demographics and characteristics. Annual secular trend analyses were conducted for the annual rate of bariatric surgery, and the specific procedural types and proportions of laparoscopic surgeries.

Results:

A steady increase in the number of procedures performed in the United States over the first 6 years of the study, a plateau for the following 2 years, and then a decline in 2020 and 2021 (during the coronavirus disease 2019 pandemic). The annual rate of bariatric surgery was lowest in 2012 at 59.2 and highest in 2018 at 79.6 surgeries per 100,000 adults. During the study period, 96.2% to 98.8% of procedures performed annually were conducted laparoscopically as opposed to the open technique. Beginning in 2012, the Roux-en-Y gastric bypass (RYGB) procedure fell to represent only 17.1% of cases in 2018, along with a sharp decline in the adjustable gastric band (AGB) procedure, replaced by a sharp increase in the sleeve gastrectomy (SG) procedure to represent over 74% of cases in 2018.

Conclusions:

Bariatric surgery utilization in the United States showed a moderate decline in the number of RYGB procedures, which was offset by a substantial increase in the number of SG procedures and a precipitous drop in the annual number of AGB procedures.
Physician Characteristics Associated With Opioid Prescribing After Same-Day Breast Surgery in Ontario, Canada: A Population-Based Cohort Study
Authors: Merchant Shaila J. , Shellenberger Jonas P. , Sawhney Monakshi , La Julie , Brogly Susan B.
Published: December 2023

Background and Objectives:

Opioid overprescribing in patients undergoing breast surgery is a concern, as evidence suggests that minimal or no opioid is needed to manage pain. We sought to describe characteristics of opioid prescribers and determine associations between prescriber’s characteristics and high opioid prescribing within 7 days of same-day breast surgery.

Methods:

Patients ≥18 years of age who underwent same-day breast surgery in Ontario, Canada from 2012 to 2020 were identified and linked to prescriber data. The primary outcome was current high opioid prescribing defined as >75th percentile of the mean oral morphine equivalents (OME; milligrams). Prescriber characteristics including age, sex, specialty, years in practice, practice setting, and history of high (>75th percentile) opioid prescribing in the previous year were captured. Associations between prescriber characteristics and the primary outcome were estimated in modified Poisson regression models.

Results:

The final cohort contained 56,434 patients, 3469 unique prescribers, and 58,656 prescriptions. Over half (1971/3469; 57%) of prescribers wrote ≥1 prescription that was >75th percentile of mean OME of 180 mg, of which 50% were family practice physicians. Adjusted mean OMEs prescribed varied by specialty with family practice specialties prescribing the highest mean OME (614 ± 38 mg) compared to surgical specialties (general surgery [165 ± 9 mg], plastic surgery [198 ± 10 mg], surgical oncology [154 ± 14 mg]). Whereas 73% of first and 31% of second prescriptions were provided by general surgery physicians, family practice physicians provided 2% of first and 51% of second prescriptions. Prescriber characteristics associated with a higher likelihood of high current opioid prescribing were family practice (risk ratio [RR], 1.56; 95% confidence interval [CI], 1.35–1.79 compared to general surgery), larger community practice setting (RR, 1.34; 95% CI, 1.05–1.71 compared to urban), and a previous high opioid prescribing behavior (RR, 2.28; 95% CI, 2.06–2.52).

Conclusions:

While most studies examine surgeon opioid prescribing, our data suggest that other specialties contribute to opioid overprescribing in surgical patients and identify characteristics of physicians likely to overprescribe.
Serotype 3 Antibody Response and Antibody Functionality Compared to Serotype 19A Following 13-Valent Pneumococcal Conjugate Immunization in Children
Authors: Fuji Naoko , Pham Minh , Kaur Ravinder , E. Pichichero Michael
Published: December 2023

Background:

Prevention of infections in children vaccinated with 13-valent pneumococcal conjugate vaccine (PCV13) may be less effective against serotype 3 than 19A.

Objective:

The aim of this study was to to determine differences in IgG and functional antibody for serotype 3 versus 19A following PCV13 immunization, in IgG antibody levels induced by PCV13 compared to naturally-induced immunity, and assess effectiveness of PCV13 against serotype 3 and 19A in prevention of acute otitis media (AOM) and colonization among 6–36-month-old children.

Methods:

Samples were from a prospective, longitudinal, observational cohort study conducted in Rochester, NY. Pneumococcal detection was by culture. 713 serum were tested for antibody levels by enzyme-linked immunosorbent assay, 68 for functional antibody by opsonophagocytosis and 47 for antibody avidity by thiocyanate bond disruption. PCV13 effectiveness in preventing AOM and colonization was determined by comparison of pre-PCV13 detection of serotypes 3 and 19A to post-PCV13.

Results:

The proportion of children who reached the antibody threshold of ≧0.35 µg/mL after PCV13 was higher for serotype 19A than serotype 3. Only serotype 19A showed significant increase in PCV13-induced opsonophagocytosis assay titers and antibody avidity. Serotype 3 naturally-induced immune children showed a positive trend of increase in antibody level as children got older, but not PCV13-immunized children. PCV13 effectiveness was not identified in preventing AOM or colonization for serotype 3 but effectiveness of 19A was confirmed.

Conclusions:

PCV13 elicits lower antibody levels and lower effectiveness to serotype 3 versus serotype 19A. Post-PCV13-induced antibody levels for serotype 3 are likely insufficient to prevent AOM and colonization in most young children.
Reducing Risk for Future Violence From Forensic Psychiatric Patients by Using Critical Factors of the Short-Term Assessment of Risk and Treatability as a Caring Tool
Authors: Pollak Charlotte , Palmstierna Tom
Published: December 2023

Background

The dual task for forensic mental health care is community protection and treatment of mental disorders. The Short-Term Assessment of Risk and Treatability (START) has become an established tool for risk assessment and care planning in forensic psychiatry. When using the START, items judged as critical factors are chosen to be addressed in the care plan. However, it is not known which critical factors that are of special interest need to be addressed to reduce the risk for future violence.

Aims

The main aim of this study was to explore how staff's choice of critical factors in the care planning influences risk for future violence.

Methods

The study is based on 787 START assessments from 285 convicted and involuntary admitted inpatients at the Forensic Psychiatric Clinic of Stockholm County, Sweden. The influence on risk for future violence by selecting a certain item as a critical factor in the care plan was measured by comparing patients' sum of vulnerabilities at the time this certain critical factor was selected with this sum at the next assessment.

Results

The results show that a patient's overall risk for future violence decreases significantly when the items “insight,” “attitudes,” “mental state,” “coping,” and “drug use” were addressed as critical factors in the care planning. The importance of specified critical factors differs between diagnostic groups and time after admission.

Conclusions

When staff select certain specified items as critical factors in the care planning, the patients' risk of relapse into acts of violence was significantly reduced.
The Value of Liver Biopsy and Histology in Liver Disease Diagnosis and Patient Care—a Pragmatic Prospective Clinical Practice Study
Authors: Khalifa Ali , Rockey Don C.
Published: December 2023

Goals:

We aimed to examine the correlation of pre-biopsy clinical diagnosis with hepatic histopathology.

Background:

Liver biopsy provides histologic information and informs physicians about the underlying clinical disease. We hypothesized that expert physicians’ pre-biopsy clinical diagnoses may obviate the need for histopathological diagnosis.

Study Methods:

Patients undergoing liver biopsy to investigate a liver diagnosis were prospectively identified. In the 80 patients included, an anonymous validated questionnaire inquiring about the most likely clinical diagnosis and liver disease stage was completed prospectively by hepatologists before biopsy performance.

Results:

The most common pre-biopsy diagnoses were alcoholic liver disease (19 diagnoses), followed by non-alcoholic steatohepatitis and autoimmune hepatitis (18 each). Overall, the predicted histologic diagnosis was the same as the histologic diagnosis in 51/80 patients (64%), and thus a new liver disease diagnosis was made in 36% of patients. The diagnosis with the greatest pre-biopsy and post-biopsy diagnosis discrepancy was autoimmune hepatitis, with the correct diagnosis being predicted in 6/18 (33%) of patients (other diagnoses included the following: non-alcoholic steatohepatitis/non-alcoholic fatty liver disease (4), alcoholic liver disease (3), drug-induced liver injury (3), others (2)). For fibrosis staging, when grouped as no fibrosis (F0), fibrosis (F1-F3), or cirrhosis (F4), the fibrosis stage was correctly predicted in 68% of patients (54/80). Notably, 7 patients (9%) who were initially thought to have no or early-stage fibrosis had F4 fibrosis, and 6/80 (8%) patients who were considered to have a liver disease diagnosis before their biopsy had normal histology.

Conclusions:

Although hepatology experts often predict the correct underlying liver disease diagnosis, histopathological diagnoses different from expected are common.
Esophageal Function Testing Patterns in the Evaluation and Management of Lung Transplantation
Authors: Yamamoto Marilyn , Kamal Afrin N. , Gabbard Scott , Clarke John , Gyawali C. Prakash , Leiman David A.
Published: December 2023

Goals:

We surveyed esophageal motility laboratories affiliated with adult pulmonary transplant centers to determine esophageal function testing (EFT) practices.

Background:

Gastroesophageal reflux and esophageal dysmotility are associated with worse lung transplant outcomes, yet no consensus guidelines for EFT exist in this population.

Study:

A deidentified online survey was sent to gastrointestinal motility laboratory directors of 49 academic and community-affiliated medical centers that perform lung transplants. Practice characteristics, including annual lung transplant volume and institutional EFT practices pre-lung transplantation and post-lung transplantation were queried. Respondents were categorized by transplant volume into small and large programs based on median annual volume.

Results:

Among 35 respondents (71% response rate), the median annual transplant volume was 37, and there were 18 large programs. Institutional EFT protocols were used pretransplant by 24 programs (68.6%) and post-transplant by 12 programs (34.2%). Among small and large programs, 52.9% and 72.2% always obtained high-resolution manometry before transplant, respectively. Endoscopy before transplant was performed more often in small programs (n=17, 100%) compared with large programs (n=15,83.3%). Pretransplant endoscopy (P=0.04), barium esophagram (P<0.01), and high-resolution manometry (P=0.04) were more common than post-transplant. In contrast, post-transplant reflux monitoring off-therapy was more common than pretransplant (P=0.01). In general, pulmonologists direct referrals for EFT and gastroenterology consultation (n=28, 80.0%), with symptoms primarily prompting testing.

Conclusions:

In the absence of established guidelines, substantial variability exists in pretransplant and post-transplant EFT, directed by pulmonologists. Standardized EFT protocols and gastroenterologist-directed management of esophageal dysfunction has potential to improve lung transplant outcomes.