bluuebunny/crossref_metadata_2025 huggingface dataset:
Elucidating the potential role of microorganisms in postmortem biotransformation: a comparison of clonazolam and its metabolite in postmortem and DUID cases
Authors: Casey Brittany K , Papsun Donna M , Mudd Anna
Published: August 2024

Clonazolam is a designer triazolobenzodiazepine first synthesized in 1971 and is primarily used for its anxiolytic and sedative effects. It became a drug of misuse in 2012 and is known for its high potency and long duration of effect. Previous studies of nitrobenzodiazepines, such as nitrazepam, clonazepam, and flunitrazepam, as well as their metabolites, have demonstrated that bacterial species native to the gastrointestinal tract and active during postmortem (PM) decomposition are capable of affecting positivity and compound-to-metabolite ratios. Further studies have not been performed with clonazolam; however, it possesses the nitro functional group necessary for this biotransformation. To understand whether clonazolam may be similarly affected, PM cases (n = 288) and driving under the influence of drugs (DUID, n = 54) cases, positive for 8-aminoclonazolam reported by NMS Laboratories from 2020 to 2023, were selected for inclusion in this study. Concentrations of clonazolam and 8-aminoclonazolam were evaluated, and concurrent identification of parent drugs and their metabolites occurred less frequently in PM cases (n = 1, 0.30% of cases) than in DUID cases (n = 21, 38% of cases). The clonazolam concentration in one PM case was 13 ng/mL. In DUID cases, the median clonazolam concentration was 4.0 ng/mL and ranged from 2.0 to 10 ng/mL. 8-Aminoclonazolam had median concentrations of 13 and 19 ng/mL, with ranges 2.0–580 and 2.8–59 ng/mL for PM and DUID cases, respectively. Due to the ever-changing landscape of the designer benzodiazepine market, in vitro studies of PM microbial biotransformation of clonazolam are unavailable. The data reported herein provide valuable information in the absence of such studies and represent an alternative method of investigating this phenomenon as a potential cause of parent nitrobenzodiazepine to metabolite conversion.
A Review on Traditional Medicine Used for Burn Treatment
Authors: Hoveidamanesh Soodabeh , Irilouzadian Rana , Bagheri Tooran , Saboury Mahdy , Fahimi Tafreshi Shirin , Ghadimi Tayyeb , Soleimanpour Samira , Sanaienia Mohammad , Farokh Forghani Siamak
Published: August 2024

Considering the high consumption of and preference for traditional treatments among people and the lack of enough studies on the effectiveness of these treatments, we aimed to review articles on the use of traditional and complementary medicine, focusing on how they affect healing, debridement, and hypertrophic scars. In this study, we conducted the literature search in international databases PubMed, Google Scholar, Ovid, Scopus, Web of Science, and Cochrane Library, as well as Persian databases Scientific Information Database (SID), Magiran, Iranmedex, and IranDoc. Retrieved hits were reviewed by three authors for screening based on inclusion and exclusion criteria, and the screening process is expressed as Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework flow chart. Twenty-two studies were included. The evaluated outcomes were wound healing in 19, pain control in 5, itching in 4, and scar appearance in 2 studies. All of the studies showed equal or improved effects compared to common treatments. Aloe vera, Centella asiatica, and Arnebia euchroma were the most common plants. We revealed that traditional medicine is beneficial in burn wound treatment. The diversity in ingredients that are used in traditional medicine brings up the need for further controlled prospective studies to evaluate the precise superiority of these treatments compared to standard care.
Targeted Sanctions as a Pathway to Accountability
Authors: Hamilton Tomas , Lucas Natalie , Prezanti Alex , Smith Megan , Strayer Amanda
Published: August 2024

The growth of ‘Magnitsky-style’ targeted sanctions has ushered in a new chapter in the history of sanctions practice that places civil society actors in an increasingly empowered position. The development of new legal and policy frameworks in several jurisdictions, led by the USA, has formalized an active role for civil society in governments’ sanction designation processes. By creating a legal framework for civil society engagement, the US Magnitsky laws enshrined the importance of civil society as a source of evidence on human rights and corruption issues into law. This article draws on the experience and observations of, and interviews with, sanctions practitioners who have witnessed the increasing role that civil society is taking in Magnitsky-style sanctions. The article begins by asking why civil society engages with targeted sanctions, before examining the legal and policy frameworks through which civil society actors engage with governments. It looks at five jurisdictions where civil society is taking an active role, the USA, UK, European Union, Canada, and Australia. The article describes the emergence of ‘sanctions clearing houses’ — organizations that act as intermediaries between global civil society and the governments with which they are trying to engage. The article considers present civil society perspectives on current barriers to engagement with sanctions regimes and concludes by emphasizing the importance of civil society engagement in this area, providing recommendations to foster this engagement.
Machine learning and deep learning tools for the automated capture of cancer surveillance data
Authors: Hsu Elizabeth , Hanson Heidi , Coyle Linda , Stevens Jennifer , Tourassi Georgia , Penberthy Lynne
Published: August 2024

The National Cancer Institute and the Department of Energy strategic partnership applies advanced computing and predictive machine learning and deep learning models to automate the capture of information from unstructured clinical text for inclusion in cancer registries. Applications include extraction of key data elements from pathology reports, determination of whether a pathology or radiology report is related to cancer, extraction of relevant biomarker information, and identification of recurrence. With the growing complexity of cancer diagnosis and treatment, capturing essential information with purely manual methods is increasingly difficult. These new methods for applying advanced computational capabilities to automate data extraction represent an opportunity to close critical information gaps and create a nimble, flexible platform on which new information sources, such as genomics, can be added. This will ultimately provide a deeper understanding of the drivers of cancer and outcomes in the population and increase the timeliness of reporting. These advances will enable better understanding of how real-world patients are treated and the outcomes associated with those treatments in the context of our complex medical and social environment.
The SEER Program’s evolution: supporting clinically meaningful population-level research
Authors: Penberthy Lynne , Friedman Steven
Published: August 2024

Although the Surveillance, Epidemiology, and End Results (SEER) Program has maintained high standards of quality and completeness, the traditional data captured through population-based cancer surveillance are no longer sufficient to understand the impact of cancer and its outcomes. Therefore, in recent years, the SEER Program has expanded the population it covers and enhanced the types of data that are being collected. Traditionally, surveillance systems collected data characterizing the patient and their cancer at the time of diagnosis, as well as limited information on the initial course of therapy. SEER performs active follow-up on cancer patients from diagnosis until death, ascertaining critical information on mortality and survival over time. With the growth of precision oncology and rapid development and dissemination of new diagnostics and treatments, the limited data that registries have traditionally captured around the time of diagnosis—although useful for characterizing the cancer—are insufficient for understanding why similar patients may have different outcomes. The molecular composition of the tumor and genetic factors such as BRCA status affect the patient’s treatment response and outcomes. Capturing and stratifying by these critical risk factors are essential if we are to understand differences in outcomes among patients who may be demographically similar, have the same cancer, be diagnosed at the same stage, and receive the same treatment. In addition to the tumor characteristics, it is essential to understand all the therapies that a patient receives over time, not only for the initial treatment period but also if the cancer recurs or progresses. Capturing this subsequent therapy is critical not only for research but also to help patients understand their risk at the time of therapeutic decision making. This article serves as an introduction and foundation for a JNCI Monograph with specific articles focusing on innovative new methods and processes implemented or under development for the SEER Program. The following sections describe the need to evaluate the SEER Program and provide a summary or introduction of those key enhancements that have been or are in the process of being implemented for SEER.
Real-world lessons: combining cancer registry and retail pharmacy data for oral cancer drugs
Authors: Howlader Nadia , Lund Jennifer L , Enewold Lindsey , Stevens Jennifer , McNeel Timothy , Rivera Donna , Mariotto Angela , Cronin Kathleen A
Published: August 2024

Background

Recent cancer care advances have introduced new oral therapies, and yet population registries lack detailed treatment data, hampering investigations into therapy uptake, adherence, and outcomes.

Objective

This study aimed to assess the representativeness and completeness of linking Surveillance, Epidemiology, and End Results (SEER) cancer registry data with data from two major retail pharmacy chains, collectively covering a large segment of the US market.

Methods

A deterministic data linkage between 11 SEER cancer registries and retail pharmacy data (excluding mail order fills) was conducted for individuals diagnosed with selected cancers from 2013 to 2017, with follow-up through 2019. Descriptive characteristics of the linked and unlinked populations were examined. In a selected subcohort of older women (aged ≥65) with first and only primary breast cancer who had Medicare Part D claims for tamoxifen, we further validated the linkage using Medicare Part D event data as the reference standard.

Results

Among 758 068 eligible individuals, only 6.4% were linked to CVS/Walgreens data; the linkage percentage varied by age, sex, race, ethnicity, registry, and cancer type. Within the subcohort of 5963 older women with breast cancer and a claim for tamoxifen in Part D data, 25% were identified as tamoxifen users in retail pharmacy data. Out of these 1490 women, 749 (50.3%) had complete longitudinal tamoxifen dispensing information from retail pharmacy data.

Conclusion

Retail pharmacy data show promise in identifying oral anticancer treatments, enhancing SEER registry efforts, but they require further validation. We propose an evaluation framework, sharing insights and potential use cases for this resource.
Description of census-tract–level social determinants of health in cancer surveillance data
Authors: Bhattacharya Manami , Cronin Kathleen A , Farrigan Tracey L , Kennedy Amy E , Yu Mandi , Srinivasan Shobha
Published: August 2024

Background

Disparities in cancer incidence, stage at diagnosis, and mortality persist by race, ethnicity, and many other social determinants, such as census-tract–level socioeconomic status (SES), poverty, and rurality. Census-tract–level measures of these determinants are useful for analyzing trends in cancer disparities.

Methods

The purpose of this paper was to demonstrate the availability of the Surveillance, Epidemiology, and End Results Program’s specialized census-tract–level dataset and provide basic descriptive cancer incidence, stage at diagnosis, and survival for 8 cancer sites, which can be screened regularly or associated with infectious agents. We present these analyses according to several census-tract–level measures, including the newly available persistent poverty as well as SES quintile, rurality, and race and ethnicity.

Results

Census tracts with persistent poverty and low SES had higher cancer incidence rates (except for breast and prostate cancer), higher percentages of cases diagnosed with regional or distant-stage disease, and lower survival than non–persistent-poverty and higher-SES tracts. Outcomes varied by cancer site when analyzing based on rurality as well as race and ethnicity. Analyses stratified by multiple determinants showed unique patterns of outcomes, which bear further investigation.

Conclusions

This article introduces the Surveillance, Epidemiology, and End Results specialized dataset, which contains census-tract–level social determinants measures, including persistent poverty, rurality, SES quintile, and race and ethnicity. We demonstrate the capacity of these variables for use in producing trends and analyses focusing on cancer health disparities. Analyses may inform interventions and policy changes that improve cancer outcomes among populations living in disadvantaged areas, such as persistent-poverty tracts.
History of the Surveillance, Epidemiology, and End Results (SEER) Program
Authors: Friedman Steve , Negoita Serban
Published: August 2024

The Surveillance, Epidemiology, and End Results (SEER) Program established in 1973 was the first laboratory for experimenting with new methods for cancer data collection and translating the data into population-based cancer statistics. The SEER Program staff have been instrumental in the development of the International Classification of Disease-Oncology and successfully implemented the routine collection of anatomic and prognostic cancer stage at diagnosis. Currently the program consists of 21 central registries that generate cancer statistics covering more than 48% of the US population and an additional 10 research support registries contributing to certain research projects, such as the National Childhood Cancer Registry.

In parallel with the geographical expansion, the program built an architecture of methods and tools for population-based cancer statistics, with SEER*Explorer as the most recent online tool for descriptive statistics. In addition, SEER releases annual updates for a comprehensive data product line, which includes SEER*Stat databases with an annual caseload of more than 800 000 incident cases. Furthermore, the program developed a full suite of analytical applications for population-based cancer statistics that include Joinpoint (regression-based trend analysis), DevCan (risk of diagnosis and death), CanSurv (survival models), and ComPrev and PrejPrev (cancer prevalence), among others.

The future of the SEER Program is closely aligned to the overall goals of the “war on cancer.” The program aims to release longitudinal treatment data coupled with a comprehensive genomic characterization of cancers with a declared goal of decreasing the cancer burden and disparities across a wide spectrum of diseases and communities.
Adult ileo-ileal intussusception caused by inflammatory fibroid polyp leading to small bowel obstruction: a case report with comprehensive literature review
Authors: Devkota Shritik , Rathi Hritika , Qadri Arshid Iqbal , Lamichhane Samiksha , Jain Nidhi
Published: August 2024

Ileo-ileal intussusception, an infrequent cause of small bowel obstruction in adults, can be initiated by inflammatory fibroid polyps. These are uncommon, benign submucosal lesions of the gastrointestinal tract. This case report explores an adult patient with inflammatory fibroid polyps-induced ileo-ileal intussusception.
Measuring health literacy to inform actions to address health inequities: a cluster analysis approach based on the Australian national health literacy survey
Authors: Cheng Christina , Elmer Shandell , Batterham Roy , Hawkins Melanie , Osborne Richard H
Published: August 2024

Background

Measuring health literacy can inform interventions to address health inequities. This study used cluster analysis to examine health literacy data to determine if it can provide more insightful information than standard descriptive analysis to better inform intervention development.

Methods

Using data from the Australian National Health Survey (2018), this study compared descriptive analysis and cluster analysis results of two states—New South Wales (NSW) and Victoria—generated from the Health Literacy Questionnaire (HLQ). Based on the nine scale scores of the HLQ, a hierarchical cluster analysis using Ward’s method for linkage was undertaken.

Results

The number of NSW and Victoria respondents was 1018 and 923, respectively. The nine HLQ scale full sample mean scores from both states were similar. However, the cluster analyses identified 11 clusters for NSW and 12 clusters for Victoria. While six clusters from each state presented similar health literacy patterns, five and six clusters from NSW and Victoria, respectively, displayed unique health literacy patterns.

Conclusions

The results demonstrate that descriptive analysis only provides an overview and may lead to one-size-fits-all interventions. The varying health literacy patterns among subgroups resulting from the cluster analysis pave the way to inform tailored actions to improve health equity.
Scars of the job market “ice-age”
Authors: Kondo Ayako
Published: August 2024

Existing studies found that entering the labor market during a recession has persistent negative effects—the scarring effects—on employment and earnings for Japanese men. The cohorts who entered the labor market during the prolonged recession between 1993 and 2004 are called “the ice-age cohorts,” and the persistent gap between them and older cohorts who entered the labor market during the bubble economy is often interpreted as the scarring effect of business cycle conditions at entry. However, the existing studies in Japan use data covering cohorts who enter the labor market in the 1990s or earlier. Motivated by the lack of empirical evidence with updated data, this article revisits the scarring effects of a recession at labor market entry on employment and earnings using data covering graduation cohorts 1984–2013. Younger cohorts who enter the labor market during the recovery do not earn more or enjoy more stable employment than the cohorts who enter the bottom of the ice-age, and that the effects of unemployment rate at entry on employment and earnings are no longer statistically significant for cohorts who enter the labor market after the job market ice-age. I also discuss potential factors that may have weakened scarring effects.
Drug-induced kidney injury: challenges and opportunities
Authors: Connor Skylar , Roberts Ruth A , Tong Weida
Published: August 2024

Drug-induced kidney injury (DIKI) is a frequently reported adverse event, associated with acute kidney injury, chronic kidney disease, and end-stage renal failure. Prospective cohort studies on acute injuries suggest a frequency of around 14%–26% in adult populations and a significant concern in pediatrics with a frequency of 16% being attributed to a drug. In drug discovery and development, renal injury accounts for 8 and 9% of preclinical and clinical failures, respectively, impacting multiple therapeutic areas. Currently, the standard biomarkers for identifying DIKI are serum creatinine and blood urea nitrogen. However, both markers lack the sensitivity and specificity to detect nephrotoxicity prior to a significant loss of renal function. Consequently, there is a pressing need for the development of alternative methods to reliably predict drug-induced kidney injury (DIKI) in early drug discovery. In this article, we discuss various aspects of DIKI and how it is assessed in preclinical models and in the clinical setting, including the challenges posed by translating animal data to humans. We then examine the urinary biomarkers accepted by both the US Food and Drug Administration (FDA) and the European Medicines Agency for monitoring DIKI in preclinical studies and on a case-by-case basis in clinical trials. We also review new approach methodologies (NAMs) and how they may assist in developing novel biomarkers for DIKI that can be used earlier in drug discovery and development.
Using Intentional, Student-Centered Reflection to Address Mental Health and Self-Care in Prelicensure Nursing Students
Authors: Gifford Sara , Kwasky Andrea
Published: August 2024

Prelicensure nursing students manage various stressors, including a rigorous curriculum, physically and psychologically demanding clinical rotations, supplementary work, family responsibilities, and an evolving licensure exam. Because of these stressors, nursing programs must address students’ mental health concerns and the potential impact on academic performance. At a private university in the Midwest, a student-centered care plan reflection was implemented to support mental health concerns about the National Council Licensure Examination and promote coping skills. In response, students reported increased motivation, improved stress management, and reduced anxiety.
The Content, Reliability, and Quality of Insulin Pen Injection Videos on YouTube as Patient Education Resource
Authors: Gülhan Güner Seçil , Tezel Müge , Özsaban Aysel
Published: August 2024

This study, conducted using the descriptive-correlational model, aims to evaluate the content, reliability, and quality of insulin pen injection videos on YouTube. The video-sharing platform YouTube was searched with the keyword “insulin pen injection.” Of the 101 relevant videos, 49 were included in the study. Video contents were evaluated independently by the “Insulin Pen Injection Guide Form,” their reliability by the “DISCERN Questionnaire,” and their quality by the “Global Quality Scale.” Of the 49 videos that met the inclusion criteria, 55.1% contained useful information, and 44.8% contained misleading information. The videos that were found to be useful were longer and had higher DISCERN and content scores. A statistically significant positive correlation was determined between the videos' DISCERN and content scores (r = 0.772, P < .001). More than half of the insulin pen injection videos available on YouTube are helpful, but the number of misleading videos is close to the helpful ones. Thus, it may be recommended that the insulin pen injection videos be evaluated by experts in line with evidence-based guidelines before sharing them on YouTube.
Hospital-based skilled nursing facility survival: Organizational and market-level predictors
Authors: Gupta Shivani , Zengul Ferhat D. , Blackburn Justin , Hearld Larry R. , Jablonski Rita , Sen Bisakha , Weech-Maldonado Robert
Published: August 2024

Background

Rising health care costs and consequent increases in Medicare reimbursements have led to many payment reforms over the years. Implementation of the prospective payment system (PPS) for hospitals in 1983 incentivized hospitals to either purchase skilled nursing facilities (SNFs) or utilize their excess capacity to establish one within the hospital. With PPS reimbursement being applied to SNFs in 1998, prior monetary incentives for hospitals to own an SNF disappeared. However, despite the reduction in numbers, many hospitals continued to operate their hospital-based skilled nursing facilities (HBSNFs).

Purpose

This study examines the organizational and market-level factors associated with the survival of HBSNFs using the population ecology of organizations framework.

Methodology

Using American Hospital Association survey data, event histories of all U.S. acute care hospitals with an open HBSNF in 1998 were plotted to examine if a hospital closed its HBSNF during a 22-year period (1998–2020). The primary independent variables included hospital size, ownership, total margin, market competition, and Medicare Advantage penetration. The independent and control variables were lagged by 1 year. Cox regressions were conducted to estimate the hazard ratios capturing the risk of HBSNF closure.

Results

The results showed that HBSNFs located in large, not-for-profit hospitals and those operating in less competitive markets had greater odds of surviving.

Practice Implications

The HBSNF administrators of small, for-profit hospitals and those operating in highly competitive markets could utilize the findings of this study to judiciously allocate slack resources to their HBSNFs to keep those open given the current emphasis on continuity of care by regulatory bodies.
A Comprehensive Review of Donor Corneal Preservation Strategies
Authors: Cipolla Jack , Jo Minhee , Sabater Alfonso L.
Published: August 2024

Successful corneal transplantation relies on the viability of the corneal endothelium. Although various preservation systems have been developed in the field of eye banking, long-term storage of the corneal endothelium poses challenges and is costly. Optisol-GS in the past has been the most commonly used solution for intermediate-term corneal storage in the United States. However, disruptions in the availability of Optisol-GS, caused by rising costs and supply shortages, have necessitated alternative methods of corneal preservation. Previously described preservation methods include hypothermia (2–8°C) for short-term storage (7–14 days), organ culture (28–37°C) for intermediate storage (4–7 weeks), and cryopreservation for longer-term storage. In this review, we examine standard practice and alternative methods for corneal storage.
The Intersection of Intimate Partner Violence, Strangulation, and Brain Injury Screening: A Pilot Project
Authors: Gbadebo Adenike
Published: August 2024

Background

Survivors of intimate partner violence are at a high risk for having a brain injury because of high rates of strangulation and head and face injuries sustained from physical abuse. In addition to acute physical injuries, survivors experience various health complications.

Problem

Many survivors do not seek medical attention for their injuries, and when they do, their brain injury often goes unrecognized and untreated. Research indicates that screening for brain injury can be an effective intervention to increase the identification of brain injuries and medical referrals for diagnosis and treatment. Unfortunately, brain injury screening is not a standard of care.

Methods

Shelter-seeking clients were routinely screened for brain injury using a modified HELPS screening tool. A positive screen prompted a medical referral.

Intervention

A modified HELPS screening tool was utilized with permission for the project.

Results

Before implementation, 36 individuals entered shelter, 0 were screened for brain injury, and the medical referral rate was 19.4% (n = 7). After implementation, 40 clients entered shelter, 36 were screened for brain injury, 77.8% (n = 28) screened positive, and the medical referral rate was 80.6% (n = 29).

Conclusions

Brain injury screening may be an effective evidence-based intervention for shelter-seeking survivors of intimate partner violence to increase medical referrals.
Acupuncture for rehabilitation after total knee arthroplasty: a systematic review and network meta-analysis
Authors: Li Wen-Xuan , Wu Cai-Qin , Feng Wei , Zhan Yi-Jun , Yang Lei , Jia Heng-Jie , Pei Jian , Li Kun-Peng
Published: August 2024

Background:

The increasing interest in acupuncture for promoting postoperative rehabilitation has encouraged its use in rehabilitation after total knee arthroplasty (TKA), but its effectiveness remains controversial.

Objective:

This study aims to assess the efficacy of different models of acupuncture-related therapies on pain relief, motor function, inflammation, and overall rehabilitation of the knee after TKA.

Methods:

Databases PubMed, Embase, Cochrane, Web of Science, Scopus, and Clinicaltrials.gov were searched to screen eligible randomized controlled trials (RCTs). All RCTs that used acupuncture/moxibustion on TKA patients were included by two researchers independently after rigorous quality evaluation, with data extracted. The statistics were performed by using R 4.2.3 and Stata 17.

Results:

The network meta-analysis incorporated 28 RCTs, 21 of which were conducted in mainland China and Taiwan. Evidence of the relation of several common acupuncture/moxibustion treatments was shown by the network meta-analysis (NMA). The results of NMA showed that electroacupuncture was the preferred therapy for soothing pain symptoms (standardized mean difference=0.58, 95% CI=0.36–0.81). Auricular acupressure was the best treatment to improve the knee motor function. Electroacupuncture was superior to special acupuncture in relieving knee joint stiffness and inflammation.

Conclusion:

Acupuncture intervention, especially electroacupuncture, can effectively alleviate pain, improve motion, reduce stiffness, and decrease inflammation in post-TKA patients with no serious adverse events.
Real-world Clinical Effectiveness and Safety of Vedolizumab and Adalimumab in Biologic-naive Patients With Crohn’s Disease
Authors: Yarur Andres J. , Bressler Brian , Brett Neil R. , Bassel Marielle , Adsul Shashi , Kamble Pravin , Mantzaris Gerassimos J.
Published: August 2024

Goals:

This study evaluated the real-world effectiveness and safety of vedolizumab versus adalimumab over 12 months of treatment in biologic-naive patients with Crohn’s disease (CD), using data from the EVOLVE study.

Background:

A comparison of vedolizumab and adalimumab may help to better position them in the therapeutic algorithm for moderate-to-severe CD.

Study:

Data were collected from medical records of patients with CD aged ≥18 years initiating treatment with adalimumab or vedolizumab between May 2014 and July 2017. Adjusted analyses were performed using inverse probability weighting to account for differences in baseline characteristics. Cumulative rates for clinical effectiveness outcomes and treatment persistence were estimated using Kaplan-Meier analyses. Disease-related exacerbations, serious adverse events (SAEs), and serious infections (SIs) were also assessed.

Results:

Data from 218 vedolizumab- and 144 adalimumab-treated patients were analyzed. Adjusted cumulative rates of clinical remission were greater with vedolizumab than with adalimumab (66.3% vs. 46.4%; P=0.006). Probability of treatment persistence was higher with vedolizumab (89.3% vs. 77.5%; P=0.024); probabilities of clinical response (68.5% vs. 61.1%; P=0.586) and mucosal healing (67.7% vs. 56.0%; P=0.562) were similar. SAEs were less likely to occur with vedolizumab [hazard ratio, 0.45 (95% confidence interval, 0.22-0.93)]; however, the likelihood of SIs [0.27 (0.06-1.20)], CD exacerbations [0.91 (0.56-1.47)], and CD-related surgeries [1.55 (0.21-11.15)] was comparable between the 2 groups.

Conclusions:

In a real-world setting, biologic-naive patients with CD treated with vedolizumab demonstrated a greater likelihood of drug persistence and achieving clinical remission, with equivalent rates of response and mucosal healing versus adalimumab-treated patients.
Association between emergency medical services’ response times, low socioeconomic status, and poorer outcomes in out-of-hospital cardiac arrest: the MEDIC multicenter retrospective cohort study for disparities in access to prehospital critical care in the Paris metropolitan area
Authors: Heidet Matthieu , Frattini Benoit , Jost Daniel , Mermet Éric , Bougouin Wulfran , Lesaffre Xavier , Wohl Mathys , Marijon Eloi , Cariou Alain , Jouven Xavier , Dumas Florence , Lecarpentier Éric , Chollet-Xémard Charlotte , Vaux Julien , Khellaf Mehdi , Souihi Sami , Vivien Benoît , Sinden Sean , Grunau Brian , Travers Stéphane , Audureau Étienne
Published: August 2024

Background and importance

Prolonged emergency medical services’ response times (EMS-RT) are associated with poorer outcomes in out-of-hospital cardiac arrest (OHCA). The patient access time interval (PATI), from vehicle stop until contact with patient, may be increased in areas with low socioeconomic status (SES).

Objectives

The objective of this study is to identify predictors of prolonged EMS-RT intervals, and to evaluate associations with clinical outcomes in OHCAs occurring in the largest metropolitan area in France.

Design

Using the Utstein-style, prospectively implemented, population-based SDEC registry for OHCAs, we conducted a multicenter, region-wide, retrospective cohort study of EMS dispatches for OHCA cases occurring in the 124 cities of the Greater Paris area, France, between January 1, 2017 and December 31, 2018.

Settings and participants

Adult, nontraumatic, EMS-assessed, non-EMS witnessed OHCAs.

Exposure

Geographic location and scene-level SES.

Outcome measures and analysis

The primary outcome was the EMS-RT interval, from activation until arrival at patient’s side. As secondary outcomes, we evaluated patient access outcomes of: (1) dispatch-to-patient contact interval (‘EMS-RT’); and (2) vehicle scene arrival-to-patient contact interval (PATI); and patient clinical outcomes of: (1) death; and (2) unfavorable neurological status, both at 30 days. Area-level SES was assessed at census tract level using the European Deprivation Index (EDI; continuous, and divided into quintiles, Q5 = most deprived). We fitted multilevel mixed-effects regression models to identify predictors of patient access outcomes, and their association with clinical outcomes.

Main results

We included 4082 cases; the median EMS-RT was 10.85 min (interquartile range [8.87–13.15]), and 138 (3.4%) survived to hospital discharge. Independent predictors of increased EMS-RT and PATI were age >65, female sex, residential location, occurrence at elevated floors, arrest unwitnessed by a bystander, and low EDI (all P < 0.018). After multivariable analysis, an overall EMS-RT interval >8 min was associated with higher mortality and poorer neurological status at hospital discharge (both P < 0.001).

Conclusion

In OHCA cases occurring in the Greater Paris metropolitan area, after adjustment for scene characteristics, EMS delays until patient contact were longer in neighborhoods of low SES, and were associated with poorer clinical outcomes.
Effect of single-photon emission computed tomography acquisition method and sampling angles on image quality and quantitative accuracy in xSPECT-reconstructed images
Authors: Hasegawa Daisuke , Iguchi Toshihiro , Takatani Masayasu , Tokunaga Kotaro , Minoda Takuma , Miyai Masahiro
Published: August 2024

Objective

The aim of this study was to evaluate the effects of the single-photon emission computed tomography (SPECT) acquisition method and sampling angles on the qualitative and quantitative interpretations of xSPECT-reconstructed images.

Methods

The spatial resolution was evaluated using a JSP phantom, and the uniformity and quantitative accuracy were verified with a NEMA IEC Body Phantom using an SIEMENS Symbia Intevo SPECT/computed tomography system. SPECT was performed using three acquisition methods (step-and-shoot, continuous, and acquire during the step), and the sampling angles were set to 2, 3, 4, 5, and 6°. The xSPECT-reconstruction technology which is used with ordered subset-conjugated gradient minimization was used for image reconstruction.

Results

Full width of half maximum, an evaluation index of spatial resolution, varied up to 2.73 mm with different sampling angles and up to 2.06 mm with different acquisition methods. Uniformity, as assessed by the coefficient of variation, improved with increasing sampling angles. The accuracy of the quantification of the hot sphere showed an error rate of approximately 10% depending on the sampling angle, and an error rate of approximately 5% depending on the different acquisition methods.

Conclusions

In xSPECT-reconstructed images, the difference in sampling angle has a greater impact on image quality and quantitativity than the difference in the acquisition method. For tests in which uniformity is important, a larger sampling angle is recommended.
Risk Factors of Negative Diagnosis of Magnetic Resonance Cholangiopancreatography in Acute Biliary Pancreatitis Patients With Choledocholithiasis
Authors: Chen Si-Hai , Wang Wen-Qing , Fei Xiao , Zhu Yin , Shu Xu , Yu Chen , Liao Qian , Xiong Hui-Fang
Published: August 2024

Objectives

Detecting choledocholithiasis in acute biliary pancreatitis (ABP) is crucial. Magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasonography (EUS) identify common bile duct stones. EUS offers better accuracy than MRCP but with sedation risks. We studied MRCP negative diagnosis risk factors in ABP patients with choledocholithiasis for improved diagnostic selection.

Methods

This retrospective study included 2321 ABP patients. After exclusions, 337 ABP patients with negative MRCP results were analyzed, including 75 with positive EUS findings. Univariate and multivariate logistic regression identified MRCP negative diagnosis risk factors.

Results

Patients with positive EUS findings were older (62.0 vs 55.0) and had higher cholecystectomy rates (18.7% vs 7.3%). Univariate analysis showed cholecystectomy history, age, and sex as potential risk factors. Then, after adjusting the other potential risk factors (direct bilirubin, alanine transaminase, γ-glutamyl transpeptidase, and alkaline phosphatase), a history of cholecystectomy (odds ratio, 2.859; 95% confidence interval [CI], 1.312–6.23), older age (1.03; 95% CI, 1.009–1.052), and male (2.016; 95% CI, 1.152–3.528) were independent risk factors of negative diagnosis of MRCP in ABP patients with choledocholithiasis.

Conclusions

Cholecystectomy history, older age, and male sex increase MRCP negative diagnosis risk in ABP patients with choledocholithiasis. Patients with these risk factors should undergo EUS first for better diagnostic outcomes.
MEK Inhibition in the Treatment of Congenital Langerhans Cell Histiocytosis: A Case Report and Review of the Literature
Authors: Wojciechowska Natalia , Burke Sydney , Ray Anish
Published: August 2024

Langerhans cell histiocytosis (LCH) is a histiocytic disorder that predominantly affects young children, with congenital manifestations being exceedingly rare. Here, we report a male infant with congenital LCH harboring a driving mutation within the mitogen-activated protein kinase pathway, specifically MAP2K1 Q56P. First-line use of targeted therapy with oral MEK inhibitor trametinib led to rapid and complete resolution of the infant’s widespread cutaneous disease. This patient remains clinically well with normal growth and development and no sign of progressive disease or medication intolerance. This case demonstrates the impact that targeted therapy can have as an alternative to systemic chemotherapy in an age group known to experience more extensive disease.
Adult with Coxsackie B virus-induced cardiomyopathy presents rare case of complicated acute embolic ischaemic stroke
Authors: KC Manish , Bhattarai Himal Bikram , Adhikari Subodh , Mandal Prince , Kashyap Ashutosh , Thapa Neeraj , Mehera Ishita
Published: August 2024

Introduction and importance:

Stroke, a global health concern, often results from embolic events of cardiac origin. Coxsackie B virus (CBV) myocarditis, a common cause of viral heart infections, can lead to cardiac thrombi formation, subsequently causing devastating complications such as embolic stroke. The authors present a rare case of a 26-year-old male who experienced an embolic stroke following CBV myocarditis and cardiomyopathy.

Case presentation:

The patient exhibited left-sided weakness, facial droop, and respiratory distress. Laboratory findings indicated leukocytosis, hyponatremia, and elevated troponin I. Imaging revealed an acute right basal ganglia infarct and multifocal pulmonary embolism. The diagnosis involved positive CBV serology, severely reduced left ventricular function, and a large apical thrombus.

Discussion:

Cardioembolic strokes, often attributable to atrial fibrillation, can also result from intracardiac thrombosis associated with myocarditis. CBV, implicated in up to 40% of acute myocarditis cases, binds to cardiac myocytes, triggering inflammation and potential thrombus formation. Myocarditis-induced hypercoagulability increases the risk of thromboembolic events, complicating the clinical course.

Conclusion:

CBV myocarditis poses a risk of heart failure, cardiomyopathy, and thromboembolic complications such as embolic stroke. Vigilant monitoring for complications and prompt management is crucial, as primary disease treatment remains primarily supportive. This case highlights the need for increased awareness and further studies to understand the intricate relationship between viral myocarditis and embolic strokes.
Assessment of knowledge, attitude and practice towards maternal healthcare among mothers in Illam: a cross-sectional study from Nepal
Authors: Yogi Tek Nath , Kafle Rijan , Uprety Samyog , Makaju Ranjit , Shrestha Simran , Gahatraj Manish , Bhusal Amrit , Ghimire Sinjin , B.K. Himal , Karki Simon , Mishra Bivek , Kunwar Anjila , Khatiwada Nirman , Niraula Sahil , Uprety Salina , Khanal Surav , Shah Purushotam , Mukhia Sweekriti , Chaudhary Dibya Raj , Malla Nakendra
Published: August 2024

Introduction:

Healthcare during pregnancy and childbirth and after delivery is important for the survival and well-being of both the mother and the neonate. Maternal healthcare in Nepal faces challenges due to various causes. However, providing proper knowledge on maternal healthcare to mothers and promoting a positive attitude towards it can have a significant impact on maternal and child health outcomes. The objective of this study was to assess knowledge, attitude and practice towards maternal healthcare among mothers in Illam.

Methods:

A cross-sectional study was conducted among 197 mothers in Illam municipality who gave birth within the last 5 years. The study used face-to-face interviews with a semi-structured questionnaire to collect data. Descriptive as well as inferential statistics were used to analyze the data.

Results:

The total number of participants was 197. The results showed majority (48.22%) belonged to the age group of 22–29 years and the mean age of the participants was 30.2± 5.37, majority were home-makers (44.7%), mean age at marriage was 21.39±3.99 years, mean age at first pregnancy was 23.9±4.33years and mean birth spacing from last child was 70±41.28 months. Overall, we found that knowledge, attitude and practice regarding antenatal care (ANC) were 72%, 83% and 69%, respectively. Similarly, knowledge, attitude and practice regarding post-natal care (PNC) were 39%, 91%, and 43%, respectively.

Conclusions:

Mothers showed satisfactory knowledge on ANC but inadequate knowledge on PNC. Most had a positive attitude towards both practices. However, actual practices related to ANC and PNC were poor despite adequate knowledge and attitude.
Malignant recto-jejunal fistula: a rare case report
Authors: Adhikari Roshna , Paudel Mukesh , Jha Ram M. , Sah Raman K. , Sitaula Saroj , Silwal Prabhat
Published: August 2024

Introduction and importance:

Malignancy can lead to colo-enteric fistulas. A malignant fistula between the rectum and the jejunum is a rare occurrence.

Case presentation:

A 60-year-old female suffered from diarrhea, vomiting, and epigastric pain for 4 months. After demonstration of a dilated rectum with heterogeneous collection on ultrasonography, contrast-enhanced computed tomography (CECT) along with rectal contrast was done, which showed heterogeneously enhancing asymmetrical circumferential thickening of the proximal rectum, including rectosigmoid junction, collection in the rectum and two recto-jejunal fistulous tracts. Colonoscopy showed ulcero-proliferative growth in the rectum with two fistulous tracts communicating with the jejunum. Biopsy from the growth indicated a poorly differentiated adenocarcinoma. Conservative and palliative treatment was provided.

Clinical discussion:

Clinical features of colo-enteric fistulas can include abdominal pain, diarrhea, and weight loss. The patient may be asymptomatic in some cases. Options for diagnosis include barium studies, enteroscopy, colonoscopy, CECT, and computed tomography enterography (CTE). Malignant bowel fistula is associated with serious complications resulting in high morbidity and mortality rates. Surgical resection and fistula repair are the mainstay of curative treatment.

Conclusion:

Long-standing gastrointestinal symptoms like chronic diarrhea in the elderly should be investigated with imaging modalities like CECT. Early detection with imaging can reduce debilitating metabolic and nutritional deficiencies and improve patient’s morbidity and mortality.
Preoperative HIFU ablation combined with femoral bone marrow nailing for the treatment of pathological fracture of femur: a case report
Authors: Yao Long , Wang Bing , Wang Ziyi , Wei Ancheng , Huang Xin , Wang Zhiqiang
Published: August 2024

Introduction and importance:

Bone is one of the common sites of metastasis in lung cancer. Pathological fractures of the femur significantly reduce patients’ quality of life and increase the risk of death. However, there is still no consensus on the optimal treatment of pathological femoral fractures. The authors’ report provides a treatment method for a patient with pathological fracture of lung cancer with preoperative HIFU lesion ablation followed by combined intramedullary nail fixation.

Case presentation:

A 61-year-old Chinese woman was hospitalized with severe pain in her right thigh. X-ray and CT examination at admission considered pathological fracture of the right femur. MRI showed a comminuted fracture of the middle and lower part of the right femur, swelling of the surrounding soft tissue, and effusion. WBS showed an abnormal concentration of imaging agent at the right femoral fracture end and abnormal bone metabolism. After a lung biopsy, it was diagnosed as lung cancer with femoral metastasis and pathological fracture.

Clinical discussion:

The patient underwent HIFU ablation before surgery to reduce the lesion, and a re-examination MRI showed that the signal at the lesion was significantly reduced, and the lesion volume was significantly reduced. The operation was performed by open reduction and intramedullary nail fixation, focal excision, and bone cement filling. After 6 months of follow-up, the patient’s bone metastasis was not aggravated, and there was no loosening or fracture of the right femoral intramedullary nail.

Conclusion:

This is a case of pathological fracture of the femur caused by bone metastases from pulmonary cancer. The patient used HIFU to reduce the lesion before the operation and combined it with intramedullary nail internal fixation to treat the pathological fracture. A satisfactory therapeutic effect was obtained. The authors believe that this is a safe and effective treatment. This case may be beneficial to the treatment of pathological fracture of bone metastasis of lung cancer.