bluuebunny/crossref_metadata_2025 huggingface dataset:
Tropheryma whipplei detection by metagenomic next-generation sequencing in bronchoalveolar lavage fluid: A retrospective study
Authors: He Zhixiong , Li Hui
Published: August 2024

Whipple’s disease(WD) is a rare chronic and systemic disease caused by the rod-shaped, Gram-positive bacterium Tropheryma whipplei (T. whipplei) that primarily affects the gastrointestinal tract, however, the involvement of the lung is rare, and few study have explored the significance of the detection of TW in bronchoalveolar lavage fluid (BALF). So, we performed a retrospective study in patients with T. whipplei positive in 848 BALF samples which detected by metagenomic next-generation sequencing (mNGS) from 21 September 2022 to 1 March 2024 in The First Hospital of Changsha. Forty-three BALF samples from forty-four (44/848, 5.2%) patients were positive for T. whipplei (one patient was excluded due to incomplete data). Twenty-nine patients were male with an average age of 46.9 years. The main symptoms included cough (36/43), expectoration (22/43), dyspnea/shortness of breath (14/43), fever (13/43), hemoptysis/bloody sputum (5/43), vomiting (2/43), abdominal pain (1/43), and only one patient complained about neurological symptoms. Chronic liver disease (including fatty liver, chronic hepatitis C and chronic hepatitis B) were the most common comorbidity (n = 11, 25.6%), followed by chronic lung disease (n = 8, 18.6%). Only 11 patients (25.6%) were immunocompromised. One patient was finally diagnosed with reactivation tuberculosis and two patients were diagnosed with lung tumors (including one primary lung adenocarcinoma and one primary lung squamous carcinoma), and twenty-two patients (53.5%) had pneumonia. T. whipplei was the sole agent in 6 samples, and Epstein-Barr virus was the most common detected pathogens, followed by Haemophilus influenzae. The most common chest CT imaging manifestation is lung nodules (18/43, 41.9%), including fourteen solid nodules and five ground-glass nodules (three cases of calcified nodules caused by pulmonary tuberculosis were excluded). Our study indicates that T. whipplei is a causative pathogen in various lung diseases, and clinicians should be wary of this. The mNGS technology improves the detection and attention of rare pathogens and provide guidance for treatment in clinical practice. In the future, the natural history of T. whipplei infections and the possible pathogenesis still need to be studied.
Prospective Study to Compare the Efficacy of Lower Urinary Tract Symptoms Visual Score versus International Prostate Symptom Score for Evaluating Men With Lower Urinary Tract Symptoms
Authors: VH Ashwath Venkataramana , V Shivakumar , Keshavamurthy Ramaiah
Published: August 2024

Aim and Objective
The number of men presenting with lower urinary tract symptoms (LUTS) to our institute’s outpatient department (OPD) is exceedingly high. Because most of the patients who visit the OPD are illiterate or undereducated, using advanced patient-based symptom measures such as the gold standard International Prostate Symptom Score (IPSS) is difficult. This calls for a less complicated grading scheme. Thus, our objective in this study is to evaluate the effectiveness of our institute’s lower urinary tract symptoms visual score (LUTS-V), a condensed score based on a visual scoring method that Silva et al. described.
Material and Methods
Silva et.al. [8] developed LUTS-V, a modified form of the visual prostate symptom score (VPSS). We prospectively instructed patients presenting with LUTS to the OPD to fill their LUTS-V and IPSS scores at their first OPD visit. We conducted our study over a period of eight months at the Institute of Nephro Urology, a tertiary center in Bangalore, Karnataka, India. We expressed data as medians and ranges, or absolute values and fractions. We tested the overall IPSS and LUTS-V scores for agreeability using Bland–Altman analysis, Spearman’s correlation plot, and the Pearson correlation coefficient. We evaluated diagnostic properties (criteria validity) in terms of sensitivity, specificity, and accuracy. We used uroflowmetry as a reference standard. We measured the time (in seconds) necessary for completion of each IPSS and LUTS-V questionnaire. We considered p < 0.05 as statistically significant.
Result
We included 280 patients in the study, ranging in age from 22 to 80 years with a mean age of 64.61 years. The patient cohort had a mean education of 7.41 years. Education status was inversely related to age according to the Pearson correlation coefficient (r = − 0.7122, p < .00001). We found that 3.2% of patients had mild symptoms, 86% had moderate symptoms, and 66.01% had severe symptoms. LUTS-V ranged from 1 to 12. We divided the patients into mild, moderate, and severe symptomatic groups and compared them with similar groups with the IPSS. Receiver operating characteristic (ROC) analysis gave us a cutoff of 4 points of LUTS-V for mild symptom and 9 points for severe symptoms. A cutoff less than 4 for mild symptoms yielded sensitivity of 73.68%, specificity of 99.23%, and accuracy of 97.5% (p = 0.001), whereas a cutoff more than 9 points for severe symptoms had high sensitivity of 95.35%, specificity of 83.07%, and accuracy of 86.3% (p = 0.0001). The patients took an average of 195 seconds to complete the IPPS, and many required help in understanding the IPSS score, whereas they took an average of 60.89 sec to complete the LUTS-V (p < 0.001).
Conclusion
LUTS-V is a simplified tool that has adequate comparability to the gold standard IPSS, which patients with a poor educational background can easily interpret.
Outcomes of bilateral temporomandibular joint arthroscopy: an international multicentric prospective study including 524 joints
Authors: Ângelo David Faustino , Ono Helcio Yogi , de Barros Romualdo Cardoso Monteiro , Maffia Francesco , Sanz David , Cardoso Henrique
Published: August 2024

Purpose: This study aimed to evaluate the efficacy of bilateral TMJ arthroscopy in patients with different Wilkes stages, comparing the results obtained in different arthroscopic levels on a larger scale, unifying similar populations.
Methods: A multicentric prospective clinical study was conducted in three TMJ departments performing temporomandibular joint surgery in Portugal and Brazil, with an enrolling window active from January 1, 2019, to December 1, 2022. The primary clinical outcome was TMJ pain evaluated through a visual analog scale. The secondary clinical outcome was the maximum mouth opening (MMO). TMJ arthroscopy was performed with a 1.9-mm arthroscope, including a video system with a 2.8-mm outer protective cannula.
Results: 262 patients, representing a total of 524 operated joints were enrolled. The mean age was 35.3 years. A significant decrease postoperatively in VAS pain was observed for all Wilkes stages. The lowest value of VAS pain was observed in Wilkes II compared to Wilkes III and IV. In the secondary outcome, MMO was observed to have a significant improvement in all Wilkes Stages.
Conclusion: in this multicentric study, bilateral TMJ arthroscopy was shown to be an effective procedure to reduce pain and increase maximum mouth opening in patients with different Wilkes stages, representing a valid minimally invasive solution.
Evolution of myocardial steatosis in patients with type 2 diabetes treated by GLP1 receptor agonists: LICAS study
Authors: Houbachi Lina , Walker Paul Michael , Fournel Isabelle , Ksiazek Elea , Petit Jean-Michel , Cochet Alexandre , Leclercq Thibault , Roger Antoine , Simoneau Isabelle , Bouillet Benjamin , Guenancia Charles
Published: August 2024

Background
The use of GLP1 receptor agonists is associated with a reduction in cardiovascular events in patients with type 2 diabetes (T2D). The mechanisms underlying this cardiovascular protection are not fully understood. We hypothesized that the reduction of intramyocardial fat content may be involved in the cardioprotective effect of GLP1 receptor agonists. Therefore, we aimed to evaluate the change in intramyocardial triglyceride content in patients with T2D treated with GLP1 receptor agonists.
Methods
This monocentric cohort study included patients with unbalanced T2D prior to the introduction of GLP1 receptor agonists. Patients underwent cardiac MRI coupled with NMR spectroscopy at baseline and six months after the introduction (M6) of a GLP1 receptor agonist to assess changes in intramyocardial triglyceride levels and morphological, functional, and cardiac tissue parameters. The relative delta (Δr) between baseline and M6 was calculated and analyzed by student test or sign test.
Results
Twenty-six patients (mean age = 62.2 ± 6.7 years, median HbA1c = 9.1%) fulfilled inclusion criteria and had both NMR measures. Compared with baseline, relative intramyocardial triglyceride levels significantly decreased after six months of treatment (mean Δr=-26% [95%CI:-39 ; -13]p = 0.003), as well as HbA1c (median Δr=-26% [IQR:25], p < 0.0001), body mass index (BMI) (mean Δr=-6% [-9 ; -4], p < 0.0001) and left ventricular mass (mean Δr= -6 [-12 ; -1] p = 0.02). The relative evolution of intramyocardial triglyceride content was not correlated with the relative evolution of HbA1c (r = 0.10) and BMI (r=-0.02).
Conclusions
We demonstrate, for the first time, a significant reduction in intramyocardial triglyceride content in patients with T2D after six months of treatment with GLP1 receptor agonists. The lack of correlation with reductions in HbA1c and BMI suggests a specific effect of GLP1 receptor agonists on myocardial steatosis, which might contribute to their previously demonstrated cardiovascular benefits.
Impact of tongue fat volume on obstructive sleep apnea in non-obese patients
Authors: Orestes Michael I. , Hill Gregory S. , Shih Robert , Collen Jacob F. , Feehs Kenneth R. , Montgomery Emily A. , Waring Katelyn M. , Watson Nora L. , Thomas Richard W. , Garibyan Lilit
Published: August 2024

Evidence suggests excess head and neck adipose tissue contributes to OSA, particularly in obese patients. Surgical treatments are often ineffective in this subset of the population. We sought to investigate the role of tongue fat in the normal and overweight populations. In this prospective cohort study, patients underwent overnight polysomnogram and MRI using a Dixon sequence. Volumetric reconstruction evaluated the size and distribution of tongue fat deposits in subjects with and without sleep apnea. The study included 86 patients; mean age of 42.2 (SD 11.2) years, 16% female. Average BMI 27.5 (SD 2.9), with 18.6% (n=16) normal BMI, 61.6% (n=53) overweight, 19.8% (n=17) obese. Logistic regression lines showed positive associations for BMI and age with AHI. No significant correlation was found between tongue fat volume or fraction and increased AHI nor presence of OSA. Although tongue volume and fat fraction were higher in patients with AHI ≥5, the difference was not statistically significant. This study suggests that tongue fat does not play a significant role in the pathophysiology of OSA in the non-obese (BMI<30) patient population. Therefore, selective treatments targeting tongue fat should focus on obese and morbidly obese patients.
Seed size-number trade-off exists in graminoids but not in forbs or legumes: A study from 11 common species in alpine steppe communities
Authors: zhou xiaolong , Duan Ronghua , Ren Zhengwei , Long Jian
Published: August 2024

Seed size and number are two important components of plant reproductive traits. Previous theoretical studies suggested that resource limitation led to a strong trade-off between seed size and seed number. However, empirical evidence from natural communities remains scarce. In this study, the relationships between seed size and seed number were tested in community level and in three functional groups- graminoids, forbs and legumes in a natural alpine steppe community in Tianshan Mountains. And the role of limiting resources in determining trade-off patterns was also examined by treating reproductive biomass of each species as a resource pool for producing seeds. Our results showed a significant trade-off between seed size and seed number at the community level. This trade-off was primarily determined by the graminoid group, while no negative relationships were observed in the forb and legume groups. Moreover, the graminoid group had lower reproductive biomass than the forb and legume groups, which indicates that the species in the graminoid group were more strictly limited by reproductive resources. In the future, more comprehensive studies are needed to test this trade-off pattern in other ecosystems and explore the underlying mechanisms in natural communities.
First Description of Alpha/Beta Values in Pediatric Medulloblastoma: Implications for Tailored Approaches in Radiation Oncology
Authors: Jazmati Danny , Sohn Dennis , Preugschas Ronja-Linda , Qin Nan , Bölke Edwin , Haussmann Jan , Schwarz Rudolf , Niggemeier Niklas David , Borkhardt Arndt , Babor Florian , Brozou Triantafyllia , Felek Melissa , Tamaskovics Balint , Melchior Patrick , Beez Thomas , Timmermann Beate , Remke Marc , Corradini Stephanie , Budach Wilfried , Matuschek Christiane
Published: August 2024

Background
Medulloblastoma is the most common malignant pediatric brain tumor, typically treated with normofractionated craniospinal irradiation (CSI) with an additional boost over about 6 weeks in children older than 3 years [1]. This study investigates the sensitivity of pediatric medulloblastoma cell lines to different radiation fractionation schedules. While extensively studied in adult tumors, these ratios remain unknown in pediatric cases due to the rarity of the disease.
Materials and Methods
Five distinct medulloblastoma cell lines (ONS76, UW228-3, DAOY, D283, D425) were exposed to varying radiation doses and fractionation schemes. In addition, ONS76 and UW2283-3 stably overexpressing MYC were analyzed. Alpha/beta values, representing fractionation sensitivity, were quantified using the linear-quadratic model of radiation survival.
Results
The study unveiled elevated alpha/beta ratios across diverse medulloblastoma cell lines, with a weighted mean alpha/beta value of 11.01 Gy (CI: 5.23–16.79 Gy). Neither TP53 status nor the levels of MYC expression influenced fractionated radiosensitivity. Furthermore, differences cannot be correlated with molecular subgroups (p = 0,07).
Conclusion
These in vitro findings strongly recommend normofractionated or hyperfractionated radiotherapy for paediatric medulloblastoma cases due to consistently high Alpha/Beta values across subgroups. Conversely, hypofractionated radiotherapy is not advisable within a curative approach. This study presents significant potential by enabling the estimation of radiobiological fractionations and dose effects in young, vulnerable patients, highlighting its importance for advancing patient-specific therapeutic strategies.
Endonasal Surgery High-Risk Carotid Injury Timeout Checklist: Implementation, Institutional Protocol and Experience
Authors: Barkhoudarian Garni , Pahlevani Mehrdad , Ratnam Seshaan , Mallari Regin Jay , Griffiths Chester , Kelly Daniel
Published: August 2024

Objective: Carotid artery injury is a rare, but major complication of endonasal operations. The morbidity and mortality of such a complication can be mitigated by preparedness and a clear plan set in place to address the hemorrhage expeditiously. This study examines the implementation of such a carotid injury timeout checklist and demonstrates its effectiveness in a patient with possible arterial injury.
Methods: A carotid injury timeout checklist was implemented for high risk endonasal procedures. The case selection was left to the surgeon, with guidelines including prior surgery, prior radiation, invasive tumors, and certain pathologies such as meningioma or chordoma. Factors affecting implementation were analyzed including tumor characteristics and patient history.
Results: Over a 12-month period, 103 endonasal operations were performed since the carotid artery injury timeout checklist was implemented, with 21 (20.4%) having a carotid artery injury timeout performed. Tumor characteristics that were associated with performing this timeout included Knosp grade (for pituitary adenomas, p=0.002), carotid artery encasement (p<0.001), extended approach (p<0.001), tumor size (p=0.05) and diagnosis (p<0.001). Re-operation and prior radiation were not factors for this cohort. The single carotid artery branch (hypertrophic vidian artery) injury that was sustained was easily and successfully managed, aided by preparation established via this protocol. The additional time necessary for this timeout to be performed was negligible with respect to the overall surgery length.
Conclusion: A carotid artery injury timeout can and should be successfully implemented for extended endonasal operations for pituitary and parasellar tumors with high risk factors including, but not limited to, carotid injury encasement, large tumor size and non-adenomatous diagnoses. A comprehensive plan for both intraoperative and perioperative management of the carotid injury is necessary to minimize the risk of morbidity and to deliver care expeditiously.
Is percutaneous vertebroplasty safe and effective in treating sacral compression fractures in patients with osteoporosis?
Authors: Qin Guangbing , Qin Zhao jie , Nong zhuo , Li Hao xi
Published: August 2024

Background: Percutaneous vertebroplasty (PVP) is widely used to treat osteoporotic thoracic and lumbar vertebral compression fractures. Currently, no study has indicated the clinical efficacy and safety of percutaneous vertebroplasty in the treatment of osteoporotic sacral compression fractures.
Measures: Pain symptoms and daily function were evaluated 1 day before surgery, 1 \ 7 \14 \0 days after surgery and 6 months after surgery, using the numerical rating scale (NRS) and Oswestry disability index (ODI). The presence of bone cement leakage was evaluated by reading postoperative imaging data.
Results: The study population comprised 72 patients (17 men and 55 women; 64–87 years).
All patients were followed-up for 1 day to 6 months. No postoperative complications, lumbago and back pain were significantly relieved in the patients, and the NRS and ODI scores were significantly improved compared with the preoperative values. At the last follow-up, none of the patients had evident sacral tail pain and were able to take care of themselves in daily life.
Conclusions:Early vertebroplasty can reduce pain symptoms, accelerate return to self-care, and limit related symptoms in patients with osteoporotic sacral compression fractures without surgical contraindications in accordance with modern enhanced recovery after surgery (ERAS).
Performance of GPT-4 in Oral and Maxillofacial Surgery Board Exams: Challenges in Specialized Questions
Authors: Warwas Felix Benjamin , Heim Nils
Published: August 2024

Purpose
The aim of this study was to evaluate the performance of GPT-4 in answering oral and maxillofacial surgery (OMFS) board exam questions, given its success in other medical specializations.
Methods
A total of 250 multiple-choice questions were randomly selected from an established OMFS question bank, covering a broad range of topics such as craniofacial trauma, oncological procedures, orthognathic surgery, and general surgical principles. GPT-4's responses were assessed for accuracy, and statistical analysis was performed to compare its performance across different topics.
Results
GPT-4 achieved an overall accuracy of 62% in answering the OMFS board exam questions. The highest accuracies were observed in Pharmacology (92.8%), Anatomy (73.3%), and Mucosal Lesions (70.8%). Conversely, the lowest accuracies were noted in Dental Implants (37.5%), Orthognathic Surgery (38.5%), and Reconstructive Surgery (42.9%). Statistical analysis indicated significant variability in performance across different topics, with GPT-4 performing better in general topics compared to specialized ones.
Conclusion
GPT-4 demonstrates a promising ability to answer OMFS board exam questions, particularly in general medical topics. However, its performance in highly specialized areas reveals significant limitations. These findings suggest that while GPT-4 can be a useful tool in medical education, further enhancements are needed for its application in specialized medical fields.
Compatibility Interactions between Anopheles gambiae and Plasmodium falciparum in a Malaria Endemic Region in Kisumu, Kenya
Authors: Onyango Shirley A. , Machani Maxwell G. , Ochwedo Kevin O. , Oriango Robin M. , Lee Ming-Chieh , Kokwaro Elizabeth , Afrane Yaw A. , Githeko Andrew K. , Zhong Daibin , Yan Guiyun
Published: August 2024

Insecticide resistance and outdoor transmission have reduced the effectiveness of existing malaria transmission prevention strategies. As a result, targeted approaches to support continuing malaria therapies, such as transmission-blocking vaccines, are required. Cross-sectional mass blood screening in children between 5 and 15 years was conducted in Chulaimbo, Kisumu, during the dry and wet seasons in 2018 and 2019. Plasmodium falciparum gametocyte carriers were identified by Microscopy. Subsequently, carries were used to feed colony bred Anopheles gambiae females in serum replacement and whole blood membrane feeding experiments. The infection prevalence was 19.7% (95% Cl: 0.003–0.007) with 95% of the infections being caused by P. falciparum. Of all confirmed P. falciparum infections, 16.9% were gametocytes. Thirty-seven paired experiments showed infection rates of 0.9% and 0.5% in the serum replacement and whole blood experiments, respectively, with no significant difference (P = 0.738). Six Pfs47 haplotypes were identified from 24 sequenced infectious blood samples. Hap_1 (E27D and L240I), Hap_2 (S98T0); Hap_3 (E27D); Hap_4 (L240I); Hap_5 (E188D); and Hap_6 without mutations. Haplotype 4 had the highest frequency of 29.2% followed by Hap_3 and Hap_6 at 20.8% each then Hap_1 with a frequency of 16.7%, whereas Hap_5 and Hap_2 had frequencies of 8.3% and 4.2% respectively. Varying frequencies of infectious Pfs47 haplotypes observed from genetically heterogeneous parasite populations in endemic regions illuminates vector compatibility to refracting P. falciparum using the hypothesized lock and key analogy. This acts as a bottleneck that increases the frequency of P. falciparum haplotypes that escape elimination by vector immune responses. The interaction can be used as a potential target for transmission blocking through a refractory host.
CAR-T therapy demonstrated safety and efficacy in relapsed/refractory diffuse large B-cell lymphoma patients complicated with hepatitis B related cirrhosis
Authors: Kong Danqing , Ping Nana , Zhu Qian , Zhang Xiao , Li Junhong , Zou Rui , Wu Depei , Jin Zhengming , Qu Changju
Published: August 2024

Chimeric antigen receptor T cell (CAR-T) therapy has demonstrated both efficacy and safety in relapsed/refractory diffuse large B-cell lymphoma (DLBCL) patients infected with hepatitis B virus (HBV). However, its applicability in individuals with liver cirrhosis remains largely unexplored due to the potential for unpredictable complications. Here, we report three cases (P1, P2, P3) of relapsed/refractory DLBCL with HBV-related cirrhosis treated with CAR-T cells infusion. P1 and P2 received CAR-T cells infusion following a conditioning regimen of fludarabine and cyclophosphamide (FC) for lymphodepletion; while P3 received SEAM (CCNU, etoposide, cytarabine, and melphalan) regimen and autologous stem cell transplantation bridging CAR-T cells infusion. P1 and P2 achieved rapid complete remission (CR), whereas P3 initially exhibited stable disease a month post-CAR-T infusion and subsequently achieved CR after local radiation salvage therapy and lenalidomide maintenance. With a median follow-up of 42 months after CAR-T, the progression free survival rate was 100%. Notably, during follow-up, these patients experienced complications associated with cirrhosis, including endoscopic variceal bleeding, HBV reactivation, or the diagnosis of hepatic malignancy. Our findings suggest that CAR-T therapy is highly effective for the treatment of DLBCL patients with HBV-related cirrhosis, albeit necessitating monitoring for potential hepatic complications.
No Operation After Short-Course Radiotherapy Followed By Consolidation Chemotherapy in Locally Advanced Rectal Cancer (NOAHS-ARC): Study Protocol for a Prospective, Phase II Trial
Authors: Quezada-Díaz Felipe F. , Bercz Aron , Romesser Paul B. , Escobar Jose L. , Caire Nicole , Díaz-Feldman Lucia E. , Manriquez Erik , Smith J. Joshua , Carvajal Gonzalo
Published: August 2024

Background
The landscape of locally advanced rectal cancer treatment has shifted over the past decade with the introduction of total neoadjuvant therapy (TNT), enhancing tumor response and oncologic outcomes. Consequently, the concept of organ preservation by means of a watch-and-wait (W&W) strategy has emerged as a viable option for select patients who demonstrate clinical complete responses (cCR) to TNT, thereby limiting the morbidity associated with multimodal treatment. Although there is increasingly robust evidence supporting the notion of organ preservation, the optimal treatment strategy and predictors of treatment response remain outstanding questions. Rectal cancer incidence is expected to rise sharply in developing countries, and the disease is already recognized as a significant public health issue in Chile. Prior to NOAHS-ARC, TNT-based treatment protocols and W&W programs had yet to be implemented in the country.
Methods
This is a single arm, multicenter phase II prospective trial accruing in Santiago, Chile. Patients with histologically proven rectal adenocarcinoma (< 7cm from anal verge) and stage II or III disease will be recruited and consented. Protocol treatment comprises induction short-course radiotherapy (25 Gy in 5 Gy fractions) followed by consolidation chemotherapy (FOLFOX x9 cycles or CAPOX x6 cycles). Patients will undergo response assessment four to eight weeks following completion of chemotherapy. Patients achieving cCR will be offered W&W management while those with incomplete clinical responses (iCR) will undergo total mesorectal exicision (TME). The primary endpoint is rate of complete tumor response, defined as the sum of pathologic complete responses (pCR) and sustained (> 1 year) cCR, which will be compared to the pCR rate of a historical cohort of patients treated with neoadjuvant chemoradiation alone. Accrual of 73 patients is anticipated assuming an estimated combined pCR/sustained cCR rate of 30%. Quality of life measures and functional bowel, urinary, and sexual outcomes will be studied. Additionally, a biorepository of longitudinally archived tissue and plasma samples will be established, in conjunction with serial endoscopic and MRI images.
Discussion
NOAHS-ARC aims to contribute to the ongoing dialogue on organ preservation while also pioneering the first standardized TNT protocol and W&W program in Chile. Additional emphasis on functional outcomes and meticulous data collection for exploratory research endeavors aim to improve patient care both locally and globally.
Trial Registration:
ClinicalTrials.gov identifier: NCT04864067. Registered April 28, 2021.
Murine Typhus as the Leading Cause of Non-focalized Fever in the Canary Islands
Authors: Vélez-Tobarias M , Torres-Vega AM , Carmelo E , Morais-Martín J , Pérez JA , Gonzalo-Hernández C , Clot G , Ascaso-Terrén C
Published: August 2024

The present prospective study aims to diagnose, through serology and PCR, the etiology of non-focalized fever lasting between 5 and 28 days in the islands of La Palma and El Hierro (Canary Islands, Spain) during the year 2021. The etiological profile described in this study is similar to that described in studies of fever of intermediate duration (FDI), with zoonoses being the main cause. Murine typhus (MT) is identified as the primary cause, followed by Q fever (QF). The incidence of MT is the highest published nationally and similar to the highest in Europe, with 39.6 cases in La Palma and 79.7 cases in El Hierro. QF, known to be endemic to the Canary Islands, presents incidences of 26.5 cases in La Palma and 15.6 cases in El Hierro. MT does not present gender differences, and its geographical distribution is homogeneous. However, QF is more prevalent in men and has a heterogeneous geographical distribution. The high incidence of MT found in both urban and peri-urban areas is particularly noteworthy, and its possible connection with climate change and/or the growth of the reservoir population in the Canary Islands is unknown. Its similarity with QF in terms of clinical signs and treatment, in addition to the absence of a specific protocol for early diagnosis, may have contributed to its underdiagnoses. MT can produce health concerns with risk of hospitalization, complications, and even death. Hence, the registration of cases for epidemiological control is deemed essential.
Clinical and functional outcomes associated with quality of life in patients with lymphangioleiomyomatosis: a cross-sectional study
Authors: Queiroz Douglas Silva , Silva Cibele Cristine Berto Marques da , Oliveira Martina Rodrigues , Amaral Alexandre Franco , Carvalho Carlos Roberto Ribeiro , Salge João Marcos , Baldi Bruno Guedes , Carvalho Celso R. F.
Published: August 2024

Background: Lymphangioleiomyomatosis (LAM) is a rare (twenty-one per million female inhabitants) neoplastic cystic lung disease that impairs health-related quality of life (HRQoL). However, the factors associated with impaired quality of life in patients with LAM are poorly understood.
Objective: To assess the clinical, psychosocial, and functional characteristics associated with impaired quality of life in patients with LAM.
Methods: This was a cross-sectional study performed on two nonconsecutive days. HRQoL (SF-36 and CRQ), lung function tests, anxiety and depression symptoms (HADS), maximal (CPET and ISWT), and submaximal exercise capacity (6MWT) were assessed. Linear associations among outcomes were assessed using Pearson's correlation and multivariate tests.
Results: Forty-five women with LAM (46±10.years; FEV1,74%pred) were evaluated. The lowest SF-36 scores were observed for general health and vitality and the highest for the physical and social domains. The lowest CRQ scores were observed for dyspnoea and fatigue, and the highest were for the emotional function and self-control domains. Sixteen (35%) women had anxiety, and 8 (17%) had depression symptoms. Most of the SF-36 and CRQ domains were associated with anxiety and depression symptoms (from r=0.4 to r=0.7; p<0.05) and exercise capacity (from r=0.3 to r=0.5; p<0.05). Lung function parameters were weakly or not associated with quality of life domains. After multiple linear regression, HRQoL was independently associated with depression symptoms and physical capacity but not with lung function.
Conclusion: Our results show that aerobic capacity and depression symptoms are the main factors, rather than lung function, related to quality of life in patients with LAM.
Associations between Anion Gap-to-Calcium Ratio and Mortality in Sepsis Patients with Diabetes Mellitus: A Retrospective Cohort Study
Authors: Cai Jing , Pu Lin , Yuan Nanbing , Liu Meng , Lin Ken , Gao Jie , Li Jingjing
Published: August 2024

We aimed to determine the association between anion gap-to-calcium ratio (ACR) and 30-day mortality in sepsis patients with diabetes mellitus (DM). Data for sepsis patients diagnosed with DM was extracted from Medical Information Mart for Intensive Care Database III. After screening, 1616 eligible subjects were included in our study finally. The receiver operating characteristic (ROC) curve is used to determine the cut-off value. Multivariable logistic regression with inverse probability of treatment weighting (IPTW) based on propensity score were used to detect the association between ACR and 30-day mortality. Our results showed that the patients with the high level of ACR had a higher risk of death within 30 days compared with those with low level of ACR (odds ratio 1.914, 95% confidence interval 1.477–2.480, P < 0.001). In a word, our results suggest that ACR may be an independent prognostic indicator for death with 30 days in critically ill patients with sepsis and DM.
West Nile virus surveillance at a fine scale in an Italian urban ecosystem
Authors: Carrieri Marco , Puggioli Arianna , Farina Marco , Romano Silvia , Tinarelli Roberto , Angelini Paola , Matteo Giulio , Dottori Michele , Calzolari Mattia , Torri Deborah , Grisendi Annalisa , Bellini Romeo
Published: August 2024

In the last fifteen years, the West Nile virus (WNV) has spread in the Po Valley plain in Italy, extending from Emilia-Romagna to Veneto in Friuli Venezia Giulia, Lombardy, and Piedmont regions. The principal vector of WNV in Italy is Culex pipiens, and lineage 2 of arbovirus can overwinter. The sensitivity of the mosquito surveillance network to the circulation of WNV in urban and rural areas and the impact of the ecological system on the dynamics and spillover of disease were investigated in this study. WNV circulation in mosquitoes collected in 2021–2023 and screened with RT-PCR differed between the two environments. The vector index (VI) was significantly higher for Culex pipiens collected in rural areas and near rural wetlands (VI = 0.08 ± 0.16 SD and VI = 0.15 ± 0.29 SD respectively) than in urban environments (from VI = 0.00 in urban parks to VI = 0.04 ± 0.13SD in peri-urban areas). The incidence of West Nile neuroinvasive disease was higher in rural (1.01 ± 0.59SD per 100.000 inhabitants) than in urban areas (0.43 ± 0.32SD cases per 100.000 inhabitants). Throughout the study duration, by monitoring the virus circulation in mosquitoes, the WNV surveillance in the urban ecosystem predicted spillover in humans with about 2–4 weeks of anticipation, allowing prompt activation of the control protocols defined in the Italian National Plan Surveillance and Control for Arboviruses. WNV circulation in mosquitoes was recorded in urban environments where the probability of the simultaneous presence of reservoirs and vectors was higher such as ecological corridors and peri-urban areas. No WNV circulation was found in mosquitoes in urban parks.
The impact of recreational cannabis legalization on cannabis-related acute care events among adults with schizophrenia
Authors: Kim Chungah , Bai Yihong , Cao Peiya , Ienciu Kristine , Chum Antony
Published: August 2024

Purpose
Patients with schizophrenia have a higher risk of cannabis use disorder and may be uniquely affected by the legalization of recreational cannabis. This study examined whether cannabis legalization led to changes in acute care utilization among patients with schizophrenia.
Method
Using linked health administrative data, we included adult patients with schizophrenia in Ontario from October 2015 to May 2021 (n = 121,061). We examined the differences in cannabis, psychosis, and mental health-related emergency department (ED) visits over three periods: pre-legalization, legalization of flowers and herbs (phase 1), and legalization of edibles, extracts, and topicals (phase 2) using interrupted time-series methods.
Results
Our study found that phase 1 was associated with decreases in cannabis-related, mental health-related, and cannabis + psychosis-related ED visits among the patients with schizophrenia. Notably, an immediate 25.8% (95% CI 13.8–37.6%) decrease in cannabis-related ED visits was observed in men, and an immediate 18.5% decrease in mental health-related ED visits (95% CI 6.0–31.2%) in women. These decreases were also shown in the comparative ITS models, demonstrating that the changes observed were distinct from trends in the general population. However, phase 2 was not associated with any significant changes.
Conclusions
Despite higher baseline rates of acute care utilization among patients with schizophrenia, cannabis legalization was associated with significant reductions, particularly during phase 1. Our findings suggest that regulatory measures accompanying legalization could enhance the quality and safety of cannabis products, potentially leading to fewer adverse health outcomes in vulnerable patient populations. Further research is needed to optimize healthcare responses for this vulnerable population.
Exploring the washback effects of a high-stakes final exam on primary English teaching from teachers’ perspectives: a case study in China
Authors: Gao Juechun , Karanasiou Panagiota-Penny
Published: August 2024

The washback effect of English tests has gained considerable attention among researchers in China, but little attention has been given to the angle of primary English education. To address this gap, this study draws on previous mechanism frameworks to investigate the washback effects of the Chengdu Primary School English Final Examination (CPEFE), a primary school diagnostic final exam, on young learners’ English teaching from the perspective of primary teachers in Chengdu, China. The participants were sixth-grade English teachers in primary school. Data were collected using in-depth semi-structured interview, as a qualitative case study method. The results revealed that the test’s emphasis on receptive skills, particularly reading skills, affected the teaching focus. Exam-oriented teaching content and traditional methods still persist, but a recognition of the importance of communicative language teaching (CLT) is emerging. It is hoped that stakeholders will recognise the importance of other constructs that are less emphasised in the CPEFE and leverage various teaching materials and methods to avoid negative washback and enhance pupils’ overall English proficiency.
Mining expressed sequence tag (EST) microsatellite markers to assess the genetic differentiation of five Hynobius species endemic to Taiwan
Authors: Chen Jou-An , Yu Pei-Ju , Jheng Sheng-Wun , Lin You-Zhu , Sun Pei-Wei , Ko Wen-Ya , Lin Chun-Fu , Ju Yu-Ten
Published: August 2024

Taiwan harbors five endemic species of salamanders (Hynobius spp.) that inhabit distinct alpine regions, contributing to population fragmentation across isolated “sky islands”. With an evolutionary history spanning multiple glacial-interglacial cycles, these species represent an exceptional paradigm for exploring biogeography and speciation. However, a lack of suitable genetic markers applicable across species has limited research efforts. Thus, developing cross-amplifying markers is imperative. Expressed sequence-tag simple-sequence repeats (EST-SSRs) that amplify across divergent lineages are ideal for species identification in instances where phenotypic differentiation is challenging. Here, we report a suite of cross-amplifying EST-SSRs from the transcriptomes of the five Hynobius species that exhibit an interspecies transferability rate of 67.67%. To identify individual markers exhibiting cross-species polymorphism and to assess interspecies genetic diversity, we assayed 140 individuals from the five species across 82 sampling sites. A set of EST-SSRs with a high interspecies polymorphic information content (PIC = 0.63) effectively classified these individuals into five distinct clusters, as supported by discriminant analysis of principal components (DAPC), STRUCTURE assignment tests, and Neighbor-joining trees. Moreover, pair-wise FST values > 0.15 indicate notable between-cluster genetic divergence. Our set of 20 polymorphic EST-SSRs are suitable for assessing population structure within and among Hynobius species, as well as for long-term monitoring of their genetic composition.
Density of wild animal populations and their conflicts with nearby farmers in southwest Ethiopia, Mankira Forest
Authors: Asaye Birhanu , Tekalign Wondimagegnehu , Dobamo Taye
Published: August 2024

Farmers' survival is seriously threatened by wild animal species' coexistence and joint use of limited resources. A study on the density of wild animals and their conflicts with nearby farmers was conducted from December 2022 to May 2023 in southwest Ethiopia, Mankira Forest. Using the distance sampling technique, the densities of the wild animal population were estimated. The incidence of conflict between humans and wild animals was measured using a questionnaire given to 241 randomly selected household heads. The estimated densities of spotted hyenas (0.40 ± 0.54), Anubis baboons (11.83 ± 4.4), grivet monkeys (15.18 ± 5.12), black-backed jackals (0.60 ± 0.14), porcupines (0.70 ± 0.12), and warthogs (1.2 ± 0.20 individuals/km2) were recorded. Potatoes, wheat, and maize were the most severely damaged cereal crops. The most prevalent and top-ranked crop-raiding species was the Anubis baboon (N = 104, 43%), which was followed by the grivet monkey (N = 82), the warthog (N = 31), and the porcupine (N = 24). Depredated livestock were cattle, poultry, sheep, donkeys, dogs, horses, and mules. The spotted hyena (N = 118), black-backed jackal (N = 65), primates (N = 39), and leopard (N = 19) were the most commonly recorded predators. Various human activities that impact wildlife include deforestation, charcoal production, livestock grazing, agricultural expansion, and settlement. Guarding was the primary mitigating strategy. Locals living near forest boundaries were particularly susceptible to the impact of wild animals. Reducing livestock damage and crop loss can be achieved through continuous ecological surveying of wild animals and raising community awareness.
Use of interferon-gamma release assay (IGRA) and CXCL-10/IP-10 for screening of latent tuberculosis infection (LTBI) in chronic kidney disease and hemodialysis patients
Authors: Silva Juliana Cristina Borges da , Vieira Nathália Barcellos , Ribeiro-Alves Marcelo , Ribeiro Roberto Stefan Almeida , Lemos Carla Cavalheiro Silva , Mendes Renata , Gomes Conrado Lysandro Rodrigues , Santos Ana Paula , Suassuna José Hermógenes , Bregman Rachel , Rodrigues Luciana Silva
Published: August 2024

Background
There is growing evidence that patients with chronic kidney disease (CKD) show a high risk of acquiring latent tuberculosis infection (LTBI) or of developing active TB. However, diagnosing LTBI is still a challenge based on current tests which reflect the cellular immunity against Mycobacterium tuberculosis infection – that may be compromised in this population. Herein, we evaluated the prevalence of LTBI among patients with CKD and those in routine hemodialysis, and LTBI predictors.
Methods
A prospective cross-sectional study was conducted in a tertiary nephrology reference hospital, Rio de Janeiro, Brazil. LTBI was diagnosed using interferon-gamma release assay (IGRA; QuantiFERON-TB Gold Plus [QFT-Plus]). CXCL-10/IP-10 release assay was determined from QFT-Plus supernatants.
Results
A total of 123 patients were enrolled in the study, 111 (90.2%) from the CKD group and 12 (9.8%) from the hemodialysis (HD). IGRA showed 39 (31.7%) positive results in the general study population: 36/111 (32.4%) in CKD and 3/12 (25%) in HD groups. Indeterminate IGRA results were observed in 4/123 (3.3%) patients. CXCL-10/IP-10 positive results were seen in 39/123 (39.8%) patients. Multivariate regression analysis identified that non-vaccination with BCG (aOR 7.41 [CI 2.15–25.48]; p = 0.0014) and the positivity for CXCL-10/IP-10 assay (aOR 4.48 [CI 1.87–10.76]; p = < 0.001) were independent risk factors for LTBI among DRC and HD patients.
Conclusion
The IGRA QFT-Plus was shown to be a useful method in the surveillance of LTBI in critical stages of CKD and routine hemodialysis. Mtb-specific CXCL-10/IP-10 responses were associated with a positive IGRA and could provide an useful adjuvant LTBI biomarker in this population.
Estimating the Effect of Inclisiran on Dyslipidemia and Primary Prevention of Cardiovascular Disease: The NHANES 1999-2018 Study
Authors: Li Haonan , Zhao Song , Wu Jiawen , Han Jun , Xu Yawei , Zhang Yi
Published: August 2024

Background
Dyslipidemia has been delineated as independent predictors of cardiovascular disease (CVD). Inclisiran, an innovative small interfering RNA (siRNA) agent, is anticipated to engender a notable reduction of approximately 50% in low-density lipoprotein cholesterol (LDL-C) levels. Given its transformative impact, we scrutinized the eligibility of US population for inclisiran treatment and evaluated its potential effects on dyslipidemia and the primary prevention of CVD.
Methods
We applied eligibility criteria from the ORION 10 and 11 trials to the 1999–2018 National Health and Nutrition Examination Survey dataset to estimate the eligible population size for atherosclerotic cardiovascular disease (ASCVD) and ASCVD-risk equivalents. Utilizing lipid reduction data from the ORION 10, we predicted the impact of inclisiran on LDL-C levels and dyslipidemia prevalence among ASCVD patients. Similarly, leveraging the ORION 11's lipid reduction data, we forecasted inclisiran's effect on 10-year CVD risk change and preventable CVD events in the ASCVD-risk equivalents population, employing the Framingham CVD Risk Score.
Results
We identified 613 ASCVD patients (5.28 million) and 377 ASCVD-risk equivalents (2.63 million) who met the eligibility criteria of the ORION 10 and 11. Among ASCVD population, 3.71 million (70.3%) would achieve ≥ 50% LDL-C reduction post-treatment. Furthermore, 4.86 million (91.9%) with high LDL-C, 0.22 million (4.2%) with low high-density lipoprotein cholesterol, 1.19 million (22.5%) with high total cholesterol, and 0.5 million (9.5%) with high triglycerides would attain target lipid profiles. For ASCVD-risk equivalents population, the estimated 10-year CVD risk would decrease from 25.2–17.6% (7.6% absolute, 30.2% relative) post-inclisiran treatment, potentially preventing 199,878 CVD events over a decade, including 136,217 coronary heart disease cases, 37,024 strokes, and 23,619 heart failures.
Conclusions
Inclisiran holds the potential to substantially diminish the prevalence of dyslipidemia and mitigate the occurrence of nearly 200 thousand CVD events in eligible US adults.
Early Pregnancy Metal Levels in Maternal Blood and Pregnancy Outcome
Authors: Goldberg Ifat Baram , Sheiner Eyal , Bal Maayan Hagbi , Bergman Doron , Damri Noam Tomasis , Rosenbaum Ron , Haimov Ayal , Wainstock Tamar
Published: August 2024

This study examines the association between early pregnancy maternal blood levels of Lead (Pb), arsenic (As), cadmium (Cd), and selenium (Se) and adverse pregnancy outcomes, while also addressing the differences between low-risk and high-risk groups based on having a history of preterm birth (PTB). This prospective cohort study recruited multigravida women at 11–13 gestational weeks, categorized into low-risk and high-risk groups. Participants completed a questionnaire, and heavy metal levels were measured in blood samples. Pregnancy outcomes were recorded following delivery. Multivariable analyses were conducted to evaluate the independent associations between heavy metal levels and pregnancy outcomes, while adjusting for variables associated with the metals levels based on the univariable analyses. Among 404 participants, the mean (± SD) levels were Pb: 3.12 ± 1.82 µg/L, As: 0.41 ± 0.4 µg/L, Cd: 0.26 ± 0.34 µg/L, and Se: 119.84 ± 21.05 µg/L. Significant differences in Pb, Se, Cd and As levels were observed between the low-risk and high-risk groups, with higher levels in the low-risk group. However, no significant associations were found between heavy metal levels and PTB, low birth weight (LBW), gestational age at delivery, birth weight, and head circumference in either univariable comparison or multivariable models, which adjusted for maternal age, BMI, employment, smoking, fertility treatments, and education. While significant differences in heavy metal levels were found between low-risk and high-risk groups, early pregnancy heavy metal levels showed no association with adverse pregnancy outcomes. These findings highlight the need for further research to understand the potential impact of these metals on pregnancy, considering population-specific factors and exposure timing.